Drs. Charles Smith And Rajgopal Menon: Their Colleagues Saw Nothing To Be Concerned About; A Sense Of Deja Vu;

The New Brunswick Inquiry into the flawed work of Dr. Rajgopal Menon has been informed that his colleagues had no idea that there were serious problems with the pathologist's work.

The commission of inquiry into pathology services in New Brunswick was struck after an audit of the laboratory work of Dr. Rajgopal Menon, 73, found a significant number of errors and missed diagnoses, especially in relation to prostate and breast cancers.

(Menon, who will testify at the inquiry later this month, has defended his work, calling the review "unjustified and unfair." He has also filed a civil suit against the regional health authority.)

As reported by the Canadian Press yesterday, in a story headed, "NB inquiry into pathology errors told lack of professionals," this evidence came from Nora Kelly, a former deputy minister of health in New Brunswick.

"Kelly said she had no inkling of serious problems with Menon's work", the story, datelined Moncton, N.B. says.

"She said there were general comments from his colleagues about his slow work habits, his tardiness and missing slides, but no one suggested his work might be sub-standard.

"They didn't like the way he operated, but they never said that he was incompetent," Kelly told commissioner Paul Creaghan, a retired judge."

Slow work...tardiness...missing slides!

Hmmm...Sounded familiar;

Where had I heard that before.

Or, as I had a chance to use my best French in a recent posting, was there not an epic sense of "deja vu?"

As I read these words, I thought back to testimony given to the Goudge Inquiry by Drs. Dirk Huyer, once head of the Suspected Child Abuse and Neglect (SCAN) Unit at the hospital for several years, under cross-examination by Commission Counsel Linda Rothstein;

Try this for size...

MS. LINDA ROTHSTEIN: Dr. Huyer, do you remember what year it was that you last saw Dr. Smith?

DR. DIRK HUYER: I suspect it was 2001.

MS. LINDA ROTHSTEIN: All right. And you would have first met him then 1989?

DR. DIRK HUYER: In January, 1990.

MS. LINDA ROTHSTEIN: 1990. During that period, at any stage, did you develop any concerns about Dr. Smith, as a professional, of course?

DR. DIRK HUYER: There were a number of times where I was notified about issues relating to Dr. Smith.

Primarily, those were issues about timeliness of reports.

And that was a recurrent pattern for me, and timeliness of -- of findings.

So, for example, I've done some talks out West, where police and Children's Aid have been there and made -- and I developed some acquaintances.

And I had been contacted by a RCP -- RCMP officer -- and I can't remember from which province -- who said to me, you know, I sent something to Dr. Smith for an opinion.

It's been a year and a half, and I can't get him.

He won't answer my call.

I -- and I need that material, because court's coming up.

And can you help me, because otherwise I'm going to have to call the
College to -- to get that stuff back.

And so I would go to Charles -- or I went to Charles and I said, Charles, you know, this officer has called me.

What -- what's up?

And then I didn't hear anything more of it following that time, so I made a presumption that he returned the material.

I had heard various things, as I say, about delay and -- and opinions being provided.

And I had heard, although I have no -- no ability to sort through this, that at times his opinion might be different at the time of the autopsy and then his final report."

So what was Dr. Huyer's opinion of his colleague?

DR. DIRK HUYER: Yes. Now, my direct observations of Dr. Smith in the autopsy suite, to me, seemed very thorough, very patient, very methodical in
his approach in doing the autopsies and watching the autopsies.

I never developed a concern about that.

And -- and as -- as you know, I have a very broad experience in watching autopsies with a variety of different pathologists.

So I did not develop any concerns during that time.

Reading his reports, which I had done on a frequent basis, again, concerns didn't jump out to me in -- in the spectrum of other pathology reports that I read.

Obviously, I can't analyse or understand the histopathology, so I couldn't evaluate that in any -- to any -- any degree.

But I -- things were not jumping out to me as being a concern.

His office was pretty cluttered and pretty much on the extreme end of what I would describe as cluttered.

But I'll tell you, I've been in a lot of cluttered offices and that, to me, isn't a definite marker of a problem."

Deja vu?

