Megan Karas was 24 and only three months into a nursing job at Abington Hospital-Jefferson Health when, she said, an unrestrained patient told her that he had murdered someone.

It was near the beginning of Karas' overnight shift in an intensive care unit on Jan. 7, 2017, when she said she walked into the room of Jacob Sullivan — at the time a hulking man of nearly 400 pounds — and offered him the nasal decongestant Flonase. Then, she said, Sullivan asked whether Pennsylvania had the death penalty. No police officers or security guards were nearby, Karas said.

"He said he didn't know why they were coming down so hard on Sara when he was the one who killed  Grace," Karas testified Monday at Sullivan's pre-trial hearing at the Bucks County Justice Center. "He always felt like he was in a dark place and wanted to kill."

Sullivan and girlfriend Sara Packer had been admitted to the hospital a week prior for suicide attempts, and the following day, they would be charged with the rape, murder, dismemberment, and disposal of Packer's 14-year-old adopted daughter, Grace.

Monday's hearing was held to determine a number of pretrial matters, including whether a jury would be able to hear certain incriminating statements at trial. Judge Diane E. Gibbons recessed Monday evening and said the hearing would resume at 9:30 a.m. Tuesday with additional witnesses.

Earlier in the day, former hospital employee Brian Hustus, who said he was assigned to stay at "arm's length" from Sullivan that night due to Sullivan's suicide risk, testified to hearing not only the comments Sullivan made to Karas, but also additional statements Sullivan made when they were alone.

"I killed her," Hustus recalled Sullivan's telling him. "Gracie was a nightmare."

Monday was to be Sullivan's last court date before his trial, which is slated to begin in September. The prosecution withdrew its request to combine Sullivan's case with Packer's.

Wearing a yellow prison jumpsuit with the word inmate stripped across the back, a noticeably thinner, clean-shaven Sullivan, 45, appeared calm, chatting with his lawyers and occasionally fidgeting in his chair in the Doylestown courtroom.

Much of Monday's proceedings was taken up by the testimony of Abington Hospital employees and centered around statements Sullivan allegedly made from his hospital bed.

Sullivan's attorney, public defender Christina A. King, argued that Sullivan had been suicidal and incoherent when he talked to hospital staff and that therefore the statements should not be allowed at trial.

After making a suicide pact, Sullivan and Packer tried to overdose at a friend's apartment in Horsham, but survived after being found unresponsive on Dec. 30, 2016, according to court documents.

"He comes into the hospital as the result of a profound suicide attempt," said King, who called to the stand several witnesses, including a paramedic and an Abington resident physician, to attest to Sullivan's physical and mental condition at the time.

Bucks County District Attorney Matthew Weintraub has described the actions of Sullivan and Packer as "some sick, perverted fantasy" perpetrated against a girl they viewed as "a disposable child."

Prosecutors allege Sullivan and Packer had planned to kill Grace for months prior to July 8, 2016. On that day, authorities said, Sullivan punched Grace in the face, then raped the girl in the attic of a home they rented in Quakertown as Sara watched. The couple then drugged Grace, bound and gagged her, and left her in the overheated attic to die, authorities said.

When Sullivan and Packer returned the next day to find Grace still alive, Sullivan told authorities, he suffocated her by placing his arm around her neck. The pair then hid Grace's body in cat litter until October, when police came to the house asking questions. Sara Packer had reported the girl missing.

The couple then allegedly sawed Grace's body up in their bathtub and headed north to dispose of the remains, which were found by hunters on Halloween 2016 in Luzerne County.

It was not immediately clear whether a pretrial hearing would take place for Sara Packer, 43, a former employee of child-services agencies. Prosecutors said one had yet to be scheduled on her behalf. She pleaded not guilty in March. Sullivan has waived previous court proceedings.

Gibbons said she would not rule on any motions immediately after Sullivan's hearing, noting that she needed time to review documents and testimony presented.

Both Sullivan and Packer are being held at Bucks County Correctional Facility without bail.