Smith’s bosses face investigation

RICHARD LAUTENS/TORONTO STAR

Justine Trayner, left, and mother Brenda Waudby wait for Justice Stephen Goudge’s report. Waudby was wrongly charged with the murder of her 21-month-old daughter. (Oct. 1, 2008)

Oct 02, 2008 04:30 AM

Theresa Boyle
Staff Reporter

The College of Physicians and Surgeons of Ontario has launched an investigation into Ontario’s former chief coroner and his deputy.

Drs. James Young and Jim Cairns yesterday came under stinging criticism by the Goudge Commission for their “lax” oversight of a pediatric pathologist whose litany of errors led to a series of wrongful murder charges and convictions.

Asked yesterday if the investigation into Young and Cairns was being undertaken because of failures on their part exposed by the commission, college spokesperson Kathryn Clarke responded: “I can only confirm that they are the subject of an investigation.”

The college investigates allegations of professional misconduct and incompetence. If cases go to a disciplinary committee, penalties can range from a reprimand to a licence revocation.

The college is also investigating Smith for professional misconduct, but because he no longer practises in Ontario, penalties – if imposed – would be limited to a fine.

Confidentiality rules normally prohibit the college from revealing details of a probe, or even if one is underway. But the college was able to confirm the investigation into Young, Cairns and Smith because of a exception to the confidentiality rule that applies when there is a “compelling public interest.”

Justice Stephen Goudge, who headed the Public Inquiry into Pediatric Forensic Pathology in Ontario, which began in April last year, yesterday released his final report.

In it, he had harsh words for Smith and his two superiors.

Goudge detailed a legion of Smith’s shortcomings, including a lack of basic knowledge about forensic pathology, providing speculative and erroneous opinions in court, making false and misleading statements in court, exaggerating his expertise and being sloppy, tardy, arrogant and dogmatic.

“Dr. Smith was adamant that his failings were never intentional. I simply cannot accept such a sweeping attempt to escape moral responsibility,” Goudge wrote in his 675-page report.

The commissioner took particular aim at Smith’s bosses, not just for failing to rein him in, but also for propping him up and protecting him. “The story of failed oversight in Dr. Smith’s years is in large part the story of Dr. Young’s and Dr. Cairn’s failures and of the context in which that happened – the completely inadequate mechanisms for oversight and accountability.”

The commissioner noted that Young sent a letter to the college in April 2002, defending Smith in response to a number of complaints that had been lodged against him. The letter, curiously penned by Smith’s lawyer, was sent to the college, even though Young was aware at the time that serious questions had been raised about the pathologist’s ethics and judgment.

“Dr. Young’s letter misled the CPSO,” Goudge wrote.

“Dr. Young told the inquiry that he sent this letter in an attempt to be fair to Dr. Smith. He did so, however, at a cost to the public interest … The letter was not balanced or objective or candid. It was not a letter worthy of a senior public office holder in Ontario,” Goudge stated.

Later that year, Cairns sent a letter to the college, defending Smith’s work on another case. “In so doing, Dr. Cairns exceeded his expertise, the effect of which was to shield Dr,. Smith’s opinion from further scrutiny,” Goudge said.

It wasn’t until 14 years after the first warning signal had been sounded and a new chief coroner was appointed to replace Young that the province acted to effectively curb Smith, the report noted.

 

Winnipeg Hospital Making Changes to ER Following Death of Homeless Man

WINNIPEG — A Winnipeg hospital is hiring round-the-clock staff to meet incoming emergency patients and give them green wristbands so that nurses know who still needs attention.

The move is intended to prevent another death like that of a homeless man at the Health Sciences Centre last week. Brian Sinclair, 45, waited in emergency for 34 hours without being helped and died, unnoticed, of a bladder infection.

Sinclair’s death has highlighted a serious flaw in all hospitals across the country, Brock Wright of the Winnipeg Regional Health Authority said Monday. Emergency rooms rely on patients, paramedics or family members to approach triage nurses to get care.

Sinclair was never registered with a nurse and was not examined until he had been dead for several hours.

“Something like this hasn’t happened before where we’ve had a patient waiting a long period of time in the emergency department without us knowing that the patient was there, waiting for care. Clearly that is not the fault of the patient,” said Wright, the health authority’s chief medical officer.

“Now that we know this is a vulnerability in our system, we have to take whatever steps are necessary to fix it.”

The health authority’s downtown hospital is adding the equivalent of 10 positions to ensure someone talks to all incoming patients. More staff, with training in social work, will also be added to regularly check on people in the waiting room, Wright said.

