Nurse Charged with Murders Raises Regulatory Issues

Horrific allegations that a former Ontario nurse murdered eight long-term-care residents over a seven-year period raises issues relating to the regulation of health-care professionals, says Elyse Sunshine.

In the wake of the alleged murders, advocates and caregivers for the elderly have suggested that nursing home employees should be subject to drug and psychiatric screening, according to CTV News.

Sunshine finds such suggestions premature.

“We have to take a step back and say: This is very tragic, very scary. But it’s not a rampant problem that we need to panic about.”

“Of course it must be very thoroughly investigated as to how something like this could occur.”

Police charged Elizabeth Wettlaufer, 49, with eight counts of first-degree murder. They allege she gave lethal doses of unnamed drugs to seven long-term-care residents at Caressant Care in Woodstock and to one resident at Meadow Park long-term-care home in London, Ont., reports CTV.

Several days before Wettlaufer was charged, she was placed under a peace bond prohibiting her from possessing insulin or any other medications unless they were for her own use, says the article.

While not commenting on the specifics of this case, Sunshine says the allegations underscore how important it is for health-care facilities to carefully manage their medications by controlling and auditing access. “There should be checks and balances.”

The eight nursing home deaths occurred between 2007 and 2014 to five women and three men ranging in age from 75 to 96, says the article.

It will be important in the coming days for officials to determine how so many alleged murders occurred over such a long period of time without being noticed, Sunshine says.

This tragedy highlights how health-care professionals working in nursing homes and other facilities must be alert to any suspicious or unusual activities, she says.

“It’s just a reminder for professionals to be cognizant of their colleagues,” says Sunshine, who represents nurses and other health-care professionals. “If something doesn’t feel right, it is something that you should raise through the proper channels.”

To protect themselves in case of an error, or worse, nurses and other health professionals should be careful to properly document their medication use, she says. “If you’re signing for medications or if you’re returning medication, make sure you follow the protocols in place in your institution.”

Wettlaufer was a registered nurse beginning in 1995 and resigned from the profession on Sept. 30, 2016, according to the College of Nurses of Ontario.

Despite Wettlaufer’s resignation, the college will almost certainly conduct its own separate investigation and hold a disciplinary hearing into allegations of professional misconduct, Sunshine says.

“I would be very surprised if they didn’t have a hearing,” she adds.

The College investigates even if a nurse has been convicted of a serious crime and has resigned her licence, Sunshine adds. “The College would want something on their records to show what had occurred and what findings they made.”

The regulator would likely seek to revoke the licence of a member found guilty of murdering patients to prevent him or her from applying for reinstatement either in Ontario or any other jurisdiction in the future, she says.

The College’s power to revoke the licence of nurses, even if they have resigned in advance of a disciplinary hearing, was recently confirmed by the Ontario Divisional Court in a case entitled College of Nurses of Ontario v. Mark Dumchin.

Officials at the nurses’ College may delay disciplinary proceedings until the criminal process is complete, particularly since Wettlaufer is in custody and the public is not at risk, Sunshine adds.

Staff at the Centre for Addiction and Mental Health (CAMH) in Toronto, where Wettlaufer was being treated, passed information to police in late September, sparking the investigation, according to media reports.

Although health-care providers like those at CAMH are normally prevented from divulging confidential patient disclosures, they can make a report to the appropriate authorities when an identifiable person or group is at risk of being harmed, Sunshine says.

“There is case law that says if there’s an identifiable person or group that’s at risk of harm by a person who is believed to have the means and ability to carry out a crime or harm another person, then this could form an exception to the usual duty of confidentiality and you could have a 'duty to warn,'" she says.