In­quiry must con­front long-term care sys­tem

The Guardian (Charlottetown) - - EDITORIAL - Thomas Walkom Thomas Walkom is a na­tional af­fairs writer for Torstar Syn­di­ca­tion Ser­vices

Per­versely, El­iz­a­beth Wet­t­laufer’s ca­sual and sys­tem­atic mur­der of eight On­tario nurs­ing home res­i­dents in her care may end up ac­com­plish­ing one thing.

It may fi­nally force the pro­vin­cial gov­ern­ment to con­front the dys­func­tional na­ture of its longterm care sys­tem.

This, at least, is the hope fol­low­ing the gov­ern­ment’s pub­li­ca­tion Tues­day of the terms of ref­er­ence meant to guide a ju­di­cial in­quiry into the for­mer nurse’s crimes.

Jus­tice Eileen Gillese is be­ing given an ex­traor­di­nar­ily broad man­date. The gov­ern­ment is call­ing on her to not only look into the spe­cific events that led to the mur­ders but also «the cir­cum­stances and con­tribut­ing fac­tors, that al­lowed th­ese events to take place.

The ap­peal court jus­tice is be­ing em­pow­ered to look at just about ev­ery­thing to do with long-term care that could have con­trib­uted to this tragedy. Let’s hope she takes ad­van­tage of the op­por­tu­nity.

What is strik­ing about Wet­t­laufer’s crimes is how easy they were to com­mit. Be­tween 2007 and 2014 she man­aged to give fa­tal in­sulin over­doses to eight sep­a­rate pa­tients in her care. She also tried, un­suc­cess­fully, to mur­der four oth­ers and com­mit­ted two in­stances of ag­gra­vated as­sault.

Yet un­til she vol­un­tar­ily con­fessed to staff at Toronto’s Cen­tre for Ad­dic­tion and Men­tal Health last fall, it seems that no one sus­pected a thing.

Not her em­ploy­ers, even though one of them had fired her for over­med­i­cat­ing a pa­tient. Not the of­fi­cials who signed the death cer­tifi­cates. Not the health min­istry, which over­sees longterm care.

The key rea­son why no one sus­pected foul play, is that nurs­ing home pa­tients are ex­pected to die.

Had the vic­tims been ba­bies, some­one might have asked ques­tions. But a nurs­ing home res­i­dent’s death is seen as nor­mal, even when one in­tended vic­tim is not un­usu­ally old.

Out­side of res­i­dents’ fam­i­lies, few have a ma­te­rial in­cen­tive to keep nurs­ing home patents alive. The gov­ern­ment’s po­lit­i­cal aim is to get el­i­gi­ble se­niors off the wait­ing list and into long-term care beds as quickly as pos­si­ble with­out spend­ing too much.

The greater the turnover at nurs­ing homes, the faster and more cheaply this wait­ing list will go down.

Sim­i­larly, nurs­ing homes face no fi­nan­cial loss if a res­i­dent dies. There are al­ways peo­ple anx­ious to fill the beds of those who pass on.

I am not sug­gest­ing that gov­ern­ments and nurs­ing homes are con­spir­ing to bump off el­derly long-term care res­i­dents. I am sug­gest­ing that nei­ther has a ma­te­rial in­cen­tive to look too closely if seem­ingly nat­u­ral deaths do oc­cur.

Of the eight killed by Wet­t­laufer, only two had au­top­sies per­formed.

There is much that Gillese›s one-per­son ju­di­cial in­quiry can use­fully look at. Why was it so easy for Wet­t­laufer to get her hands on in­sulin and then im­prop­erly in­ject it? Why didn›t the Col­lege of Nurses in­ves­ti­gate her af­ter she was fired for over­med­i­cat­ing? How did she man­age to as­sault and kill so many over such a long time with­out any­one notic­ing?

It can also look at broader struc­tural is­sues: Would nurs­ing homes be safer if they were bet­ter-staffed? Should physi­cians on con­tract to nurs­ing homes be ex­pected to do more than make reg­u­lar sched­uled vis­its and con­sult oc­ca­sion­ally by tele­phone? Is the cur­rent re­quire­ment of one reg­is­tered nurse per home suf­fi­cient? Would a real and prop­erly funded home-care sys­tem take some of the pres­sure from long-term care in­sti­tu­tions?

But per­haps the most im­por­tant ques­tion the in­quiry can an­swer is this: Why was it so easy for of­fi­cial­dom to con­clude that th­ese deaths were nat­u­ral? Peo­ple live a long time th­ese days. Why should so many as­sume that a nurs­ing home res­i­dent al­ready has one foot in the grave?

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