Every once and a while a book is published which brings exceptional clarity and insight into its subject matter.
“Accused to Acquitted: The clue is in the evidence” by Dr. Patricia Horsham is one such book.
It cuts through layers of myth and junk science to illustrate on a case by case basis how parents and caregivers have been wrongly convicted because so-called medical experts willfully ignored innocent explanations which might explain a child’s tragic death. (Chapter Eight, for example, is headed: “Medical disease versus Shaken Baby Syndrome);
Horsham is an Emergency Pediatrician who has written extensively on the medical assessment of sexually abused children and actively participated in the legal process through her testimony as an expert witness in court.
“I have found that the most significant problems occur in the interpretation of medical data when overzealous, incorrect choices are made between two aspects of interpretation of one piece of information, without any justifiable supporting evidence for that choice,” she writes. “Unfortunately the choice is often to support the foregone conclusion of child abuse, without realizing that the diagnosis is based only on one doctor’s suspicion.
Horsham recognizes the helplessness of suspected, (but innocent) parents, who’s quiet voices “are ignored by the great and powerful professional groups,” - and who face “an overwhelming assumption that once the suspicion of child abuse has been raised that the parents are lying…and any further information is greeted with similar skepticism.”
The ten chapters contain dozens of concrete examples in which parents and caregivers were put through hell because so-called experts did not do their job in a scientific and dispassionate way.
“Accused to Acquitted” is written in easy to understandable language which is backed up by a glossary that helps the reader make sense of the medical terminology, and should be useful to parents, doctors, defence lawyers, prosecutors and judges – as well as ordinary people who have high expectations of their criminal justice system.
I only wish it would have been written about twenty-five years ago when Dr. Charles Smith began his rampage through Ontario’s criminal justice system.
Had it been available, I doubt if we have seen the harm caused to so many innocent people – many of them grieving parents – whose lives were turned upside down by his faulty opinions and refusal to consider innocent explanations for the child’s death.
Dr. Horsham has done an important public service by publishing this book which may also be relevant in countries far beyond Canada’s borders.
Copies may be obtained by email through,,,medlaw2@rogers.com;
Harold Levy…hlevy15@gmail.com;
Wednesday, December 17, 2008
SUZANNE HOLDSWORTH RETRIAL: PART SEVENTEEN; QUESTIONS FROM JURY; PETERLEE MAIL;
"The jury in the trial of a babysitter accused of murdering a toddler will continue its deliberations tomorrow (Thursday)" the story begins, under the heading "Verdict still awaited in murder trial."
"Members were sent home for the evening after spending five hours considering if Suzanne Holdsworth killed two-year-old Kyle Fisher," it continues;
"Holdsworth, 38, is accused of killing two-year-old Kyle Fisher in her home in Millpool Close, on the Central Estate, Hartlepool, in July 2004.
The jury were sent out to begin their discussions early this morning.
They returned to the courtroom to request to see video footage taken from inside the home of Kyle's mother, Clare Fisher, and asked to hear the tape of the 999 call made to the ambulance service by Holdsworth.
Members also asked for another look at the banister from the staircase in Holdsworth's home.
The prosecution alleges the mother of two repeatedly banged the little boy's head against the banisters after snapping in a fit of temper.
Holdsworth was jailed for life in 2005. But the Court of Appeal overturned the conviction in May and ordered a re-trial.
The trial at Teesside Crown Court heard evidence from medical experts, appearing for the defence, who said an epileptic seizure was most likely to have led to Kyle's death.
The defence also told the jury they could not be sure that Holdsworth inflicted the fatal blows on Kyle, blaming his 24- year-old mother Clare Fisher instead.
Holdsworth, now of Boggart Hill Drive, Seacroft, Leeds, denies murder.
Keep returning to our website on Friday for the latest developments from court."
Harold Levy...hlevy15@gmail.com;
"Members were sent home for the evening after spending five hours considering if Suzanne Holdsworth killed two-year-old Kyle Fisher," it continues;
"Holdsworth, 38, is accused of killing two-year-old Kyle Fisher in her home in Millpool Close, on the Central Estate, Hartlepool, in July 2004.
The jury were sent out to begin their discussions early this morning.
They returned to the courtroom to request to see video footage taken from inside the home of Kyle's mother, Clare Fisher, and asked to hear the tape of the 999 call made to the ambulance service by Holdsworth.
Members also asked for another look at the banister from the staircase in Holdsworth's home.
The prosecution alleges the mother of two repeatedly banged the little boy's head against the banisters after snapping in a fit of temper.
Holdsworth was jailed for life in 2005. But the Court of Appeal overturned the conviction in May and ordered a re-trial.
The trial at Teesside Crown Court heard evidence from medical experts, appearing for the defence, who said an epileptic seizure was most likely to have led to Kyle's death.
The defence also told the jury they could not be sure that Holdsworth inflicted the fatal blows on Kyle, blaming his 24- year-old mother Clare Fisher instead.
Holdsworth, now of Boggart Hill Drive, Seacroft, Leeds, denies murder.
Keep returning to our website on Friday for the latest developments from court."
