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Every patient I ever picked had some dementia and that was part of what became my criteria. If they had dementia, they couldn’t report or if they reported, they wouldn’t have been believed…

– Elizabeth Wettlaufer, Ontario, Canada 2018

These are the words of Canadian registered nurse Elizabeth Wettlaufer who pleaded guilty in 2016 to murdering eight and attempting to murder six more of her patients.

At the time of writing, Wettlaufer is Canada’s most prolific serial killer. Her crimes only came to light when she confessed to killing her patients and her extensive interviews with investigators and medical professionals have provided a rare, invaluable opportunity for so much insight into the mind of not only a killer, but a healthcare serial killer.

Wettlaufer’s crimes prompted the Canadian Government to establish The Public Inquiry into the Safety and Security of Residents in the Long-Term Care Homes System (short-named The Long-Term Care Homes Public Inquiry) that started in 2018.

The highly vulnerable women and men she murdered were James Silcox, Maurice Granat, Gladys Millard, Helen Matheson, Mary Zurawinski, Helen Young, Maureen Pickering and Arpad Horvath. She also attempted to murder several more of her patients.

Wettlaufer’s crimes are shocking however the circumstances of how she committed them are all too familiar when compared to other cases of healthcare serial murder. Most of the patients she murdered were at Carresant Care in Woodstock, Ontario. She was eventually fired from the facility because she made too many mistakes with patient care, including administering medication. Wettlaufer was a member of the Ontario Nurses Association which brought a grievance against the dismissal. Carresant Care didn’t have the appetite for arbitration so settled with Wettlaufer, resulting in $2000, a reference and a sealed employment file. Wettlaufer was free and able to apply for other jobs with the knowledge that her past would not interfere with her working in another healthcare setting.

Wettlaufer first started injecting patients with unauthorised doses of insulin in 2007 when she was working at Carresant Care. She injected Clotilde Adriano, 87 with additional insulin on a number of occasions in 2007. Mrs Adriano died later in 2008. Her death was not attributed to Wettlaufer but police classified her actions as an aggravated assault against Mrs Adriano.

Wettlaufer told police she’d chosen Mrs Adriano as a victim because she was already an insulin-dependent diabetic so the nurse could get her hands on insulin easily.

That same year Wettlaufer also committed an aggravated assault against Mrs Adriano’s sister Albina Demedeiros, who also lived at the Carresant Care home (the sisters were in rooms next to each other). Ms Demedeiros died in 2010 at age 91.

Again, Wettlaufer said she picked Ms Demedeiros because she was already a diabetic and confessed she dosed her with extra insulin several times. Wettlaufer told investigators she essentially “stood back” and didn’t help Ms Demedeiros following the injections that caused unstable blood sugar levels.

Maurice Silcox, 84, died on August 12, 2007. Wettlaufer confessed she’d deliberately chosen Mr Silcox, a World War II veteran, because she’d found him difficult. He had Alzheimer’s Disease and Wettlaufer told police she felt like it was “his time to go” and she had an “urge to kill him” because of the challenges caring for him and his conduct towards staff.

The document “Statement of Facts on Guilty Plea” from The Long-Term Care Homes Public Inquiry detailed that Wettlaufer admitted she felt a deep sense of guilt after overdosing Mr Silcox because he cried out “I love you” and “I’m sorry” before he died. The shame of her actions compounded when his family praised her for her nursing care of their father and grandfather. She also admitted to police that after killing Mr Silcox it felt like a “pressure lifted from my emotions”.

Had Wettlaufer not confessed to killing Mr Silcox no one would have known he was murdered. The cause of his death was originally attributed to complications from hip surgery he’d had the week before.

Wettlaufer murdered Maurice Granat, 84 on 23 December 2007. She told police that Mr Granat had been inappropriate with her and that angered her, coupled with general resentment and pressure over her life and relationship at the time, and she decided to kill him.

Laura Jackson, a close family friend, said that on the night Mr Granat died she’d visited him at the care home and seen the former mechanic “fighting off” Wettlaufer who scurried out of the room when his visitors arrived. Ms Jackson said Wettlaufer stuck in her mind because the nurse was rude and pushy and returned later to inject Mr Granat with “something” (unbeknownst to her, insulin) and he died less that one hour later.

