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newsmakers fPediatric BY GLENN KAUTH collecting the proverbial dust on the shelf, Goudge's work saw the government move into action. When he recommended the government review more than 140 cases of shaken-baby syndrome to see if they held up to current science, for example, the govern- ment announced it would go ahead with a probe of what it estimated were 220 cases. In his report, Goudge was harshly critical 'Throughout the 1990s, coroners, police officers, and Crown counsel brought a litany of concerns about Dr. [Charles] Smith's work practices to the attention of the (chief coroner's office),' wrote Justice Stephen Goudge. J ust weeks after he called on the govern- ment to alter laws governing forensic pathology in Ontario, Court of Appeal Justice Stephen Goudge saw results. Responding to Goudge's inquiry into the province's pediatric forensic pathology system, including the work of disgraced pathologist Dr. Charles Smith, the gov- ernment announced it would introduce legislation governing Ontario's coroners system. The changes include the formation of a death investigation oversight council comprised of experts from the medical, legal, and public sectors to keep an eye on the work of the chief coroner and the chief forensic pathologist. That was exactly one of the key measures Goudge called for in his report released Oct. 1. In fact, while many inquiry reports end up 6 December 2008 of Ontario's record on child forensic pathol- ogy, not only of Smith's work but also the actions of the two people who headed up the Office of the Chief Coroner for Ontario, former chief coroner Dr. James Young and Dr. James Cairns, then the province's deputy chief coroner. Both, he noted, failed to pro- vide proper oversight of Smith, who became Ontario's top pediatric forensic pathologist during his time at the Hospital for Sick Chil- dren between 1981 and 2005. "Throughout the 1990s, coroners, police officers, and Crown counsel brought a litany of concerns about Dr. Smith's work practices to the attention of the (chief coroner's office)," Goudge wrote. "People complained repeatedly about Dr. Smith's failure to produce reports in a timely fash- ion; his unresponsiveness; his carelessness; and the inconsistencies between his writ- ten reports, his pre-trial comments, and his sworn evidence. In many instances, nothing was done to respond to these concerns." The consequences of Smith's mistakes were, of course, tragic. A review found he made questionable conclusions in 20 of 45 child-death cases. In 12 of those cases, the courts found those accused, many of them family members of the deceased, guilty. In one of the more notorious instances, Smith insisted a girl's death was due to stab wounds, a conclusion that led to charges against her mother. He maintained that finding despite subsequent conclusions from numerous other experts that she died of a dog attack. "I've seen dog wounds, I've seen coyote wounds, I've seen wolf wounds," Smith testified during the case. "I recently went to an archipelago of islands owned by another country up near the North Pole and had occasion to study osteology and look at pat- terns of wounding from polar bears." For Goudge, Smith's words were evidence Smith was trying to overstate his expertise. "His attempt to so exaggerate his abilities disguised his lack of relevant expertise," the judge wrote, adding Smith was also prone to arrogant criticism of other experts, had a tendency to speculate on the witness stand, and would even resort to the language of betting to back up his testimony. Nevertheless, the government has yet to move on many of Goudge's 169 recommen- dations. Not all of them involve legislative changes, of course, and many of them would cost money. For example, he urged the government to fund fellowships in forensic pathology and increase the number of regional forensic pathology positions in order to address the shortage of qualified professionals. He also called for more legal aid funding so lawyers can better defend the accused in child deaths, including money to hire their own defence experts. "For their part, defence counsel must remain fully conscious of their ethical duty of competence and not take on a criminal pediatric homicide or similar case beyond their competence or skills," Goudge wrote. "Legal Aid Ontario also has an important role to play in providing remuneration levels sufficient to ensure that only experi- enced and competent counsel take on these serious criminal matters." Also left open is the question of com- pensation. While the government has said it is acting on Goudge's recommendation to examine ways to compensate the victims of Smith's work, it's unclear exactly what will happen. Already, one of the victims, William Mullins-Johnson, has launched a $13-million lawsuit against Smith, Young, and Cairns. gets scathing review Goudge sees results within a matter of weeks of calling for change orensic pathology system