Goudge Inquiry; Secret Report Commissioned By Sick Kids Now Public;

A hitherto secret report commissioned by the Hospital for Sick Children in Toronto has been introduced as an exhibit at the Goudge Inquiry.

On May 31, 2005, I reported in the Toronto Star that the missing exhibits from the Mullins-Johnson case had been found by officials from the Chief Coroner's office.

The missing exhibits had been found on top of Dr. Charles Smith's desk in his office at the Hospital's pathology department during an audit of forensic materials which had been ordered by then Chief Coroner Dr. Barry McLellan.

The story contained an interview with Hospital spokesperson Helen Simeon, who said that Dr. Smith had agreed to go on administrative leave pending a review by an "outside" pathologist.

Simeon, said Smith had been allowed to return to his work on non-criminal autopsies after the reviewer reported that Smith was doing a satisfactory job.

Simeon declined to identify the reviewer or release the report.

I have always wanted to see this report with a view to discovering how thorough the review process was - and whether it was sufficient to protect the public.

I was therefore intrigued to discover earlier today that the entire report was only four paragraphs long.

But first a little history.

In 2001, Smith was removed from the roster of forensic pathologists permitted to conduct autopsies in suspicious deaths.

A year later, three complaints to the Ontario College of Physicians and Surgeons relating to his work in suspicious death cases were upheld.

Here is the letter:

It is addressed to Dr. Ronald Laxer, a Hospital for Sick Children Vice President, and runs under the heading Re Pediatric Surgical Pathology Review."

I was requested to review pediatric surgical pathology cases to determine the appropriateness of diagnoses made by Dr. Charles Smith and to form an opinion as to whether the overall performance of Dr. Smith based on this review, is at a level expected for a pathologist working in a pediatric hospital such as Sick Kids.

I have completed the review of 60 surgical pathology cases that in my estimation reflect a spectrum of challenging interpretations and that have, predominately, important implication for patient care. Foe each case I examined all pathology slides without knowledge of the content of Dr. Smith's report and formed a diagnostic opinion. After which, I studied the pathology report and compared my diagnosis with the reported diagnosis. On each case I scored for agreement, minor disagreements with no or minimal patient consequence, or major discordance with serious implication for patient care (as per scoring sheets provided).

Of the 60 surgical pathology cases I concur with Dr. Smith's diagnosis in 57. In the remaining three we disagree in a minor way that has no implications for patient care.

In general I find Dr. Smith's reports to be appropriately informative, thorough and diagnostically accurate. Extrapolating from this review, the process of which I believe to be appropriate assessment, I conclude that his performance is at a level expected for a pediatric pathologist in a sophisticated children's hospital dealing with complex diagnostics."

The letter is signed by James Dimmick, Consultant Pediatric Pathologist, Professor of Pathology and Laboratory medicine, University of British Columbia.

This Blogster is not questioning in any way the integrity of Dr. Dimmick's report.

My concern, however, is that given Dr. Smith's unfortunate history at the Hospital for Sick Children - on both forensic and non-forensic pathological matters - Dr. Dimmick should have been asked to do more than study microscopic slides.

Dr. Dimmick should have been instructed to report on whether he believed that Dr. Smith has the "integrity" to continue to work as a pathologist at the Hospital for Sick Children.

To fulfil this mandate he should have been permitted to visit Smith's working place, inspect his chaotic office where so many key forensic exhibits had been misplaced, to interview Dr. Smith in depth, to assess whether he had the requisite knowledge, capability and balance, and to interview his colleagues to get their views as to Dr. Smith's strengths, weaknesses and character.

I do not get the impression from Dr. Dimmick's letter that any of this was done - and I am confident that if these steps were taken, they would have been laid out thoroughly as is customary in reporting letters.

We are now aware that in 1997 Dr. Smith came under considerable criticism by other physicians and surgeons at the Hospital for erroneous interpretations of histological samples - and that he was struck from the surgical pathology roster until he completed an educational program - and that his salary was reduced accordingly.

We are also are aware that Both Deputy Chief Coroner James Cairns and former Chief Coroner Dr. James Young, testified that the Hospital did not inform them of Smith's flawed work, requirement to take courses, and reduction in his salary.

I am wondering if the Hospital communicated this information to Dr. Dimmick - so that he would be able to probe whether Dr. Smith had improved his knowledge in those areas where his interpretations had been flawed.

This Blogster personally believes that the Hospital's "outside" probe of Dr. Smith did not go nearly far enough - and makes me wonder whether the Hospital might be putting its own interest and that of Dr. Charles Smith before that of the public.

Just wondering!

Epilogue:

On Sept. 12, 2005, I reported in the Star that Dr. Smith had tendered his resignation and departed from the hospital in July.

The resignation was tendered just several weeks after June 7, 2005, when former Chief Coroner, Dr. Barry McLellan, announced an unprecedented review of all cases handled by Smith at the hospital since 1991 where he had performed an autopsy or provided an opinion.

Simeon said she was unable to say why Smith resigned because that information is confidential.

Dr. McLellan said he felt compelled to order the review, which will revisit the deaths of more than 40 children, "in order to maintain public confidence in the coroner's office."