Part One: Extraordinary Development in Canada: Three Inquiries Based on Flawed Pathology In One Country At The Same Time; Crisis?

"HIGH-LEVEL DISCUSSIONS HAVE NOW TAKEN PLACE BETWEEN MY DEPARTMENT, THE DEPARTMENT OF PUBLIC SAFETY AND THE RCMP ON AN INVESTIGATION INTO POSSIBLE CHARGES OF CRIMINAL NEGLIGENCE AGAINST THE FORMER PATHOLOGIST."

FROM NEW BRUNSWICK HEALTH MINISTER MICHAEL MURPHY'S ANNOUNCEMENT OF PUBLIC INQUIRY;

Something extraordinary is happening in Canada;

Three inquiries ordered in response to the work of pathologists are now under way in Canada: In Ontario, New Brunswick and Newfoundland;

This development is most unusual in a country where ordered because of the alleged failings of pathologists are very rare - if not non-existent.

It points to the spectre fo a crisis on Canadian pathology;

The Ontario inquiry - now winding up - is based on the flawed work in a forensic context of former Hospital for Sick Children pediatric pathologist Dr. Charles Smith, the subject of this Blog.

It is known as the Goudge Inquiry;

The New Brunswick Inquiry - - just getting underway - is centred on the alleged misdiagnoses in a hospital context attributed to former Miramichi pathologist Dr. Rajgopal Menon.

It is referred to as the Creaghan Inquiry.

Both inquiries were ordered because of serious allegation that pathologists had caused serious damaged to the public through flawed opinions within the forensic context in one province (Ontario) and misdiagnosis of tissue samples in the other.(New Brunswick);

I am heeding the advise of one of our readers - a very constructive critic of this site - who cautions that it is misleading to focus entirely on Dr. Smith.

This reader points out that there are serious problems with pathology itself elsewhere in Canada - and that Dr. Smith may not be the only pathologist who has delivered sub-standard work in Canadian hospitals or courts.

I was particularly fascinated by the New Brunswick Health Minister Michael Murphy's announcement of the Public Inquiry which was released on February 22, 2008, because of interesting parallels with the Goudge Inquiry, which was established by former Ontario Attorney General Michael Bryant on April 25, 2007;

The announcement was released on February 22, 2008, under the heading "Health Minister announces Justice Paul Creaghan will head inquiry into pathology review."

"Health Minister Michael Murphy today named Justice Paul S. Creaghan to head a commission of inquiry into the case of a former Miramichi pathologist and a review of more than 24,000 patient cases diagnosed by the pathologist." the announcement began.

"We are honoured to have someone with Justice Creaghan's experience and stature take on this important task," Murphy said," it continued.

"It is expected he will report back to me within six months with his findings as they relate to the former pathologist and how to prevent any recurrence of this situation."

On Feb. 11, the Miramichi Regional Health Authority announced it would undertake a review of all cases examined by the former pathologist during his tenure with the RHA between 1995 and February 2007. This involves about 24,000 cases.

The decision to carry out the review followed an independent audit of 227 cases of breast and prostate cancer biopsies examined by the pathologist in 2004-05. The audit found 18 per cent of cases had incomplete results and three per cent of the cases were misdiagnosed.

The re-examination of cases by outside pathologists will also include about 100 cases the former pathologist reviewed while working for a brief period for Regional Health Authority 4 in Edmundston in 2002.

Justice Creaghan has been a member of the Court of Queen's Bench since 1985, sitting in Miramichi and later Moncton. He has been a supernumerary judge since 2002.

Assisting Justice Creaghan will be Marc Antoine Chiasson, who has been appointed as counsel to the inquiry.

The commission of inquiry will be conducted under the procedures and requirements set out in the Inquiries Act.

The scope of the inquiry includes a review of hiring policies, quality assurance programs and performance monitoring as they relate to the former pathologist. It also includes a review of the roles of the Medical Advisory Committee and the College of Physicians and Surgeons in dealing with complaints against the doctor.

The appointment of an inquiry was one of four complementary actions announced by Murphy on Feb. 11.

A second action involved a review of the existing mandate and processes of Medical Advisory Committees in investigating questions of medical judgment and granting of privileges to physicians working in each RHA. (Regional Health Authority H.L.);

"This review will be part of the mandate of the inquiry headed by Justice Creaghan," Murphy said.

Thirdly, the minister asked the College of Physicians and Surgeons to review its processes for investigating complaints and carrying out disciplinary action against physicians. The college has been asked to submit a plan within 30 days to address issues related to transparency, expedited hearings and the sharing of information with RHAs on complaints against physicians.

"Today, the deputy minister of Health and other senior staff from my department are meeting with representatives of the college to provide them with a more detailed formal request of what we want from the College," Murphy said. "This includes a plan of action from the college that can be implemented within six months in order to achieve what I believe must be radical change in the disciplinary process."

Fourthly, Murphy said police would be asked to investigate.

"High-level discussions have now taken place between my department, the Department of Public Safety and the RCMP on an investigation into possible charges of criminal negligence against the former pathologist," he said.

The minister said his department continues to work to identify additional pathologists or pathology laboratories that can assist with the review of all cases.

"We are now in detailed discussions with a single laboratory and we hope these discussions will be concluded very shortly, as our first priority is to have all these cases reviewed as quickly as possible," said Murphy. "Until there is a signed agreement, I can't tell you the name of the company or share other details."

The department has set up a toll free number (1-866-577-5901) where patients and family members can call for information."

Here are some of the parallels between the two Inquiries that are evident to this Blogster:

0: Both involve an examination of the hiring policies, quality assurance programs and supervision of pathologists in hospital settings;

0: Both raise questions as to whether the respective College of Physicians and Surgeons did an adequate job of protecting the public through their professional discipline complaints processes;

0: Both involve allegations of serious negligence on the pathologist's part said to have caused miscarriages of Justice and distrust of the criminal justice system in Ontario and the deaths of patients in New Brunswick.

0: Both demonstrate the huge public trust that has been placed in pathologists - whether they be dealing within the forensic or hospital systems - and what can happen if and when that trust is betrayed;

0: Both make this Blogster whether the horrors underlying both inquiries are just the tip of the iceberg - and whether the delivery of pathological services should be reviewed throughout Canada.

There is one major difference between the two inquiries; The New Brunswick Inquiry appears to be directly related to Dr. Menon's work - while Commissioner Goudge can only consider Dr. Smith's work as a basis for making his recommendations as to how Ontario's system of pediatric forensic pathology has to be reformed.

In short, Commissioner Goudge is not permitted to make any recommendations as to civil liability or criminal responsibility on Smith's part;

One other difference: While former Ontario Attorney General Michael Bryant has avoided any suggestion of criminality on Smith's part, Health Minister Murphy, says unequivocally in his announcement that his officials have discussed a possible criminal investigation of "the former pathologist" with the RCMP (Royal Canadian Mounted Police);

However, Bryant may have stayed silent on the possibility of a criminal investigation out of respect for the independence of the police - and there is nothing to stop any police force from investigating crimes such as perjury or obstructing justice allegedly committed by Dr. Smith;

Next Posting: The Newfoundland Inquiry;

Harold Levy...hlevy15@gmail.com;