Autopsies rare in nursing home deaths, chief pathologist tells Wettlaufer inquiry

Ontario seniors who die in long-term care get far fewer autopsies than the general population, the province's chief forensic pathologist told the Wettlaufer inquiry on Monday. 

About 40 per cent of deaths that are investigated in Ontario get autopsies, a standard percentage in jurisdictions with robust pathology programs, Dr. Michael Pollanen testified at the Elgin County courthouse in St. Thomas, Ont. 

For people in long-term care, the rate of autopsy is less than 10 per cent, Pollanen said. 

"The elderly have barriers to access in life and in death. Generally speaking, they're not very well represented in the death investigation system or in autopsies."

The inquiry into the safety and security of residents in the long-term care home system in Ontario is looking at how nurse Elizabeth Wettlaufer got away with harming and killing residents over a decade-long career in nursing homes. 

After killing eight people and hurting six, Wettlaufer checked herself into a psychiatric facility and confessed to her crimes.

Pollanen testified he thinks the death of Maureen Pickering, one of Wettlaufer's victims, was "a missed opportunity." 

Pickering had severely low blood sugar after being injected with insulin by Wettlaufer. She was rushed to hospital, where she fell into a coma. She died five days later. Her doctor flagged the death, but the coroner didn't do an autopsy. 

"It's a missed opportunity, because the autopsy would have forged those links that could have formed the basis on which to get to the truth," Pollanen said.  

Pollanen also testified about how the office of the chief forensic pathologist is structured and how autopsies are performed.

Insulin, which Wettlaufer used to kill her victims, is never tested for during toxicology probes after death, Pollanen said. 

"There's no mechanism currently to diagnose hypoglycemia after death using fluids from a dead body," he said. 

Generally, elderly people don't get autopsies because their age-related diseases skews their deaths into the "natural causes" category, which don't require an autopsy.

But that lack of autopsy is a "huge opportunity" for the death investigation system, Pollanen said, which could help contribute to determining more precise causes of death or factors leading up to death. 

Autopsies are performed in Toronto and in smaller regional forensic pathology units across the province, Pollanen said. 

The inquiry has previously heard that no autopsies were done on any of Wettlaufer's victims. In some cases, the deaths were flagged, but the coroner did not begin a death investigation, which could have triggered an autopsy. 

There could be value in forensic pathologists working with the province, coroners and nursing homes to do an in-depth study of deaths, but that wouldn't be the right approach to catch a "clandestine serial killer," Pollanen said. 

'Secret homicides'

Wettlaufer's homicide falls into a category called "secret homicides," Pollanen said.

Those are murders that are not detected at first, and may not be until a confession from a killer, as was the case with Wettlaufer.

"Some secret homicides can only be revealed by confession," he said. 

A review by Pollanen of several secret homicide cases showed that they span all age groups, from age one to 95, he testified. 

The first part of the four-month inquiry dealt with facilities such as nursing homes and home-care agencies. The second phase is dealing with the coroner's office, the Ontario College of Nurses and the Ministry of Health and Long-Term Care. 

Two officials from the Ontario College of Nurses are also scheduled to testify this week.