The day after Elizabeth Wettlaufer pleaded guilty to killing eight patients and assaulting or trying to murder six others, the college responsible for protecting the public from bad nurses said it was accelerating an investigation into her professional conduct.

The 50-year-old nurse is expected to be sentenced to life in prison, with no chance of parole for 25 years, during court hearings on June 26 and 27 in Woodstock, Ont. Sometime after that, the College of Nurses of Ontario will strike a disciplinary panel to rule on Wettlaufer’s job performance as a serial-killing registered nurse.

It’s safe to assume the panel will sanction Wettlaufer severely. What many want to know is why it didn’t do so well before she confessed to her crimes, without prompting, in September 2016, and voluntarily resigned her status as a registered nurse.

The college, after all, was informed 30 months earlier that Wettlaufer had been fired from a nursing home for putting the life of a patient at risk. Yet she continued to work — and kill — as a fully licensed registered nurse. It has some close observers of the college bluntly questioning its ability to police its profession.

“I think they’ve lost their way,” says Greg Shaw, who spent 25 years as vice-president of strategic human resources at several major Toronto hospitals. “Protection of the public has become secondary to protection of the privacy of the nurse.”

The college rejects such accusations. In a newly released annual report, executive director Anne Coghlan states that “safety is at the forefront of the standards we set and uphold.”

Yet a growing chorus of voices is calling for a public inquiry into Wettlaufer’s attacks on patients during a nine-year period. They want to assess, in part, if the college did its job. Premier Kathleen Wynne and Health Minister Eric Hoskins have said they will consider holding one.

Family and friends of seniors killed by a former nurse say they were disgusted June 1 as Elizabeth Wettlaufer pleaded guilty to eight counts of first-degree murder. The victims' friends and family are calling for reform in long-term care.

If Wettlaufer had not confessed, “I’m very afraid that the loss of life would have continued,” says Doris Grinspun, CEO of the Registered Nurses Association of Ontario, a public policy advocacy group that represents 41,000 nurses and backs calls for an inquiry.

“We want to know if there were alarm bells that went unattended,” she adds, referring to both Wettlaufer’s employers and the college.

Public pressure has been mounting on the college since the Star revealed that Wettlaufer was fired from Woodstock’s Caressant Care nursing home — where she killed seven elderly residents with overdose injections of insulin — on March 31, 2014.

As required by provincial regulations, the employer notified the college of Wettlaufer’s firing with an April letter citing a life-threatening “medication error.” When reporting a nurse to the college, employers must also complete a form that asks them to list, in chronological order, the events that led to the report.

The college’s response alluded to the secrecy and lengthy investigations that has long frustrated hospital administrators and nursing home employers.

It asked Caressant to keep all documents relevant to Wettlaufer’s firing for up to two years “pending investigation.” It added that the matter would be treated as confidential, and Caressant would not be informed of any investigation the college might conduct.

One relevant document would have been Caressant’s termination letter to Wettlaufer. It described the error that got her fired as part of “a pattern of behaviours that are placing residents at risk.”

“You have an extensive disciplinary record for medication-related errors which includes numerous warnings as well as 1, 3 and two 5 day suspensions,” the termination letter says.

Jane Meadus, staff lawyer at Toronto’s Advocacy Centre for the Elderly legal clinic, says a public inquiry must examine why the college, according to evidence so far, didn’t suspend her licence, place her under supervision, or ban her from administering medication until she retrained.

The college posts the records of the 160,000 nurses it governs on its website, including their registration status, cautions they may have received, orders for retraining and the outcome of disciplinary hearings. What’s clear is that after being fired in March 2014, Wettlaufer’s public record remained unblemished until she resigned and confessed her crimes.

The college has repeatedly refused Star requests for interviews. It won’t say what actions it took when it learned of Wettlaufer’s firing, citing legislation it insists extends confidentiality protection even to confessed serial killers.

It adds it recently asked the government for changes that would allow the college — “when there is compelling public interest” — for the release of some information before a college investigation is completed.

Employers must report nurses to the college when they are fired, considered incompetent, suffering from addiction, or have abused patients. The college insists it reviews each report — 1,400 in 2016, including 300 complaints from the public — and determines “an appropriate regulator response based on an assessed level of risk to the public.

“The extent of the investigation depends on the nature of the information provided,” it said in a recent statement to the Star. “For example, a report of incomplete or late charting would receive a different level of investigation than a report of deliberate patient harm.”

