A public inquiry examining the circumstances that allowed a nurse to kill elderly patients in her care began in southwestern Ontario on Tuesday, seeking to heal “broken trust” in the long-term care system.
The probe, led by Ontario Court of Appeal judge Eileen Gillese, is examining systemic factors that allowed Elizabeth Wettlaufer to inject more than a dozen patients with overdoses of insulin while working at long-term care homes and private residences for nearly a decade.
Wettlaufer’s crimes were never detected and only came to light when she confessed them to mental health workers and police.
“The idea that (the victims) were killed when they were in their most vulnerable states has shocked the province,” said Alex Van Kralingen, who represents the families of several of Wettlaufer’s victims. “Put bluntly, my clients want to ensure that this never happens again.”
Wettlaufer pleaded guilty to eight counts of first-degree murder, four counts of attempted murder and two counts of aggravated assault, and was sentenced to life in prison without parole eligibility for 25 years last summer.
Gillese said the inquiry will seek to answer what failings allowed Wettlaufer’s crimes to take place, and what can be done to prevent similar tragedies in the future.
“We can begin to heal the moment we begin to feel heard,” she said in her opening statement, citing a quotation sent to her by a friend. “In many ways that is what our inquiry is about. Healing our broken trust in the long-term care homes system.”
Gillese noted that there have been four extensive investigations leading up to the inquiry. They focused on the facilities and agencies that employed Wettlaufer, the Office of the Chief Coroner and the Ontario Forensic Pathology Service, the College of Nurses of Ontario, and the Ministry of Health and Long-Term Care.
The commission’s legal team reviewed more than 41,000 documents and interviewed experts and dozens of other people, she said.
Mark Zigler, co-lead counsel for the commission, noted that the inquiry is timely.
“We are dealing with an aging population,” he said. “There’s greater and greater demand for these types of (long-term care) facilities.”
There are 627 long-term care homes in Ontario, and nearly 79,000 beds, Zigler said. Those numbers have not grown significantly in recent years, he said, though demand has escalated.
Some of the people who have permission to call and question witnesses at the Long-Term Care Homes Public Inquiry include one of Wettlaufer’s surviving victims, family and friends of those she killed, and advocacy and health-care organizations.
Wettlaufer herself does not have to appear before the inquiry. Gillese ruled that the 50-year-old would not be compelled to testify, supporting a recommendation from commission counsel, but her confessions were submitted as evidence to the inquiry.
Gillese is expected to release her final recommendations by July 31, 2019.