A nursing home in Woodstock, Ont., didn't report to the Ministry of Health and Long-Term Care an insulin overdose just a week and a half after Elizabeth Wettlaufer was hired.
It's impossible to say if a report would have shut down Wettlaufer's killing spree before it began, but the home's director of nursing testified at a public inquiry Monday that a report was never filed.
"Insulin overdoses didn't happen. They're very, very rare," testified Helen Crombez, the Caressant Care home's former director of nursing.
Crombez hired Wettlaufer, who went on to kill seven patients undetected at Caressant Care. She was fired in 2014 for frequently making errors, including with patients' medication. But she was given a letter of reference and then hired by Meadow Park nursing home in London, where she killed one more person.
Ministry not informed
Crombez testified that incidents within the home that resulted in a resident being sent to hospital were supposed to trigger a report to the ministry. She was unclear about why a report on Wettlaufer was never filed.
She said while working a double night shift on July 6, 2007, Wettlaufer injected elderly patient Clotilde Adriano, 87, with insulin.
Adriano was rushed to hospital, which should have triggered a report to the Ministry of Health and Long-Term Care — and an inspection of the facility and a review of the incident.
Adriano didn't die because of that incident, though she was determined to be Wettlaufer's first victim at the Caressant Care home. Wettlaufer was charged with aggravated assault in 2016 for that crime.
The Public Inquiry into Long-Term Care in Ontario was established after Wettlaufer was sentenced to eight concurrent life terms for killing eight people. She used insulin she accessed at the nursing homes where she worked.
Wettlaufer's crimes might not have come to light had she not confessed to a psychiatrist in 2016.
Nurses overworked and underpaid
The ministry was also not called in August 2007 when James Silcox, 84, died after being injected with insulin by Wettlaufer.
She filled out paperwork about his death, citing it as "accidental" as well as "sudden and unexpected." That should have triggered a call to the ministry as well, but didn't.
Crombez testified that as the night nurse at the care facility, Wettlaufer worked alone with no oversight. She was responsible for close to 100 patients during her night shifts. Another nurse worked in a different wing of the facility and was responsible for about 60 patients.
Crombez testified that she was not aware that Wettlaufer had been fired from her first job for being high on a narcotic.
"I would hope that [as a result of this inquiry] the College of Nurses would put employee's places of work on their website, with the timeframe and the reason they left, so employers can get a true picture of what the person was about," Crombez said.
'The most terrible thing'
Last week Crombez tearfully apologized to families of Wettlaufer's victims.
The inquiry is scheduled to last nine weeks and is taking place at the Elgin County courthouse in St. Thomas.
The inquiry has heard that opioids and insulin went missing from the Caressant Care home in Woodstock when Wettlaufer worked there.
The inquiry has also heard that Wettlaufer's union launched grievances protesting her suspensions for medication errors and absences without investigating the circumstances surrounding the discipline measures.