Serial killers that few pursue
There’s a strange reluctance to study murder by nurse
It was a cheerful Lisa Corrente who stepped to the microphone Wednesday to begin her cross-examination of the woman who is probably the world expert on HCSK, the unofficial acronym for Health Care Serial Killers.
She was testifying at the public inquiry into the safety and security of residents in long-term care, aka the Elizabeth Wettlaufer inquiry, which has moved to Toronto for a few days of expert and technical evidence.
The expert is Beatrice Yorker, an American nursing professor who while in law school in Georgia, saw on TV a story about a nurse who had been caught injecting patients with potassium chloride, to lethal effect.
Law student Yorker was curious. She did a search for ‘nurses charged with murder’ on legal data bases, and “to my horror, nine cases popped up.”
That was in the 1980s, and led to her odd specialty.
In any case, Corrente represents Meadow Park Long Term Care in London, Ont., the care home where the Canadian HCSK Wettlaufer killed the last of her eight elderly victims, 75-year-old Arpad Horvath.
By that time, Wettlaufer was freshly fired for a string of medication errors from the Caressant Care home in Woodstock, but no one knew it, because her union (the Ontario Nurses Association) grieved the firing and successfully negotiated a settlement that saw Caressant pay Wettlaufer $2,000 for daring to try to fire her and agree to provide a neutral reference.
Corrente went over the numbers that Yorker has found over the years, 131 cases worldwide since 1970 where health-care providers have been prosecuted for murder or assault. Most HCSK are nursing staff.
Only two of those cases are Canadian.
One was the series of pediatric deaths on a cardiac ward at Toronto’s Hospital for Sick Children in the early 1980s, where one nurse was wrongly accused (and exonerated after a preliminary inquiry and a formal inquiry) and another suspect was never prosecuted.
The other, of course, is Wettlaufer, who wreaked her havoc over the course of almost a decade of work, mostly in care homes in southern Ontario.
She was caught — though that’s clearly the wrong word — only after she conveniently confessed her crimes to a psychiatrist and social worker at the Centre for Addiction and Mental Health in Toronto.
She later pleaded guilty to eight counts of first-degree murder, four of attempted murder and two of aggravated assault, all in relation to vulnerable aged patients under her care at three care homes and one who was still living at home.
Wettlaufer was sentenced last summer to life in prison with no chance of parole for 25 years.
“So,” said Corrente, “of 131 prosecutions globally since the 1970s, only two were in Canada?”
“Yes,” Yorker replied. “Are you aware of any earlier ones in Canada?” Corrente asked.
“No,” said Yorker.
The lawyer pressed merrily ahead: “So, one hospital case and only one case in long-term care?”
“Yes,” said Yorker. “That’s less than half of one per cent?” Corrente said. “Given our population, that’s a very low incidence rate?” “Very low,” said Yorker. “So would you consider (Wettlaufer) an isolated case? An anomaly?”
“I don’t know if I’d go that far,” Yorker said, “because we know it does happen, so probably there aren’t enough mechanisms to detect it in long-term care.”
One of Yorker’s key points is that too little is known about health-care professionals who deliberately try to harm patients, and that, with few exceptions, regulatory and professional groups have demonstrated remarkably little appetite to study the phenomenon.
Yorker’s ground-breaking 2006 study on HCSK, written with five others from around the world, was rejected for publication by a number of leading journals, finally landing only in the magazine of the American Academy of Forensic Sciences.
As Yorker put it once, shark attacks and dog bites — now, those things get attention. But HCSK? Not so much.
Yorker wouldn’t know this, but if the rest of the first world isn’t terribly good at researching and studying HCSK, Canada, with its dismal track record at this sort of thing, is bound to be even worse.
Not all HCSK can be prevented, Yorker said, but that’s no reason not to try to get better data, better information, about them, and to improve ways of doing business.
“There are still people so clever and so determined they will evade the systems in place, just like terrorists,” she told the inquiry.
She suggested a few tweaks: There needs to be better medication tracking, for instance, so where possible nurses could be linked to patients, though that’s tricky with insulin, Wettlaufer’s weapon of choice and a popular one, because doses vary so greatly.
Health-care workers should be better educated about what exactly is an unexpected death, especially in a care home, where death is hardly a stranger. Staffing ratios matter.
And the whole health-care culture needs to move away from blame, she said, where staff may be reluctant to report errors or suspicions for fear of being disciplined, to one where “if you see something, say something” is the ethos.
After all, though the chances of being killed by a health-care professional are low, the lucky among us will grow old, and may end up at a care home.
In fact, such homes are the new growth area. Since Yorker did her 2006 study, there have been 41 new cases of HCSK.
And where in 2006, 70 per cent of HCSK took place in hospitals and only 20 per cent in LTC and nursing homes, in the new cases of the last dozen years, that percentage has risen to 36 per cent.
As Yorker said once, this in reply to a lawyer’s question about the widespread reluctance to look suspiciously upon someone like a kindly nurse or a pleasant nurse’s aide, “There are really bad people out there who can trick you.”