Inquiry into Pediatric Forensic Pathology in Ontario
January 10, 2008



Cross-examination of Dr. Katy Driver, Dr. Dirk Huyer and Dr. Michelle Shouldice, Hospital for Sick Children SCAN Team, by Suzan Fraser, counsel for Defence for Children International-Canada.

The following is an excerpt from the transcript of the Inquiry into Pediatric Forensic Pathology in Ontario. For the official transcript, or for more information about the Inquiry, visit the Inquiry web site: http://www.goudgeinquiry.ca.


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1
2
3 THE INQUIRY INTO PEDIATRIC FORENSIC
4 PATHOLOGY IN ONTARIO
5
6
7
8 ********************
9
10
11 BEFORE: THE HONOURABLE JUSTICE STEPHEN GOUDGE,
12 COMMISSIONER
13
14
15
16 Held at:
17 Offices of the Inquiry
18 180 Dundas Street West, 22nd Floor
19 Toronto, Ontario
20
21
22 ********************
23
24 January 10th, 2008
25

                            . . . . .

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5 CROSS-EXAMINATION BY MS. SUZAN FRASER:
6 MS. SUZAN FRASER: Thank you, Mr.
7 Commissioner. Good afternoon.
8 Good afternoon, Doctors. My name is Sue
9 Fraser, and I'm here on behalf of an organization called
10 Defence for Children International, which is an
11 international charity grassroots organization based in
12 Geneva, whose aims are to promote and protect the rights
13 of the children, as set out in the UN Convention,
14 including their freedom -- their right to be free from
15 violence, and including their right to -- to their
16 identity.
17 So I just have a few questions for you
18 today, and my time is limited, so to the extent that
19 you're able to answer in a yes or no fashion, that would
20 be of great assistance to me, but if you can't, I
21 understand that as well.
22 And I'll -- I'll frame my questions just
23 sort of -- because Dr. Shouldice, you're there now, the
24 Director, part of what you do, I understand, relates to
25 injury interpretation, but I understand that there's


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1 another aspect of child maltreatment, where the injuries
2 might not actually be obvious. Where there's an illness,
3 and it's suspected that the illness is due to
4 maltreatment.
5 Am I correct?
6 DR. MICHELLE SHOULDICE: Hm, I'm trying
7 to think of a scenario that might fall into that
8 category, and I honestly can't think of one (1) off the
9 top of my head.
10 MS. SUZAN FRASER: Okay. So is it fair
11 to say that primarily the SCAN team is called in when
12 there's an injury interpretation question?
13 DR. MICHELLE SHOULDICE: No, not
14 necessarily. That would one (1) piece of what we would
15 do.
16 MS. SUZAN FRASER: Okay.
17 DR. MICHELLE SHOULDICE: From a physician
18 point of view, we could be involved in any type of
19 concern of physical abuse. Also concerns of neglect.
20 MS. SUZAN FRASER: Yes.
21 DR. MICHELLE SHOULDICE: Also concerns
22 where there may be concerns that parent's non-adherence
23 to medical recommendations may place a child at risk of
24 harm; what we call -- what we term "medical neglect."
25 MS. SUZAN FRASER: All right. So the


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1 treatment team is rema -- recommending a particular
2 course of treatment that -- that they think will be --
3 will improve the child's health. The parents as the con
4 -- as being in a position to give consent have declined
5 that treatment, and there's a concern that that is not in
6 the best inference --interest of the child.
7 Is that the type of example that you're
8 thinking of?
9 DR. MICHELLE SHOULDICE: That is the type
10 of example.
11 MS. SUZAN FRASER: Okay. So in those
12 circumstances, you would be called to give an opinion, or
13 you're called in terms of a resource to the treatment
14 team as to what to do in those circumstances?
15 DR. MICHELLE SHOULDICE: More the latter.
16 A resource to the treatment team in terms of what to do,
17 and when a threshold has been reached that would require
18 reporting to the Children's Aid Society.
19 MS. SUZAN FRASER: All right. So what my
20 understanding is, is that part of your expertise is in
21 determining the -- where the medical meets the legal in
22 terms of what triggers a report to the Children's Aid
23 Society.
24 Is that fair?
25 DR. MICHELLE SHOULDICE: That would be


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1 frequently what we're asked to provide advice on, yes.
2 MS. SUZAN FRASER: Okay. And then in
3 those circumstances where the team determines that a
4 contact to the Children's Aid Society must be made, do
5 you take over carriage, for lack of a better word, of the
6 contact with the Children's Aid Society?
7 DR. MICHELLE SHOULDICE: That varies --
8 MS. SUZAN FRASER: Okay.
9 DR. MICHELLE SHOULDICE: -- depending on
10 our degree of involvement with the case.
11 MS. SUZAN FRASER: All right. So in some
12 circumstances, you might become the primary contact and
13 liaison with the Children's Aid Society?
14 DR. MICHELLE SHOULDICE: In some
15 circumstances, yes.
16 MS. SUZAN FRASER: All right. And in
17 some circumstances, that might remain with the treatment
18 team?
19 DR. MICHELLE SHOULDICE: That's correct.
20 MS. SUZAN FRASER: Okay. And does that
21 determination made based on the individual treatment
22 team's comfort with -- can the treatment team choose to
23 have you do that, and say, you know, I'm not comfortable?
24 I'm just trying to get a sense of the dynamic.
25 DR. MICHELLE SHOULDICE: It would be more


