The suspected murders of eight elderly patients in two Ontario nursing homes shouldn't automatically trigger more investigations into deaths in such facilities, says a member of the province's geriatric and long-term care review committee.
Police have said seven of those patients received a fatal dose of a drug, and the deaths have prompted some provincial legislators to press the Ontario government on whether it would conduct a review to ensure Ontario's 78,000 long-term-care residents are safe. Meanwhile, some advocates are also calling for the coroner to increase the number investigations of deaths at such facilities.
"I think that's unnecessary, because then you put a lot of resources into investigating natural deaths," said Dr. Heather Gilley, a geriatrician and assistant professor in the University of Toronto's faculty of medicine.
"This is a highly unusual and rare occurrence," she said. "You need to be careful that you respond proportionately to the problem."
Elizabeth Wettlaufer, 49, a former nurse, is accused of murdering eight patients in Woodstock and London between August 2007 and August 2014. The victims were between the ages of 75 and 96.
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Ontario's Office of the Chief Coroner investigates around 15,000 deaths per year in Ontario, about 20 per cent of all deaths in the province.
Those investigations are based on deaths that meet certain criteria set out in Sec. 10 of the Coroner's Act. Those criteria include deaths that are believed to have occurred suddenly and unexpectedly; through violence, misadventure, negligence, misconduct or malpractice, from any illness not being treated by a medical professional or from any cause other than disease.
In 2015, the office investigated 884 deaths that occurred in long-term care facilities. The coroner's office used to automatically investigate every death that occurred in such homes. That policy was later amended to probe one in every 10 deaths, but that practice was dropped when it was determined it had no effect on public safety.
Since 2014 the coroner has only been investigating deaths in long-term care facilities that meet the criteria of Sec. 10 of the Coroner's Act, though every death in a long-term care facility must be reported to the coroner's office.
Determining whether a death in a nursing home is suspicious can be difficult, as many patients in these facilities are in the end stages of life. And all that investigators have to go on when looking into a patient's death are nurses' protocols and the paperwork provided by the facility.
"The problem is that many of these things, they just look like regular deaths," said Jane Meadus, a lawyer with the Advocacy Centre for the Elderly, "So unless the coroner comes and actually looks at things, they're never going to know."
As well, she said, a home won't report if a death occurred due to the facility's own negligence.
This is why Meadus is advocating for coroners to do random investigations, or spot checks, when it comes to deaths at homes. She said they need to look at the bodies in some cases and take blood tests to determine if there are any toxicology issues.
"Because if they're just coming in and looking at a chart, they're not going to see it," she said.
Ontario Health Minister Eric Hoskins said every long-term-care home is required to have a medication management system in place, approved by both the director of nursing and the pharmacist who provides the drugs to the home. It is reviewed quarterly by the home.
The protocols nurses in long-term care homes follow are generally strict. The College of Nurses of Ontario has a medication practice standard by which nurses must abide, including not administering medication unless proper authorization has been received.
The strict monitoring of medication, which often requires sign-off from supervisors — in the case of potent narcotic drugs, for example — makes it difficult for nurses to tamper with medications. When it comes to narcotics, there are very strict policies in place to ensure control, said Candace Chartier, CEO of the Ontario Long Term Care Association. Double signatures are needed to sign off on the use of such drugs. As well, doses are closely monitored, ,
"One can't just fill up a syringe and it not be noticed, because the bottle would be missing," said Chartier, who is a registered nurse.
In the Wettlaufer case, police suspect that at least seven of the eight deaths were the result of a fatal overdose of a drug administered by the registered nurse. But Chartier said it's difficult to administer medication for a nefarious purpose in a long-term care facility, because it's an environment where there is someone around all the time.
"It's probably easier not to give a drug than give a drug and give it wrong," said Chartier,
Still, Meadus said, a registered nurse in a facility like Caressant Care Nursing Home is basically in charge and has a lot of control over medication management. A nurse could easily take medication intended for one patient and give it to another, she said.
But Gilley warned against jumping to any premature conclusions in Wettlaufer's case and being too quick to add regulations to a system that in general is safe.
Were there, for example, any red flags that people were dying unexpectedly that should have triggered a call to the coroner?
"I'd like to know what failed in the existing system before we go starting to say there needs to be a lot of changes," she said. "I'm not a huge believer that more regulations are necessarily needed until we understand what happened."