Gerald Rupple used a webcam to plead guilty to 11 charges of child abuse, endangerment and perjury on Friday.
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He was driving 11 children from El Rancho Charter Middle School in Anaheim Hills on April 24, 2014, when he passed out. The bus smashed into a tree, injuring the students, several seriously.
Rupple was arrested for allegedly lying to the DMV and his employees about his pulmonary hypertension, which can cause dizziness, seizures and blackouts.
The video conference took place from Arizona, where he is recovering from a major transplant.
"As you know, he's undergone a double-lung transplantation, so his medical condition does not affect his mental status," said Dr. Rajeev Saggar, Rupple's physician from Banner University Medical Group in Phoenix.
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He testified during the hearing to reassure the judge Rupple knew what he was doing by pleading guilty.
Doctors feared he may not survive a drive to California.
The judge does want him present for sentencing, where he faces a maximum of 26 years and four months in prison; though, the court may have offered a deal for the plea.
Rupple's tentative sentencing date, depending on his health, is scheduled for Oct.19.