Wayne Hedges, 57, passed away in January 2009 but Wettlaufer admitted overdosing him with insulin a few months before his death, causing a hypoglycaemic event. Mr Hedges was a diabetic who also had schizophrenia and developmental delays and had lived at Carresant Care for almost a decade. Wettlaufer said she made a decision it was Mr Hedge’s “time to go” and she claimed he would sometimes mention he wanted to die.

Her next victim was the defenceless Michael Priddle. Wettlaufer attempted to kill him with an overdose of insulin (she couldn’t recall to police whether in was 2008 or 2009) and he barely survived the overdose, according to the nurse’s statement. Mr Priddle had Huntington’s disease, a degenerative, inherited condition. He was unable to speak, had difficulty swallowing and was checked half hourly as he was such a risk for injuries.

Wettlaufer said she got her “surging” feeling the night she tried to kill Mr Priddle, which she took as a sign from God that his life should come to an end.

Gladys Millard was the next unfortunate victim of Wettlaufer. Mrs Millard had Alzheimer’s disease and had lived at Carresant Care since 2006. On 13 October 2011 Mrs Millard was on Wettlaufer’s patient list during the night shift. Wettlaufer told police Mrs Millard was difficult to care for, including administering medication to the woman. Early the next morning Wettlaufer felt her “red surge” and grabbed insulin from the medications refrigerator and injected Mrs Millard, who was not a diabetic.

Finding a place on the elderly woman’s body where she could not push her or fight her, Wettlaufer gave the overdose to Mrs Millard. Covering her tracks, Wettlaufer wrote in her handover notes for the day staff that Mrs Millard had been agitated through the night but was now sleeping and not to be disturbed. When staff did check on her, no one connected that the woman’s fast decline – she was sweating, twitchy, pale and her vital signs were low – had anything to do with the “care” she’d received from Wettlaufer. Mrs Millard died in discomfort and stress, her body shutting down for good because Wettlaufer decided to end her life.

The next patient Wettlaufer confessed to murdering was 95-year-old Helen Matheson, a gentle lady who had dementia (but not diabetes). Wettlaufer chillingly decided to kill Mrs Matheson after she’d shown an act of kindness to her by bringing the nonagenarian a piece of pie.

The “Agreed Statement of Facts on Guilty Plea” document from the Long Term Care Enquiry states ‘…they discussed Helen Matheson’s fondness of blueberry pies and ice cream and how Helen Matheson uses to bake such pies…’

Wettlaufer wrote in her nursing notes: ‘she (Helen Matheson) ate 4 bites with ice cream then smiled and said “that’s enough dear, but the crust is lovely”…’

Describing her feelings to police about Mrs Matheson, Wettlaufer said she had a rising feeling in her chest before she injected the gentle woman with insulin and then ‘…after I did it, I got that laughter’.

Mrs Matheson lingered for more than 24 hours and was moved to the palliative care section of Carresant Care, dying with her son at her side. Wettlaufer even looked after her while she was dying, noting ‘Helen was flinching and appeared uncomfortable so 10mg (of morphine) was given…’ Killed by her nurse, Mrs Matheson wasn’t even able to rest in peace, her body exhumed in June 2017 for an autopsy.

Mary Zurawinski had dementia and had only been living at Carresant Care for six months when Wettlaufer injected her with insulin. Telling the widowed mother of four that the needles of insulin were for pain (Mrs Zurawinski was not diabetic) Wettlaufer described again the feeling rising and “laughter” that came after she’d fatally injected the 96-year-old.

Scottish-born Helen Young, 90, had lived at Carresant Care since 2009 and was murdered by Wettlaufer in July 2013. Mrs Young had dementia but not diabetes and Wettlaufer told investigators she was irritated by Mrs Young’s constant cry of “help me, nurse”.

Wettlaufer decided she’d kill Mrs Young when the woman was asking for help and saying she wanted to die. Like previous victims, Wettlaufer told Mrs Young the multiple injections of insulin were for pain relief. She died the next morning, suffering from the overdose with seizures and discomfort. Later when Mrs Young’s upset niece came to pick up her belongings, Wettlaufer comforted the woman.