In 2015, disciplinary panels that handle the most serious cases issued measures against 10 nurses, including one who had his or her licence revoked. Action was taken against another 268 nurses — from oral cautions to suspensions — without the need for a panel to be struck.

Throughout the investigation process, employers are kept in the dark, says Shaw, whose years as an HR executive included stints at the Sunnybrook and Women’s College Health Sciences Centre, William Osler Health System and the Ontario Hospital Association.

“When an employer files a complaint with the college, as they’re obliged to do, it goes into a black hole,” adds Shaw, now a consultant in the sector. “You don’t know if it’s going to go to a disciplinary hearing or whether they’re dealing with it. You have no idea what’s going on.

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“I’m aware of a number of circumstances where the college took more than two years for it to be dealt with, in which time the nurse has no notation on their licence, so they’re free to seek alternative employment and free to work in a full capacity.”

Disciplinary orders issued more than two years after incidents of bad performance are easily found on the college’s website.

“The College has acknowledged that the timelines to address complaints and reports is long, and in some cases too long,” it said in a statement to the Star on Thursday. “We continue to review our processes and add resources to shorten the time to complete these cases. All matters that pose serious risk are triaged and given priority.”

Labour lawyer Brian Smeenk has long called for the college to place interim restrictions on nurses when an employer flags practices that clearly put the public at risk.

He represented Toronto’s Sunnybrook Health Sciences Centre when it fired a drug-addicted nurse in February 2013 for stealing medication from the hospital, and altering medical records, over the course of five years. The college didn’t place restrictions on her ability to practise until November 2015, Smeenk says.

“In the meantime the hospital hadn’t heard a word from the college about the case,” he says. “It was a mystery to us how the college came to a decision, because they never heard from (hospital) management about what actually happened.”

The college says it “did not have the legal right to restrict or suspend a nurse without first completing an investigation” until the provincial Protecting Patients Act became law this month. The college, which advocated for the change, says it can now impose interim restrictions when it has “reasonable and probable grounds that a nurse’s practice poses a risk or is likely to pose a risk of harm or injury to a patient.”

Less than a month after losing her Caressant job in March 2014, Wettlaufer landed one at the Meadow Park nursing home in London, Ont. In August, she killed 75-year-old Arpad Horvath with an insulin overdose.

She resigned from Meadow Park in October 2014 to be treated for abuse of alcohol and the drugs she stole from the nursing home. When she resumed work with other employers, she tried to kill two more patients with insulin overdoses, one at a nursing home in Paris, Ont., in September 2015, and another at a private residence in Ingersoll in August 2016.

Meadus wants a public inquiry to also examine whether employers who hired Wettlaufer after she was fired from Caressant Care exercised due diligence.

“They clearly fired her for cause,” Meadus says. “So how does she end up working for a whole bunch of other places, and nobody says, ‘Well maybe we shouldn’t be hiring this woman.’ That’s a really big systemic problem.”

Wettlaufer told police during her confession that she admitted in the Meadow Park job interview to having been fired for medication errors, but was given a “second chance.” And while she tried to hide her tracks during the murders, she also seemed to be hoping someone would stop her.

Beginning in 2009, she confessed her crimes to a long list of people, including a young nurse’s aide at Caressant, a pastor and his wife, a couple of friends, two former lovers, and sponsors helping in her struggle with alcohol and drugs.

On Sept. 16, she admitted herself to the Centre for Addiction and Mental Health (CAMH) in Toronto and confessed some more. She talked about the stress of growing up in a fervent Baptist household, about her bisexuality, about her 10-year-old marriage falling apart when her husband suspected a relationship with a woman online, about depression and suicidal thoughts, about the anger and frustration that made her want to kill.

The centre informed police and the College of Nurses of Ontario (CNO). On Sept. 30, Wettlaufer emailed the college and resigned her status as a registered nurse: “I Elizabeth T. Wettlaufer am no longer fit to practice as a nurse. I have deliberately harmed patients in my care and am now being investigated by the police for same.”

She called an investigator from the college the same day and detailed the 14 times she killed or tried to kill patients. Wettlaufer also had CAMH fax the college a handwritten four-page confession.

In one of its recent statements, the college told the Star the information Wettlaufer provided on Sept. 30 “resulted in the College’s current investigation.”

“Now that the police investigation is complete and court proceedings are moving forward quickly, CNO has accelerated its own investigation into Ms Wettlaufer’s professional conduct. But we can’t provide any further information at this time.”

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