Advocates for elderly nursing home residents say the case of Ontario nurse Elizabeth Wettlaufer, who pleaded guilty Thursday to murdering eight of her elderly patients and trying to kill four others, must be addressed with a public inquiry.
A courtroom in Woodstock, Ont., in the southwestern part of the province, heard graphic details Thursday about how Wettlaufer used lethal injections of insulin to kill the people in her care. She confessed to the murders in a taped interview with police last fall.
"It makes it so clear that these vulnerable people faced evil," said Wanda Morris, vice-president of advocacy for the Canadian Association of Retired People (CARP) in an interview with CBC News. "And I'm hoping that the sheer horror of it will result in some further action."
Her group is calling for a public inquiry, either at the provincial or federal level.
Morris said while there are many good nursing homes operating across Canada, abuse happens far too regularly. The scrutiny of an inquiry is needed to examine how long-term care homes deal with abuse and unexpected deaths, she said.
"This was extreme," said Morris. "But there isn't a week that goes by where we don't hear about neglect, abuse, or just simply disinterest so that our most frail elderly are left without protections in a facility that is meant to care and protect them."
Fired from nursing home
Wettlaufer's guilty pleas draw part of the story to a close, but questions persist about how her actions went undetected and how to prevent something like this from happening again.
The nurse's actions only came to the attention of police when Wettlaufer told people at the Centre for Addiction and Mental Health in Toronto what she had done. CAMH staff contacted the police in September.
Details that have emerged in and outside of court suggest that red flags were raised much earlier, including a concerning pattern of behaviour at her workplaces.
Wettlaufer was employed by Caressant Care for seven years before she was fired in March of 2014. She was terminated because of a "serious" incident where she gave the wrong medication to a patient.
It wasn't the first mistake. According to police records, she had an "extensive disciplinary record" for medication-related errors, was suspended numerous times and given multiple warnings.
In her termination letter, Wettlaufer's boss said her behaviour put residents at risk.
Seven of the deaths occurred at Caressant Care.
Despite her problematic employment record from Caressant Care, Wettlaufer maintained her nursing licence and continued to find work through various staffing agencies. She was working in a London facility in 2014 when the last of the eight patients died.
Case 'an anomaly'
Wettlaufer contacted the College of Nurses of Ontario to resign her licence after police began their investigation.
Advocates who support an inquiry say the college's role could be examined in the process.
Candace Chartier, CEO of the Ontario Long-Term Care Association, said the Wettlaufer case is not the norm and would have been difficult to prevent.
"We're the most heavily stringent, compliant system in North America. There's not any kind of regulation that could have prevented something like this from happening," she said in an interview on CBC News Network.
Chartier called the Wettlaufer case "an anomaly" and a tragic one.
"This is the first time in Canadian history somebody's ever done this in long-term care. It's devastating," she said.
Chartier said that while "nobody could have ever guessed that somebody would do this," there could be room for a review of how insulin is handled.
In long-term care homes there are some medications that require a protocol known as double-signing. When a nurse plans to administer those medications another nurse has to sign off. Insulin is not one of those drugs.
"Maybe this is something that we need to look at. We need to do a deep dive, and we need to determine, is insulin a drug that should be double-signed," said Chartier.
No word on inquiry
Another measure that could be considered: implementation of biometric technology that helps verify a patient is getting the correct dosage of the correct medication.
Some nursing homes also have so-called "granny cams" to monitor how staff are treating patients.
But Chartier said she doesn't think more regulations for long-term care homes are required.
Ontario's Health Minister Eric Hoskins was asked Thursday what actions the government is prepared to take in response to the Wettlaufer case.
Hoskins said he and Premier Kathleen Wynne have spoken in the past about their "openness to play whatever role" is needed on this matter, but that for now his focus is on the families and the devastating day they had in court.
Morris, from CARP, said it'll take more than an inquiry to help prevent another Wettlaufer; a cultural change is needed because many elderly people aren't treated with respect and dignity.
"We need to get rid of the toxic environment."