Thursday, October 9, 2008


The National Post Editorial appeared on Friday October 3d, under the heading, "Painful lessons from the career of Charles Smith." (It is an expanded version of the Post's on-line editorial published previously on this Blog.)

"When a profession is granted certain privileges by society -- in the form of honorifics, special legal protections, restricted competition, and the like -- it is generally understood that society will get something back in return," the editorial began.

"The final report of the Goudge inquiry into the grotesque career of pediatric pathologist Charles Smith, released this week, is enough to make one wonder why doctors still get the best, most deferential deal of all after decades of increasing insistence on being treated like businessmen," it continued.

"Smith may be a semi-psychopathic liar of the sort one might occasionally encounter in any field of work; if so, his own existence and personal conduct are ultimately of no more enduring interest than any other statistically improbable accident, like the fall of a meteorite.

The question is how a man without any formal training in forensic pathology could rise to become head of the pathology unit at the country’s flagship children’s hospital -- even after warning signs about his competence had begun to appear.

As the Goudge report notes, “As early as 1991, a year before Dr. Smith’s appointment as [Toronto SickKids unit] director, a trial judge acquitted a girl who, as a 12-year-old babysitter, had been charged with manslaughter in the death of a 16-month-old child.

His reasons for judgment strongly criticized Dr. Smith, the Crown’s central witness, for both his methodology and his conclusions.”

Exactly how many lives was Smith going to be allowed to ruin before some action was taken against him by the profession?

Plenty, as it turns out: It was 14 years before the Chief Coroner’s review of Dr. Smith’s casework commenced, and that review found fault with the findings in 20 of his investigations, 12 of which had led to criminal convictions.

Justice Stephen Goudge did not have to look far for reasons why Smith was protected for so long.

He was respected in the medical profession because he was willing, even eager, to perform pediatric autopsies -- perhaps the single most unpleasant, undesirable job in the world -- in search of evidence of abuse.

He was a dynamic, convincing lecturer, and the positive feedback he got from speaking to cops and fellow doctors, far from encouraging him to pursue continuing education in forensic pathology, convinced him he had nothing to learn from anyone.

Over the years, many pathologists had united with him in endorsing unsupported theories about particular deaths; if Smith came under scrutiny, so would their own work.

And, as the judge makes a particular point of noting, he was and is an amiable man — one who had a unique role as an advocate for the innocent and defenceless, and who thus allowed himself to become a prosecutor in the guise of an objective expert witness.

This led to the strange spectacle that took place out of public view throughout the 1990s: a near-literal parade of defendants, defendants’ family members, foreign pathologists, and worried cops and lawyers, all desperately searching for some authority that would entertain their worries about Dr. Smith.

Ontario Chief Coroner James Young and his deputy James Cairns, who were best placed to do something, had committed to a view of Dr. Smith as one of the leaders in his field.

Early on, it seems they stuck by him just because this assumption was so powerful; later, they defended him, not shrinking from the occasional lie, knowing perfectly well that he had displayed signs of carelessness, habitual deception, and incompetence.

Quizzed by the inquiry on why he continued to support Dr. Smith actively well into 2002, even as he entertained inescapable private doubts about the man’s honesty, Dr. Young could only offer a miserable “I just don’t know.”

The overall picture is one of professional solidarity overwhelming professional duty to the public. And frankly, there is no evidence that duty ever put up much of a fight.

Perhaps the fault lies partly with ourselves, for turning doctors into hirelings of the state and looking the other way as medical education has become more strenuous and expensive.

Perhaps we messed up when we abandoned the Hippocratic Oath back in the ‘60s.

But physicians should study the Goudge report and give some hard thought to the reality behind the privileges they receive -- the reverence, the attention, the power, the golf-club memberships, the freebies from drug companies and medical suppliers.

These things are supposed to be part of a reciprocal bargain, one that, in the Smith case, went badly and inexplicably awry."