Inquiry into Pediatric Forensic Pathology in Ontario
November 15, 2007

 

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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                    November 15th 2007

 25

 

                            . . . . .

 

[Page 182]

 

 14  CROSS-EXAMINATION BY MS. SUZAN FRASER:

 15                 MS. SUZAN FRASER:   Thank you, Dr.

 16  McLellan, Dr. Pollanen.  I'm Suzan Fraser.  We've met. 

 17                 I have one (1) question that is troubling

 18  me, and I'm trying to determine whether there is any

 19  significant difference between a criminally suspicious

 20  death and a suspicious death.  And I'm -- the term

 21  "criminally suspicious" has been used throughout these

 22  proceedings, but I'm interested in both of your opinion

 23  as to if there's a difference between criminally

 24  suspicious and suspicious, starting with Dr. McLellan, I

 25  suppose. 

 

[Page 183]

 

  1                 DR. BARRY MCLELLAN:   I -- I think, in

  2  large part, the two (2) terms are used interchangeably.

  3  We've talked about the importance of keeping an open mind

  4  when approaching any death investigation if it, in

  5  quotes, "is suspicious," I think that means that we're

  6  thinking that that is potentially unnatural, and thinking

  7  broadly that would include the possibility of it being

  8  criminally suspicious.

  9                 And I think in many ways the terms are

 10  used interchangably.

 11                 MS. SUZAN FRASER:   All right.  Now we've

 12  also used, sometimes homicidal/criminally suspicious

 13  cases.  That's been used as a title in some of the

 14  guidelines, and homicidal/criminally suspicious implies

 15  some sort of thinking about the manner of death.

 16                 Would you agree?

 17                 DR. BARRY MCLELLAN:   Yes.

 18                 MS. SUZAN FRASER:   And, Dr. Pollanen,

 19  your view as to whether there's any value added to the

 20  use of the word criminally in terms of criminally

 21  suspicious versus plain old suspicious?

 22                 DR. MICHAEL POLLANEN:   Well, I think it -

 23  - it comes from the fact that the police are involved.

 24  These cases when they arrive to the morgue facilities are

 25  attached to police investigations, and often higher

 

[Page 184]

 

  1  levels of police investigation including homicide

  2  detectives.

  3                 So the -- by virtue of police involvement

  4  we  -- we call them criminally suspicious.

  5                 MS. SUZAN FRASER:   All right.  And --

  6                 DR. MICHAEL POLLANEN:   Just -- just to

  7  sort of give you a nuanced version of that.  Sometimes we

  8  get cases that are brought in as routine matters, and the

  9  pathologist is the one who generates the suspicion.

 10                 MS. SUZAN FRASER:   Yes?

 11                 DR. MICHAEL POLLANEN:   Based upon the

 12  autopsy findings.

 13                 MS. SUZAN FRASER:   Yes, I see.  All

 14  right.  Dr. McLellan, I have some questions for you.  Dr.

 15  Pollanen, you're off the hook for probably the balance of

 16  it, but we'll just see how we do here.

 17                 Picking up on Mr. Falconer's point, Dr.

 18  McLellan, in terms of the information that's given to a

 19  family following the death of a child, and particularly a

 20  young child, I take it that the office of the Chief

 21  Coroner and coroners have no standard information that

 22  they give to family members of the deceased upon the

 23  sudden or unexpected death of a loved one?

 24                 There's no standard information pamphlet

 25  about the death investigation process.  Is that fair?

 

[Page 185]

 

  1                 DR. BARRY MCLELLAN:   There actually is a

  2  pamphlet through the office about the coroner's death

  3  investigation --

  4                 MS. SUZAN FRASER:   Yes?

  5                 DR. BARRY MCLELLAN:   -- that is given out

  6  frequently to families.  But as far as what communication

  7  takes place around an individual case, the circumstances

  8  are virtually always so different that it's not, to use

  9  your term, standard communication.

