LA STORIA DEL DR SMITH

CRIME
Pathology
Dr. Charles Smith: The man behind the public inquiry
Last Updated: Monday, December 7, 2009 | 1:38 PM ET Comments0Recommend4
CBC News
Dr. Charles Smith was long regarded as one of Canada's best in forensic child pathology. A public inquiry was called after an Ontario coroner's inquiry questioned Smith's conclusions in 20 of 45 child autopsies. (Frank Gunn/Canadian Press)On a typical case, he might have to decide whether a child had been shaken to death or accidentally fallen from a highchair.

Dr. Charles Smith was once considered top-notch in his field of forensic child pathology. In 1999, a Fifth Estate documentary singled him out as one of four Canadians with this rare expertise.

For 24 years, Smith worked at Toronto's Hospital for Sick Children. In the hospital's pediatric forensic pathology unit, he conducted more than 1,000 child autopsies.

But Smith no longer practises pathology. An Ontario coroner's inquiry reviewed 45 child autopsies in which Smith had concluded the cause of death was either homicide or criminally suspicious.

The coroner's review found that Smith made questionable conclusions of foul play in 20 of the cases — 13 of which had resulted in criminal convictions. After the review's findings were made public in April 2007, Ontario's government ordered a public inquiry into the doctor's practices.

That inquiry, led by Justice Stephen Goudge and concluding in October 2008, found that Smith "actively misled" his superiors, "made false and misleading statements" in court and exaggerated his expertise in trials.

'Smith was adamant that his failings were never intentional. I simply cannot accept such a sweeping attempt to escape moral responsibility.'
—Justice Stephen Goudge
Far from an expert in forensic child pathology, "Smith lacked basic knowledge about forensic pathology," wrote Goudge in the inquiry report.

"Smith was adamant that his failings were never intentional," Goudge wrote. "I simply cannot accept such a sweeping attempt to escape moral responsibility."

Acted more like a prosecutor

Some have accused Smith of taking on a role larger than pathologist. The lawyer for Brenda Waudby said he was on a crusade and acted more like a prosecutor. Waudby was convicted in the murder of her daughter after Smith analyzed the case.

Brenda Waudby was wrongly accused of killing her 21-month-old daughter Jenna in 1997. (Frank Gunn/Canadian Press)A pubic-like hair found on her daughter went missing during Smith's investigation. It was discovered he had kept the hair in his office before police found it five years later. In the end, Waudby's charges were dropped and the child's babysitter was convicted.

Smith said he had a passion for uncovering the truth in child deaths. The Ontario pathologist told media lampooning him he had "a thing against people who hurt children." He welled up when speaking about a mother looking for the cause of her baby's death.

Smith had been in search of his own personal truths. He was born in a Toronto Salvation Army hospital where he was put up for adoption three months later. After years of looking for his biological mother, he called her on her 65th birthday. But she refused to take his call.

Smith's adoptive family moved often. His father's job in the Canadian Forces took them throughout Canada and to Germany. He attended high school in Ottawa, and graduated from medical school at the University of Saskatchewan in 1975.

Sick Kids tenure

Hired by Toronto's Hospital for Sick Children in 1979, Smith worked in surgery for a year and then moved on to pathology training. A pathologist studies diseases and illnesses by assessing matter such as cells, tissues, organs and fluids. Pathologists also examine biopsy material, and give a subsequent diagnosis.

When it comes to autopsy reports, the field of pathology can be a subjective one. It's based on research and opinion, and it's especially controversial in Canada, where there is no formal training or certification process. Only a handful of practitioners in Ontario are entrusted with the job — and they've learned by doing.

With child victims, forensic analysis is rarely cut and dried. It can take an infant up to 24 hours to die of a shaking incident, which is a crime that doesn't leave evidence the way a regular killing might.

After his initial training at Sick Kids, as the Toronto hospital is known, Smith began conducting child autopsies in 1981. He started with children who had died of accidental and natural causes. By the late '90s, Smith saw more forensic child cases than any other pathologist across the country.

Smith's unit used arrest warrants to reinvestigate cases of sudden infant death syndrome (SIDS). He oversaw the autopsies of exhumed babies that led to new murder charges.

In one such case, Smith appeared before a court in the death of six-month-old Sara Podniewicz. He concluded she had been dead for up to 15 hours before her parents reported the death. The parents had told a 911 operator the girl had died just moments before. Smith's analysis led to second-degree murder charges.

In December 2009, Sherry Sherrett-Robinson was acquitted of killing her son whom Smith had concluded died of asphyxia a decade earlier. Smith suggested Sherrett-Robinson's son, Joshua, suffered a skull fracture and neck hemorrhages. Ontario's chief forensic pathologist, Dr. Michael Pollanen, however, told the Ontario Court of Appeal that he did not find a skull fructure and noted the neck hemorrhages were caused during the autopsy process.

First doubts

In 1991, a family in Timmins, Ont., was the first to raise questions about Smith's work. He had concluded their one-year-old baby had died from being shaken. The child had been under the care of a babysitter who said the baby had fallen down stairs.

In court, experts challenged Smith's opinion, which had resulted in the babysitter's charge of manslaughter. The judge in the case stated Smith should have taken other causes into consideration.

Once the most prolific pathologist, Smith began getting a reputation for late cases, and his disorderly desk produced samples that had gone missing.

In 2002, he received a caution from the Ontario College of Physicians and Surgeons. The college said he was being "overly dogmatic" and had a "tendency towards overstatement."

In June 2005, Dr. Barry McLellan, Ontario's chief coroner, started the review of 45 child autopsies conducted by Smith between 1991 and 2002. The review, released in April 2007, found that Smith had made mistakes in 20 cases involving the deaths of children. The review cast doubt on criminal convictions in 13 of the cases.

