Preventing another Nurse Serial Killer!!

[Truth66]

July 31, 2019 was a huge day in Nursing in the Province of Ontario here in Canada. The long awaited report and recommendations from the Ontario Long Term Care Homes Public Inquiry was released. The Public Inquiry was initiated after former nurse Elizabeth Wettlaufer was convicted after confessing to killing 8 seniors and attempting to kill 6 others in Long Term Care facilities (Nursing Homes).

The report is 4 volumes in length and contains 91 recommendations in an attempt to prevent similar incidents in the future. I’m proud of the fact that I submitted a 67 page package to the inquiry last year. Unfortunately what I submitted was deemed outside of the Inquiry’s Mandate.

My submission was based on a growing reality that Nurses are experiencing stiff opposition from Insurance Providers and Workers Compensation Boards and having their disability claims denied and in essence starved into submission to be at work, when they are clearly not medically cleared to be there. Many of these Nurses are required to be at work, doing various nursing duties which includes giving out medications, yet many are mentally impaired by the medications that have been prescribed to treat their condition. The professional accountability that Nurses have to their governing bodies means absolutely nothing to various Insurance Providers and Worker’s Compensation Boards.

I kept pointing out in my submission that if the Inquiry wants to help prevent deaths from overdoses of medication, then they need to address the issue of Nurses working while being impaired. Yet, when going through what I have read so far, the Iquiry focused on issues with regards to Intentional Deaths and did not included Un-Intentional Deaths.

Wettlaufer committed those homicides by overdosing her victims with Insulin.

Here’s a link to the Inquiry’s website for Nurses here to access the various volumes of the Inquiry to read through. Just a heads up, it’s a lot of reading.

https://longtermcareinquiry.ca/en/final-report/

[Crash_Cart]

I'm failing to see any correlation involving stiff opposition from Insurance Providers and Workers Compensation Boards with Nurses having their disability claims dismissed, and the information contained within this report.

The published results of this 900+ page investigative report is primarily about the history of one Nurse who's charged with a long history of professional misconduct and homicide. It also examines events and failures in the healthcare system which lead to such occurrences in great detail.

However, I never seen anything that relates to Wettlaufer making any attempts to file for any such disability compensation benefit so far. Unless I am missing something, the report never indicates Wettlaufer was injured on the job, or otherwise attempted to file for any disability benefits. It only suggests she was an alcoholic and had a drinking problem, which isn't really a compensable job related injury or anything.

If this fact does somehow exist, can you point to a specific page, or reference containing this information?

I'm not making the connection as indicated in your introductory preamble. These claims about workers compensation and the information provided in this published report seem entirely unrelated to one another.

[Truth66]

My submission to the Inquiry was with regards to overdose's of medication. If a Nurse is impaired there's a risk of overdosing someone when giving medications. Wettlaufer Intentionally killed these seniors with overdoses of Insulin, yet it could easily have been a different type of medication. As mentioned several times in the reports, the Inquiry's focus was on the "Intentional".

If a Nurse is impaired, they can "Un-Intentionally" overdose a patient. One of the corner stones of the Inquiry was prevention, which is why I did the submission that I did. If preventing overdoses of medication then the "Un-Intentional" should have been looked at.

When I made references to what goes on with Workers Compensation Boards and Insurance Companies is that this is a growing problem with Nurses being at work when they are not medically cleared to be their due to their illness/injury. These Nurses are having to work while potentially impaired with the medications used to treat their injury/illness when their disability claims are denied. This opens the door of these Nurses of "Un-Intentionally" overdosing someone and potentially killing them.

[Truth66]

WOW!!! I have just gone through a section of Volume 2 of the Inquiry reports. Starting on page 615, there are numerous pages with regards to Wettlaufers Mental Incapacity which included her stealing/taking Ativan. On one incident she had taken 25mg of Ativan as a suicide attempt due to her depression. On pages 617 and 618 there's eyewitness reports indicating of how incapacitated Wettlaufer was while taking Ativan during the working hours of her shift in 1995. On page 625 in indicates that Wettlaufer was incapcitated as a result of alchohol dependence.

After reading these several pages, I'm even more shocked that the Inquiry did not examine impairment issues of Nurses who are at work who clearly shouldn't be their due to their illness/injury and run the risk of Un-Intentionally injuring/killing someone. In particular the role of disability claim denials which essentially starves Nurses into submission to be at work regardless of their impairment(s).

In fact my submission included several documents pertaining to disability claim denials in order to be off work while going through treatments. For many Insurance Companies and Workers Compensation Boards, they dismiss the professional responsibility of Nurses and focus only on their internal policies pertaining to disability.

