Advocates and caregivers for the elderly are calling for deeper investigations of deaths occurring in nursing homes and for drug and psychiatric screening of caregivers following allegations a southwestern Ontario nurse killed eight patients under her care.

“What we know is the population who’s there tends to be very frail and tends to have cognitive impairment, which of course, is the perfect recipe if you’re going to have a predator and you’re going to look for victims,” said Laura Tamblyn-Watts of the Canadian Centre for Elder Law.

Police have laid eight counts of first-degree murder against Elizabeth Tracey Mae Wettlaufer, accusing her of administering lethal doses of an unnamed drug to five women and three men ages 75 to 96 between 2007 and 2014.

Seven of the deaths occurred in a Woodstock, Ont. nursing home, while the eighth happened in a long-term care facility in London, Ont. about 45 minutes away.

All the deaths had previously been believed to have been natural. None of the allegations against Wettlaufer have been tested in court.

Staff working in long-term care must undergo a criminal background check and vulnerable sector screening, but are not subjected to any psychiatric evaluation or drug testing. That should change, says Miranda Ferrier, president of the Ontario Personal Support Worker Association.

“There are ways to steal medications,” she said, pointing to narcotic pain relievers fentanyl and morphine as being typically accessible in nursing homes.

“There was a handful of drugs, fistfuls actually, that were available to her in a long-term care facility,” she said of Wettlaufer’s role as a nurse.

Nurses are required to sign for each medicine they administer and then at the end of a shift as they are handing off to another nurse, they must count each medication and go through the documentation for each.

Candace Chartier, CEO of the Ontario Long Term Care Association, said medications are double locked and only registered staff has access. Some medications require signing off and documenting by two registered nurses. And facilities are governed by “stringent” medication reconciliation practices and policies.

“Long-term care is a very safe environment. We have to meet over 500 regulations every day. And not only that, we have a very rigorous inspection system where we’re inspected based on risk,” she said.

“We do a good job in a really heavily regulated environment.”

But advocates say the province of Ontario must reinstate its previous level of oversight of nursing homes.

“They’ve pulled back on their inspections at the moment so they’re not doing full inspections in Ontario of all homes every year anymore,” said Jane Meadus, staff lawyer for the Advocacy Centre for the Elderly.

The centre is asking the coroner to conduct an investigation into deaths at long-term care homes. It’s left to nursing homes to choose to report deaths, says Meadus. Given the advanced age of patients, their deaths often aren’t investigated by a coroner.

Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario, said incidents like this one are an “anomaly.”

“It’s very difficult for me to grapple with this situation to see how it evolved to the point of so many, so many untimely deaths and so much devastation."

Chartier says, while the case is shocking, it doesn’t signal fundamental flaws in the system.

“This is not something that has ever happened in long-term care before. The community is shocked. I really don’t know if you could regulate or change legislation in any way that could have prevented this. I think that we will be able to see that once the alleged crime comes out, once the details come out.”

Wettlaufer was a nurse for more than 20 years. According to the Ontario College of Nurses database, she resigned her nursing licence Sept. 30, just one day after police began their investigation.

She was placed under a peace bond earlier this month. Among the bond’s 10 conditions are that Wettlaufer was barred from acting as a caregiver for anyone or from entering any nursing home, long-term care facility or hospital under for medical treatment. She was banned from possessing any medication or insulin that wasn’t for her own use and ordered to live with her parents in Woodstock under a night-time curfew.

The 49-year-old woman is in custody in Woodstock and will remain there until her next court date scheduled for Nov. 2 when she will appear by video.

During question period Tuesday, opposition parties challenged the Liberals to explain how this could happen but the government offered few answers.

“I don’t think there is anyone in this legislature who would not agree this is a tragic, tragic circumstance,” said Premier Kathleen Wynne. “I know that the member opposite knows it would be inappropriate for me to comment on an ongoing police investigation.”

That was echoed by Attorney General Yasir Naqvi: “It would be highly inappropriate for any one of us to comment extensively on this ongoing police investigation."

And by Minister of Health and Long-term Care Eric Hoskins: “Look, there will be time to answer those questions. Now is the time to, I think, respect that this is an ongoing police investigation."

While rare, murder charges against nurses are not unprecedented.

A Danish nurse was recently sentenced to life in prison for killing three patients. A nurse in Italy has been accused of delivering fatal drug overdoses to more than 30 patients. A nurse in the United States confessed in 2004 to killing dozens of patients in his care with a drug overdose.