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Elizabeth Tracey Mae Wettlaufer, charged with the murder of eight elderly nursing-home patients, leaves the courthouse in Woodstock, Ont., on Oct. 25, 2016.

GEOFF ROBIN/The Globe and Mail

The tip that led to the arrest of a former Ontario nurse on eight first-degree murder charges came from a Toronto clinic that had been treating the accused for addiction, according to a source – the latest development in a case that has captured the nation's attention and could prompt a review of nursing-home oversight.

The information provided to police on Sept. 29 explains how an investigation into a spate of alleged homicides, which spanned nearly a decade and straddled two jurisdictions, could culminate in an arrest within just one month. Elizabeth Wettlaufer, 49, was charged Tuesday.

The source said Ms. Wettlaufer made comments that caught the attention of staff at the Centre for Addiction and Mental Health, who alerted the Toronto Police Service. "She said things that caused concerns," the source said. Toronto authorities then contacted their counterparts in Woodstock, Ont., where seven Caressant Care nursing-home residents were allegedly killed between 2007 and 2014. The eighth death took place in 2014 at Meadow Park nursing home in nearby London, Ont.

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As Woodstock residents digested the news that a serialkiller may have been in their midst, working with some of society's most vulnerable, Ontario Premier Kathleen Wynne told the legislature that a review of government oversight of nursing homes may be launched "at some point" if deemed necessary.

Ms. Wettlaufer's family, friends and co-workers were perplexed at her arrest, saying the allegations do not jibe with the woman they knew to be kind and good to her clients. On Wednesday, new details emerged about Ms. Wettaufer's life that suggest she was struggling with addiction and mental-health issues, and, at least recently, seems to have had bouts of short-term employment.

While Ms. Wettlaufer worked at Caressant Care from 2007 to 2014, she appears to have bounced from one nursing job to the next in the years since. Since 2014, she worked at Meadow Park nursing home, then with Lifeguard Homecare and, most recently, with Saint Elizabeth Home Health Care. The latter two employers offer in-home care.

The Globe has made numerous attempts to obtain comment from Lifeguard Homecare, both by phone and in person. A representative from the company confirmed to the CBC that Ms. Wettlaufer had been employed part-time for just over a year, and had not worked with Lifeguard Homecare since the summer.

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Saint Elizabeth's head of public relations, Madonna Gallo, said Ms. Wettlaufer worked with the company out of its Oxford office, not far from Woodstock, for six weeks in July and August. Citing the continuing police investigation, Ms. Gallo declined to comment on whether Saint Elizabeth knew about Ms. Wettlaufer's employment history or whether she was involved in any professional incidents while with the company.

On Oct. 6, Ms. Wettlaufer agreed to the terms of a peace bond, a protective order sought by law enforcement when there are reasonable grounds to believe a person appears likely to commit a serious crime. Among the conditions was that she continue any mental-health treatment with her family doctor or any other doctor to whom she was referred, including by CAMH.

"To protect the personal health information of our patients, CAMH does not disclose the names of its clients," the centre said Wednesday in a statement. "Nor does CAMH comment on any ongoing police investigations."

Health-care professionals are generally bound by patient confidentiality requirements; however, there are exceptions. Ontario law, for example, says doctors must contact authorities if they have reasonable grounds to suspect that a resident of a nursing or retirement home has suffered harm or is at risk of harm due to "improper or incompetent treatment or care, unlawful conduct, abuse or neglect."

Wade Messenger, who lives next door to Ms. Wettlaufer in an apartment building, said his neighbour was an erratic opioid addict who told him last month that she had been fired from two nursing jobs – one for stealing medication, and another, he said, for giving a patient the wrong medication while she was under the influence. Mr. Messenger was struck by his neighbour's tone, saying "she was very nonchalant about it – like it was nothing."

He said the conversation came after Ms. Wettlaufer apologized for a years-long campaign of harassment toward him, which he said, included rubbing banana peel on his door and cutting the beard off a Christmas elf decoration hanging from his door. "It has been a nightmare," he said. "Everyone perceives her as being this sweet, innocent, tiny little lady. But they haven't lived next to her."

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Mr. Messenger, who said he was interviewed by police as part of the investigation, said he was surprised that Ms. Wettlaufer had been able to continue working in home after home. "Where did the system fail?" he said.

Medications, especially narcotics, are supposed to be strictly controlled inside nursing homes, but there are people who will find ways to obtain drugs if they want them badly enough, said Miranda Ferrier, the president of the Ontario Personal Support Worker Association, which represents more than 22,000 PSWs.

Ms. Ferrier said the association has received an "astounding" number of reports about personal support workers being under the influence while on duty. She described a case, from about a year-and-a-half ago, in which a worker at a long-term care home was found to have been removing fentanyl patches from patients' arms and putting them on herself. She said her understanding is that the woman had an addiction.

In one recent case in which a nurse was dismissed from a Toronto hospital for stealing drugs, the Ontario Human Rights Tribunal ruled that the woman suffered a disability in the form of addiction and, therefore, could not be discriminated against because of that disability. The tribunal ordered that the employer rehire the woman.

Ms. Ferrier said her association plans to approach the province about instituting mandatory drug testing for personal support workers upon hiring, as well as periodically after that. "[Clients] have every right to have a safe home environment with … accountable employees," Ms. Ferrier said. "That's what they deserve. It's common sense."

With a report from Rick Cash in Toronto, and The Canadian Press

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