Harold Levy...hlevy15@gmail.com;
SUZANNE HOLDSWORTH RETRIAL: PART SIXTEEN; POLICE ACCUSED OF 'SELECTIVE' INVESTIGATION AS CASE GOES TO JURY;
BACKGROUND:
Babysitter Suzanne Holdsworth, who has previously found guilty of murdering her neighbour's two-year-old son by repeatedly banging the boy's head against a wooden banister, has won an appeal against her conviction. She has been granted bail after Court of Appeal Judges declared her conviction for the murder of a toddler "unsafe" in the light of new medical evidence.
Acting for Suzanne, Henry Blaxland QC of Garden Court's Crime team argued that new evidence showed she was the victim of a miscarriage of justice over the death of the two-year old boy. The Court of Appeal was told that they child had abnormalities which predisposed him to epilepsy.
Henry Blaxland QC said that the doctors who gave evidence at trial "got it wrong" and "collectively failed to diagnose" that the Kyle had a "highly unusual brain", which indicated three abnormalities, two of which predisposed him to epilepsy."
Henry Blaxland QC also stated that the prosecution's case at trial 'was based on expert medical opinion evidence to the effect that the child died from fatal brain swelling or oedema which was caused by a blow or blows of significant force.'
A jury was told in 2005 that the mum-of-two smashed the toddler’s head against a bannister with the force of “a car crash at 60mph," Yet Kyles's skull was unbroken and there was no evidence of hair, blood or tissue on the wood.
One of the experts providing fresh evidence on behalf of the defence is forensic pathologist Dr. Christopher Millroy who participated in the Ontario Chief Coroner's Review of suspicious death of infant's cases involving Dr. Charles Smith and later testified at the recently concluded Goudge Inquiry;
-------------------------------------------------------------------------------
"Andrew Thomas, defending murder accused Suzanne Holdsworth, told the Teesside Crown Court jury yesterday that the Crown Prosecution Service had only ever been given his client as a possible suspect," the latest Northern Echo story, dated Wednesday 17 December, 2008, begins, under the heading, "Police accused of a 'selective' investigation.
"The 38-year-old mother-of-two denies murdering Kyle Fisher while babysitting him at her then home in Millpool Close, Hartlepool, in July, 2004. She maintains he suffered a seizure," the story, by reporter Karen Westcott, continues.
"However, she is accused of repeatedly ramming his head into the banister in a rage while looking after him for just over an hour, causing fatal brain swelling.
The prosecution has argued that Kyle would have collapsed no more than 15 minutes after suffering the head trauma – meaning Miss Holdsworth was the only possible suspect.
Andrew Robertson, prosecuting, said the curved and linear bruising on the toddler’s head matched the banister.
But during his final speech to the jury yesterday, Mr Thomas said he believed the bruising to Kyle’s head was not caused on the night he collapsed, but possibly the day before.
He reminded the jury that Kyle’s mother, Clare Fisher, of nearby Troutpool, Hartlepool, had noticed bruising on her son’s head during the morning of the day he collapsed. He said that as a teenage, single mother, she was unable to cope, suffered depression and was known to “mistreat” Kyle. He said she was the one with motive, adding that older, unexplained bruises on Kyle’s body meant she was the only “credible candidate” for causing the fatal injuries.
He said: “It was a selective, flawed investigation, which caused the prosecution to fix on a selective view of the facts to maintain the case against Suzanne Holdsworth. Suzanne Holdsworth was innocent and did nothing more than get involved because she cared.”
The court has accepted the toddler suffered three serious brain abnormalities, two of which left him pre-disposed to suffer from epileptic fits.
The defence has argued that Kyle suffered a serious head injury, possibly the day before he collapsed, which may have caused a slow bleed on his brain.
That, Mr Thomas claimed, could have triggered a massive epileptic fit, leading to brain swelling. Or, he said, the toddler could have simply had a second minor bang that night, which could have triggered the brain swelling.
He said: “Tragically, the two problems that Kyle had came together.”
The prosecution accused the defence of grasping at straws."
Harold Levy...hlevy15@gmail.com;
Babysitter Suzanne Holdsworth, who has previously found guilty of murdering her neighbour's two-year-old son by repeatedly banging the boy's head against a wooden banister, has won an appeal against her conviction. She has been granted bail after Court of Appeal Judges declared her conviction for the murder of a toddler "unsafe" in the light of new medical evidence.
Acting for Suzanne, Henry Blaxland QC of Garden Court's Crime team argued that new evidence showed she was the victim of a miscarriage of justice over the death of the two-year old boy. The Court of Appeal was told that they child had abnormalities which predisposed him to epilepsy.
Henry Blaxland QC said that the doctors who gave evidence at trial "got it wrong" and "collectively failed to diagnose" that the Kyle had a "highly unusual brain", which indicated three abnormalities, two of which predisposed him to epilepsy."
Henry Blaxland QC also stated that the prosecution's case at trial 'was based on expert medical opinion evidence to the effect that the child died from fatal brain swelling or oedema which was caused by a blow or blows of significant force.'
A jury was told in 2005 that the mum-of-two smashed the toddler’s head against a bannister with the force of “a car crash at 60mph," Yet Kyles's skull was unbroken and there was no evidence of hair, blood or tissue on the wood.
