As part of his plea agreement, Cullen promised to cooperate with authorities if they did not seek the death penalty for his crimes. A month later, he pled guilty to the murder of three more patients in New Jersey. In November 2004, Cullen pled guilty in an Allentown court to killing six patients and trying to kill three others. He repeatedly interrupted the proceedings by taunting the judge with the chant, "Your Honor, you need to step down." Cullen was ordered to be restrained and gagged.