Death Investigation in Long Term Care

Dr. Dirk Huyer, the Chief Coroner, was cross-examined by David Golden, lawyer for Caressant Care, at the Long Term Care Inquiry.  Dr. Huyer appeared unfamiliar with Ontario Long Term Care Clinicians. Dr. Roger Skinner frequently speaks at the Ontario Long Term Care Clinicians annual conference.  Dr. Skinner is Chair of the Geriatric and Long Term Care Review Committee.  The Committee publishes a report, available on-line, about LTC death reports. Members of our Board of Directors assist with the review of their cases and provide clinical input.

The program for this year’s conference is available at:  https://www.oltcc.ca/annual-conference/

Our three-day conference, where Jane gave a workshop last year, is the largest conference for long term care physicians in Canada.  This year will be an update on the Long Term Care Inquiry and what can be applied to the medical care of our residents.

Our residents and families will not receive much assurance about the role of OCCO in LTC deaths.  The coroner is often helpful, especially if there are concerns by the family or caregivers—one of questions on the Institutional Patient Death Report (IPDR). The Coroner is essential in deaths where there is assault of other misadventure requiring police involvement. The involvement of the coroner varies with the individual and their experience in LTC.  The initiation of the threshold death in 2013 may have improved the coroner’s involvment.  A death became less of a routine event.

Physicians take responsibility of pronouncing death very seriously.  That is why Dr. Skinner is a regular speaker at our conference.  Workshops on completion of the death certificate were also been part of past programs.  The physician completing the certificate is often an on-call doctor, after-hours, or on the weekend, for an unknown resident, being cared for by casual staff. 

The death of Maureen Pickering in March 2014 was the seventh of Wettlaufer's murder. An investigation of the death not only could have prevented the subsequent eighth murder and two attempted murders but also the arrest of a serial killer. Would the Coroner or other forensic investigation identify the previous six murders? There remains the charges of aggravated assaults and attempted murder, outside the review of death investigation.

A consistent and transparent solution is required.  Death examination and review must also have a quality component to benefit all residents in long term care.  

 

Doctors in Long Term Care

As someone who has worked alongside nurses, PSWs and managers in LTC for 37 years, my wish is that they never need to experience the tribulation of those who are taking the witness stand.  The charting and scenarios are very familiar.  The picture that I see evolving is that many partial contributors (?accomplices) allowed these horrific murders to occur.  On behalf of the OLTCC, I am interested to see what the physicians may have observed.

Heather Mallick of the Star identifies six levels of failure: the nurses’ union, the nursing regulator, the inspectors, her employers, the coroner and the pastor who did not believe her confession.  On the final point, there were likely others outside the health care system who had concerns.  And, there were likely others in Circle of Care, like doctors, who had concerns and did not know how to address them.

Doctors are often seen on the sidelines in long term.  The vast majority of Ontario LTC MDs are independent contractors and paid separately through OHIP.  I doubt that this will change any time soon.  Yet, they are the ones responsible for medical care and providing 24/7 coverage.  The LTCHA requires that every facility has a Medical Director who is responsible for the medical program.

Long Term Care Inquiry

The Public Hearings of Long Term Care Inquiry opened in St. Thomas on June 5.  Elizabeth Wettlaufer murdered or injured fourteen persons.  She confessed and was convicted to long imprisonment last year.  The Public Hearings allows the survivors, families of victims and the public to hear the details of these tragic events.  

Ontario Long Term Care Clinicians is a Participant at the Hearings.  Dr. Fred Mather, OLTCC President, said the following in his opening remarks:

“With shock, sadness and sympathy, OLTCC is here to listen to the facts of the intentional deaths in and other risks to long term care residents.  We will witness the effect that these events had on residents, families, staff and others.  We await to carry forward recommendations for improvements in the safety and security of our facilities.”

Updates and observations from the Inquiry will be provided on the web site, www.oltcc.ca, under the Blog tab.