by Written on behalf of Wise Health Law June 05, 2018 3 min read

Last year, nurse Elizabeth Wettlaufer pled guilty to murdering eight residents of long-term care homes over the course of more than seven years. She was sentenced to life in prison with no chance of parole for 25 years. This morning, the public Inquiry into what exactly happened began at the Elgin County Courthouse in St. Thomas, Ontario. The Inquiry is being held in southwestern Ontario, where Wettlaufer’s offences took place, so that affected friends and family could easily attend. The courtroom on the first day of the inquiry was full of family members of victims, health-care administrators, and government officials.

The Long-Term Care Homes Public Inquiry to Date

The Long-Term Care Homes Public Inquiry was established in August 2017 following Wettlaufer’s conviction of eight counts of first degree murder, four counts of attempted murder, and two counts of aggravated assault. Justice Eileen Gillese was appointed Commissioner of the Inquiry. The Inquiry’s first public step was to conduct three community meetings in the fall of 2017, to, among other things, introduce the members of the Commission, explain how the Inquiry would work, and hear from the community and those affected by Wettlaufer’s actions. The Inquiry then held a series of participation standing hearings in late 2017 to decide who would be able to participate in the public inquiry that is now taking place. The third and last step is the public inquiry itself.

The Mandate of the Inquiry

The Inquiry was given a mandate to:
  • inquire into the events which led to Wettlaufer’s offences and the circumstances and contributing factors that allowed them to occur; and
  • prepare a final report with recommendations for what can be done to prevent such tragedies from being repeated in the future.

The First Day of the Public Inquiry

Justice Gillese re-iterated to those assembled in the courtroom that the purpose of the inquiry is to determine
...what failings in our long-term care homes system could allow Elizabeth Wettlaufer to seriously harm or kill 13 residents in long-term care homes and attempt to kill a home-care client in her own home without detection, while working as a registered nurse.
To date, the Commission’s legal team has reviewed more than 41,000 documents in investigations into:
  • Long-term care homes and home-care agencies where Wettlaufer worked;
  • The Office of the Chief Coroner and Ontario Forensic Pathology Service;
  • The College of Nurses of Ontario; and
  • The Ministry of Health and Long-Term Care (the Ministry).
The inquiry will now hear evidence on Wettlaufer’s offences, the circumstances that surrounded them, and the contributing factors that may have permitted these offences to be committed. Throughout the Inquiry, more than 900 pages of evidence will be made public, including transcripts of Wettlaufer’s interviews, her confession, and the reasoning behind her sentencing. Seventeen witnesses will testify, beginning with several who worked at the long-term care home in Woodstock where Wettlaufer’s offences first began. Other witnesses will include individuals from the Ontario Nurses Association, the Ontario College of Nurses, the coroner’s office, the Ministry, and several organizations representing long-term care homes. In addition, a patient who survived Wettlaufer’s attempt to kill her will also address the Inquiry. In September, the Inquiry will move from St. Thomas to Toronto for one week to hear from expert witnesses on matters such as safe medication practices as well as serial killers in a health-care setting. Ultimately, as Justice Gillese noted on the first day of proceedings:
In many ways, this inquiry is about healing — healing our broken trust in the long-term care homes system. I most sincerely hope that through these public hearings, the Ontario public begins to feel heard — and therefore, begins to heal.
The Inquiry is open to any interested members of the public. It will deliver its final Report on July 31, 2019. We will continue to monitor the Inquiry as it proceeds and provide further information as it becomes available. At Wise Health Law, we provide exceptional guidance on health law matters to public hospitals, long-term care homes, and other health-care providers across the province. We monitor trends and developments in the health sector so that we can provide consistently forward-thinking legal advice and risk management guidance to all of our clients. We have offices in both Toronto and Oakville, Ontario, and are easily accessible. Contact us online, or at 416-915-4234 for a consultation.


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