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.