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1 who has the most direct knowledge of the primary area of
2 concern.
3 MS. SUZAN FRASER: All right.
4 DR. MICHELLE SHOULDICE: So, for example,
5 if it's a social worker that has a concern based on some
6 psychosocial information, then we would encourage that it
7 be that person that makes the referral.
8 MS. SUZAN FRASER: I see. And you would
9 facilitate that, I take it, in terms of how that's to be
10 done and -- and what steps to be taken?
11 DR. MICHELLE SHOULDICE: Perhaps to some
12 extent sometimes just providing the advice that a
13 referral needs to be made and who best to contact.
14 MS. SUZAN FRASER: I see. And then in
15 terms of the -- sorry, going back to the example of
16 neglect, if there's a case where there is determined some
17 sort of neglect, is there a treatment aspect to that, as
18 well as the referral?
19 Is there a way that you assist in -- in
20 treating children who may be subject to neglect by their
21 -- by their caregivers?
22 DR. MICHELLE SHOULDICE: So our
23 psychologist would ha -- does provide some treatment
24 services most in the area of where children have
25 experienced trauma.


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1 MS. SUZAN FRASER: Yes.
2 DR. MICHELLE SHOULDICE: And so in some
3 cases of neglect that trauma experience is maybe a part
4 of that and she may become involved in a family in a
5 treat -- treatment capacity in that type of a case.
6 MS. SUZAN FRASER: All right. And I -- I
7 take it, then, that the SCAN Team can provide services,
8 whether or not there is a referral to a Children's Aid
9 Society. You might continue to be involved in the
10 treatment of a particular patient whether or not there's
11 a referral to the Children's Aid Society.
12 DR. MICHELLE SHOULDICE: Yes, an example
13 would be -- again, our psychologist provides services to
14 families where a child has certain types of sexual
15 behaviours which may actually be not at the level to
16 raise concern or not of a cause to raise concern of
17 sexual abuse, necessarily.
18 And the CAS may be currently involved, may
19 not be currently involved, may have been involved in the
20 past and she may provide treatment services in that type
21 of a circumstance.
22 MS. SUZAN FRASER: All right. And in the
23 cases where you do sort of become the primary liaison or
24 contact with Children's Aid Society, then you become the
25 person who actually gives evidence in Court.


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1 Is that fair?
2 DR. MICHELLE SHOULDICE: Or probably one
3 (1) of the people.
4 MS. SUZAN FRASER: All right. And in
5 your experience it's not just the SCAN person who comes
6 where there's a question of abuse, there are other
7 physicians who might attend or are required to attend?
8 DR. MICHELLE SHOULDICE: In Court?
9 MS. SUZAN FRASER: Yes.
10 DR. MICHELLE SHOULDICE: I would say
11 typically there -- there is more than just the SCAN
12 physician that would attend, particularly in the types of
13 complex cases we've been discussing here.
14 MS. SUZAN FRASER: All right.
15 DR. DIRK HUYER: Although that -- that
16 has changed over the years. Probably, in my early years
17 and certainly from many years of my practice, I would be
18 the primary person who would attend, and the other
19 physicians would not attend and I would provide the
20 opinions that they had provided to me in testimony.
21 That changed over the late '90's to the
22 fact that more inclusive to involving more physicians to
23 get there opinion. So it was almost the consensus report
24 that I had written and then -- signed only by me, but
25 taking that information. And so that's changed now that


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1 other physicians would now more -- much more frequently
2 be contacted and attend.
3 MS. SUZAN FRASER: And -- and I'm just --
4 I'm standing here thinking about the -- the challenge
5 that a lawyer would be faced and somebody coming with the
6 reputation of the -- on behalf of all of the Hospital for
7 Sick Children's physicians in providing that sort of
8 consensus, that would be something -- if somebody wanted
9 to challenge that report, that might be a difficult for -
10 - thing for them to do.
11 DR. DIRK HUYER: It could be.
12 MS. SUZAN FRASER: All right. Just on a
13 final note, Dr. Shouldice, when you give evidence in
14 Court in a child protection proceeding do you get paid
15 for your services by whoever calls you as a witness?
16 DR. MICHELLE SHOULDICE: In a child
17 protection proceeding --
18 MS. SUZAN FRASER: Yes.
19 DR. MICHELLE SHOULDICE: -- in Family
20 Court?
21 MS. SUZAN FRASER: Yes.
22 DR. MICHELLE SHOULDICE: So we charge
23 expert witness fees if we testify as an expert in Court.
24 MS. SUZAN FRASER: Yes.
25 DR. MICHELLE SHOULDICE: I personally