One of the experts providing fresh evidence on behalf of the defence is forensic pathologist Dr. Christopher Millroy who participated in the Ontario Chief Coroner's Review of suspicious death of infant's cases involving Dr. Charles Smith and later testified at the recently concluded Goudge Inquiry;
-------------------------------------------------------------------------------
"Andrew Thomas, defending murder accused Suzanne Holdsworth, told the Teesside Crown Court jury yesterday that the Crown Prosecution Service had only ever been given his client as a possible suspect," the latest Northern Echo story, dated Wednesday 17 December, 2008, begins, under the heading, "Police accused of a 'selective' investigation.
"The 38-year-old mother-of-two denies murdering Kyle Fisher while babysitting him at her then home in Millpool Close, Hartlepool, in July, 2004. She maintains he suffered a seizure," the story, by reporter Karen Westcott, continues.
"However, she is accused of repeatedly ramming his head into the banister in a rage while looking after him for just over an hour, causing fatal brain swelling.
The prosecution has argued that Kyle would have collapsed no more than 15 minutes after suffering the head trauma – meaning Miss Holdsworth was the only possible suspect.
Andrew Robertson, prosecuting, said the curved and linear bruising on the toddler’s head matched the banister.
But during his final speech to the jury yesterday, Mr Thomas said he believed the bruising to Kyle’s head was not caused on the night he collapsed, but possibly the day before.
He reminded the jury that Kyle’s mother, Clare Fisher, of nearby Troutpool, Hartlepool, had noticed bruising on her son’s head during the morning of the day he collapsed. He said that as a teenage, single mother, she was unable to cope, suffered depression and was known to “mistreat” Kyle. He said she was the one with motive, adding that older, unexplained bruises on Kyle’s body meant she was the only “credible candidate” for causing the fatal injuries.
He said: “It was a selective, flawed investigation, which caused the prosecution to fix on a selective view of the facts to maintain the case against Suzanne Holdsworth. Suzanne Holdsworth was innocent and did nothing more than get involved because she cared.”
The court has accepted the toddler suffered three serious brain abnormalities, two of which left him pre-disposed to suffer from epileptic fits.
The defence has argued that Kyle suffered a serious head injury, possibly the day before he collapsed, which may have caused a slow bleed on his brain.
That, Mr Thomas claimed, could have triggered a massive epileptic fit, leading to brain swelling. Or, he said, the toddler could have simply had a second minor bang that night, which could have triggered the brain swelling.
He said: “Tragically, the two problems that Kyle had came together.”
The prosecution accused the defence of grasping at straws."
Harold Levy...hlevy15@gmail.com;
Tuesday, December 16, 2008
SUZANNE HOLDSWORTH RETRIAL: PART FIFTEEN; CLOSING ADDRESSES; EVENING GAZETTE COVERAGE;
BACKGROUND:
Babysitter Suzanne Holdsworth, who has previously found guilty of murdering her neighbour's two-year-old son by repeatedly banging the boy's head against a wooden banister, has won an appeal against her conviction. She has been granted bail after Court of Appeal Judges declared her conviction for the murder of a toddler "unsafe" in the light of new medical evidence.
Acting for Suzanne, Henry Blaxland QC of Garden Court's Crime team argued that new evidence showed she was the victim of a miscarriage of justice over the death of the two-year old boy. The Court of Appeal was told that they child had abnormalities which predisposed him to epilepsy.
Henry Blaxland QC said that the doctors who gave evidence at trial "got it wrong" and "collectively failed to diagnose" that the Kyle had a "highly unusual brain", which indicated three abnormalities, two of which predisposed him to epilepsy."
Henry Blaxland QC also stated that the prosecution's case at trial 'was based on expert medical opinion evidence to the effect that the child died from fatal brain swelling or oedema which was caused by a blow or blows of significant force.'
A jury was told in 2005 that the mum-of-two smashed the toddler’s head against a bannister with the force of “a car crash at 60mph," Yet Kyles's skull was unbroken and there was no evidence of hair, blood or tissue on the wood.
One of the experts providing fresh evidence on behalf of the defence is forensic pathologist Dr. Christopher Millroy who participated in the Ontario Chief Coroner's Review of suspicious death of infant's cases involving Dr. Charles Smith and later testified at the recently concluded Goudge Inquiry;
-------------------------------------------------------------------------------
"SUZANNE Holdsworth was either the manipulative killer of a Teesside toddler or a caring good Samaritan wrongly accused, a murder trial jury heard," the Evening Gazette story dated December 16, 2008 begins, under the heading "Lawyers sum up case in Holdsworth trial."
"Jurors were told they had to consider who assaulted two-year-old Kyle Fisher – his babysitter Holdsworth, 38, or his mother Clare Fisher, 24," the story continues;
"QCs began making their final speeches to Teesside Crown Court yesterday.
Prosecutor Andrew Robertson said: “The reality in our submission can only be this: that Miss Holdsworth caused the injuries that you’ve seen to that child while he was in her sole care.
