"I THINK -- MY UNDERSTANDING OF "THINK DIRTY" IS THAT IT WAS INTENDED TO TELL THE MEMBERS OF THE DEATH INVESTIGATION TEAM AND THE PATHOLOGIST TO CONSIDER CHILD ABUSE, AND IN OTHER CIRCUMSTANCES, HOMICIDE. I THINK IT HAS GROWN TO MEAN SOMETHING MORE THAN IT WAS EVER INTENDED TO MEAN."
DR. MICHAEL POLLANEN; IN RESPONSE TO QUESTION POSED BY COMMISSIONER STEPHEN GOUDGE;
In recent postings I have focused on the "think dirty" policy introduced by Dr. James Young, former Chief Coroner of Ontario, which has come under considerable scrutiny at the Goudge Inquiry.
I have three principle problems with this misguided policy - which fortunately was discarded by Dr. Barry McLellan when he headed the Chief Coroner's Office;
First - It was utterly unnecessary;
Second: It should never have been foisted on coroners throughout Ontario - with their minimum training in forensic science, and:
Third, it was developed for use in the context of so-called "femicides" - and then applied to infant deaths without any consideration given to the complexity of infant deaths and the consequences to innocent parents and caregivers.
Not all pathologists and coroners agreed with the "think dirty" policy.
As Theresa Boyle, my former colleague at the Toronto Star, wrote in a story published on Jan 17, 2008 under the heading "Pathologists directed to "think dirty, probe told," Dr. David Dexter, a Kingston, Ontario pathologist decided to ignore it;
"A Kingston pathologist said he ignored a provincial directive to "think dirty" when conducting autopsies on children because doing so could have led him to conclude they'd died of abuse when they hadn't," Boyle's story began.
"When you're starting from that point of view, the sort of inference is that you've got to create a trail of evidence or logic ... that reflects back on something bad having happened," Dr David Dexter explained to a public inquiry this morning," the story continued;
""So it's an issue of bias, it's an issue of tunnel vision.... It's the wrong approach," he added.
In 1995, former chief coroner Jim Young issued a new protocol for pathologists, coroners and chiefs of police to use in death investigations involving children. It stated:
"Unfortunately in this day and age child abuse is a real issue and it is extremely important that all members of the investigative team 'think dirty.'
"They must actively investigate each case as potential child abuse and not come to a premature conclusion regarding the cause and manner of death until the complete investigation is finished and all members of the team are satisfied with the conclusion."
Dexter, who serves as director of the regional forensic unit in Kingston, said the wording of the protocol is "absolutely" problematic.
He told the Inquiry into Pediatric Forensic Pathology this morning that he thought the protocol was inappropriate because it could lead him down the wrong path when trying to determine how a child died.
"It infers a bias, a bias that something bad has happened. You've got to be open to a variety of possibilities. So objective thinking is the approach," he said.
The inquiry is looking at errors Dr. Charles Smith made in 20 cases in which people were charged, convicted or otherwise implicated in the deaths of children.
The difference between coroners and pathologists is that coroners oversee entire death investigations while pathologists conduct autopsies."
Dr. Michael Pollanen, Ontario's Chief Forensic Pathologist, clearly understood the danger posed by the "think dirty" policy.
Here is his testimony at the Goudge Inquiry in response to questions posed by Justice Stephen Goudge;
COMMISSIONER STEPHEN GOUDGE: Thanks. Before we leave this, there is a question that I have been meaning to ask you. It is a general question, Dr. Pollanen.
The evidence-based approach that you have eloquently put forward really has, as its goal, think truth, if I can put it that way, as opposed to "think dirty". Is that a fair juxtaposition?
DR. MICHAEL POLLANEN: Yes.
COMMISSIONER STEPHEN GOUDGE: Where does a heightened index of suspicion fit into that, if at all? Do you equate that with "think dirty", or is it somewhere in between, or --
DR. MICHAEL POLLANEN: "Think dirty" is an unfortunate turn of phrase.
COMMISSIONER STEPHEN GOUDGE: Yeah. Yeah.