 10                 MS. SUZAN FRASER:   All right.  So -- I'm

 11  sorry, I didn't know about the existence of that; that

 12  overlooked my notice. 

 13                 But it's not mandated that coroners give

 14  that pamphlet or that information sheet to family

 15  members?

 16                 DR. BARRY MCLELLAN:   It's not mandated,

 17  but it's been circulated to coroners with a memo

 18  encouraging that it be used and given to -- to families

 19  whenever possible.

 20                 MS. SUZAN FRASER:   I see.  Thank you.  In

 21  terms of pediatric forensic pathology, the Office of the

 22  Chief Coroner had -- has drawn a distinction between

 23  those who are under five (5) and other children in youth.

 24                 Is that fair?

 25                 DR. BARRY MCLELLAN:   Yes, as far as the

 

[Page 186]

 

  1  standardized investigation, correct.

  2                 MS. SUZAN FRASER:   And I understand that

  3  to be because for those children who are five (5) and

  4  under, there is -- the pathology is more complicated for

  5  then children who are over five (5).

  6                 Is that fair?

  7                 DR. BARRY MCLELLAN:   It's because the

  8  death investigation itself is more complicated.

  9                 MS. SUZAN FRASER:   All right. 

 10                 DR. BARRY MCLELLAN:   And that includes

 11  the issue of -- of pathology.

 12                 MS. SUZAN FRASER:   All right.  But in the

 13  common medical understanding of the word pediatrics,

 14  pediatrics is medicine, as I understand it, for children

 15  and youth; that would include infants, toddlers, and

 16  young adolescents.

 17                 Is that fair?

 18                 DR. BARRY MCLELLAN:   The term pediatric

 19  can, in different situations, refer to different age

 20  groups, correct.

 21                 MS. SUZAN FRASER:   All right.  And in

 22  terms of The Paediatric Death Review Committee, what is

 23  the age range -- age range for the deaths that that

 24  committee reviews?

 25                 DR. BARRY MCLELLAN:   There is no absolute

 

[Page 187]

 

  1  cutoff.  There have been deaths reviewed up to the ages

  2  of eighteen (18), and there have in fact, in isolated

  3  circumstances been some complicated deaths over the age

  4  of eighteen (18) that have still been reviewed by that

  5  committee.

  6                 MS. SUZAN FRASER:   All right.  So it --

  7  The Paediatric Death Review uses a more common -- is it

  8  more common in terms of the word -- takes the common --

  9  never mind that questions at all.

 10                 But generally what we understand for

 11  pediatrics being used in general medicine, if you go to a

 12  pediatrician, that the committee would look at young

 13  people who would be eighteen (18) and under.

 14                 Is that fair?

 15                 DR. BARRY MCLELLAN:   This may be of

 16  assistance.  We have other review committees in the

 17  office.  One is the Patient Safety Review Committee.

 18                 And it may be that for a complex medical

 19  manner that in -- in one (1) situation where it appears

 20  that it's of more pediatric expertise, it may go to The

 21  Paediatric Death Review Committee.  And another it may

 22  appear to be surrounding an issue that may potentially be

 23  more systemic in a hospital environment, and in that case

 24  it may go to The Patient Safety Committee, so it's up to

 25  the regional coroner to use discretion as to where best

 

[Page 188]

 

  1  to send the case for review.

  2                 MS. SUZAN FRASER:   All right.  And in

  3  terms of your office, I take it that the office of the

  4  Chief Coroner during your time did not have a youth

  5  advisory committee or a young people advising either The

  6  Paediatric Death Committee or your office.

  7                 DR. BARRY MCLELLAN:   There has not been a

  8  youth advisory committee, no.

  9                 MS. SUZAN FRASER:   All right.  And in

 10  terms of the -- turning to the legislation, the deaths

 11  that are to be reported, and in terms of children, we

 12  understand that deaths must be reported where a child

 13  dies in a child residence -- and if it's helpful, Dr.

