The Wettlaufer inquiry wrapped up Thursday for a summer hiatus with more details of the killer nurse's brief time working in home health care.
As a nurse with St. Elizabeth Home Health Care, serial killer Elizabeth Wettlaufer administered a deadly dose of insulin to her patient Beverly Bertam — who narrowly survived. That insulin dose was stolen from another St. Elizabeth patient, after Wettlaufer showed up at that patient's home unannounced and unscheduled.
Both the theft and the surprise visit were news to Steven Carswell, director of quality for the South West Local Health Integration Network, who testified Thursday that he only heard about those events in the past few weeks.
The network has overseen home care in the southwest since absorbing the area's Community Care Access Centre, and contracts St. Elizabeth as a service provider.
"The preparations for this inquiry is when we put all the pieces together of who that patient was, and found out that that event had not been previously reported to us," Carswell said, adding that St. Elizabeth should have reported the event right away.
Carswell said the network will conduct a review with St. Elizabeth to find out why the company didn't report the incident sooner, and will work with other service providers to clarify when and how to report serious incidents.
When pressed as to whether the network should have more direct contact with patients rather than relying on service providers to report, Carswell was noncommittal but said it would be considered.
"There are a lot of important contexts in terms of how that would happen, the workload associated with that, how we can ensure that happens," he said.
"I think it is an important conversation, that I'd like to dig deep in with our providers."
Wettlaufer treated several other patients as a subcontractor for the Hamilton Niagara Haldimand Brant LHIN (then a CACC), but Carswell testified her work didn't result in any further unexpected deaths.
Understaffing an issue in home care
Wettlaufer first applied to St. Elizabeth in 2014, but wasn't hired. When she reapplied in July 2016, Wettlaufer admitted to making a medication error and being fired, but said she'd been cleared and was ultimately hired.
Home care and nursing homes share many of the same problems in attracting and retaining nurses, the Ontario inquiry into Elizabeth Wettlaufer's crimes heard Wednesday.
During the inquiry into the safety and security of residents in long-term care, chronic understaffing in the nursing homes where Wettlaufer worked has come up again and again.
Provincial law dictates that nursing homes must have one registered nurse on duty 24/7, and Wettlaufer would sometimes be the only one available, particularly during night shifts at Caressant Care in Woodstock.
It has been suggested that the lack of available nursing staff could have played a role in how Wettlaufer was able to continue practising for so long. In September 2016, she confessed to a psychiatrist that she had injected people with insulin between 2007 and 2016, killing eight and harming six. Wettlaufer, now 51, was sentenced in June 2017 to eight concurrent life terms in prison.
Qualified home-care staff leaving for hospitals
In testimony from Donna Ladouceur, co-chief executive officer for the South West Local Health Integration Network, the inquiry heard that the home-care industry has experienced problems with qualified staff leaving to seek work in hospitals.
That could be because home care has become more difficult in recent years, Ladouceur said. Many patients return home from hospital earlier than in the past, meaning their care needs would be higher.
"Seven years ago, after having a hip replacement, a knee replacement, [patients] might've been in hospital seven, eight days. They were in hospital for much longer periods of time," said Ladouceur, who said Ontario's aging population has also played a role in increasing care needs. .
"When patients make the choice to stay in their home, their acuity level is going to change and go up."
Compounding the issue is that nurses who work in home care often have longer commutes, less pay and less support than those who work in hospital, Ladouceur said.
Still, Ladouceur said that overall, St. Elizabeth home care has good practices and is attuned to risk levels.
The inquiry will resume in September.