(At a general level, the comments of Menon's and Smith's colleagues raise crucial questions about hospital culture; Are there pressures on doctors and hospital staff to keep silent about other physicians - even when they have knowledge that the public could be harmed? Is this culture reflected in hospital administrations ad the various self-regulating colleges? Why don't Doctors get more actively involved in cleaning up their professions? Is there a "thin white line?")

Harold Levy...hlevy15@gmail.com;

Crisis Up-Date: Creaghan (New Brunswick) Inquiry Into Pathologist Rajgopal Menon;

"THE PERSONS WHO ARE SERVED BY THE MIRAMICHI REGIONAL HEALTH AUTHORITY WERE UNDERSTANDABLY UPSET WHEN THEY LEARNED AND HEARD ABOUT THE SITUATION CONCERNING PATHOLOGY SERVICES AT THEIR HOSPITAL. I WANT TO GIVE THEM EVERY OPPORTUNITY TO BE HEARD," HE SAID, ADDING THEY MAY GIVE EVIDENCE WITHOUT LEGAL REPRESENTATION OR MAY HAVE COUNSEL AT THEIR SIDE, SHOULD THEY SO WISH."

JUSTICE PAUL CREAGHAN:

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The Miramichi Mirror reported earlier this week that the Creaghan Inquiry into 227 cases handled by New Brunswick pathologist Dr. Rajgopal Menon is set to begin hearing evidence tomorrow (Monday May, 5, 2008, in a story headed, "Pathology Scandal: Justice Urges Objectivity;"

The New Brunswick Inquiry is one of three probes involving flawed pathology that are now underway in Canada - including the Goudge Inquiry in Ontario's review of the botched work of Dr. Charles Smith - which have raised fears that the nation's health care system is in a state of crisis.

"Step back," the story begins.

"That was the advice of pathology scandal Commission of Inquiry Justice Paul Creaghan to a gathering of legal, provincial and federal representatives at a preliminary hearing in Moncton on Monday," (April 28) it continues.

""Step back," Creaghan said, "put aside personal agendas and consider the issues ..."

Creaghan delivered the advice while discussing the investigative process that will take place during the three phases of the inquiry scheduled for May, June and September of this year.

"This is an investigative process ... not a discovery process, not a trial and not an adversarial process," said Creaghan, adding what the intent of the hearings will be is to get to the bottom of the situation.

The inquiry will focus on cases handled by former pathologist Dr. Rajgopal Menon in 2004-2005, specifically, a review of 227 of Menon's cases by Dr. Rosemary Henderson initiated by management of the Miramichi Hospital.

Henderson found that 18 per cent of the 227 cases were incomplete and three per cent were misdiagnosed.

Creaghan said the inquiry will focus on quality assurance issues and quality control of services provided.

"Witnesses will testify with the constitutional protection that their testimony will not be used in any criminal or civil proceeding. Witnesses may have counsel with them when testifying, should they need assistance as to how to appropriately answer a question," he said.

During the meeting, Creaghan introduced other members of the commission, including principal counsel Marc-Antoine Chiasson, counsel Remy M. Boudreau and manager Pauline St.Laurent-Pinto, as well as lawyers representing the provincial department of health, the Miramichi Regional Health Authority, the College of Physicians and Surgeons, the Canadian Medical Professional Association, Menon, the Canadian Cancer Society and a class action lawsuit.

Creaghan said only Chiasson will be permitted to question witnesses without his leave — and he will grant leave to others only under special circumstances. He cited as an example of special circumstances testimony given by someone from out of province who may not be able to return to testify at a later time.

Phase one of the inquiry is set to begin tomorrow and run through to Tuesday, May 13, excluding the weekend. Expected to give evidence in phase one are former provincial deputy minister of health Nora Kelly, department of health physician resource advisor Lynn St. Pierre Ellis, hospital services executive director Lise M. Daigle, deputy minister of health Don Ferguson, MRHA chief of pathology Dr. Dariusz Strselczak, and former MRHA chief operating officers John Tucker and James Wolstenholm.

