The actions of a nurse who killed vulnerable patients in her care were the "most egregious" Ontario's nursing regulator has ever seen, the body said Tuesday as it revoked Elizabeth Wettlaufer's certification and found her guilty of professional misconduct.
But the College of Nurses of Ontario defended itself when asked if it could have done more to flag Wettlaufer as a concern, saying it had not found evidence of her intent to harm patients when it previously investigated two incidents involving her.
Wettlaufer was found guilty of 14 counts of professional misconduct after a hearing before a disciplinary panel that came nearly two months after she pleaded guilty to murdering eight seniors in her care.
The 50-year-old — who is currently serving a life sentence with no chance of parole for 25 years — was not present at the hearing.
"This is the most egregious and disgraceful conduct this panel has ever considered," said Grace Fox, the chair of the five-person panel that deemed Wettlaufer's conduct unprofessional, dishonourable and disgraceful.
In June, Wettlaufer pleaded guilty to the first-degree murder of eight seniors, attempted murder of four others and aggravated assault of two more people, all by way of insulin overdoses, between 2007 and 2016.
She confessed to the murders while at a psychiatric hospital in Toronto last fall before detailing the crimes to the college and ultimately to police in Woodstock, Ont.
The college has previously said little about Wettlaufer's case. Its role as a regulator came under the spotlight at Tuesday's disciplinary hearing.
The college knew Wettlaufer was fired from the Caressant Care nursing home in Woodstock for a medication error in 2014, but she continued to work — and harmed patients and killed another — until she resigned as a nurse in September 2016.
The disciplinary panel heard Wettlaufer had given one patient insulin that belonged to another patient and was fired for that incident, which came after three other medication errors. Caressant Care told the college about the firing, but the college decided not to conduct a formal investigation after interviewing the facility's nursing director.
The college was satisfied that Wettlaufer owned up to the errors and that there was no evidence of intent to harm her patients, said Mark Sandler, a lawyer representing the college, after the hearing.
By not doing an official investigation, the incident remained private, which meant the public, and other nursing employers, didn't know about the termination.
Questions about the college's role will be addressed in an upcoming public inquiry into the matter that has been called by the province, Sandler said.
"One of the issues that will undoubtedly come up at the inquiry is whether notices of termination are publicly posted or not," Sandler said. "There are very compelling reasons why they're not — on the other hand in light of this case that ... will be a legitimate systemic issue that the commissioner will wrestle with."
Doris Grinspun, the CEO of the Registered Nurses Association of Ontario, wants firings to be disclosed to future employers.
"It should be mandatory that the employer has an obligation to disclose termination to the next employer if it has to do with matters related to patient safety," Grinspun said.
The disciplinary panel also heard about an incident in 1995 when Wettlaufer was found "dazed and disoriented at work" and required hospitalization after illicitly taking lorazepam, a drug used to treat anxiety and sleeping disorders.
The college investigated and found that Wettlaufer had not tried to harm patients, but was recommended for treatment and to practise nursing with conditions that included avoiding drugs and alcohol for one year. She completed that term without issue.
That incident remained public for six more years, Sandler said.
"The bottom line is that we're very comfortable in the way in which the college responded in its two interactions with Ms. Wettlaufer," Sandler said.
Earlier in the day, Megan Shortreed, another lawyer for the college, presented an agreed statement of facts from Wettlaufer's guilty plea and her confession to police in the criminal case as the basis for the college's findings of misconduct.
Shortreed noted that Wettlaufer's psychiatrist informed the college about her confession on Sept. 29, 2016.
The college started an investigation immediately, Shortreed said, but was told to back off by police and the Crown attorney to allow their own investigation to proceed.
The disciplinary panel heard that Wettlaufer then emailed and called the college on Sept. 30, saying she was no longer fit to practise as a nurse and wished to resign.
She told the college's intake investigator that she had given 14 patients insulin overdoses on purpose, although she wasn't sure if the eight deaths were directly or indirectly related to her actions, the panel heard.
"She said she would never again practise nursing," Shortreed said. "Wettlaufer had no explanation as to why she had done these things."