“However you look at it, those injuries led to Kyle’s death, and tragic though it is, both for Kyle and for Miss Holdsworth, she sadly was responsible for his unlawful death.
“Immediately regretted, immediately panicking, probably as a result of a momentary loss of temper, a short-lived intention to cause serious harm on the spur of the moment.
“That, we submit, is the only possible inference from the facts in this case.”
Defence barrister Andrew Thomas told the jury: “The awful prospect in this case is the Good Samaritan who was prepared to get involved and to help and who happened to be there when Kyle eventually collapsed is the person who is blamed for his tragic death.
“There is clear evidence, you may think, that Kyle was mistreated by his mother and that he suffered injuries at her hands.
“Because of those injuries Kyle collapsed on the night of July 21 (2004), not because he had been assaulted there and then, but because tragically he was a very vulnerable child with conditions, most of which had never been diagnosed, that meant because of an earlier injury he collapsed that night.
“You may think that when you look at the powerful evidence, it is Clare Fisher who is the credible candidate for having attacked Kyle.”
Kyle Fisher died from brain swelling two days after he collapsed at Holdsworth’s home on Millpool Close, Hartlepool.
Mr Robertson said Kyle was assaulted causing extensive bruising to his scalp, with up to 11 impacts requiring significant force, leading to the fatal brain swelling.
Holdsworth, now of Boggart Hill Drive, Seacroft, Leeds, denies murder.
Proceeding;"
Harold Levy...hlevy15@gmail.com;
Babysitter Suzanne Holdsworth, who has previously found guilty of murdering her neighbour's two-year-old son by repeatedly banging the boy's head against a wooden banister, has won an appeal against her conviction. She has been granted bail after Court of Appeal Judges declared her conviction for the murder of a toddler "unsafe" in the light of new medical evidence.
Acting for Suzanne, Henry Blaxland QC of Garden Court's Crime team argued that new evidence showed she was the victim of a miscarriage of justice over the death of the two-year old boy. The Court of Appeal was told that they child had abnormalities which predisposed him to epilepsy.
Henry Blaxland QC said that the doctors who gave evidence at trial "got it wrong" and "collectively failed to diagnose" that the Kyle had a "highly unusual brain", which indicated three abnormalities, two of which predisposed him to epilepsy."
Henry Blaxland QC also stated that the prosecution's case at trial 'was based on expert medical opinion evidence to the effect that the child died from fatal brain swelling or oedema which was caused by a blow or blows of significant force.'
A jury was told in 2005 that the mum-of-two smashed the toddler’s head against a bannister with the force of “a car crash at 60mph," Yet Kyles's skull was unbroken and there was no evidence of hair, blood or tissue on the wood.
One of the experts providing fresh evidence on behalf of the defence is forensic pathologist Dr. Christopher Millroy who participated in the Ontario Chief Coroner's Review of suspicious death of infant's cases involving Dr. Charles Smith and later testified at the recently concluded Goudge Inquiry;
-------------------------------------------------------------------------------
"SUZANNE Holdsworth was either the manipulative killer of a Teesside toddler or a caring good Samaritan wrongly accused, a murder trial jury heard," the Evening Gazette story dated December 16, 2008 begins, under the heading "Lawyers sum up case in Holdsworth trial."
"Jurors were told they had to consider who assaulted two-year-old Kyle Fisher – his babysitter Holdsworth, 38, or his mother Clare Fisher, 24," the story continues;
"QCs began making their final speeches to Teesside Crown Court yesterday.
Prosecutor Andrew Robertson said: “The reality in our submission can only be this: that Miss Holdsworth caused the injuries that you’ve seen to that child while he was in her sole care.
“However you look at it, those injuries led to Kyle’s death, and tragic though it is, both for Kyle and for Miss Holdsworth, she sadly was responsible for his unlawful death.
“Immediately regretted, immediately panicking, probably as a result of a momentary loss of temper, a short-lived intention to cause serious harm on the spur of the moment.
“That, we submit, is the only possible inference from the facts in this case.”
Defence barrister Andrew Thomas told the jury: “The awful prospect in this case is the Good Samaritan who was prepared to get involved and to help and who happened to be there when Kyle eventually collapsed is the person who is blamed for his tragic death.
“There is clear evidence, you may think, that Kyle was mistreated by his mother and that he suffered injuries at her hands.
“Because of those injuries Kyle collapsed on the night of July 21 (2004), not because he had been assaulted there and then, but because tragically he was a very vulnerable child with conditions, most of which had never been diagnosed, that meant because of an earlier injury he collapsed that night.
“You may think that when you look at the powerful evidence, it is Clare Fisher who is the credible candidate for having attacked Kyle.”
Kyle Fisher died from brain swelling two days after he collapsed at Holdsworth’s home on Millpool Close, Hartlepool.
Mr Robertson said Kyle was assaulted causing extensive bruising to his scalp, with up to 11 impacts requiring significant force, leading to the fatal brain swelling.
Holdsworth, now of Boggart Hill Drive, Seacroft, Leeds, denies murder.