"I am very surprised with the overall results of the review, and concerned," McLellan said. "In a number of cases, the reviewers felt that Dr. Smith had provided an opinion regarding the cause of death that was not reasonably supported by the materials available for review."

The chief coroner said the results of the review were being shared with defence and Crown attorneys involved in all of the relevant criminal cases.

After resigning from Sick Kids in 2005, Smith accepted a pathology position in Saskatoon. He was fired after three months. A tribunal later reinstated him, but without a licence, Smith was unable to practise.

Smith told media his marriage ended in light of stress from the highly publicized events. He had lived with his wife and two children on a farm north of Newmarket, Ont.

As a member of the Christian and Missionary Alliance, Smith says he has been fuelled by his life's purpose — finding out the truth for parents who have lost babies. (da CBC News Canada)

SCATOLA NERA

giovedì 09 aprile 2009, 07:00
Nelle sale operatorie degli ospedali laziali arriva la scatola nera
di Giuseppe Taccini
ilGiornale.it
Camici bianchi, niente paura. L’introduzione della scatola nera in sala operatoria, in discussione al Consiglio regionale del Lazio, è quanto di più lontano dall’essere una sorta di «grande fratello» che controlla l’operato dei chirurghi.
Piuttosto si tratta di «un supporto utile al lavoro dell’équipe medica» e «un mezzo per evitare errori e rischi». Parola del consigliere del Pdl, Erder Mazzocchi, firmatario unico della proposta di legge regionale numero 475 del 30 marzo 2009.
Quali cambiamenti andranno a rivoluzionare i meccanismi operatori di tutte le strutture sanitarie del Lazio se la Pisana dovesse dare il via libera al provvedimento? Presto detto. «La medicina non è una scienza esatta e c’è sempre un margine di errore insopprimibile, legato all’essere umano, l’importante è capire perché si è sbagliato ed evitare che quell’errore si ripeta» è la premessa di Mazzocchi.
Veniamo ora alle funzioni del nuovo strumento. «Con la scatola nera sarà possibile effettuare un’analisi dettagliata su eventi avversi o inattesi intra-operatori e un’analisi a posteriori - si legge nella proposta - tramite una comparazione degli interventi omogenei, per quanto concerne il presentarsi di eventi avversi, per poter scegliere le strategie anestesiologiche e chirurgiche più adeguate al caso».
Il nuovo apparecchio, che effettuerà videoregistrazioni sincronizzate degli atti dell’èquipe chirurgica e dei parametri vitali del paziente solo con telecamere ambientali a tutela della privacy, avrà soprattutto finalità scientifiche e didattiche, permettendo quindi il controllo qualità sul quadro clinico.
Ma non solo. Servirà anche a valutare eventi di danno sospetto, previo provvedimento dell’autorità giudiziaria. Negli ultimi anni parenti e ammalati si rivolgono sempre più spesso a studi legali o associazioni che si occupano di malasanità per gridare la propria rabbia per veri o presunti danni medici subiti. Il filmato completo, che permette di controllare ciò che fa il chirurgo e contemporaneamente ciò che accade nel corpo del paziente, direbbe la verità anche in tal caso.
«La scatola nera da un lato rappresenterebbe una sicurezza per il paziente poiché l’intervento sarebbe completamente monitorato - spiega il consigliere regionale del Pdl -. Dall’altro servirebbe a evitare richieste di risarcimento danni nei confronti delle strutture sanitarie in caso di denunce senza fondato motivo».
I medici, ove chiamati in giudizio per risarcire i danni patiti dal paziente, devono poter contare su un’adeguata difesa medico-legale per dimostrare al giudice l’impossibilità di prevenire l’evento dannoso. In questi casi, questa nuova strategia potrebbe risultare una soluzione decisiva nella controversia.
Lo strumento sarà gestito esclusivamente da personale autorizzato, individuato da un’apposita commissione tecnica nominata dalla giunta regionale. I file verranno conservati in un server di ciascuna azienda sanitaria locale di competenza, mentre i dati registrati dal sistema saranno raccolti in un archivio informatico su cui vigilerà il direttore sanitario.
«L'introduzione di questa innovazione, pur gravando sul bilancio regionale in modo non lieve, deve essere vista non come una semplice spesa ma come un investimento» conclude Mazzocchi. La cosa che a questo punto ci si domanda è se per ottenere una copia della registrazione in caso di necessità, il paziente debba attendere mesi e mesi come spesso avviene in alcune strutture sanitarie quando si richiede una cartella clinica.

SCIENZE FORENSI

Vai a www.freewebs.com/gvgiusti e trovi nella home l'indicazione di un sito, evidenziato in giallo, che ti consente la lettura gratuita e integrale di un volume dedicato allo stato delle scienze forensi negli USA. L'Autore, un notissimo scienziato forense, giunge alla conclusione che è necessario migliorare molto la preparazione degli scienziati forensi, per evitare errori, per esempio condannare gli innocenti o lasciar libero un colpevole. Se ciò è vero per gli USA, temo che a maggior ragione sia vero da noi, dove le scienze forensi sono in pratica monopolio di Carabinieri e Polizia.
Nulla dice il libro sulla patologia forense o la medicina legale. Eventi recenti in Gran Bretagna e negli Stati Uniti non consentono valutazioni ottimistiche. Per l'Italia, la diretta esperienza acquisita mostra situazioni abbastanza simili, tali da suggerire la necessità di una migliore preparazione, e un invito alla prof. Rossana Cecchi di proporre più frequenti seminari dei patologi forensi. Il mio personale punto di vista è di abolire le scuole di specializzazione, che tanto servono a ben poco, e di cercare di immaginare una scuola nazionale di medicina legale. Io ci penso. Pensateci anche voi.