"This is an investigative and not an adjudicated process," said Creaghan before repeating his advice that everyone step back and remember "... this is a review intent to improve health issues in Miramichi, and indeed the the province."

He added the preliminary hearing was intended to help people feel comfortable with the process before the public hearings proceed and to introduce the parties given standing before the commission.

"I have pledged the process would be open ... [But] this is not a press conference and I do not intend to conduct this in the media," said Creaghan. "It is an opportunity to identify how we intend to proceed."

Phase two set for Miramichi

Phase two of the inquiry is set to be held in Miramichi in June. Creaghan said this phase will provide patients affected by the review of cases every opportunity to be heard.

"The persons who are served by the Miramichi Regional Health Authority were understandably upset when they learned and heard about the situation concerning pathology services at their hospital. I want to give them every opportunity to be heard," he said, adding they may give evidence without legal representation or may have counsel at their side, should they so wish.

"In that case, Chiasson may have some further questions to complete the witnesses' testimony. If the person is without a lawyer, he will lead the evidence."

Creaghan explained witnesses will be advised their testimony cannot be used in any criminal or civil proceeding that may ensue.

"George McAllister has been granted standing to represent any person who may wish to testify as an aggrieved party. Should a person who appears at this phase of the hearing wish to have McAllister lead his or her testimony, he may do so," said Creaghan. "Again, aside from follow-up questioning by Chiasson, there will be no cross-examination of these witnesses without leave."

Chiasson said to date there are 20-plus names scheduled to appear in phase two of the hearings in Miramichi. He said he anticipates these numbers will grow significantly.

Summer hiatus

The inquiry will be adjourned during July and August to afford the members of the commission an opportunity to review the information provided throughout phase one and two of the hearings.

The final phase is scheduled to resume Sept. 8 and will provide an opportunity for all parties with standing to present evidence they deem necessary and relevant under the restrictions imposed by Creaghan.

"To conclude this final phase of the public hearings, the commission intends to recall Henderson and will also call Dr. Heathcote, head of pathology at the Queen Elizabeth Hospital in Halifax. These witness will be available for questioning by all parties with standing," Creaghan said.

Lawyers with standing before the commission who wish to call witnesses in phase three must provide their names, addresses, telephone numbers and any other relevant information prior to August 4, 2008.

McAllister said a request for funding to assist individuals with the financial support they may need to proceed is currently before Premier Shawn Graham.

"I understand they are going to make a decision this week," said McAllister, adding he could not assess the amount of funding involved at this time because it will fluctuate with the length of the hearings and the number of individuals participating in the class-action suit.

"We haven't costed it out, but generally speaking, most of the parties here are going to have two lawyers; they are going to call experts and all of the rest of it. It is a very expensive commission and you cannot affect people here effectively without funding," he said."

Harold Levy...hlevy15@gmail.com;

Three Deadly Scandals: A Sad Testament To Canadian Pathology;

"THREE MAJOR ONGOING SCANDALS IN ONTARIO, NEWFOUNDLAND AND LABRADOR AND NEW BRUNSWICK — WHICH HAVE COLLECTIVELY BEEN LINKED TO HUNDREDS OF DEATHS, TENS OF THOUSANDS OF SUSPECT TEST RESULTS AND DOZENS OF QUESTIONABLE IMPRISONMENTS — AND THEIR REQUISITE HIGH-PROFILE PUBLIC INQUIRIES, HAVE HIGHLIGHTED THE PATHOLOGY SYSTEM'S SERIOUS FAILINGS."

NATIONAL REVIEW OF MEDICINE STORY; SAM SOLOMON;

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The National Review Of Medicine - a publication for Canadian physicians - has published an article that echos this Blog's conclusion that the three on-going Inquiries - including the Goudge Inquiry which center's on Dr. Charles Smith's flawed work - signal a "crisis" in Canada's health care system.

The story, by Sam Solomon, appears today, under the heading "Canadian pathology mired in crisis" - and the sub-heading "Three deadly scandals expose gross failings in training, oversight...