Proceeding;"
Harold Levy...hlevy15@gmail.com;
Monday, December 15, 2008
CREAGHAN REPORT; PART FIVE; NEW BRUNSWICK PATHOLOGIST INQUIRY RESULTS FUEL CLASS-ACTION LAWSUIT, CBC REPORTS;
"A lawyer representing patients in a proposed class-action lawsuit against the Miramichi Regional Health Authority says a report into Dr. Rajgopal Menon is reinforcing the necessity of the legal action," CBC News reported on December 12, 2008;
"Mike Dull of Wagners Law Firm in Halifax said Justice Paul Creaghan's inquiry into the disgraced pathologist reinforces his clients' belief there were some serious problems at the Miramichi Regional Hospital," the CBC report continued;
""We've been confident all along that we have a strong case of systemic negligence," Dull alleged.
"The recent findings of the inquiry, they stand alone and they only serve to support our initial belief, and we're happy to see the inquiry recognize the serious systemic issues which took place at the Miramichi Regional Hospital."
The proposed class action has been filed and a court must now decide whether to certify it. None of the allegations has been proven in court. Dull would not say how many individuals are involved.
The public relations case against Menon continued to worsen on Thursday.
Health Minister Michael Murphy released a report by Ottawa-based Gamma-Dynacare Medical Laboratories.
The lab re-examined about 23,000 tests conducted by the former pathologist at Miramichi Regional Hospital and Edmundston Regional Hospital. The cases were from Miramichi, dating between 1995 and 2007, and from Edmundston in 2002.
The Ottawa lab found 5,286 of the cases reviewed had a complete or partial change in findings. That translates into about 25 per cent of his tests over a 12-year period that contained problems of some degree.
'We have a good health-care system. We've had a few bumps along the road.'
— Health Minister Michael MurphyOf the 370 tests results that Menon got completely wrong, 101 were cancer biopsies.
Murphy said he didn't know how many of those patients were worse off because of the errors, but he said they will get the care they need.
"The province will continue to ensure that everybody gets the proper care that they deserve. We have a good health-care system. We've had a few bumps along the road," the health minister said.
Progressive Conservative MLA Claude Landry, the Opposition's health critic, said he worries that the new larger regional health authorities set up by the Liberals will make fixing the system more difficult.
The health minister said some changes are already underway, but he will announce broader reforms by mid-February.
Former patient hopes good comes out of inquiry
A former patient of Menon's is looking forward to see what changes are brought about to help patients affected by the pathologist's misdiagnoses.
Sister Kathleen Waters said patients deserve support, advocacy and transparency. Waters's test results weren't affected, but her faith in the health-care system was.
Waters testified in front of the Creaghan inquiry and now hopes the judge's 52 recommendations released Wednesday spark reform in the health system.
"They say in spiritual life, good can come out of something bad. And I think a lot of good — if the Department of Health responds to these suggestions," Waters said. "If patients assume the responsibility to be implicated in their care, I think a lot of good can come out of this. I think it's a real grace in an ironic way."
She hopes the recommendations will lead to new resources for the patients affected by those problems. Anne McTiernan-Gamble of the Canadian Cancer Society said her organization is reaching out to patients in Miramichi.
"What happened in the Miramichi we were very concerned about the patients and their families," she said. "In addition we wanted to let them know that we have the cancer information services available to them and support services for them that's only a phone call away.""
Harold Levy...hlevy15@gmail.com;
"Mike Dull of Wagners Law Firm in Halifax said Justice Paul Creaghan's inquiry into the disgraced pathologist reinforces his clients' belief there were some serious problems at the Miramichi Regional Hospital," the CBC report continued;
""We've been confident all along that we have a strong case of systemic negligence," Dull alleged.
"The recent findings of the inquiry, they stand alone and they only serve to support our initial belief, and we're happy to see the inquiry recognize the serious systemic issues which took place at the Miramichi Regional Hospital."
The proposed class action has been filed and a court must now decide whether to certify it. None of the allegations has been proven in court. Dull would not say how many individuals are involved.
The public relations case against Menon continued to worsen on Thursday.
Health Minister Michael Murphy released a report by Ottawa-based Gamma-Dynacare Medical Laboratories.
The lab re-examined about 23,000 tests conducted by the former pathologist at Miramichi Regional Hospital and Edmundston Regional Hospital. The cases were from Miramichi, dating between 1995 and 2007, and from Edmundston in 2002.
The Ottawa lab found 5,286 of the cases reviewed had a complete or partial change in findings. That translates into about 25 per cent of his tests over a 12-year period that contained problems of some degree.
'We have a good health-care system. We've had a few bumps along the road.'
— Health Minister Michael MurphyOf the 370 tests results that Menon got completely wrong, 101 were cancer biopsies.
Murphy said he didn't know how many of those patients were worse off because of the errors, but he said they will get the care they need.
"The province will continue to ensure that everybody gets the proper care that they deserve. We have a good health-care system. We've had a few bumps along the road," the health minister said.
Progressive Conservative MLA Claude Landry, the Opposition's health critic, said he worries that the new larger regional health authorities set up by the Liberals will make fixing the system more difficult.
The health minister said some changes are already underway, but he will announce broader reforms by mid-February.
