No autopsy done in suspicious death of 1 of Wettlaufer's patients, colleague testifies

A hospital physician who treated one of former nurse Elizabeth Wettlaufer's victims recommended that the coroner be called if the patient died, according to Wettlaufer's former colleague Karen Routledge.

But no autopsy was done on Maureen Pickering, Routledge testified today on the seventh day of a public inquiry into Wettlaufer's crimes.

Routledge, who is a registered nurse, described how Pickering was rushed to hospital after she was found unresponsive, cold and clammy at the Caressant Care nursing home in Woodstock, Ont. Those symptoms could point to hypoglycemia, or to a host of other conditions like a heart attack, neurological condition or infection, Routledge said.

Pickering returned to Caressant Care, where she later died. Routledge did call the coroner's office, but said the coroner didn't seem concerned. So, when Routledge filled out her portion of the coroner's office form regarding a patient death, she didn't list it as "sudden or unexpected."

"It's not unusual for a long-term care patient to have a stroke, and that was the indicator that Woodstock General emergency had given us, that it was possible she had a stroke," said Routledge. 

Insulin easy to access

At the Caressant Care home, there wasn't much to stop nurses from tampering with insulin doses, Routledge said.

The insulin was kept inside locked medication rooms, but nurses like Wettlaufer had full access.

Many patients took different doses of insulin every day, based on their blood sugar. But there was no system of oversight at the home to make sure nurses logged the correct blood sugar reading, or gave the right dose to their patients.

"At Caressant Care there was no double-check on insulin," said Routledge. "Physically, geographically there was one nurse on second floor for 32 residents, you didn't have that availability of another registered staff."

Because insulin is an uncontrolled substance, it would also have been easy for a nurse to slip leftover cartridges into their pocket, Routledge said.

Although Wettlaufer was injecting patients — including Pickering — with insulin overdoses, Routledge said she had no idea Wettlaufer was doing intentional harm.

"I racked my brain thinking how could this happen how could you not know? And I haven't come up with anything. My heart goes out to the families and it's something that's going to stay with me forever," she said.

In disciplinary meetings, where Routledge sometimes acted as a union representative, Wettlaufer was contrite about her mistakes. 

"She was remorseful, tearful ... And for a couple of weeks, things would improve," she said. 

Routledge said she never detected any slurring speech or impaired behaviour in Wettlaufer.

Nursing director winds up testimony

Wettlaufer's former boss told the inquiry that nurses have access to many deadly medications.

"How can you prevent everything?" said Helen Crombez, former nursing director at Caressant Care.

In hindsight, she told the inquiry, a blood sugar check could have been issued for every patient that showed signs of hypoglycemia but at the time, that wasn't protocol. 

Previous testimony revealed that several of Wettlaufer's colleagues at Caressant Care were concerned about her behaviour, and wrote letters to management about her treatment of residents and staff. Although Wettlaufer faced warnings for these incidents, she was not suspended. 

The inquiry has heard that Crombez hired Wettlaufer at the home and fired her seven years later for making numerous medication errors. In her time in Woodstock, Wettlaufer killed seven elderly patients in her care.

Crombez testified Monday that Caressant Care didn't file a report when a patient received an insulin overdose just a week and a half after Wettlaufer was first hired as a nurse.

The Long-Term Care Homes Public Inquiry, established on Aug. 1, 2017, after Wettlaufer was sentenced to eight concurrent life terms, is headed by Justice Eileen Gillese. It began hearings in St. Thomas on June 5 into how Wettlaufer's crimes went undetected for so long.

Wettlaufer's killing spree began in 2007 and continued until 2016, when she finally confessed to a psychiatrist and a social worker. Until then, her employers, police and Ontario's licensing body for nurses had no idea eight patients had been murdered and six more poisoned — all with injections of massive doses of insulin.

Wettlaufer pleaded guilty in court to the murders and attempted murders and was sentenced June 26, 2017, to life in prison with no chance of parole for 25 years.

Later this week, the inquiry will hear from another colleague of Wettlaufer's, and from the president of a home care company where Wettlaufer worked after leaving Caressant Care.