Sir William Osler famously said, "As is our pathology so is our practice... what the pathologist thinks today, the physician does tomorrow," the story begins;

"If Dr Osler — a pathologist himself — was right, then Canada's entire medical system is in deep trouble, says Canadian Association of Pathologists president Dr Jagdish Butany," it continues;

""Over the last 20-plus years, we have not paid enough attention to laboratories and pathology and pathologists," he says.

"[The healthcare system has] relegated pathologists to the basement and given them that same priority."

The result of that chronic disregard is now becoming readily apparent: Canadian pathology is in crisis.

SYSTEMIC PROBLEMS

Three major ongoing scandals in Ontario, Newfoundland and Labrador and New Brunswick — which have collectively been linked to hundreds of deaths, tens of thousands of suspect test results and dozens of questionable imprisonments — and their requisite high-profile public inquiries, have highlighted the pathology system's serious failings.

As a result, an expert panel of leading medical authorities are now in the process of setting up a comprehensive review of the current deficiencies in pathology in Canada.

The details of the review haven't been finalized yet, says Royal College of Physicians and Surgeons of Canada CEO Dr Andrew Padmos, but the report will have another goal as well: to restore the public's severely shaken confidence.

The three scandals have done grievous damage to the profession's reputation.

"They've given us a black eye," Dr Butany admitted to the National Post last month as he and Dr Padmos dutifully denied a crisis exists and reassured reporters across the country that Canadian pathology is indeed trustworthy and can be repaired.

In conversation, however, cracks appeared in the veneer of their everything's-under-control exhortations.

After explaining that Canadian health human resources problems are having a particularly acute effect on the field of pathology — "We are concerned the problem is going to become worse and more widespread and we don't have in place an effective pan-Canadian action to stop it" — Dr Padmos quickly sought to quell any possible anxiety.

"Is it an absolute knockdown crisis? Of course not. What they need is some hope and some planning."

The shortage of pathologists and lab technologists is already putting pressure on the system.

"People are working too long hours, or past your threescore and ten, even," says Dr Butany, "so that makes for an increasing potential for mistakes. You don't have time to critically analyse previous work, to sit back and think."

But the real culprit in all three scandals appears to be a lackadaisical approach to quality assurance and training.

ONTARIO

Dr Charles Smith was once considered the epitome of expertise when it came to pediatric forensic pathology.

If a child died under suspicious circumstances in Ontario, all eyes turned to Dr Smith.

If Dr Smith served as an expert witness in a homicide case, people listened.
But that trust was misplaced.

Dr Smith is now at the centre of a public inquiry into the entire field of pediatric forensic pathology in the province.

Many child murder convictions that Dr Smith helped resolve have been thrown into question and the provincial Chief Coroner's office is now suggesting a total of 142 cases be reviewed.

Although Dr Smith made a dramatic apology to his victims at the inquiry, he wasn't actually on trial.

In fact, there's one thing he and his victims seem to be able to agree on: the balance of the blame should go to the pediatric forensic pathology system itself and the lack of oversight, training and quality assurance.

The inquiry's closing arguments wrapped up April 1. Justice Stephen Goudge is due to submit his final report and recommendations to the government by September 30.

NEWFOUNDLAND AND LABRADOR

In a strange twist of fate, the Ontario inquiry has come to a head at almost exactly the same time another inquiry, this one potentially just as broad as the Ontario one, is just getting underway in Newfoundland and Labrador.

This inquiry, headed by Justice Margaret Cameron, is looking at how 383 women were given incorrect estrogen and progesterone hormone receptor breast cancer test results (which determine whether the patient should receive tamoxifen) over an eight-year period from 1997 to 2005. Over a hundred of those women are now dead.

Again, the absence of standardized quality assurance — a problem that still persists today, says Dr Padmos — appears to have contributed significantly to the errors.

There have also been suggestions that a St John's lab may have misinterpreted the results of a now-outmoded method of immunohistochemical testing on biopsy tissue; a 2003 internal memo by pathologist Gershon Ejeckam called the lab's technique "unreliable and erratic" and said diagnoses based on those tests "will surely jeopardize patient care."

Amidst allegations of a politically motivated coverup, some have called for Health Minister Ross Wiseman's resignation. The inquiry's final report is due no later than July 30.