Wettlaufer knew exactly what she was doing when she gave Maureen Pickering fatal doses of insulin in March 2014, although in her statement to police she claimed she only wanted to place Mrs Pickering in a coma so she’d calm down. Wettlaufer explained she was irritated that she had do give so much attention to Mrs Pickering when she also had to care for many other patients and give them their medications. The 79-year-old Mrs Pickering was in Carresant Care with advanced dementia and needed virtually one-to-one care because she wandered and could also get highly agitated and aggressive. So much so a privately paid care attendant was employed to assist at times to relieve the nursing staff at Carresant. The evening Mrs Pickering was dosed with insulin, Wettlaufer was the charge nurse and busy attending to the whole facility.

Mrs Pickering was transferred to the local hospital after she was found unresponsive and sweating heavily. The hospital determined she’d had a stroke and returned her to the care facility’s palliative ward where she died, in much discomfort. The nursing notes described that she responded to touch and voice with moans and eye movements and then deteriorated further over the next few days and passed away.

Wettlaufer had been moved on from Carresant Care when Mrs Pickering died after she’d made an error with administering drugs to a patient. For Carresant Care it was the last straw in a catalogue of concerns held about Wettlaufer. It was revealed later at the public enquiry, sparked by Wettlaufer’s crimes that when the Carresant Care administrator was filling out the termination form to submit to the College of Nurses of Ontario, she ran out of room because there had been so many incidents of misconduct recorded on Wettlaufer’s file.

Wettlaufer found another job at a care home – Meadow Park Nursing Home and in April 2014 she continued her killing spree, fatally injecting Arpad Horvath, 75. Mr Horvath had multiple health issues including dementia and diabetes and according to Wettlaufer’s confession, he tried to fight off the nurse as she administered the fatal dose of insulin. Mr Horvath lingered for a week, dying on 31 August 2014.

The killer RN moved on again, this time so she could get clean and sober. Wettlaufer was relying heavily on alcohol and opioids (stolen from her workplaces) to manage the stress she felt about her personal life and work. In fact in her confession she blamed her offending, in part, on stress and the demands of her role as an RN in aged care.

She found work with an agency that provided home-based care and another retirement and aged care home called Telfer Place in Paris, Ontario.

There, in September 2015 she attempted to murder a woman in her 70s called Sandra Towler who was hospitalised after being injected with insulin by Wettlaufer but survived.

The next victim was a woman called Beverly Bertram who was 69 and required care in her home after having surgery on her leg. A diabetic, Ms Bertram needed a nurse to administer intravenous antibiotics via a picc line. Wettlaufer attended to her on August 20 2016 for Saint Elizabeth Health Care.

After visiting Ms Bertram, Wettlaufer turned up unannounced at another patient’s home. This person was in the shower while Wettlaufer let herself in, claiming she was looking for an oxygen meter she’d left there on a previous visit. She was actually rifling through the person’s medication to steal insulin to use on Ms Bertram. Her motive was calculating; Ms Bertram was a diabetic with her own insulin but Wettlaufer knew that if Ms Bertram died, her medication would be checked. Nothing would seem amiss if her insulin supply was in order and therefore, no one would scrutinise Wettlaufer’s actions.

Wettlaufer put insulin through Ms Bertram’s picc line and the woman reported later feeling very unwell. In a move that saved her life, Ms Bertram did not give herself her dose of insulin that day and recovered at home. Wettlaufer checked Ms Bertram’s medical notes to see that the woman had survived.

Days later she resigned from Saint Elizabeth Health Care. It was a move that displayed some sort of restraint and acknowledgment of the danger she posed to her patients. The agency had told Wettlaufer she’d be assigned to caring for children with diabetes in a school environment. Wettlaufer panicked. She later told police she could not trust herself not to do harm to her young patients.

It was actually a tip-off to police that set them on the path to Wettlaufer. While she was a patient at the Centre for Addiction and Mental Health (CAMH) Wettlaufer had confided information that led staff to report concerns to police about the possible killings of patients in her care. The Centre invited Wettlaufer to talk to a lawyer but when she declined the offer they told her they had to report the information to the police and the College of Nurses of Ontario. This did not halt Wettlaufer’s confessions and she continued to disclose information, like a purge, during her stay at CAMH.

A handwritten confession (in addition to the long interview with police in which she confessed all and tried to explain her actions) detailed the patients that died, and didn’t die, at her hand.

Wettlaufer matter-of-factly wrote who her victims were, why she targeted them and how she felt at the time of committing the murders. For one of the victims, Helen Matheson, Wettlaufer describes her as “quiet and reserved” and “I’m not sure why I chose her. I was feeling angry an (sic) frustrated about my job…”

There was also additional confession from Wettlaufer to murdering another patient, which would have pushed her victim count up to 15 (nine murders and six attempted murders).

