Murders by nurses not as rare as we think, researcher tells inquiry

Murders at the hands of health-care workers aren't as rare as people might think, a leading researcher told the Elizabeth Wettlaufer inquiry Wednesday.

Beatrice Yorker, a professor of nursing and criminal justice at California State University, Los Angeles, said the Wettlaufer case has still provided a trove of information never before seen in the field.

She has studied at least 90 cases worldwide that date back to the 1990s, each one involving health-care professionals who became serial killers targeting their patients.

The public inquiry is looking into how Wettlaufer, an Ontario nurse, kept up a near decade-long run of murdering patients undetected.

"Nobody has given as much detail as she has," Yorker said. "When it comes to premediation, she's given us more insight than any other health-care killer."

The Woodstock, Ont., woman confessed in 2016 to killing eight of her patients and trying to kill six more — all with injections of lethal amounts of insulin.

The 51-year-old former registered nurse is currently serving a life sentence for her crimes at the Grand Valley Institute for Women in Kitchener, Ont.

"What I tell people," Yorker told CBC News in 2016, "is that the number of victims is well into the hundreds, and the number of suspicious deaths is over 2,000 associated with [health-care professionals] who have been prosecuted for serial killing patients in their care."

The professor agreed to share her findings and any trends she has uncovered to assist the inquiry in making recommendations that may prevent a similar situation from arising again. The first part of the inquiry began in August 2017 at the courthouse in St. Thomas, Ont., and wrapped up about a month ago.

Expert and technical evidence is set to be heard in Toronto on Sept. 12, 13 and 14.

Insulin increasingly used to kill

Yorker's research indicates a trend in the way some of the murders in care facilities are being committed. She has stated about one-third of the crimes are carried out by injecting patients with lethal amounts of insulin, and around 60 per cent are carried out by registered nurses.

The inquiry has already heard that the Caressant Care long-term care home in Woodstock, Ont., did not keep tabs on its insulin supplies. That's where Wettlaufer killed seven of her eight victims between 2007 and 2014.

Wettlaufer went on to work at the Meadow Park care facility in London, Ont., where she killed an eighth elderly patient — also with an insulin overdose. That facility did not keep close tabs on its insulin supplies at the time either, according to evidence presented at the inquiry.

At both facilities, insulin was stored in an unlocked fridge.

Too much insulin causes hypoglycemic shock — essentially a blood sugar level crash that can render victims unconscious and cause fatal organ damage.

The inquiry has been told insulin dissipates from the body quickly making it hard for investigators to trace after a person's death. Even in cases where insulin is found during an autopsy, it's extremely difficult to determine if it was produced naturally by the body or administered intentionally through injection.

Warning sign: deceptive behaviour

Yorker's research also suggests that health-care professionals who preyed on their patients often showed indicators of deceptive behaviour in the workplace leading up to their crimes.

In Wettlaufer's case, the inquiry has heard about a pattern of dishonesty relating to her work history and problems with employers.

Yorker said that's consistent with established patterns among health-care serial killers, who are more likely to have falsified credentials than a to possess a criminal record.

"They were liars more often than they were criminals," she told the inquiry.

In one instance, Wettlaufer withheld key information from prospective employers about why she left her first nursing job at a hospital in northern Ontario.

Wettlaufer insisted she quit that job, when she was actually fired for stealing narcotics from the hospital and overdosing.

Motives never fully explained

While Wettlaufer has never fully explained her motives for killing some of her patients, she described feeling "a red surge" of anger that she claimed led her to target the elderly victims. She also confessed to having addictions to various  opiates and said she would frequently steal drugs from her patients or employers.

Expert's suggestions

Yorker said Ontario's long-term care facilities could make improvements in several key areas to prevent similar killings in the future.

They include:

• Better tracking of medication.
• Educating health-care providers about what is an expected or good death, and what should be considered an atypical or abnormal death.
• Routine data collection of all deaths deemed atypical or abnormal.
• The encouragement of health-care workers to speak up about suspicious behaviour. "If you see something, say something," Yorker said. "It's actually your duty."

Confession finally came in 2016

The inquiry has heard that by 2014 there were rising concerns Wettlaufer was putting patients at risk by making medication errors. She was fired from Caressant Care, but continued working elsewhere as a nurse.

Neither police nor her employers claim to have had any clues she was a serial killer until she confessed, which sparked a massive police investigation.

Given the fact that Wettlaufer did not kill her victims in recognizable clusters or patterns, Yorker said it's possible Wettlaufer could have continued killing had she not confessed.

Later this week, the inquiry will hear from a medication management expert and a witness from Ontario's Ministry of Health and Long-Term Care.

John Lancaster can be reached at 416-205-7538 or at john.lancaster@cbc.ca