NEW BRUNSWICK

The New Brunswick investigation is slightly different from those in Ontario and Newfoundland in that it focuses more specifically on the work of one pathologist, Dr Rajgopal Menon of Miramichi, who was found to have a misdiagnosis rate of 3% and an incomplete diagnosis rate of 18% in a recent audit.

Another report released late last month said Dr Menon's "vision seemed to be failing," his hands were shaky and his work "fails to meet the current standards of surgical pathology."

Already, Dr Menon's lawyer, Mel Norton, has employed the same tactics that Dr Smith's have in Ontario, blaming the pathology system and the lack of oversight.

"[It's] too convenient just to aim the gun at one person," he told the Telegraph-Journal in February.

The government has ordered reviews of all 24,000 of Dr Menon's cases, from 1995 until 2007, and the RCMP has also been asked to consider charges of criminal negligence against Dr Menon.

Retired judge and former provincial Tory health minister Paul Creaghan, who is heading the inquiry, is due to submit his final report by August 22."

Harold Levy...hlevy15@gmail.com;

Part Four; Extraordinary Development: Three Inquiries In To Work Of Pathologists At One Time In One Country; The New Brunswick Connection;

"THESE INCLUDED DIAGNOSES OF MALIGNANT CASES AS BENIGN," THE 21-PAGE REPORT SAYS, INCLUDING A CASE IN WHICH MENON FAILED TO RECOGNIZE A CASE OF METASTATIC BREAST CANCER.

"IT IS THE REVIEWERS' OPINION THAT DR. RAJGOPAL MENON FAILS TO MEET THE CURRENT STANDARDS OF SURGICAL PATHOLOGY," THE REPORT SAYS.

FROM REPORT INTO WORK OF DR. RAJGOPAL MENON - FORMER CHIEF PATHOLOGIST OF THE MIRAMICHI REGIONAL HEALTH AUTHORITY;

While considerable attention is being focused on Dr. Charles Smith today because the Goudge Inquiry has posted written submissions from the various lawyers involved, there is a development in New Brunswick.

This Blog has previously reported that the New Brunswick government has appointed Paul Creaghan - a former Conservative health minister and a retired judge - to conduct a public Inquiry into the allegedly botched work of a pathologist named Dr. Rajgopal Menon.

(Other public Inquiries in to the work of Pathologists in Canada are currently under way in Ontario and Newfoundland;)

Today the Canadian Broadcasting Corporation (CBC) released an independent review of Menon's work as former chief pathologist for the Miramichi Regional Health Authority which it obtained through a successful application to overturn a publication ban.

"A former New Brunswick pathologist misdiagnosed cancer tests in half the cases reviewed last year by outside doctors, and continued to work even though he had cataracts in both eyes," the CBC story begins under the heading "N.B. pathologist had shaky hands, cataracts: report;"

"The report by two Maritime pathologists was released on Thursday" the story continues;

"It found that Dr. Rajgopal Menon, the former chief pathologist for the Miramichi Regional Health Authority, made "major diagnostic" mistakes in six of 12 "problem" cases he handled between 1999 and 2006.

"These included diagnoses of malignant cases as benign," the 21-page report says, including a case in which Menon failed to recognize a case of metastatic breast cancer.

"It is the reviewers' opinion that Dr. Rajgopal Menon fails to meet the current standards of surgical pathology," the report says.

The review of Menon's work was done last spring by Dr. Bruce Wright, a pathologist at the South Shore Regional Hospital in Bridgewater, N.S., and Dr. Rosemary Henderson, a pathologist at the Queen Elizabeth Hospital in Charlottetown, P.E.I.

Their report also says tremors in Menon's hands threw into question his ability to prepare tissue samples for diagnosis and that he continued to work while requiring surgery on both eyes to remove cataracts.

"Prior to his cataract surgery late in 2006, the technologists observed that his vision seemed to be failing, such that he needed request forms to be held closer and closer to his eyes and he needed to get closer and closer to specimens as he was working with them."

Wright and Henderson submitted their findings to the New Brunswick College of Physicians and Surgeons last year and Menon's medical licence was subsequently suspended. He can no longer practice medicine in New Brunswick.