This was publicly revealed by CBC News on 31 January 2019. The national broadcaster found out the information from a partly redacted London (Ontario) Police Report revealing Wettlaufer had confessed to injecting palliative care patient Florence Beedall, 77, with insulin in August 2014 while she worked at Meadow Park care home.

Ms Beedall died an hour after being injected with insulin. Despite police conceding they had grounds to go ahead with a charge of assault with a weapon, the charge didn’t proceed. A factor was the concerns of Ms Beedall’s family about unwanted publicity.

The confessions saved much time and expense for police and the Crown Prosecutors who would have faced an almost impossible task of proving the murders had Wettlaufer not spilled all her secrets in the two-and-a-half hour confession. Most of her victims were cremated but two bodies were exhumed.

That Wettlaufer confessed and has spoken at length to investigators is invaluable to the study of killers, especially those who are in the business of studying the motivations and red flags for healthcare serial killers. Wettlaufer said she confessed to the killings out of fear she would harm children after she was told she would be transferred to work in schools where she’d be helping students, in particular with diabetes (her murder method was death by insulin).

In the small interview room in Woodstock, Ontario, Wettlaufer sits barefoot, in a red top and black trousers calmly confessing to her crimes.

‘I did have a sense when my marriage broke up God was going to use me for something…,’ Wettlaufer told the detective. (In 1997 she married Daniel Wettlaufer, a truck driver she’d met at church and the pair separated in 2007.)

‘After a while…some of the murders…whether it was God or the Devil pulling me…’

Susan Horvath, whose father Arpad Horvath was murdered by Wettlaufer told a media pack after the nurse pleaded guilty that she was traumatised by how her father had died and would never forgive the killer nurse.

‘She created all this to get caught…she planned this step by step…she wanted to get caught…’ Ms Horvath said.

‘I mean if anyone wants to destroy their life, this is how you do it…she just pulled the plug on herself…’

Ms Horvath called on changes to happen to nursing homes – better policy, more due diligence on the hiring of staff and improvements in the administration of aged care.

‘I don’t want my dad’s death and everybody’s death to be wasted…we have to make a change.

‘I know one thing, my mom is not stepping into a nursing home.’

Wettlaufer received the automatic sentence for first degree murder under Canadian law – 25 years before eligibility to apply for parole.

The ripple effect of Wettlaufer’s crimes not only affected family and friends of her victims but also the overall psyche of people (and their loved ones) who would spend the last months or years of their lives in aged care.

At the inquiry Dian Shannon, the then head of Telfer Place, Wettlaufer’s last place of employment said; ‘Pretty much everyone wants to die before you move into long-term care, given the option’.

‘We were trying really hard to create that environment where people felt good about moving into long-term care. She stole that away from everybody, that idea that “this can be OK, I’m not betraying my parents, I’m not betraying my loved one”.’

There is a school of thought that Wettlaufer confessed for attention and played on her mental health so she could be sent to a forensic facility rather than prison. Wettlaufer was transferred to Institut Philippe-Pinel de Montreal in Quebec in late 2018.

Canadian-based Podcast Stat released an episode on 7 January 2019 of an interview with mental health nurse “Stacey” a former friend of Wettlaufer who provided a perspective behind the headlines about the serial killer.

Stacey told host Karen Wickiam, a retired Emergency RN, that when she found out about her friend’s shocking crimes on that news she ‘immediately went to the washroom and threw up...’

Stacey lived in the same apartment block in Woodstock and they spent a lot of time together.

‘The Beth (Elizabeth) I knew is the one that loved her parents immensely and looked after my dog when I had to travel for work...but this Beth was also a monster and took a lot of lives.’

Stacey described Wettlaufer as outgoing and extremely friendly and the pair would sometimes share dinner and drinks.

‘I did see a different side of her and was in total disbelief when I found out what she had done and the crimes she committed...’

She also felt Wettlaufer’s transfer to a medium security facility was disrespectful to her victims and their loved ones.

‘I just feel like she’s getting exactly what she’s always wanted, which is the attention she always wanted,’ Stacey said.

‘Now she’s able to do gardening and baking and do all these things that she’s always loved to do…

‘I don’t feel like she’s really paid a price for what she’s done to these families...It makes me wonder now...whether she is a master manipulator...’