Elizabeth Wettlaufer, the former nurse accused of killing eight seniors in long-term care homes in Ontario, is now facing six new charges in relation to people who were in her care.

Ontario Provincial Police announced the new charges against Wettlaufer, four counts of attempted murder and two counts of aggravated assault, ahead of her court appearance in Woodstock, Ont., on Friday.

The new charges are related to incidents that allegedly occurred between June 2007 and August 2016, and involved these people who were in her care:

• Clotilde Adriano, 87, aggravated assault at Caressant Care

• Albina deMedeiros, 90, aggravated assault at Caressant Care

• Wayne Hedges, 57, attempted murder at Caressant Care

• Michael Priddle, 63, attempted murder at Caressant Care

• Sandra Towler, 77, attempted murder at Telfer Place

• Beverly Bertram, 68, attempted murder at private residence in Oxford County

Court documents allege Wettlaufer injected the six new alleged victims with insulin.

Adriano, deMedeiros, Hedges and Priddle have since died, “although their confirmed causes of death are not attributed to the accused,” police said in a statement.

Wettlaufer, 49, appeared in person in a packed Woodstock, Ont., courtroom on Friday morning. CTV London reporter Daryl Newcombe said it was a dramatic scene as victims’ family members stared at Wettlaufer throughout the proceedings.

Newcombe reported that Wettlaufer remained expressionless, but she scanned the room, making eye contact with several people in the public gallery.

John Beaney, vice-president of operations at Revera, the company that operates Telfer Place in Paris, Ont., said in a statement that the company is “shocked and saddened to learn of the new charges, and grateful to report that the resident involved at Telfer Place is doing well.”

He added: “To our knowledge, there are no further incidents under investigation at Telfer Place or any other Revera home at this time.

“Like everyone in the long term care community, which is made up of deeply committed and caring people, this case has been disturbing and heart-breaking to all of us,” Beaney said.

In October, Wettlaufer was charged with eight counts of first-degree murder in the deaths of seniors at two Ontario long-term care homes: Seven resident deaths at Caressant Care in Woodstock and one death at Meadow Park in London.

Police said the homicides occurred between 2007 and 2014, when patients, between the ages of 75 and 96, were allegedly administered a drug.

None of the allegations have been proven in court.

Outside the courthouse, OPP Sgt. David Rektor said the investigation has been challenging, but continues.

“Very intense investigation and obviously, there’s still a lot more questions than answers,” Rektor told reporters. “But it’s an ongoing investigation and it’s one all the (police) services are jointly looking at and working together.”

In October, police sources told CTV Toronto that the investigation into Wettlaufer was prompted by information provided to a psychiatric hospital in Toronto where she was seeking treatment.

College of Nurses of Ontario records show that Wettlaufer was first registered as a nurse in 1995 but resigned in Sept. 30, 2016. She is no longer a registered nurse.

Unprecedented case?

In light of the new charges, the Crown told court Friday, that it will take a lot more time than was anticipated to go through the evidence related to the case.

“I’m sure they haven’t even gotten the full disclosure on the (alleged) murders, much less on these new charges that just came out now,” CTV News legal analyst Edward Prutschi said on CTV News Channel.

Prutschi said he believes the case may be unprecedented in Canada.

“It’s just hard to imagine … I don’t know if there are any examples in Canadian history of this level of seriousness of charges being faced by a single person,” he said. “It’s really quite dramatic.”

The charges against Wettlaufer are also raising questions about possible problems within the province’s long-term care facilities.

CARP, a Canadian non-profit organization that advocates on behalf of seniors and the elderly said in statement that they were “disturbed” to learn of the additional charges.

“While the families of the alleged victims are dealing with these horrible charges, the investigations into the state of long term care industry is ringing alarm bells for families across Ontario,” said Wanda Morris, CARP’s vice-president of advocacy.

With files from The Canadian Press