Sunday, April 30, 2017

A decade later: (Part four): Hospital For Sick Children; Dr. Gideon Koren; Charles Smith; Toronto; Editorial: Gideon Koren wasn't the only prestigious staff member who the Hospital for Sick Children failed to curb before serious harm was done: How about Charles Smith? Just take a look at Justice Stephen Goudge's independent report... From editorial: "There is much in common between Gideon Koren and Charles Smith: Both brought fame, prestige and money, to the world-famous hospital; Both were treated with silk gloves in spite of the disturbing allegations against them which called for a strong measure of protection of the public. Both were permitted by SickKids to carry on their work - Koren, in spite of the Discipline Panel's statement that there were grounds for dismissal, Smith in spite of the fact that his colleagues at the hospital believed that children of trusting parents were at risk. Both Koren and Smith have left legacies of destroyed lives and families; Some of the Smith cases have yet to be sorted out in the Ontario Court of Appeal, and the aftermath of Motherisk, as innocent parents ae forced to fight in the courts to get their children back, could go on for years."


EDITORIAL: Rachel Mendleson reports in her Toronto Star story, (April 29, 2017) headed, "Years before Motherisk scandal, SickKids stood by doctor who wrote ‘poison pen letters,'  that, after finding the allegations against Dr. Gideon Koren proven,"  a discipline panel,   composed of  the former presidents of SickKids and the University of Toronto, ruled,  "Your actions constitute gross misconduct and provide sufficient grounds for dismissal.” Although the panel upbraided Koren  for "repeatedly lying” and showing a “reckless dereliction of duty,” Mendleson notes: "But, citing his research achievements and the many young doctors he supervised, who they said would be “disproportionately disadvantaged” if Koren were fired, they instead docked him two months’ pay, fined him $35,000 and continued his suspension until June 1, 2000. Koren remained head of the Motherisk Program he founded in 1985.  Charles Smith, the notorious namesake of this Blog, also faced a barrage of serious allegations before his voluntary, departure from the Hospital in July, 2005.  However, before he quietly slunk out into the night - without announcement or ceremony. the once celebrated pathologist had been the subject of a battery of complaints made by physicians at the hospital who were concerned about his diagnostic accuracy. In response to evidence called about the hospital's response to these complaints, Justice Stephen Goudge, concluded in the report of his independent Inquiry into many of  Smith's cases: "As well as timeliness, the hospital had concerns about Dr. Smith's diagnostic accuracy, Clinicians rely on pathologist's  diagnoses to make critical decisions of treatment. Diagnostic discrepancies in surgical pathology can have profound effects on patient care. As pathologist-in-chief, Dr. Becker dealt with diagnistic concerns about Dr. Smith's pathology reports on several occasions. Arround 1997, there was deonstrable convern at Sickkids about Dr. Smith's clinical skills in the reading and interpretation of microscopic slides. ........"On March 21, 1997, Dr. Paul Thorner, the associate head of pathology at SickKids, wrote a memo to Dr. Becker regarding diagnostic discrepancies in four of Dr. Smith's surgical pathology cases. The identification of four misdiagnoses within a short time frame was concerning. The first involved an error in what should have been a straightforward diagnosis. In the second case, the  proper diagnosis was one that was easy to confuse with the diagnosis made by Dr. Smith. The third case involved diagnosis of an unusual lesion that might be difficult to recognize. These three cases did not affect patient care. The fourth did. In the fourth case, Dr. Smith misdiagnosed two frozen  sections of tissue. Dr. Smith reported that  the two frozen sections were reactive, or non-malignant. Based on Dr. Smith's diagnosis, the patient was removed from the operating roo to recover.  Subsequently the tissue samples were blocked and the permanent slides were prepared. Dr. Smith correctly read the permanent section as malignant. The child had to return to the operating room for placement of a chemotherapy line. At a minimum, the child required a second surgical procedure. More seriously, the peoper treatment may have been  delayed unnecessarily. In April 1997,  Dr. Becker prepared a letter addressed to Dr. Smith about "a disproportion in the number of complaints about  diagnostic inconsistencies from pediatricians and surgeons"  regarding Dr. Smith's surgical pathology work. The letter indicated  that Dr. Becker was curtailing Dr. Smith's responsibilities in surgical pathology  until Dr. Smith completed continuing medical education courses  to improve his surgical pathology skills. The letter was unsigned and appears not to have been sent. Dr. Smith testified that no one ever advised him of significant concerns regarding his surgical pathology work or informed him that, as a result, he should cease performing surgical cases. Dr. Becker's letter also stated that, as Dr. Smith woud not be conducting surgical pathology on a regular rotation, his "salary from the Division of Patholgy will be reduced by $20,000 for 1997." However, Dr. Smith's salary was not reduced in this matter. Whether the letter was sent or not, it clearly reflects Dr. Becker's concerns with Dr. Smith's diagnostic skills.".........Also, in 1997, a SickKids oncologist complained about two surgical pathology cases in which Dr. Smith had made errors.........These cases were a small minority of all the surgical pathology work that Dr. Smith conducted during the course of his career. However, at times, his colleagues were clearly frustrated with his diagnostic mistakes. This frustration was evidenced by an email written by Dr. Thorner to Dr. Becker in May, 1997 in which he referred to two complaints  regarding Dr. Smith as "another nail for the coffin." However it must be said that the complaints regarding diagnostic issues did not rise to the level where the pathologist-in-chief formally restricted Dr. Smith's privileges."  There is much in common between Gideon Koren and Charles Smith: Both brought fame, prestige and money, to the world-famous hospital; Both were treated with silk gloves in spite of the disturbing allegations against them which called for a strong measure of protection of the public. Both were permitted  by SickKids to carry on  their work - Koren, in spite of the Discipline Panels statement that there were grounds for dismissal, Smith in spite of the fact that his colleagues at the hospital believed that children of trusting parents were at risk.  Both have left legacies of destroyed lives and families: some of the Smith cases have yet to be sorted out in the Ontario Court of Appeal, and the aftermath of Motherisk, as innocent parents fight to get their children back, could go on for years.

Harold Levy: Publisher: The Charles Smith Blog.

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PUBLISHER'S NOTE: I am monitoring this case/issue. Keep your eye on the Charles Smith Blog for reports on developments. The Toronto Star, my previous employer for more than twenty incredible years, has put considerable effort into exposing the harm caused by Dr. Charles Smith and his protectors - and into pushing for reform of Ontario's forensic pediatric pathology system. The Star has a "topic" section which focuses on recent stories related to Dr. Charles Smith. It can be found at: http://www.thestar.com/topic/charlessmith. Information on "The Charles Smith Blog Award"- and its nomination process - can be found at: http://smithforensic.blogspot.com/2011/05/charles-smith-blog-award-nominations.html Please send any comments or information on other cases and issues of interest to the readers of this blog to: hlevy15@gmail.com. Harold Levy: Publisher; The Charles Smith Blog.