DR. MICHAEL POLLANEN: I think -- my understanding of "think dirty" is that it was intended to tell the members of the Death Investigation Team and the pathologist to consider child abuse, and in other circumstances, homicide.
I think it has grown to mean something more than it was ever intended to mean.
And I think the best way to say this in -- now -- where we -- where we sit now relative to "think dirty", is that if we think truth, if we think objectively, then there is no need to give specific advice about "thinking dirty", for example, or having high -- a high index of suspicion.
Because if -- if you're -- if you're allowing the facts to guide your thinking, they will guide you in the correct direction.
There needs to be no a priori set up for it.
Because if you are engaging the issues in a evidenced-based manner, you will get there.
But if it were so simple.
The -- the other competing variable is that we have, purely on an operation basis, and out of necessity, have identified a group of cases which are criminally suspicious and homicidal.
For the -- for the nature -- because we need to do -- to develop protocols and procedures to deal with those cases.
Because it's a -- it's an epidemiological situation that when you have undifferentiated cases -- this large number of undifferentiated cases, at some point in time before the pathologist gets involved, there has to be some type of streaming.
So the streaming happens essentially by the police, with some input by the coroner into this criminal -- this sort of amorphous category of criminally suspicious.
And that to some extent is "think dirty", unless you are making that decision, or those decisions are purely being made on the basis of evidence and fact.
So there's a lot of -- there's a lot of corollaries that come out of this discussion, but I think the best -- the best framework, or the best model to use to understand the methodology or the desirable process is the framework of an evidence based approach using as an a priori principle: think truth, think objectively, search for the truth.
I think that's the best platform because if you do that you don't need to think benign or malignant, the evidence will guide you.
COMMISSIONER STEPHEN GOUDGE: Okay. A couple of implications, I am sure more than a couple, have been read into the heightened index of suspicion notion.
One is the implication of presumption which you've spoken about; the other is an implication of more thorough investigation than one would have in a simple case.
Is that a fair kind of assertion of two (2) implications that might flow out of the notion of heightened index of suspicion?
DR. MICHAEL POLLANEN: You could think of it that way and I'll -- I'll give a concrete example. In the -- if you look at the protocol that -- the analysis that led to the '95 memo, six thirty-one (631) I think it was --
COMMISSIONER STEPHEN GOUDGE: Yes.
DR. MICHAEL POLLANEN: -- you'll notice that there was an analysis of how frequently x-rays were being done --
COMMISSIONER STEPHEN GOUDGE: Right.
DR. MICHAEL POLLANEN: -- on infants. And what this -- what they found when they did that analysis, which was a very good analysis, was that x-rays were not
being done frequently, or as frequently as would be desirable.
COMMISSIONER STEPHEN GOUDGE: Right.
DR. MICHAEL POLLANEN: And the reason that's significant is that we -- we know that one of the patterns of child abuse are, for example, multiple fractures.
COMMISSIONER STEPHEN GOUDGE: Fractures, yes.
DR. MICHAEL POLLANEN: So the -- the evidence base, to use that term, the -- the conclusion that came from the analysis in the document was "do x- rays".
It did not support the conclusion "think dirty".
COMMISSIONER STEPHEN GOUDGE: So if heightened index of suspicion means gather all the evidence you possibly can and follow it wherever it leads, you would say that's fine?
DR. MICHAEL POLLANEN: Correct. It -- it can include -- it necessarily includes that.
COMMISSIONER STEPHEN GOUDGE: Okay. If it was to mean start with an a priori presumption, you would say that's not fine?
DR. MICHAEL POLLANEN: Correct. And let me enlarge that one (1) other way and say, we've talked about petechia; well, if we see petechia in someone's eyes at autopsy then that is an indication that the neck will need to be dissected in a special way to determine if they have been strangled.
Well, are the petechia telling us to "think dirty"?
The petechia have within their differential diagnosis, manual strangulation, and because of that we need to apply a technique to detect it if it's there.
So in a way both are achieving the same outcome, except one (1) has as its value a search for the truth platform.
COMMISSIONER STEPHEN GOUDGE: Right. Okay, that is a helpful exchange. Thank you.