Former patient hopes good comes out of inquiry
A former patient of Menon's is looking forward to see what changes are brought about to help patients affected by the pathologist's misdiagnoses.
Sister Kathleen Waters said patients deserve support, advocacy and transparency. Waters's test results weren't affected, but her faith in the health-care system was.
Waters testified in front of the Creaghan inquiry and now hopes the judge's 52 recommendations released Wednesday spark reform in the health system.
"They say in spiritual life, good can come out of something bad. And I think a lot of good — if the Department of Health responds to these suggestions," Waters said. "If patients assume the responsibility to be implicated in their care, I think a lot of good can come out of this. I think it's a real grace in an ironic way."
She hopes the recommendations will lead to new resources for the patients affected by those problems. Anne McTiernan-Gamble of the Canadian Cancer Society said her organization is reaching out to patients in Miramichi.
"What happened in the Miramichi we were very concerned about the patients and their families," she said. "In addition we wanted to let them know that we have the cancer information services available to them and support services for them that's only a phone call away.""
Harold Levy...hlevy15@gmail.com;
Sunday, December 14, 2008
THE CREAGHAN REPORT: PART FOUR; WHERE IS THE OUTRAGE?
The Telegraph-Journal quotes Health Minister Mike Murphy as finding the obscene amount of misread biopsies as "shocking",in a story that appeared under the heading "Review Minister releases laboratory's comprehensive assessment of former pathologist's work."
A sub-heading reads: "New Brunswick pathologist Dr. Rajgopal Menon misdiagnosed 101 cancer biopsies, a comprehensive review of his work shows."
"Mike Murphy Health Minister Mike Murphy stood in the provincial legislature Thursday and delivered the most damning evidence the disgraced pathologist has yet received about the quality of his work during his tenure at the Miramichi Regional Hospital and a brief stint at the Edmundston Regional Hospital," the story begins.
"The Ottawa lab that performed the review also found that the findings of 5,286 of the more than 23,700 biopsies, including 100 in Edmundston, for all diseases that Menon examined were partially or completely changed," it continues;
"The Ottawa lab's review raises Menon's diagnosis discrepancy to more than 22 per cent over his entire 13-year Miramichi career. An assessment of a smaller sample by a Prince Edward Island pathologist in 2007 found a discrepancies in 18 per cent of Menon's cases.
"It's shocking, very shocking," Murphy said of the numbers. "It was a difficult statement to read today. The pathologist in question may have properly assessed a cancer, but improperly assessed the stage of the cancer.
"The staging of the cancer is very important for the treating physician to provide the necessary medication."
Conducted by Ottawa-based Gamma-Dynacare Medical Laboratories, the review re-diagnosed procedures or tests that included biopsies and surgical resection specimens.
Blood work and X-rays were not affected, Murphy said.
Murphy said Regional Health Authorities A and B and their physicians have worked to ensure as many patients as possible were informed before the announcement was made.
"However, in some instances, it's been a challenge to contact patients who have moved from the area," he said. "Therefore, any patient with questions should contact their family doctor or referring surgeon."
Murphy said the province's doctors are ensuring their patients with changes to their diagnoses are provided with the proper information, support and treatment if necessary.
Murphy said Thursday the Ottawa lab report shows that 370 of all the tests for various diseases done by Menon, or roughly 1.5 per cent, were misdiagnosed completely.
Dr. Jagdish Butany, president of the Canadian Association of Pathologists, has that while there is no set acceptable number, human error would suggest the 1.5 per cent number is probable. Butany made the comment while appearing earlier this year before the pathology inquiry headed by Justice Paul Creaghan Creaghan that was sparked by concerns of over Menon's misdiagnosis rate.
The health minister also said that his department hopes to respond by mid-February to Creaghan's 52 recommendations, released Wednesday, on how to prevent a similar situation from reoccurring.
Murphy said that some had already been addressed by the Miramichi Regional Hospital, including a quality assurance program.
Others require consultation with key stakeholders such as the College of Physicians and Surgeons of New Brunswick and finances from the department.
"I'm confident that we now have all the information we'll need in our work to ensure that such things never happen again in Miramichi, Edmundston or anywhere else in New Brunswick," Murphy said.
"I can assure the members opposite and all New Brunswickers that the commission's report will be considered extensively in the coming weeks.""
-----------------------------------------------------------------------------------
As usual, the message delivered by the system is trust us...somehow ignoring the fact that we trusted them before...and look what happened.
One reader expressed the outrage many people who have suffered irremediable loss may rightfully feel that their government and health officials have let them down;
Another reader has objected that the comments are inflammatory.
I disagree; They are exceptionally honest and reflect the outrage that this inexcusable number of avoidable errors calls for.
"From what I read, he was the only applicant and nobody bothered to check this credentials???," the angry reader wrote;
"Health officials at all levels are responsible here. A lot of so-called doctors have been hired with questionable background and some disappeared in the night, I remember Bathurst...Dr. Creaghan said Dr. Menon was hired in 1994 and should not have been working in 2005? He was just as incompetent during those years than after 2005! This is third-world country health care."