The report has been made public now because the CBC and other media outlets went to court to have a publication ban overturned.

In February, Court of Queen's Bench Justice William Grant in Saint John lifted the ban but allowed 30 days for appeals.

Menon's work was called into question in 2007 after complaints about incomplete diagnoses and delayed lab results.

Health officials are now reviewing more than 20,000 tests he handled over the course of a decade.

In their report, Wright and Henderson made three recommendations:

The New Brunswick College of Physicians and Surgeons require a health assessment with respect to Menon's ability to conduct the practice of pathology.

If the results of that assessment find him fit to continue practising, that he be required to complete remedial surgical pathology training.

Should Menon resume practising, that he be required to take part in quality assurance activities and be regularly monitored.

The reviewers also said the College should determine whether Menon was either legally or ethically required to disclose his visual problems to the hospital.

Wright and Henderson examined Menon's surgical slides and reports to determine accuracy of the diagnoses, the completeness and accuracy of the reports, and how long the work took.

They did not interview Menon.

Of 10 cases referred by Menon to an outside pathologist for consultation, the report found that only two were considered "to have been handled in an acceptable fashion with no significant concerns."

Delayed referring cases outside:

The report also shows that Menon took an average of 34 working days to send five cases out for referral, while the other pathologist at the same hospital referred all his cases out on the same day.

"The reviewers were told at length that Dr. Menon needs to be reminded repeatedly to carry through with expressed intentions to refer cases, perform additional levels or special stains and generally attend to outstanding cases," the report states.

"In August 1998, a list of outstanding cases from 1997 was generated that showed a previous pathologist to have three outstanding cases … and Dr. Menon to have 32 outstanding cases."

Staff formally notified senior hospital officials of these issues as early as 1995, the report shows.

Last month, the New Brunswick government announced Paul Creaghan, a former Conservative health minister and a retired judge, would lead a public inquiry into the Menon case.

Health Minister Mike Murphy has asked the Royal Canadian Mounted Police (RCMP) to review several misdiagnoses by Menon;

Reporter Bobbi-Jean MacKinnon notes in a story that ran today in the Telegraph-Journal out of Saint John New Brunswick that:

"A review of nine cases referred out by Menon were delayed almost seven weeks in cases where the delays could have affected treatment and prognosis.

In similar cases, the hospital's chief pathologist was able to refer cases within a day. And Menon's average turnaround time for cases approached 11 days - twice that for the chief."

MacKinnon also notes that:

"The review found he had to be reminded repeatedly "to carry through with expressed intentions to refer cases, perform additional levels or special stains and generally attend to outstanding cases."

It often takes two to three calls or visits before the matter is dealt with, staff told the experts behind the review. One surgeon interviewed, however, said Menon usually responded to queries about outstanding cases within a day."

"Slides he handled went missing," MacKinnon continues. "Nearly 550 Pap smear slides handled by Menon between 2000 and 2004 disappeared.

At one point, he was asked whether he had removed the slides to use them for his own venture - he was working on an automated slide scanner he touted as a way to eliminate human error.

Most of the slides were later recovered or found."

(Dr. Charles Smith was also criticized for significant delay, failure to refer cases to specialists, and loss of forensic materials);

This Bloggist is particularly fascinated by the fact that the Health Minister has asked the Royal Canadian Mounted Police to investigate Menon with respect to "several misdiagnoses".

This Bloggist would appreciate help in understanding the following conundrum:

Dr. Charles Smith attained the lofty status of head of the Ontario Pediatric Forensic pathology Unit (along with his lofty reputation)

Dr. Rajgopal Menon rose to the level of Chief Pathologist of the Miramichi Regional Health Authority;

However, the work of both of these once eminent pathologists was found to be seriously flawed - causing harm to numerous individuals - when it was exposed to independent scrutiny;

Are these two entirely unique situations?

Or are they merely a reflection of an overall flaw in Canada's health system which allows incompetent physicians - in other areas of medicine as well - to rise, without being challenged by their peers, to positions of prestige and power?

Harold Levy...hlevy15@gmail.com;

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;