PUBLISHER'S VIEW: (Editorial): In the most recent post (Part Nine) I referred to the late Peter Kormos' observation that Justice Stephen Goudge would not let Charles Smith get away with his defence that his failings were "never intentional." This reminded me of another one of Smith's many defences - that it was unfair to pick on him because he acted no differently than any other pathologist would have acted within the prevailing knowledge of pathology at the time. The flaw in this defence was, of course, that other pathologists in the province hopefully did not lie under oath, hide or destroy evidence that might show that their opinion was wrong, see themselves as members of the prosecution team, falsely pretend that they had superior knowledge to bring to the forensic issues in the case, or unfairly disparage the opinions of truly knowledgeable experts who testified for the defence. One of the biggest lessons I learned from reporting on Smith for more than a decade was the danger of creating a false impression that innocent people were only being wrongfully charged and convicted because of one notorious, arrogant, narcissistic, manipulative, opportunistic pathologist named Charles Smith. While we must always be on guard for forensic frauds such as Manock and Smith, what about all the other parents and caregivers who may have been put through the horror of being wrongfully investigated, charged and convicted based on the evidence of pathologists or medical practitioners who, unlike Smith, were well-meaning, sincere, fair, unbiased and neutral - but reached incorrect conclusions of child sexual abuse because the prevailing, accepted pathology being taught in the medical schools and practiced in the field at the time was wrong. I learned this lesson around the time of the Goudge Inquiry when I was contacted by a retired physician who told me that when he began practicing medicine in the 1950's it was widely taught and believed that the mere existence of an enlarged hymen in a child was an indication that she had been sexually abused. This doctor told me that he and many other doctors of his vintage now, in the light of research and newly acquired knowledge, had suffered restless nights because they had inadvertently helped perpetuate miscarriages of justice because they had reiterated the flawed, prevailing medical orthodoxy of the time. I thought about my conversation - and the lessons I have learned - when I read an article entitled "Medical Considerations in the diagnosis of child sexual abuse," by Felicity Goodyear-Smith, published by the IPT Journal in Volume Six, 1994. The abstract reads: "There are no medical signs in the vast majority of sexual abuse cases. Many findings promoted as physical indicators of abuse have been shown to be present in nonabused children. In particular hymenal openings said to measure more than 4 mm, genital rashes and redness, and anal reflex dilatation have been demonstrated to be unreliable medical indicators. Children can be harmed both by unnecessary invasive investigation (including general anesthesia) and by subsequent interventions if the allegations are false. Doctors must insure that they have an empirical basis for the interpretation of their findings, and that they do not allow someone else's belief that a child has been abused to color their clinical judgment. Describing normal findings as "consistent with abuse" is decried. This practice is likely to mislead a court to erroneously believe that there is physical evidence supportive of abuse." Goodyear Smith's conclusion is very wise, worthy of framing, particularly relevant to contemporary issues as to whether short falls can kill and shaken baby syndrome - and will hold a hallowed place on this Blog: "There are no physical signs of abuse to be found in the vast majority of sexual abuse cases. Medical findings supporting or proving abuse are not as clear cut as may be expected. Many of the medical indicators advocated are frequently found in non-abused children. The ubiquitous practice of describing completely normal examination findings as being "consistent with abuse" is likely to be misunderstood in a courtroom as evidence supporting an allegation. Lay people serving as jurors are particularly apt to be misled by medical experts giving such testimony. Physicians examining a child for possible sexual abuse are likely to have been briefed by other workers who have already decided that the child has been sexually abused. Many social workers and psychologists believe that false allegations are extremely rare and that "children never lie about abuse," and see their role as a "validator" that the abuse has occurred. Once a belief that sexual abuse has taken place has become entrenched, very little can be done to sway the believers otherwise. To even suggest the possibility of a false allegation is often to invite an emotional outburst and accusations of condoning or even colluding with abuse. Actions and decisions may subsequently be made without scientific substantiation of the allegations. Doctors called upon to perform forensic sexual abuse examinations should have up-to-date information on the range of normal for nonabused children. They should be very cautious on how they interpret their findings, and insure that they have an empirical basis for their claims. Children can be seriously harmed both by invasive investigative practices and by subsequent interventions when the allegations are unfounded. Physicians must always have in mind the Hippocratic vow, primum non nocere: first do no harm."
The entire article can be found at:
http://www.ipt-forensics.com/journal/volume6/j6_2_1.
Harold Levy: Publisher; The Charles Smith Blog;
PUBLISHER'S NOTE:
I have added a search box for content in this blog which now encompasses several thousand posts. The search box is located near the bottom of the screen just above the list of links. I am confident that this powerful search tool provided by "Blogger" will help our readers and myself get more out of the site.
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/
Information on "The Charles Smith Blog Award"- and its nomination process - can be found at:
http://smithforensic.blogspot.
Please send any comments or information on other cases and issues of interest to the readers of this blog to:
Harold Levy;
Publisher: The Charles Smith Blog;