Harold Levy...hlevy15@gmail.com;
A sub-heading reads: "New Brunswick pathologist Dr. Rajgopal Menon misdiagnosed 101 cancer biopsies, a comprehensive review of his work shows."
"Mike Murphy Health Minister Mike Murphy stood in the provincial legislature Thursday and delivered the most damning evidence the disgraced pathologist has yet received about the quality of his work during his tenure at the Miramichi Regional Hospital and a brief stint at the Edmundston Regional Hospital," the story begins.
"The Ottawa lab that performed the review also found that the findings of 5,286 of the more than 23,700 biopsies, including 100 in Edmundston, for all diseases that Menon examined were partially or completely changed," it continues;
"The Ottawa lab's review raises Menon's diagnosis discrepancy to more than 22 per cent over his entire 13-year Miramichi career. An assessment of a smaller sample by a Prince Edward Island pathologist in 2007 found a discrepancies in 18 per cent of Menon's cases.
"It's shocking, very shocking," Murphy said of the numbers. "It was a difficult statement to read today. The pathologist in question may have properly assessed a cancer, but improperly assessed the stage of the cancer.
"The staging of the cancer is very important for the treating physician to provide the necessary medication."
Conducted by Ottawa-based Gamma-Dynacare Medical Laboratories, the review re-diagnosed procedures or tests that included biopsies and surgical resection specimens.
Blood work and X-rays were not affected, Murphy said.
Murphy said Regional Health Authorities A and B and their physicians have worked to ensure as many patients as possible were informed before the announcement was made.
"However, in some instances, it's been a challenge to contact patients who have moved from the area," he said. "Therefore, any patient with questions should contact their family doctor or referring surgeon."
Murphy said the province's doctors are ensuring their patients with changes to their diagnoses are provided with the proper information, support and treatment if necessary.
Murphy said Thursday the Ottawa lab report shows that 370 of all the tests for various diseases done by Menon, or roughly 1.5 per cent, were misdiagnosed completely.
Dr. Jagdish Butany, president of the Canadian Association of Pathologists, has that while there is no set acceptable number, human error would suggest the 1.5 per cent number is probable. Butany made the comment while appearing earlier this year before the pathology inquiry headed by Justice Paul Creaghan Creaghan that was sparked by concerns of over Menon's misdiagnosis rate.
The health minister also said that his department hopes to respond by mid-February to Creaghan's 52 recommendations, released Wednesday, on how to prevent a similar situation from reoccurring.
Murphy said that some had already been addressed by the Miramichi Regional Hospital, including a quality assurance program.
Others require consultation with key stakeholders such as the College of Physicians and Surgeons of New Brunswick and finances from the department.
"I'm confident that we now have all the information we'll need in our work to ensure that such things never happen again in Miramichi, Edmundston or anywhere else in New Brunswick," Murphy said.
"I can assure the members opposite and all New Brunswickers that the commission's report will be considered extensively in the coming weeks.""
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As usual, the message delivered by the system is trust us...somehow ignoring the fact that we trusted them before...and look what happened.
One reader expressed the outrage many people who have suffered irremediable loss may rightfully feel that their government and health officials have let them down;
Another reader has objected that the comments are inflammatory.
I disagree; They are exceptionally honest and reflect the outrage that this inexcusable number of avoidable errors calls for.
"From what I read, he was the only applicant and nobody bothered to check this credentials???," the angry reader wrote;
"Health officials at all levels are responsible here. A lot of so-called doctors have been hired with questionable background and some disappeared in the night, I remember Bathurst...Dr. Creaghan said Dr. Menon was hired in 1994 and should not have been working in 2005? He was just as incompetent during those years than after 2005! This is third-world country health care."
Harold Levy...hlevy15@gmail.com;
Saturday, December 13, 2008
CREAGHAN REPORT: PART THREE; INDEPENDENT REVIEW REVEALS SERIOUS ERRORS AFFECTING TREATMENT OF PATIENTS;
As the Canadian Press revealed in a story dated Friday, December 12, under the heading, "Review of pathologist's tests reveal different results..."An independent review of 23,000 tests done by a former Miramichi pathologist has found about a quarter of the retested samples show a "complete or partial change" in the results."
"The New Brunswick government revealed the results of the review of the tissue samples on Thursday in its response to an inquiry into the pathology lab at the Miramichi Regional Hospital," the story continued;
"A news release says the independent study showed different results in 5,286 tissue samples.
Of the 370 cases that had a complete change in findings - meaning a complete change in diagnosis - 101 involved cancer.
The remaining 4,916 "partial changes" in results meant the pathologist made some error in the report, ranging from a minor change to something that could affect a patient's treatment.
Meghan Cumby, a spokeswoman for the health minister, said the changes could be minor or "it might involve important data ... that could mean a change in the stage the cancer is at."
"It's information that could have been important to have," she added.
Earlier this week, a public inquiry by Justice Paul Creaghan was released into work done by Dr. Rajgopal Menon, the former chief pathologist at the hospital in northern New Brunswick.
The news release issued by the Health Department on Thursday does not mention Menon by name, but instead refers to a review of the work done by "a former Miramichi pathologist."
