Serial killer Elizabeth Wettlaufer went undetected for one fundamental reason: Old people are expected to die.
And when, like eight of her 14 victims, they do die, few of us are surprised.
That’s the gist of Justice Eileen Gillese’s report into just how Wettlaufer, a registered nurse, managed to kill eight Ontario nursing home residents over a nine-year period.
She also assaulted or attempted to kill six more, including an elderly woman receiving home care.
In the end, she was caught only because she turned herself in.
Had she not done so, Gillese says, the killings would never have been discovered.
How could this happen? A reading of Gillese’s report suggests the crimes were easy to pull off. Wettlaufer stole insulin from the institutions where she worked and injected it into her victims.
No one knew of the thefts. No one suspected foul play. Often, the crimes took place at night when she was the only nurse on duty.
Some deaths were investigated by the provincial coroner’s office. But no autopsies were performed.
As Gillese notes, only eight to nine per cent of deaths in long-term care homes are autopsied. The percentage for the overall population is 40.
Over her long career, Wettlaufer was twice fired for making medical errors, including drug theft.
But in both cases, in an effort to avoid union grievances, her employers agreed to pretend she had quit of her own accord.
One even provided her with a reference that, in effect, allowed her to keep on killing.
In her report, Gillese finds no individuals at fault. The problem, she says, is systemic.
She makes common-sense recommendations for improving the system — such as putting windows into nursing home drug cupboards in an effort to deter the theft of pharmaceuticals.
She would also require long-term care facilities to report deaths electronically rather than by fax to the provincial coroner’s office. This would allow the coroner to better determine unusual death patterns.
She suggests that nursing homes be required to have more registered nurses on staff to deter rogue behaviour and that these homes hire pharmacists or pharmacy technicians to manage the drug supply.
She says the government should pick up the tab.
Throughout, Gillese’s report is focused tightly on the phenomenon of serial killers operating in the health-care system. This is both a strength and a weakness.
It is a strength because her recommendations are attainable.
She points out that health-care serial killers pose a problem worldwide and that Wettlaufer is not unique.
Such killers, however, can be thwarted by fairly simple means, such as better training, staffing and reporting.
The larger problem, which she doesn’t really address, goes beyond serial killers. It has to do with how society views old people, particularly those in nursing homes.
Increasingly, as the report points out, nursing homes are populated by the most vulnerable. Roughly 90 per cent suffer from some form of cognitive impairment, while 86 per cent require help in basic functions, such as eating.
It is easy — and convenient — to accept the deaths of such people as not only inevitable, but desirable.
This attitude provides fertile ground for serial killers. More importantly, it provides fertile ground for what I suspect is a much larger group — those who see nursing homes not as places where people can live out their lives with as much joy as possible, but as short-term way stations on the road to an inexorable death.
Thomas Walkom is a columnist with Torstar Syndication Services.