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1 don't get that money --
2 MS. SUZAN FRASER: Okay.
3 DR. MICHELLE SHOULDICE: -- because my
4 testimony would be provided on -- during the daytimes
5 when I am employed by the hospital --
6 MS. SUZAN FRASER: Yes.
7 DR. MICHELLE SHOULDICE: -- and the
8 hospital pays me a salary.
9 MS. SUZAN FRASER: Right.
10 DR. MICHELLE SHOULDICE: That money comes
11 back to the hospital; it doesn't come to me personally.
12 MS. SUZAN FRASER: All right. So just in
13 terms of billing, the hospital bills your time and the
14 hospital has an account where the money is received.
15 DR. MICHELLE SHOULDICE: The -- my
16 secretary bills the time --
17 MS. SUZAN FRASER: Yes.
18 DR. MICHELLE SHOULDICE: -- and the money
19 comes back into an account.
20 MS. SUZAN FRASER: I see. All right.
21 COMMISSIONER STEPHEN GOUDGE: Who fixes
22 your fee?
23 DR. MICHELLE SHOULDICE: It's the
24 Ministry of the Attorney General fee schedule that we
25 use.


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1 COMMISSIONER STEPHEN GOUDGE: What is it?
2 DR. MICHELLE SHOULDICE: I couldn't tell
3 you, honestly.
4 COMMISSIONER STEPHEN GOUDGE: You just
5 go, Dr. Shouldice --
6 DR. MICHELLE SHOULDICE: I just tell my
7 secretary --
8 COMMISSIONER STEPHEN GOUDGE: -- and do
9 an --
10 DR. MICHELLE SHOULDICE: -- I went to
11 Court and she does the billing. I honestly don't know.
12 DR. DIRK HUYER: As -- as I do bill
13 because I'm -- I'm not salary --
14 COMMISSIONER STEPHEN GOUDGE: Right.
15 DR. DIRK HUYER: -- otherwise the fees
16 that the Ministry of Attorney General, as I understand
17 them to be -- and what I bill is a hundred and twenty-
18 five dollars ($125) per hour for testimony, a hundred
19 dollars ($100) per hour for -- for preparation of
20 reports.
21 COMMISSIONER STEPHEN GOUDGE: This is for
22 child protection cases?
23 DR. DIRK HUYER: No, this is -- no, that
24 would be Ministry of Attorney General, so the others
25 would be under the -- the different Ministry --


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1 COMMISSIONER STEPHEN GOUDGE: Different--
2 DR. DIRK HUYER: -- those are criminal
3 cases. And then Legal Aid rates are similar or a little
4 bit lower, and whenever I'm asked as far as defence
5 counsel, am I willing to accept Legal Aid rates, I say
6 yes.
7 So whatever the Legal rate -- Aid rates
8 are as well. I think they might be a touch lower, but
9 pretty close.
10 COMMISSIONER STEPHEN GOUDGE: Okay,
11 thanks.
12
13 CONTINUED BY MS. SUZAN FRASER:
14 MS. SUZAN FRASER: Does a hundred and
15 eight dollars ($108) an hour ring a bell? So, yeah --
16 DR. DIRK HUYER: Yeah, that's why I say,
17 a touch lower, a little bit --
18 MS. SUZAN FRASER: But that would --
19 DR. DIRK HUYER: -- pretty close though.
20 Yeah.
21 MS. SUZAN FRASER: Just throwing that
22 out, because I think that's what the rate is, but I'm not
23 certain, Mr. Commissioner.
24 I think that I'm almost at the end and I
25 just -- on that issue then, Dr. Huyer, you said those are


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1 the Ministry of the Attorn -- Attorney General rates, the
2 hundred and twenty-five dollars ($125) an hour, but
3 that's something that you would bill whether you were
4 attending in a child protection proceeding in Family
5 Court or in a criminal case?
6 DR. DIRK HUYER: No, I haven't attended
7 in a Family Court matter for a while --
8 MS. SUZAN FRASER: I see.
9 DR. DIRK HUYER: -- but I -- I -- I
10 reduced the rates in Family Court to a hundred dollars
11 ($100) per hour in testifying, given that the -- it seems
12 to me the budgets are a little bit lower for the
13 Children's Aid Societies, because it's directly billed to
14 the Children's Aid Society, as far as funding goes. So
15 that had always been my approach to -- to utilize for
16 years.
17 MS. SUZAN FRASER: Thank you. Thank you,
18 those are my questions, Mr. Commissioner.