[Crash_Cart]

11 hours ago, Truth66 said:

In particular the role of disability claim denials which essentially starves Nurses into submission to be at work regardless of their impairment(s).

Alcoholism and drug dependency is not a work injury.

[Truth66]

You are correct that Alcoholism and drug dependency is not a work injury.

If a person has a significant work injury and is taking various medications to treat that injury which would create impairement then it becomes an issue. Many Workers Compensation Boards and Insurance Companies have the mentality of "if you can sit at home, you can sit at work". Yet, they completely disregard the fact that when a Nurse steps foot into their place of employment they are immediately accountable to their governing body.

Here in Ontario, the College of Nurses of Ontario defines Incapacity as both Physical and Mental. So if an injury is significant that a Nurse cannot physically respond to emergency situations, then that Nurse should not be at work. For example in a Long Term Care facility taking care of seniors, especially ones with Dementia, there's a high risk of seniors choking (especially at meal times), which would require the nurse to intervene. An injured Nurse can not say to the one who is choking, "Hang on I'll get a Nurse".

Here in Ontario, most nurses working in Long Term Care facilities do not do direct physical care on the Residents. This is done by Personal Support Workers. So the Workers Compensation Board and a few Insurance companies will indicate to the Nurse that the job is not that physical, therefore the Nurse can be at work in spite of their injury. Yet most Nurses in these facilities are the ones giving out medications, doing treatments, doing up care plans, etc. If that Nurse is taking various medications to treat that injury which creates impairement, then they shouldn't be at work.

It's quite common to see a single Nurse giving out medications to more than 30 Residents on a day shift. If that Nurse was recovering from an injury and was impaired with various medications to treat that injury, how many potential injuries could that Nurse un-intentionally do with that many residents to give medications to?

Keeping in mind that this Inquiry was with regards to Long Term Care facilities.

[JKL33]

What does any of that have to do with someone who purposefully sets out to hurt others or commits murder and attempted murder?

It sounds like you are trying to argue your concerns by capitalizing on a completely unrelated tragedy?

[Truth66]

I worked in Long Term Care for over 15 years as a Nurse. Again a big part of the Inquiry was with regards to Prevention. If we're going to prevent deaths of these seniors of overdosing of medication(s), then both the Intentional and Un-Intentional needs to be looked at.

No one wants to see needless deaths of these seniors when they can clearly be prevented. That means looking at the Intentional and Un-Intentional ways that these seniors can be seriously injured/killed.

On the Inquiry's website it outlines the legal framework. https://longtermcareinquiry.ca/en/legal-framework/

Part of that framework (as mentioned on the site) is looking at relevant legislation which includes the Long Term Care Homes Act here in Ontario which is here: https://www.ontario.ca/laws/statute/07l08#BK29

Under the heading of Safe and Secure Home the legislation states, "Every licensee of a long-term care home shall ensure that the home is a safe and secure environment for its residents."

Under the heading of Duty to Protect the legislation states: "Every licensee of a long-term care home shall protect residents from abuse by anyone and shall ensure that residents are not neglected by the licensee or staff."

It's worth noting that in the legislation under penalties it states:

"1) Except where subsection (2) applies, every individual who is convicted of an offence under this Act is liable,

(a) for a first offence, to a fine of not more than $100,000 or to imprisonment for a term of not more than 12 months, or to both; and

(b) for a subsequent offence, to a fine of not more than $200,000 or to imprisonment for a term of not more than 12 months, or to both."

Therefore, by allowing a Nurse to be at work who is impaired, with the potential of Un-Intentionally harming any one of those residents is in violation of the legislation. Furthermore, this goes against the before mentioned College of Nurse of Ontario Guidelines on Incapacity. Recently I learned that if a Nurse knows that they should not be at work due to their incapacity and Un-Intentionally kills a resident by overdosing them with medication, they could be charged under the Criminal Code of Canada with the charge of Criminal Negligence. Criminal Negligence carries a prison term of up to a year.

So, I'm definitely not capitalizing on the tragedy of what Wettlaufer did to her victims. My primary concern is the safety of the residents in these facilities. If it wasn't, I would never had done the submission to the Iquiry that I did.

[hppygr8ful, ASN, RN, EMT-I]

I too am failing to see how this article would prevent a nurse serial killer from doing their work. Serial killers are a breed unto themselves and there are no known causative factors that lead to it. They are also not nearly so rare as the general public thinks they are. The article implies that impairment with drugs and/or alcohol can lead to this which is a terrible assumption to make as if nurses in recovery from substance misuse don't have enough stigma over their heads as it is.

Hppy