Tuesday, December 15, 2009

Smith made 'ridiculous' conclusions: pathologist

Dr. Charles Smith

Dr. Charles Smith

Updated: Tue Dec. 18 2007 16:31:17

The Canadian Press

TORONTO — Discredited pathologist Dr. Charles Smith second-guessed his colleagues in some of the child death cases he oversaw and jumped to "ridiculous" conclusions, a pathologist who frequently clashed with Smith told a public inquiry Tuesday.

Once considered a leading Canadian expert in the field of forensic pediatric pathology, Smith also made serious errors in diagnosing patients at Toronto's Hospital for Sick Children, including a girl with a kidney tumour who didn't receive the right medical treatment as a result, the inquiry heard.

Dr. Ernest Cutz, a pathologist and expert in sudden infant death syndrome or SIDS, said there were a number of cases where Smith suspected criminal activity even though there was no evidence to support his opinions.

In one case, Cutz concluded that an infant had died accidentally after being found tangled in the cord from a venetian blind close to the crib.

But Smith, who signed off on Cutz's cases as director of Ontario's forensic pediatric pathology unit, said the incident "looked suspicious" and that the parents might be involved, Cutz said.

"I found it quite ridiculous, especially knowing that this is a recognized hazard, which has been documented in the literature, and it has even been the subject of television reporting," he said.

Smith never explained the reasons behind his suspicions, Cutz added.

"There was no evidence from police or other investigations that anything untowards has happened, and I presume that's how it ended up classified," he said.

Another case involved a small child who had the croup and died after collapsing in a shower that was intended to alleviate his respiratory problems, Cutz said.

During the autopsy, Cutz found a fungal obstruction in the child's airway, which he concluded had developed as part of his illness and caused the child's death.

Smith thought the obstruction was a red herring - something that happened while the child was being resuscitated - and suspected the mother had a mental disorder and was somehow responsible for the child's death, Cutz said.

Smith also made errors in his surgical pathology work at the Hospital for Sick Children, the inquiry heard.

Dr. Glenn Taylor, now head of the hospital's pathology division, testified about one case where Smith misdiagnosed a girl in 1996 as being in the early stages of a kidney tumour, when she actually had a more aggressive form of the illness.

Taylor, who reviewed the original slides after the child returned to the hospital about a year later with a recurrence of the tumour, discovered the error, which had prevented the girl from receiving proper medical treatment.

"It would have at least included ... additional chemotherapy and possibly radiation therapy," said Taylor, who testified he didn't know what happened to the girl.

"It would have been a more aggressive treatment."

The inquiry into pediatric forensic pathology in Ontario also heard Cutz's misgivings about the forensic unit, which he felt had strayed from its initial, primarily academic focus towards forensics and conducting more autopsies of criminally suspicious cases.

It was a concern he seemed to share with Dr. Laurence Becker, the former head of the hospital's pathology division, who drafted a letter in 1999 proposing that the hospital sever its link with the coroner's office through the unit and perform autopsies only in medical or natural death cases.

Cutz, who conducted research with Becker, a fellow SIDS expert, said they had supported the move to form the unit in 1991 because they believed it would help fund and support their research.

But that work effectively stopped when they were cut off from accessing tissue samples from SIDS cases investigated by the coroner, Cutz said.

In early 1997, Cutz said he was surprised to hear that the coroner's office was considering removing him from performing all medical-legal autopsies because of "vague" allegations that he was soft on crime and didn't co-operate with police.

He later straightened things out with Dr. David Chiasson, former chief forensic pathologist at the coroner's office, and his name wasn't taken off the autopsy roster, he said.

But Cutz, who didn't hide his distaste for Smith's methods during Tuesday's hearing, testified he had reservations about the former Ontario pathologist from the time he was appointed director of the forensic unit.

"I didn't know if Dr. Smith was qualified, but I didn't think that he had the appropriate training to assume that, to do those kinds of (forensic) cases," Cutz said.

"But it was his choice. ... I wouldn't have recommended him to do it."

Led by Justice Stephen Goudge, the inquiry into pediatric forensic pathology in Ontario was called after an expert panel reviewed 45 cases Smith handled between 1991 and 2001.

The panel found problems in 20 of those cases, which raised serious doubts about opinions given by Smith and the criminal proceedings that stemmed from his findings.