Elizabeth Wettlaufer, the former Ontario nurse accused of murdering eight nursing-home patients, was fired from the Caressant Care facility in Woodstock after she received several disciplinary warnings and was suspended four times for administering drugs improperly, according to court documents released this week.
The documents say she was dismissed at the end of March, 2014, from the Caressant home, where she is now alleged to have murdered seven residents. Her dismissal letter said Ms. Wettlaufer, who worked at Caressant for nearly seven years, had "an extensive disciplinary record for medication-related errors."
However, she was able to continue working as a nurse for more than two years, during which she is alleged to have murdered another patient and attempted to kill two others.
Ms. Wettlaufer resigned her licence from the College of Nurses of Ontario on Sept. 30, 2016, when police began an investigation and interviewed her.
Under Ontario's Regulated Health Professions Act, an employer who fires a nurse for professional misconduct or incompetence must notify the college within 30 days.
The College of Nurses said it is not allowed to comment directly on Ms. Wettlaufer's 2014 termination.
However, it said in a statement that its actions depend on how much it was told about the alleged misconduct.
"All reports by employers are assessed by the College and appropriate action is taken based on information provided by the employer during the assessment," the statement said.
Details of Ms. Wettlaufer's firing are outlined in an Information to Obtain (ITO) court affidavit by Detective Constable Tim Pinder of the Woodstock police.
The affidavit quotes from her dismissal letter, issued on March 31, 2014, by Brenda Van Quaethem, who was then an administrator at Caressant, after an incident involving a patient identified only as Ms. Doidge.
"On March 26, 2014, I became aware of a serious situation ...," the letter said. "... Instead of giving her the medication that had been prescribed for her, you gave her medication that was prescribed for another resident ... the resident experienced distress as a result."
The letter noted that Ms. Wettlaufer said it was an unintentional error.
"This is another incident in a pattern of behaviours that are placing residents at risk," the letter said. "You have an extensive disciplinary record for medication-related errors which include numerous warnings as well as 1-, 3- and two 5-day suspensions."
The ITO also indicates Ms. Wettlaufer is suspected of using insulin, the hormone that lowers blood-sugar levels, to commit the alleged murders.
During the five days between giving the wrong medication to Ms. Doidge and her dismissal, Ms. Wettlaufer is alleged to have killed Caressant resident Maureen Pickering, who died on March 28.
Ms. Wettlaufer has also been charged with first-degree murder in the deaths of six other Caressant residents: James Silcox, Maurice Granat, Gladys Millard, Helen Matheson, Mary Zurawinski and Helen Young. She was also charged with attempting to murder two other Caressant residents, Wayne Hedges and Michael Priddle, and committing aggravated assault on two others, the sisters Clotilde Adriano and Albina Demedeiros.
"Wettlaufer had direct care of each of the victims ... at, or just prior to, the time of their deaths," the ITO says.
She later got a job at Meadow Park Long Term Care in London where, five months after she left Caressant, 75-year-old resident Arpad Horvath died. She is now accused of his murder.
On four separate instances when she was taking care of him in the summer of 2014, Mr. Horvath suffered extremely low blood-sugar levels, the ITO says.
The last time, on Aug. 24, he had to be hospitalized after he was found unresponsive, cold and clammy, the ITO said. He died a week later.
Ms. Wettlaufer then worked at the Telfer Place Long Term Care in Paris, Ont. She has been charged with the attempted murder in September, 2015, of resident Sandra Towler.
Ms. Towler had to be hospitalized, the ITO said, noting that insulin was not controlled or monitored at Telfer Place.
The job at Telfer also took a bad turn for Ms. Wettlaufer. The ITO says that, in April, 2016, she was "asked not to return to their facility due to her behaviour towards other staff members."
Ms. Wettlaufer's last two employers were agencies providing in-home care. She is charged with the attempted murder in August, 2016, of Beverly Bertram, at a private residence in Oxford County.
Det. Constable Pinder said in the ITO that he met Helen Crombez, the Caressant's nursing director, and reviewed with her the patient notes of seven of the victims, which mentioned they had excessive sweating, seizures and bulging eyes.
"Crombez stated that these symptoms are consistent with an insulin overdose," the ITO said.
Ms. Adriano was found on Aug. 27, 2007, "clammy, sweating and difficult to arouse," the ITO said, adding that "Wettlaufer was working that night and that was the only time that Adriano exhibited those symptoms."
The ITO confirms earlier reports that the investigation began from a tip Toronto police received after Ms. Wettlaufer checked herself into the city's Centre for Addiction and Mental Health last fall.
The ITO said she started treatment at CAMH on Sept. 16 and that the psychiatrist who attended her was Alan Khan, who later provided a statement to Toronto police.
The affidavit indicates that investigators initially had only the first names of some of the victims.
Det. Constable Pinder said he spoke with Saint Elizabeth home-care service in Woodstock to identify Beverly – the alleged victim, Ms. Bertram.
Similarly, police initially knew two other victims, Mr. Hedges and Mr. Priddle, only as Wayne and Mike.