National Column: Wettlaufer inquiry must confront struggling long-term care system

by Thomas Walkom

Perversely, Elizabeth Wettlaufer’s casual and systematic murder of eight Ontario nursing home residents in her care may end up accomplishing one thing.

It may finally force the provincial government to confront the dysfunctional nature of its long-term care system.

This, at least, is the hope following the government’s publication Tuesday of the terms of reference meant to guide a judicial inquiry into the former nurse’s crimes.

Justice Eileen Gillese is being given an extraordinarily broad mandate. The government is calling on her to not only look into the specific events that led to the murders but also “the circumstances and contributing factors” that allowed these events to take place, including the effect of “policies, procedures, practices and accountability and oversight mechanisms” as well as any other “relevant matters that the commission considers necessary.”

In short, the appeal court justice is being empowered to look at just about everything to do with long-term care that could have contributed to this tragedy. Let’s hope she takes advantage of the opportunity.

What is striking about Wettlaufer’s crimes is how easy they were to commit. Between 2007 and 2014 she managed to give fatal insulin overdoses to eight separate patients in her care.

She also tried, unsuccessfully, to murder four others and committed two instances of aggravated assault.

Yet until she voluntarily confessed to staff at Toronto’s Centre for Addiction and Mental Health last fall, it seems that no one suspected a thing.

Not her employers, even though one of them had fired her for overmedicating a patient. Not the College of Nurses of Ontario, which regulates her profession. Not the officials who signed the death certificates.

Not the health ministry which oversees long-term care.

The key reason why no one suspected foul play, I suspect, is that nursing home patients are expected to die.

Had the victims been babies, someone might have asked questions. But a nursing home resident’s death is seen as normal even when, as in the case of one 63-year-old that Wettlaufer tried to kill, the victim is not unusually old.

Indeed, outside of residents’ families, few have a material incentive to keep nursing home patents alive.

The government’s political aim is to get eligible seniors off the waiting list and into long-term care beds as quickly as possible without spending too much.

The greater the turnover at nursing homes, the faster and more cheaply this waiting list will go down.

Similarly, nursing homes face no financial loss if a resident dies. There are always people anxious to fill the beds of those who pass on.

I am not suggesting that governments and nursing homes are conspiring to bump off elderly long-term care residents. I am suggesting that neither has a material incentive to look too closely if seemingly natural deaths do occur.

It is perhaps telling that of the eight killed by Wettlaufer, only two had autopsies performed.

There is much that Gillese’s one-person judicial inquiry can usefully look at. It can, of course, look at the obvious questions: Why was it so easy for Wettlaufer to get her hands on insulin and then improperly inject it? Why didn’t the College of Nurses investigate her after she was fired for overmedicating? How did she manage to assault and kill so many over such a long time without anyone noticing? It can also look at broader structural issues:
Would nursing homes be safer if they were better-staffed? Should physicians on contract to nursing homes be expected to do more than make regular scheduled visits and consult occasionally by telephone? Is the current requirement of one registered nurse per home sufficient? Would a real and properly funded home-care system take some of the pressure from long-term care institutions? Or like the move to so-called community mental care a few decades ago is the promise of home care just an empty slogan used by governments keen to cut costs?

But perhaps the most important question the inquiry can answer is this: Why was it so easy for officialdom to conclude that these deaths were natural? People live a long time these days. Why should so many assume that a nursing home resident already has one foot in the grave?

Thomas Walkom appears Monday, Wednesday and Friday.
Copyright 2017-Torstar Syndication Services

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