A nurse has appeared in court charged with murdering three patients at Stepping Hill Hospital in Stockport in 2011.
Victorino Chua, 48, of Churchill Street, Heaton Norris, is also charged with 31 other offences including GBH and attempted poisoning.
He is accused of murdering patients Tracey Arden, 44, Arnold Lancaster, 71, and Alfred Derek Weaver, 83.
At Manchester Magistrates' Court, he confirmed his name, age and address.
Mr Chua was remanded in custody to appear at Manchester Crown Court on Tuesday.
He faces one count of causing grievous bodily harm with intent, 22 counts of attempting to cause grievous bodily harm with intent, seven counts of attempting to administer poison and one count of causing poison to be administered with intent.
Investigators have been examining the contamination of various medical products, between June 1 and July 15 2011 at the hospital.