“With the changes that we’re talking about, the situation like the one that Mr. Sinclair experienced will not happen again. That’s our goal.”

The hospital is no closer to understanding how Sinclair sat waiting so long without care, he said. Wright suggested Sinclair’s difficulty communicating may have contributed to what happened, but that will ultimately be answered in an upcoming inquest.

Manitoba’s chief medical examiner has said the man’s death was entirely preventable and has called an inquest. The examiner said Sinclair’s bladder infection probably could have been treated by changing his catheter and prescribing antibiotics.

The health authority is conducting an internal review and will make any other changes it feels are necessary, Wright said.

Also on Monday, opposition politicians kept up pressure on the government to bring in an outside expert to examine Manitoba’s emergency departments.

Health Minister Theresa Oswald said there have been more than 50 “critical incidents” at the province’s hospitals since reporting unusual deaths or injuries became mandatory in 2006.

“We might take into account that about 200,000 people visited ERs during that time,” Oswald told the legislature.

Premier Gary Doer said the province has spent millions to follow recommendations of an earlier emergency room task force, including one for nurses to keep tabs on patients waiting in emergency.

“We’re not questioning his ability to spend money,” said Conservative Leader Hugh McFadyen. “What we are questioning is their management of the health-care system.”

 

Despite ‘unacceptable’ practices, doctor avoids serious allegations

KATE HAMMER

September 30, 2008

GO HERE

The most serious allegations against a family doctor accused of endangering his patients by performing cosmetic surgery without proper training were dropped yesterday as he pleaded no contest to lesser allegations and the College of Physicians and Surgeons of Ontario restricted him from performing most surgical procedures.

Jimmy Poon, a Toronto-area family physician, performed invasive procedures including liposuction, breast augmentation and vaginoplasty without formal surgical training, until a patient complaint launched a college investigation. He will be allowed to continue his family practice, but will be subjected to unannounced inspections and required to take a physician review course.

The decision was based upon a joint submission from Dr. Poon’s lawyer and the lawyer for the college, and approved by a disciplinary panel consisting of three doctors and two members of the public.

It comes more than a year after the death of Krista Stryland, a 32-year-old real-estate agent who died shortly after a liposuction procedure performed by another general practitioner. That renewed pressure on the college and the province to more effectively police cosmetic surgical procedures not covered by OHIP.

Piecemeal regulation changes were recently proposed by the college to Queen’s Park, but have yet to take effect. As the first disciplinary hearing relating to cosmetic surgery, Dr. Poon’s case has set a precedent.

Despite evidence that Dr. Poon “fell below the standard of practise in his performance of cosmetic procedures, his administering of anesthesia for cosmetic surgical procedures and in his charting, there’s no evidence of misconduct or standards issues in relation to his family practice,” college lawyer Lisa Spiegel said.

Dr. Poon’s lawyer, David Leonard, who appeared at the hearing on his client’s behalf, pleaded no contest to allegations that Dr. Poon failed to maintain the standard of practice of the profession.

“They’ve struck an appropriate balance in terms of what the college is concerned about with Dr. Poon’s practice, addressing the public’s concern and allowing him to carry on the rest of his practice, where there were no concerns expressed,” Mr. Leonard said.

In three separate reviews of Dr. Poon’s patient charts submitted to the college’s discipline committee, experts found evidence of “unsafe” and “unacceptable” practices. These included the discharge of patients minutes after eight- and 10-hour-long procedures, administering nearly double the recommended safe dose of local anesthetic and performing numerous complex procedures at once on a single patient.

“Dr. Poon’s care displays a woeful lack of knowledge and judgment,” wrote one of the reviewers, Peter Neligan, chief of plastic surgery at the University Health Network.

Allegations that Dr. Poon “breached a term, condition and limitation on his certificate of registration,” that he “engaged in disgraceful, dishonourable or unprofessional conduct,” and that he is “incompetent,” were dropped.

 

DARK DAYS RETURN: HSC death not a single case of human error

By TOM BRODBECK

What does it say about a health-care system that allows people to die in hospital emergency rooms awaiting care?

It’s about the saddest commentary you can get in health care, considering ERs are often the last stop for patients seeking emergency medical attention.

Even in the so-called dark days of the 1990s, when hospital budgets were cut and federal transfer payments were reduced, we didn’t see people dying in ERs waiting for patient care.

We saw people waiting hours for care, laying on gurneys in crowded ER hallways for days at a time and people waiting months for various forms of treatment in the 1990s.

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