The review by Ottawa-based Gamma-Dynacare Medical Laboratories applied to procedures or tests in which tissue was removed from patients.
These included biopsies and surgical resection specimens. Blood work and X-rays were not looked at in the study.
An independent pathologist was also involved in the review of cases, where patients were tested primarily in 2006 and 2007.
Health Minister Michael Murphy said regional health authorities have "worked together to ensure that as many patients as possible were informed of their results before any announcement was made."
"In some instances, however, it has been challenging to contact patients who have moved from the area. I encourage any patient with questions to contact his or her family doctor or referring surgeon."
The public inquiry found Wednesday that Menon should have lost his licence in 2005, two years before he was suspended from working by the College of Physicians and Surgeons of New Brunswick.
"Overall, we found that his service was unsatisfactory in terms of both attention to his duties and to the level of his performance," Creaghan wrote in his three-volume report.
Menon, who is now in his 70s, told reporters on Wednesday that his work was not as flawed as the inquiry was told and he questioned the way the hospital was managed.
"My rate of errors are much less than what you've seen in the (inquiry) report," he said.
Menon's lawyer, Rod Gillis, could not be reached for comment on Thursday.
In his report, the retired judge also pinpointed a litany of systemic problems within New Brunswick's health care system and found that the Health Department had no idea whether pathology labs in the province were operating at acceptable levels of quality.
He said there has been no program of quality control in the pathology lab at the Miramichi Regional Hospital since 1994.
Menon worked at the Miramichi hospital from 1995 until early 2007, when his licence was suspended following complaints about incomplete diagnoses and delayed lab results.
It has since been reinstated but Menon must complete remedial training before he can return to the laboratory.
An audit of Menon's work earlier this year found 18 per cent of 227 breast and prostate cancer reports were incomplete and six per cent were incorrect.
Murphy said the government will reveal its full response to the inquiry report by mid-February, but "the hospital has already implemented some recommendations to ensure the integrity of its specimen analysis."
But he said some of the 52 recommendations will require consultations, while "others have significant financial implications for the province and must be carefully considered." "
Harold Levy...hlevy15@gmail.com;
"The New Brunswick government revealed the results of the review of the tissue samples on Thursday in its response to an inquiry into the pathology lab at the Miramichi Regional Hospital," the story continued;
"A news release says the independent study showed different results in 5,286 tissue samples.
Of the 370 cases that had a complete change in findings - meaning a complete change in diagnosis - 101 involved cancer.
The remaining 4,916 "partial changes" in results meant the pathologist made some error in the report, ranging from a minor change to something that could affect a patient's treatment.
Meghan Cumby, a spokeswoman for the health minister, said the changes could be minor or "it might involve important data ... that could mean a change in the stage the cancer is at."
"It's information that could have been important to have," she added.
Earlier this week, a public inquiry by Justice Paul Creaghan was released into work done by Dr. Rajgopal Menon, the former chief pathologist at the hospital in northern New Brunswick.
The news release issued by the Health Department on Thursday does not mention Menon by name, but instead refers to a review of the work done by "a former Miramichi pathologist."
The review by Ottawa-based Gamma-Dynacare Medical Laboratories applied to procedures or tests in which tissue was removed from patients.
These included biopsies and surgical resection specimens. Blood work and X-rays were not looked at in the study.
An independent pathologist was also involved in the review of cases, where patients were tested primarily in 2006 and 2007.
Health Minister Michael Murphy said regional health authorities have "worked together to ensure that as many patients as possible were informed of their results before any announcement was made."
"In some instances, however, it has been challenging to contact patients who have moved from the area. I encourage any patient with questions to contact his or her family doctor or referring surgeon."
The public inquiry found Wednesday that Menon should have lost his licence in 2005, two years before he was suspended from working by the College of Physicians and Surgeons of New Brunswick.
"Overall, we found that his service was unsatisfactory in terms of both attention to his duties and to the level of his performance," Creaghan wrote in his three-volume report.
Menon, who is now in his 70s, told reporters on Wednesday that his work was not as flawed as the inquiry was told and he questioned the way the hospital was managed.
"My rate of errors are much less than what you've seen in the (inquiry) report," he said.
Menon's lawyer, Rod Gillis, could not be reached for comment on Thursday.
In his report, the retired judge also pinpointed a litany of systemic problems within New Brunswick's health care system and found that the Health Department had no idea whether pathology labs in the province were operating at acceptable levels of quality.
He said there has been no program of quality control in the pathology lab at the Miramichi Regional Hospital since 1994.
Menon worked at the Miramichi hospital from 1995 until early 2007, when his licence was suspended following complaints about incomplete diagnoses and delayed lab results.
It has since been reinstated but Menon must complete remedial training before he can return to the laboratory.
An audit of Menon's work earlier this year found 18 per cent of 227 breast and prostate cancer reports were incomplete and six per cent were incorrect.
Murphy said the government will reveal its full response to the inquiry report by mid-February, but "the hospital has already implemented some recommendations to ensure the integrity of its specimen analysis."
But he said some of the 52 recommendations will require consultations, while "others have significant financial implications for the province and must be carefully considered." "
Harold Levy...hlevy15@gmail.com;
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