 14  McLellan, I can have the registrar pull up the

 15  legislation.

 16                 Would that be helpful?

 17                 DR. BARRY MCLELLAN:   Well, it may be

 18  helpful for others; I have it right in front of me here.

 19                 MS. SUZAN FRASER:   All right, that's --

 20  that's from the institutional report, Mr. Registrar, and

 21  it's page 76.  And if you could turn to the next page,

 22  page 77.

 23                 DR. BARRY MCLELLAN:   In my document it's

 24  page 78, but --

 25                 MS. SUZAN FRASER:   And I think that's

 

[Page 189]

 

  1  what it will end up being, Dr. McLellan.

  2                 DR. BARRY MCLELLAN:   It's Section 10

  3  you're probably looking for.

  4                 MS. SUZAN FRASER:   Yeah.  If you could go

  5  to page 78, Registrar.  My apologies.  Page 79.  Thank

  6  you. 

  7                 We have both where a child dies in

  8  residence; and I take it that would include a group home?

  9                 DR. BARRY MCLELLAN:   Yeah, so I -- on my

 10  document here, it's on the bottom of page 78, we have

 11  subsection 2(b), a children's residence under Part 9,

 12  Licensing of the Child and Family Services Act or

 13  premises.

 14                 MS. SUZAN FRASER:   Yes.  And that would

 15  include a group home?

 16                 DR. BARRY MCLELLAN:   Correct.

 17                 MS. SUZAN FRASER:   All right.  And we

 18  also know that it would also include -- would it include

 19  foster care?

 20                 DR. BARRY MCLELLAN:   Depending upon where

 21  the foster care is provided, yes.

 22                 MS. SUZAN FRASER:   Yes, all right.  And

 23  in terms of children -- death involving children who are

 24  outside of the care of their parents, they may be in the

 25  custody of the state in a youth justice facility, and in

 

[Page 190]

 

  1  those circumstances a death would -- an investigation

  2  would be mandatory and in inquest would be mandatory.

  3                 DR. BARRY MCLELLAN:   Correct.

  4                 MS. SUZAN FRASER:   All right.  And for

  5  the children who are in the care of the Children's Aid

  6  Societies or who have had contact or an open file with

  7  the Children's Aid Society under the current mandate of

  8  The Paediatric Death Review Committee, those deaths would

  9  be reviewed by that committee.

 10                 Is that fair?

 11                 DR. BARRY MCLELLAN:   Correct.

 12                 MS. SUZAN FRASER:   All right.  And are

 13  you aware, Dr. McLellan, that in 2003 Defence for

 14  Children International produced a report, and that's at

 15  Tab 20 of Volume III, and for counsel, that was produced

 16  separately in PDFs from our office on Monday.

 17                 Do you have it, Dr. McLellan?

 18                 DR. BARRY MCLELLAN:   I do.

 19                 MS. SUZAN FRASER:   All right.  And that

 20  report really was about the need for there to be an

 21  independent advocate for children and youth, but at page

 22  23 it touched on the death review process in The

 23  Paediatric Death Review Committee, so I'd ask you turn

 24  that up, please.

 25 

 

[Page 191]

 

  1                       (BRIEF PAUSE)

  2 

  3                 MS. SUZAN FRASER:   So it starts on page

  4  23 and then turning to page 24:

  5                   "What the report does is it details the

  6                   fact that The Paediatric Death Review

  7                   Committee was formed under the

  8                   leadership of the Ontario Association

  9                   of Children's Aid Societies and the

 10                   Office of the Chief Coroner."

 11                 And did the report get that right, Dr.

 12  McLellan?

 13                 DR. BARRY MCLELLAN:   I would have to go

 14  back in history.  My understanding is is was formed under

 15  the leadership of the Office of the Chief Coroner.

 16                 MS. SUZAN FRASER:   All right.  But it

 17  indicates further down that: