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 9th, 2008 25

2
  1                        Appearances
  2  Linda Rothstein      (np) )     Commission Counsel
  3  Mark Sandler         (np) )
  4  Robert Centa              )
  5  Jennifer McAleer     (np) )
  6  Johnathan Shime       (np) )
  7  Ava Arbuck           (np) )
  8  Tina Lie             (np)  )
  9  Maryth Yachnin       (np)  )
 10  Robyn Trask          (np) )
 11  Sara Westreich             )
 12  
 13  Brian Gover          (np) )     Office of the Chief Coroner
 14  Luisa Ritacca             )     for Ontario
 15  Teja Rachamalla           )
 16  
 17  Jane Langford        (np) )     Dr. Charles Smith
 18  Niels Ortved         (np) )
 19  Erica Baron          (np) )
 20  Grant Hoole          (np) )
 21   
 22  William Carter            )     Hospital for Sick Children
 23  Barbara Walker-Renshaw(np) )
 24  Kate Crawford             )
 25

3
  1                   APPEARANCES (CONT'D)
  2  Paul Cavalluzzo      (np) )     Ontario Crown Attorneys'
  3                                   Association
  4  
  5  Mara Greene          (np) )     Criminal Lawyers'
  6  Breese Davies             )     Association
  7  Joseph Di Luca       (np) )
  8  Jeffery Manishen      (np) )
  9  
 10  James Lockyer        (np) )     William Mullins-Johnson, 
 11  Alison Craig              )     Sherry Sherret-Robinson and
 12  Phillip Campbell     (np) )     seven unnamed persons
 13  Peter Wardle              )     Affected Families Group
 14  Julie Kirkpatrick     (np) )
 15  Daniel Bernstein     (np) )
 16  
 17  Louis Sokolov             )     Association in Defence of
 18  Vanora Simpson       (np) )     the Wrongly Convicted
 19  Elizabeth Widner      (np) )
 20  Paul Copeland         (np) )
 21  
 22  Jackie Esmonde        (np) )     Aboriginal Legal Services 
 23  Kimberly Murray      (np) )     of Toronto and Nishnawbe
 24  Sheila Cuthbertson    (np) )      Aski-Nation
 25  Julian Falconer      (np) )

4
  1                 APPEARANCES (cont'd)
  2  Suzan Fraser              )     Defence for Children 
  3                             )     International - Canada
  4  
  5  William Manuel     (np)   )     Ministry of the Attorney
  6  Heather Mackay            )     General for Ontario
  7  Erin Rizok          (np)   )
  8  Kim Twohig          (np)   )
  9  
 10  Natasha Egan       (np)   )     College of Physicians and 
 11  Carolyn Silver     (np)   )     Surgeons
 12  
 13  Michael Lomer      (np)    )    For Marco Trotta
 14  Jaki Freeman        (np)   )
 15  
 16  Emily R. McKernan   (np)   )    Glenn Paul Taylor
 17  
 18  
 19  
 20  
 21  
 22  
 23  
 24  
 25

1 TABLE OF CONTENTS Page No. 2 3 KATY DRIVER, Sworn 4 DIRK HUYER, Sworn 5 MICHELLE SHOULDICE, Sworn 6 7 Examination-In-Chief by Ms. Linda Rothstein 6 8 9 10 Certificate of transcript 296 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

1 --- Upon commencing at 9:31 a.m. 2 3 THE REGISTRAR: All rise. Please be 4 seated. 5 COMMISSIONER STEPHEN GOUDGE: Good 6 morning. 7 MS. LINDA ROTHSTEIN: Good morning, 8 Commissioner. 9 COMMISSIONER STEPHEN GOUDGE: Ms. 10 Rothstein...? 11 MS. LINDA ROTHSTEIN: We have three (3) 12 witnesses this morning: Dr. Katy Driver, Dr. Dirk Huyer, 13 and Dr. Michelle Shouldice. Registrar, could you please 14 swear in our witnesses. 15 16 KATY DRIVER, Sworn 17 DIRK HUYER, Sworn 18 MICHELLE SHOULDICE, Sworn 19 20 EXAMINATION-IN-CHIEF BY MS. LINDA ROTHSTEIN: 21 MS. LINDA ROTHSTEIN: Doctors, you 22 should have in front of you four (4) volumes of 23 documents, which we have reviewed prior to today. And 24 then you'll find on the cart to your right there are 25 overview reports in white binders and it may be that as

1 we go through some of your examination I ask you to turn 2 to the overview reports, that's where you'll find them. 3 All right. I'm going to start with you, 4 Dr. Driver, and review your background. You can turn to 5 Tab 1 of Volume I. And we have there a copy of your 6 curriculum vitae, 302450. 7 Are you there, Dr. Driver? 8 DR. KATY DRIVER: Yes, I am. 9 MS. LINDA ROTHSTEIN: Terrific. Dr. 10 Driver, you obtained your medical training at Madras 11 University in India? 12 DR. KATY DRIVER: That is correct. 13 MS. LINDA ROTHSTEIN: Graduating as a 14 doctor in 1962? 15 DR. KATY DRIVER: Yes. 16 MS. LINDA ROTHSTEIN: You moved to Canada 17 in 1968? Am I right? 18 DR. KATY DRIVER: Yes. No, I moved to 19 Canada in 1964. 20 MS. LINDA ROTHSTEIN: Oh, I'm sorry. And 21 you completed your residency in pediatric medicine at 22 McGill in 1968? 23 DR. KATY DRIVER: That is correct. 24 MS. LINDA ROTHSTEIN: All right. You 25 became qualified to practice medicine in Ontario in 1971.

1 DR. KATY DRIVER: Yes. 2 MS. LINDA ROTHSTEIN: And you started 3 working at the Hospital for Sick Children in that same 4 year -- 5 DR. KATY DRIVER: That is correct. 6 MS. LINDA ROTHSTEIN: -- am I right? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: Initially, Doctor, 9 you were working as a teaching fellow, it's described on 10 the first page of your CV, at the Hospital for Sick 11 Children. 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: What was that? 14 DR. KATY DRIVER: It was -- that was one 15 (1) of the positions were a teaching fellow supervised 16 and arranged for the medical students that were going 17 through Sick Kids, at that time. 18 MS. LINDA ROTHSTEIN: Okay. Between 1972 19 and 1974, you assumed the position of teacher, nurse 20 practitioner program? 21 DR. KATY DRIVER: That is correct. 22 MS. LINDA ROTHSTEIN: And in 1973 you 23 joined what we've all heard about, known as the SCAN Team 24 or the Suspected Child Abuse and Neglect Team, at the 25 Hospital for Sick Children?

1 DR. KATY DRIVER: Except it wasn't known 2 as SCAN Team, at that time. 3 MS. LINDA ROTHSTEIN: I understand, Dr. 4 Driver, that indeed that team was first established in 5 1973. Am I right about that? 6 DR. KATY DRIVER: That's right. 7 MS. LINDA ROTHSTEIN: What was it known 8 as, at that time? 9 DR. KATY DRIVER: Just Child Abuse Team. 10 MS. LINDA ROTHSTEIN: All right. It -- 11 it was a position that was very new. Am I right? 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: You split your time 14 between the SCAN Team and working -- 15 DR. KATY DRIVER: In the outpatient -- 16 MS. LINDA ROTHSTEIN: -- in the 17 outpatient department of the hospital. 18 What did that involve, Dr. Driver? 19 DR. KATY DRIVER: They had something 20 called a Continuing Care Unit and I looked after the 21 medical part of that; looking after children with complex 22 problems that were seen by different specialties, and 23 this was providing continuing care. 24 MS. LINDA ROTHSTEIN: All right. In 1975 25 I understand you began a general pediatric practice --

1 DR. KATY DRIVER: Yes. 2 MS. LINDA ROTHSTEIN: -- outside of the 3 Hospital for Sick Children? 4 DR. KATY DRIVER: Yes. 5 MS. LINDA ROTHSTEIN: And you then split 6 your time between the SCAN Team, which I understand 7 comprised about 30 percent of your working life? 8 DR. KATY DRIVER: That's right. 9 MS. LINDA ROTHSTEIN: And your clinical 10 work outside of the hospital, approximately 70 percent of 11 your working life? 12 DR. KATY DRIVER: That is correct. 13 MS. LINDA ROTHSTEIN: And you eventually 14 left the SCAN Team in 1999 to practice full time outside 15 of the hospital. 16 Is that right? 17 DR. KATY DRIVER: That's correct. 18 MS. LINDA ROTHSTEIN: All right. We'll 19 come back to the various developments of the SCAN Team 20 during your tenure after I review the background of Dr. 21 Huyer and Dr. Shouldice. 22 So turning to you, Dr. Huyer, at Tab 2 of 23 Volume II. You did two (2) years of undergraduate 24 science at Queen's between 1980 and 1982 before going to 25 medical school?

1 DR. DIRK HUYER: That's correct. 2 MS. LINDA ROTHSTEIN: And you started 3 medical school in 1984 at the University of Toronto? 4 DR. DIRK HUYER: No, I would have started 5 in 1982. 6 MS. LINDA ROTHSTEIN: Sorry, 1982; 7 receiving your medical degree in 1986? 8 DR. DIRK HUYER: That's correct. 9 MS. LINDA ROTHSTEIN: During medical 10 school I understand that you also supported yourself, at 11 least in part, by working as a pathology assistant at the 12 Toronto morgue? 13 DR. DIRK HUYER: Yeah, I worked -- 14 MS. LINDA ROTHSTEIN: Tell -- yeah. 15 DR. DIRK HUYER: -- worked essentially 16 five (5) days per week, the evening shift, so between 17 4:00 and 8:00. And if there was a -- at that time the 18 pathologists primarily were fee-for-service pathologists 19 and they would often do the bulk of the daytime work in 20 the evening after they finished with their practices in 21 the hospitals. And it would vary on the number that we 22 would do, but over the three (3) -- approximate three (3) 23 years I was working there, I assisted in about a thousand 24 (1,000) autopsies, but worked regularly on weekends as 25 well.

1 MS. LINDA ROTHSTEIN: How did you become 2 interested in taking on a part-time position like that, 3 or almost full-time? 4 DR. DIRK HUYER: I had an interest in 5 forensics from my early days. Some people attribute it 6 to me watching Quincy, but I think that it -- it 7 developed as an interest of mine as far as investigative 8 and evaluative areas within medicine. 9 And I had a goal at that point, or a 10 desire to be a forensic pathologist, but unfortunately I 11 made a dec -- well, it's not unfortunate -- but I made a 12 decision that I wished to stay in Canada, and I didn't 13 wish to do hospital pathology, and so the opportunity to 14 become a forensic pathologist at that stage in Canada was 15 not viable in my mind. And so I did not carry through 16 the pathway to pathology. 17 MS. LINDA ROTHSTEIN: All right. You did 18 have occasion as a pathology assistant to work with many 19 of the pathologists whose names have been mentioned, at 20 least in passing, in our Inquiry. 21 Dr. Hillsdon Smith, I understand, who was 22 then the Chief Pathologist? 23 DR. DIRK HUYER: That's correct. 24 MS. LINDA ROTHSTEIN: Dr. Deck? 25 DR. DIRK HUYER: Yes.

1 MS. LINDA ROTHSTEIN: Dr. Hans Sepp? 2 DR. DIRK HUYER: Yes. 3 MS. LINDA ROTHSTEIN: Dr. McAuliffe? 4 DR. DIRK HUYER: Yes. 5 MS. LINDA ROTHSTEIN: To name but a few, 6 I take it? 7 DR. DIRK HUYER: Yes. 8 MS. LINDA ROTHSTEIN: And also with Barry 9 Blen -- Blenkinsop, who was a pathology assistant at the 10 Toronto Forensic Pathology Unit. 11 DR. DIRK HUYER: Yeah, Barry hired me, 12 and Barry was my main mentor and educator in doing 13 pathology assistant work, and I learned much from Barry 14 over the years. 15 MS. LINDA ROTHSTEIN: Now, Dr. Huyer, I 16 understand that when it came to choosing a residency 17 program, you initially chose a program in Urology? 18 DR. DIRK HUYER: That's correct. 19 MS. LINDA ROTHSTEIN: And -- but you 20 decided it wasn't for you? 21 DR. DIRK HUYER: Yeah, I -- I was 22 positioned at the Toronto General Hospital which had the 23 most -- as I understood, the most interesting cases in 24 Canada, and frankly I wasn't overly stimulated by the 25 work, and I chose to withdraw after six (6) months as

1 opposed to maintaining a -- a -- one (1) of the 2 positions, offering the position up, hopefully making it 3 available for someone else who may have more interest 4 than I did. 5 MS. LINDA ROTHSTEIN: You ultimately 6 became licensed to practice as a general practitioner in 7 1987? 8 DR. DIRK HUYER: That's correct. 9 MS. LINDA ROTHSTEIN: And between 1987 10 and 1989 you practised family medicine? 11 DR. DIRK HUYER: Yes. 12 MS. LINDA ROTHSTEIN: In 1989 you joined 13 the Hospital for Sick Children as a member of the SCAN 14 Team? 15 DR. DIRK HUYER: Yes, I did. 16 MS. LINDA ROTHSTEIN: And I understand, 17 Dr. Huyer, that you responded to a posting of some kind - 18 - a vacancy, an advertisement? 19 DR. DIRK HUYER: Yeah, I was again not 20 overly enamoured by my work in family practice, and so I 21 was looking for other opportunities and so I would scour 22 through the medical journals and newspapers for positions 23 that might be of interest. And I had spent many years 24 working with children at summer camps and -- and I had 25 made -- and I -- this, I thought, would join my forensic

1 interest with my work with children, and so I thought I'd 2 apply for the position and I did, obviously, obtain the 3 position. 4 MS. LINDA ROTHSTEIN: Now, Dr. Huyer, you 5 didn't have any training as a pediatrician at that time? 6 DR. DIRK HUYER: No, I did not. 7 MS. LINDA ROTHSTEIN: I understand that 8 there was in fact only one (1) other applicant; I think 9 you told us that. 10 DR. DIRK HUYER: That's what I was told. 11 I don't know if that's factual, but that's what I was 12 told. 13 MS. LINDA ROTHSTEIN: But it is 14 interesting in the sense that does it reflect, do you 15 think, the difficulties that the SCAN Team has had in 16 recruiting members of its team over the years? 17 DR. DIRK HUYER: Oh, there's no question 18 about that and Dr. Driver can speak a little more about 19 that in the earlier days. But following my time there, 20 it was very challenging to have physicians not only join 21 a team, but take on the work, even if they were doing 22 just a little bit of the work within their own practice 23 with their own patients. It's a very challenging area to 24 have people step forward and -- and take on, and I've 25 experienced that throughout my career.

1 MS. LINDA ROTHSTEIN: And I expect that 2 we'll explore the various reasons why that is so as we go 3 through the testimony of the three (3) of you. 4 I understand, Dr. Huyer, that you were 5 initially funded to work two (2) days a week for the SCAN 6 Team. 7 DR. DIRK HUYER: Yes. 8 MS. LINDA ROTHSTEIN: And eventually it 9 increased so that you were working four (4) days a week 10 by 1993. 11 DR. DIRK HUYER: Yes. 12 MS. LINDA ROTHSTEIN: And indeed you 13 eventually became the Director of the SCAN Team following 14 -- in July of 1998. 15 DR. DIRK HUYER: That's correct. 16 MS. LINDA ROTHSTEIN: You continued in 17 the position of Director until December of 2001? 18 DR. DIRK HUYER: Yes. 19 MS. LINDA ROTHSTEIN: And, Dr. Shouldice, 20 you succeeded Dr. Huyer in the position of Director? 21 DR. MICHELLE SHOULDICE: Yes. 22 MS. LINDA ROTHSTEIN: Okay. A couple of 23 other things about your background, though, Dr. Huyer. I 24 understand that the other sort of aspect of your career - 25 - well, there's a couple of things -- one (1), at some

1 stage you became very interested in doing cosmetic 2 medicine. 3 Is that right? 4 DR. DIRK HUYER: I don't know if I would 5 say I was very interested. The Hospital for Sick 6 Children funding was not substantial and I had a mortgage 7 and I had a family, and so I found a source of income 8 that I felt was a desired need, and so by the -- by the 9 patients or the clients at that time, so I practised that 10 for a number of years while -- before I got funding for 11 four (4) days at Sick Children's. 12 MS. LINDA ROTHSTEIN: You also, I 13 understand it, Dr. Huyer, became appointed as a coroner 14 in 1992. 15 DR. DIRK HUYER: Yeah, I think it was 16 late 1991 -- 17 MS. LINDA ROTHSTEIN: Sorry. 18 DR. DIRK HUYER: -- but right around the 19 change from '91 to '92, that's correct. 20 MS. LINDA ROTHSTEIN: Tell us about that, 21 if you would. 22 DR. DIRK HUYER: Again, following my 23 earlier comments about an interest in forensic medicine 24 and death -- and death evaluation, not being able to 25 achieve my initial younger year goal of being a forensic

1 pathologist, I thought if I had the opportunity to be a 2 coroner, that would be something that was of great 3 interest to me and that interest was furthered by my work 4 at the Forensic Pathology Unit. And so when an 5 opportunity came forward to apply for a coroner's 6 position, I did so in Toronto, but I did not receive that 7 position because I lived north -- in north Peel. But 8 then a position came forward in Peel and I applied and I 9 was successful in -- in obtaining that position. 10 So it, again, gave me another aspect to my 11 career, which I felt was something I was significantly 12 interested in, which was further investigation related to 13 medical issues. 14 MS. LINDA ROTHSTEIN: Can you sketch out 15 for the Commissioner how much of your time was involved 16 in coronial work, starting with late 1991 when you first 17 became a coroner? 18 DR. DIRK HUYER: In the years between '92 19 and '96 I would complete approximately seventy-five (75) 20 investigations per year, as well as my work at Sick 21 Children's. 22 In '96 I joined the Brampton roster and my 23 numbers moved to approximately a hundred and twenty-five 24 (125) to a hundred and fifty (150) per year. And as time 25 moved on towards '99/2000 I was doing approximately two

1 hundred and fifty (250) coroners investigations per year. 2 And then following my departure at Sick 3 Children's in late 2001, early 2002, since that time I've 4 done on -- right around five hundred and fifty (550) to 5 five hundred and sixty (560) coroners investigations per 6 year, consistently over the past five (5) years. 7 MS. LINDA ROTHSTEIN: And does that come 8 close to approximating a full-time career? 9 DR. DIRK HUYER: It certainly seems that 10 way. My volume has been very high, and it's a large 11 volume. I'm -- I'm told -- although I don't know this, 12 I'm told that I'm the busiest in Ontario. 13 Again, I don't know that for a fact by 14 comparing numbers, but I think that that number probably 15 would be higher than if you looked at the time allotment 16 on a -- on a 9:00 to 5:00 kind of schedule. I think that 17 that probably is a higher number than would be recognized 18 in a full-time hour analysis. 19 MS. LINDA ROTHSTEIN: I understand, Dr. 20 Huyer, that after being relieved of the duties of 21 director of SCAN you stayed on for a period of time as 22 one (1) of the members of the SCAN Team? 23 DR. DIRK HUYER: I don't think it was 24 quite that extensive. Essentially, there was a -- there 25 were limited resources to replace my position, not

1 dollars-wise, but staff-wise, and so after my departure 2 there was a -- a void of physicians. And so over the 3 first six (6) months of 2000, I attended one (1) day a 4 week, if I recall correctly, to essentially provide 5 supportive collegial discussion, a role I wasn't seeing 6 patients actively, but to sort of help with the 7 transition was the way I interpreted it. 8 MS. LINDA ROTHSTEIN: And today, what -- 9 how would you describe your various career activities, 10 today? 11 DR. DIRK HUYER: I -- I still have a 12 number of career activities; by far, the majority is the 13 coroner's work. But I -- I continue to be on staff at 14 all the Peel based hospitals, so Credit Valley, Trillium 15 Health Centre, William Osler Health Centre, as well as 16 Headwaters Health Centre in Orangeville, and Etobicoke 17 General and Trillium Health Centre in Mississauga where I 18 provide what we've titled, Regional Child Maltreatment 19 Services. So I'm available to anybody in the Peel 20 community who wish to consult with me around areas of 21 child maltreatment. 22 I don't involve myself in head -- serious 23 head injury cases because those cases tend to go to Sick 24 Children's, and so I haven't been able to have the same 25 interaction or -- or involvement with those cases.

1 That's one (1) aspect of my career. 2 The other aspect is I -- I am a member of 3 an expert's consultation group in the area of child 4 sexual abuse within the Province of Ontario, providing 5 consultative servi -- services to all of the network of 6 sexual assault centres across Ontario. I continue to 7 teach a lot, which is reflected in my curriculum vitae, 8 to various groups about various topics, child 9 maltreatment being a common one. 10 I continue to provide academic work, to 11 some extent, at the Hospital for Sick Children, and I try 12 to attend about once a month to meet with the -- the SCAN 13 Team physicians and -- and nurse practitioners where we 14 do case consultations on both cases I might bring or 15 cases they would present to me, so that we can learn from 16 each other and -- and share our experience. 17 I think that's the majority of things. 18 Oh, I'm an inquest coroner, as well, so I preside over 19 inquests in -- in Ontario. I think that's the majority 20 of things that I do now. 21 MS. LINDA ROTHSTEIN: Thank you. 22 DR. DIRK HUYER: You're welcome. 23 MS. LINDA ROTHSTEIN: Dr. Shouldice, your 24 CV is found at Tab 3 of Volume I. It's 152733. 25 You received your Bachelor of Science

1 Honours Degree from Queen's in 1989? 2 DR. MICHELLE SHOULDICE: Yes. 3 MS. LINDA ROTHSTEIN: And you then 4 started on a Masters of Science Degree at Queen's as 5 well, in anatomy? 6 DR. MICHELLE SHOULDICE: Yes. 7 MS. LINDA ROTHSTEIN: Receiving a Master 8 of Science Degree in 1992? 9 DR. MICHELLE SHOULDICE: Yes. 10 MS. LINDA ROTHSTEIN: And if I understand 11 it, at least for two (2) of the years that you were 12 completing your Masters of Science Degree you were also 13 enrolled in the undergraduate medical program at the 14 University of McMaster? 15 DR. MICHELLE SHOULDICE: Yes, I was. 16 MS. LINDA ROTHSTEIN: I don't know quite 17 how you did that, but perhaps you can tell the 18 Commissioner at little bit about how that came about? 19 DR. MICHELLE SHOULDICE: I was -- over 20 the -- the two (2) year overlap I was writing my thesis 21 and presenting it for -- for approval. 22 MS. LINDA ROTHSTEIN: You found that 23 medical school just didn't take up enough hours in the 24 day, is that right, Dr. Shouldice? 25 DR. MICHELLE SHOULDICE: I wanted to

1 completed my masters even though I had gained admissions 2 to -- to medical school. 3 MS. LINDA ROTHSTEIN: All right. So you 4 received your MD from McMaster in 1994, as I understand 5 it. 6 DR. MICHELLE SHOULDICE: Yes. 7 MS. LINDA ROTHSTEIN: And you became a 8 pediatric resident at the Hospital for Sick Children 9 between 1994 and 1997? 10 DR. MICHELLE SHOULDICE: Yes. Between 11 1994 and 1998. 12 MS. LINDA ROTHSTEIN: Okay. And I 13 understand that indeed between '97 and '98 you were the 14 Associate Chief Resident at the Hospital for Sick 15 Children? 16 DR. MICHELLE SHOULDICE: One (1) of the 17 associate chief residents, yes. 18 MS. LINDA ROTHSTEIN: In the pediatric 19 program? 20 DR. MICHELLE SHOULDICE: Yes. 21 MS. LINDA ROTHSTEIN: All right. You did 22 your American Boards in pediatrics in 1997? 23 DR. MICHELLE SHOULDICE: Yes. 24 MS. LINDA ROTHSTEIN: And you did your -- 25 a fellowship in pediatric medicine with a focus on child

1 maltreatment between '98 and '99? 2 DR. MICHELLE SHOULDICE: Yes. A focus in 3 both child maltreatment and in neuro-developmental 4 pediatrics. 5 MS. LINDA ROTHSTEIN: Now, I understand, 6 Dr. Shouldice, that you were the first physician in 7 Canada to complete a fellowship comprised of those sub- 8 specialties, at least in maltreatment. 9 Am I right about that? 10 DR. MICHELLE SHOULDICE: As far as I 11 know, yes. 12 MS. LINDA ROTHSTEIN: All right. So tell 13 us about that, how did you come to focus on child 14 maltreatment when we have this sense, at least sitting in 15 this room, that that's a fairly unusual path for a 16 physician? 17 DR. MICHELLE SHOULDICE: I had become 18 interested in the area during my residency. During the 19 final year of our residency we have substantial elective 20 time and I chose to spend some time in the area of child 21 maltreatment at that time, thinking that if I were to go 22 into general practice it was an area that I was not as 23 familiar with and felt I needed further education in. 24 After I completed my residency I had 25 planned to go on to do a fellowship to gain more

1 experience, specifically in neuro-developmental 2 pediatrics, and was offered the opportunity to include in 3 that fellowship further training in child maltreatment 4 and chose to -- to do so. 5 MS. LINDA ROTHSTEIN: And you were 6 offered that opportunity by whom? 7 DR. MICHELLE SHOULDICE: By Dr. Huyer. 8 MS. LINDA ROTHSTEIN: Okay. So, Dr. 9 Huyer, talk about that for a moment. You were, at that 10 stage -- we're getting a little bit ahead of ourselves -- 11 but you were, at that stage, the Director of the SCAN 12 Team? 13 DR. DIRK HUYER: Yes, I was. 14 MS. LINDA ROTHSTEIN: And you were 15 looking to build human resources for that team, I take 16 it? 17 DR. DIRK HUYER: Well, whether it was for 18 that team or not was not necessarily the issue. The 19 issue is to build resources within the area of child 20 maltreatment. And so there's been other fellows who have 21 -- who have attended at the SCAN Program who have not 22 stayed in Toronto; there's one (1) specifically in 23 Halifax who did a fellowship and she now leads the child 24 maltreatment team in Halifax. 25 So the -- the -- I had an opportunity to

1 work with Dr. Shouldice in her pediatric year and was 2 enthused by the work that she did and the interest that 3 she -- she showed, and so when an opportunity came 4 forward, I jumped at that opportunity. 5 And that had been a time where we, in the 6 hospital, had restructured and SCAN became part of -- of 7 a bigger department called the Department of Pediatric 8 Medicine, which had a higher focus on education and 9 supported our program somewhat in that education focus. 10 And so the -- the fellowship then was under the Division 11 of Pediatric Medicine, which made it easier, shall we 12 say, to -- to develop that fellowship and -- and get a 13 funding model that would support it; there -- I think 14 that that's essentially the way it -- it fell through. 15 MS. LINDA ROTHSTEIN: So do I hear you to 16 say, Dr. Huyer, that it wouldn't have been possible, at 17 least at that stage, to fund a fellowship solely related 18 to the work of the SCAN Team? 19 DR. DIRK HUYER: I'm not sure it wouldn't 20 have been possible because a lot of things that I tried 21 to do were fairly creative, and so I think that there 22 would have been a possibility, but it would have required 23 a person who had the interest. 24 And subsequent to Michelle being there, 25 there's -- certainly in my timeframe there was two (2)

1 other fellows in the years after Michelle: one (1) who 2 has gone on to work in the cha -- the Aylmer area in 3 Ontario, and then the one (1) from Halifax. And I -- 4 Michelle can speak to others that have followed. 5 MS. LINDA ROTHSTEIN: Okay. But, 6 Shouldice, just to complete at least on overview of your 7 background, in 1999 you actually became, at least in part 8 -- well, you became a staff pediatrician at the Hospital 9 for Sick Children, if I understand it. 10 DR. MICHELLE SHOULDICE: Yes. 11 MS. LINDA ROTHSTEIN: And your work 12 became divided 25 percent with the SCAN Team -- 13 DR. MICHELLE SHOULDICE: Yes. 14 MS. LINDA ROTHSTEIN: -- and 75 percent 15 with general pediatrics. 16 DR. MICHELLE SHOULDICE: Outpatient 17 general pediatrics, yes. 18 MS. LINDA ROTHSTEIN: All right. And 19 then, as I understand it, it -- it shifted a little bit 20 over the following years with the sort of division of 21 work changing a little bit, you ultimately becoming the 22 Director that succeeded Dr. Huyer. 23 DR. MICHELLE SHOULDICE: Yes. 24 MS. LINDA ROTHSTEIN: And you assumed 25 that position in --

1 DR. MICHELLE SHOULDICE: 2000 -- 2 MS. LINDA ROTHSTEIN: -- 2002? 3 DR. MICHELLE SHOULDICE: 2002 I became 4 the acting Director, in 2003, the Director. 5 MS. LINDA ROTHSTEIN: Okay. And when you 6 became the Director SCAN were your -- were your then 7 duties solely with the SCAN Team or did you continue to 8 maintain a practice with the general pedia -- pediatric 9 side? 10 DR. MICHELLE SHOULDICE: No, I continued 11 to work in the outpatient general pediatric area and I 12 also continued as Director of the outpatient general 13 pediatric area. 14 I also have focussed the majority of my 15 general pediatrics work in the area of developmental 16 pediatrics and have since been cross appointed to 17 Bloorview -- what is not called Bloorview Kids Rehab, 18 previously called Bloorview MacMillan's Children's 19 Centre, where I do developmental assessments. 20 MS. LINDA ROTHSTEIN: Not content with 21 the -- one (1) masters degree you had, I understand that 22 in September 2005, you commenced a Masters of Education 23 at the University of Toronto? 24 DR. MICHELLE SHOULDICE: Yes. 25 MS. LINDA ROTHSTEIN: Just tell us about

1 that, if you would, Dr. Shouldice. What -- what was the 2 interest there? 3 DR. MICHELLE SHOULDICE: I've always been 4 interested in education, which is partly why I've chosen 5 to work in an academic teaching centre, but I guess have 6 increasingly recognized the lack of knowledge amongst 7 pediatricians in particular, and professionals in 8 general, with respect to both the areas that I work in, 9 both child maltreatment and child development, and -- and 10 so I planned to continue working in education in those 11 areas and wanted to gain further understanding of how 12 best to do so. 13 MS. LINDA ROTHSTEIN: Now all of you, Dr. 14 Driver, Dr. Huyer, Dr. Shouldice, all of you have 15 appointments with the University of Toronto as assistant 16 professors, if I'm correct? 17 DR. MICHELLE SHOULDICE: Yes. 18 DR. KATY DRIVER: Yes. 19 MS. LINDA ROTHSTEIN: And all of you 20 have, throughout your careers, been very actively 21 involved in various kinds of teaching at the community 22 level, colleagues, inside the hospital. 23 Is that right? 24 DR. MICHELLE SHOULDICE: Yes. 25 DR. DIRK HUYER: Yes.

1 MS. LINDA ROTHSTEIN: All right. So 2 we'll come back to that for sure. But I wanted to just 3 give the Commissioner a picture, if we can, about what 4 the SCAN Team was, Dr. Driver, and how it first started. 5 And we do have a document that is of some 6 assistance to us in at least providing a bare outline. 7 If you turn to your Volume IV, Tab 25. This is from the 8 website of the Hospital for Sick Children. It's 302432. 9 10 (BRIEF PAUSE) 11 12 MS. LINDA ROTHSTEIN: So, Dr. Driver, 13 historically it works if I start with you and move to my 14 right, so I'm going to do that. 15 DR. KATY DRIVER: Sure. 16 MS. LINDA ROTHSTEIN: Commissioner the 17 seating arrangement is very well designed by Ms. McAleer 18 to reflect not only alphabetical order, but the stages of 19 the SCAN Team through it's development and of course 20 seniority, which is always important, so I'm going to 21 move left to right a lot. 22 Dr. Driver, starting with you. You've 23 told us that the SCAN Team was established in '73. Am I 24 right in understanding it was the first such team to be 25 established in Canada?

1 DR. KATY DRIVER: That's correct. 2 MS. LINDA ROTHSTEIN: Okay. What can you 3 tell us -- it -- it preceded your tenure by just a bit -- 4 but what can you tell us was the impetus for the creation 5 of that team? 6 DR. KATY DRIVER: I think the child 7 protection laws were there that anybody who became aware 8 or was concerned about a child injury being non- 9 accidental had to report it. 10 And it was found that there was very 11 little knowledge, there was a lot of reluctance; people 12 saying, Well I'm not sure this is child abuse or not, and 13 I'm not going to report it. So I think there was -- Dr. 14 Bates was given the mandate to start looking at the 15 issues to -- it was easier for Sick Kids professional -- 16 whoever saw the child was concerned, to pass it on to 17 somebody within the hospital, and then it was for Dr. 18 Bates to just look at the child, take the history, pass 19 it on to Children's Aid, so -- and -- and at the same 20 time develop more expertise in the area. 21 So that was the humble beginning of the 22 Team. 23 MS. LINDA ROTHSTEIN: So you're referring 24 to Dr. Robert Bates, are you, Dr. Driver? 25 DR. KATY DRIVER: Yes.

1 MS. LINDA ROTHSTEIN: And he was the 2 first Director of the Team? 3 DR. KATY DRIVER: That is correct. 4 MS. LINDA ROTHSTEIN: What was his 5 background? 6 DR. KATY DRIVER: A pediatrician. 7 MS. LINDA ROTHSTEIN: All right. So when 8 you joined the Team, I understand that there were two (2) 9 pediatricians, you and him? 10 DR. KATY DRIVER: Yes. 11 MS. LINDA ROTHSTEIN: And a psychiatrist? 12 DR. KATY DRIVER: Who would give us 13 opinion, yes. 14 MS. LINDA ROTHSTEIN: Yes. A social 15 worker who at least had some links with your team? 16 DR. KATY DRIVER: The social worker -- 17 initially we did not have a designated social worker for 18 the Team. 19 MS. LINDA ROTHSTEIN: All right. 20 DR. KATY DRIVER: It was more if there 21 was an in-patient, then whoever was the ward social 22 worker would become involved with the case. 23 MS. LINDA ROTHSTEIN: All right. 24 DR. KATY DRIVER: And then slowly we had 25 our own social worker.

1 MS. LINDA ROTHSTEIN: But it was 2 certainly conceived of, am I right, the SCAN Team as a 3 multi-disciplinary approach and program, is that right? 4 DR. KATY DRIVER: It was always a multi- 5 disciplinary approach. 6 MS. LINDA ROTHSTEIN: And again, help us 7 with that. What was the point of calling on a number of 8 disparate disciplines to focus on this work? 9 DR. KATY DRIVER: Because there was 10 always a physical part, there was also the psychosocial 11 part, and so we felt we always needed the social work 12 expertise as well as when possible, the psychiatrist's 13 input on the case. 14 MS. LINDA ROTHSTEIN: All right. So if 15 you -- if you look at again this website, it looks like 16 in the beginning, it -- it moved with a fairly small case 17 load of a hundred and fifteen (115) children in 1973. 18 Do you see that in the second paragraph, 19 Dr. Driver? 20 DR. KATY DRIVER: Yes. 21 MS. LINDA ROTHSTEIN: Does that reflect 22 your recollection? 23 DR. KATY DRIVER: Yeah. 24 MS. LINDA ROTHSTEIN: All right. And 25 then by eight hundred (800) in the 1990s?

1 DR. KATY DRIVER: Right. 2 MS. LINDA ROTHSTEIN: So there was a 3 dramatic increase in the number of cases that the team 4 was entrusted with. 5 That reflected what? Increased reporting? 6 More knowledge about the existence of the team? 7 DR. KATY DRIVER: I think a bit of both. 8 Initially when we was seeing, we were only seeing 9 allegations of physical abuse. Sexual abuse was not, at 10 that time, part of the team. 11 The increase in numbers was people 12 becoming more aware that children were maltreated, and 13 were -- it was easier to refer on their suspicions to the 14 team, together with the involvement with sexual abuse, so 15 the numbers increased. 16 COMMISSIONER STEVEN GOUDGE: Where would 17 the referrals come from, Dr. Driver? 18 DR. KATY DRIVER: Most of -- 19 COMMISSIONER STEVEN GOUDGE: Would they 20 come from a variety of Toronto area hospitals, from 21 pediatricians? Were they children who were brought to 22 Sick Kids for treatment? Where would they come from? 23 DR. KATY DRIVER: I think initially it 24 was within the hospital, but as people became aware of 25 the team, we would often get calls from physicians who

1 had seen a child that they were concerned about in 2 another hospital, or in their private office, to -- more 3 as a sounding board: What should I do? Should I report 4 this? Is this something? 5 So it -- it was -- that's how the numbers 6 increased. 7 COMMISSIONER STEVEN GOUDGE: And in 8 circumstances like that, would the team examine the 9 child, or would it be done by consultation through some 10 kind of paper reporting, or a variety of ways? 11 How would the team come to a view about -- 12 DR. KATY DRIVER: I think the -- when a 13 physician called, or anybody called, we had always 14 somebody -- the team had an on-call system, where there 15 would be a pediatrician and a social worker on call, and 16 it would be one person as first call, and one as a 17 backup. And whoever was the first call person, would 18 receive that call; would -- if -- if it was the social 19 worker, would discuss it with the physician. 20 And then sometimes we would ask that we -- 21 we would agree to see the child. Sometimes we would give 22 instructions over the phone, what should be done. So 23 that varied. 24 COMMISSIONER STEVEN GOUDGE: Okay. 25 Thanks. Sorry, Ms. Rothstein.

1 MS. LINDA ROTHSTEIN: That's -- that's 2 fine Commissioner. And so, continuing -- 3 COMMISSIONER STEVEN GOUDGE: Dr. Driver 4 looks like he wants to add something. 5 MS. LINDA ROTHSTEIN: By all -- Dr. 6 Huyer. 7 COMMISSIONER STEVEN GOUDGE: Dr. Huyer, 8 sorry. 9 DR. DIRK HUYER: If I could add into 10 that? 11 MS. LINDA ROTHSTEIN: Please. 12 DR. DIRK HUYER: As time went on, 13 Commissioner -- and I think that that's part of the 14 reflection of the eight hundred (800) number -- those 15 eight hundred (800) would not have all been direct 16 patient contacts. 17 COMMISSIONER STEVEN GOUDGE: Okay. 18 DR. DIRK HUYER: They would have been 19 patient contacts of some sort, and with more resources 20 and more physician availability, we saw directly more 21 children -- 22 COMMISSIONER STEVEN GOUDGE: Right. 23 DR. DIRK HUYER: -- but there were many 24 times where we would receive information -- and the 25 sources were wide across Ontario at times, stretching

1 from Windsor to Ottawa to Thunder Bay. 2 COMMISSIONER STEVEN GOUDGE: So you would 3 get consultations from across the Province? 4 DR. DIRK HUYER: And across 5 professionals, so Children's Aid, police, pathologists, 6 coroners, physicians, nurses, teachers. There was a wide 7 range of professionals, because we opened our door very 8 widely -- 9 COMMISSIONER STEVEN GOUDGE: Okay. 10 DR. DIRK HUYER: -- given the fact that 11 we felt we were one (1) of few resources available to 12 help with this area. And so -- 13 DR. MICHELLE SHOULDICE: And I would just 14 add parents, as well. 15 DR. DIRK HUYER: Parents, exactly. 16 Parents would call in. 17 And -- and, so it would really vary on the 18 case. If we developed a comfort level on the telephone, 19 and we knew the people that were calling as far as 20 physicians or health care providers, we may not see those 21 -- those children. But we may then see part of the exam, 22 so some photographs, or some x-rays. 23 COMMISSIONER STEVEN GOUDGE: Right. 24 DR. DIRK HUYER: And so it would vary 25 from case to case.

1 2 CONTINUED BY MS. LINDA ROTHSTEIN: 3 MS. LINDA ROTHSTEIN: What about today, 4 Dr. Shouldice, just while we're on this point about what 5 the numbers are, and what the sort of referral sources 6 are? 7 DR. MICHELLE SHOULDICE: So for direct 8 patient contacts, our numbers fluctuate from year to year 9 somewhat, but between five hundred and fifty (550) and 10 seven hundred (700) direct contacts. And it -- I think 11 we would provide approximately one (1) paper review every 12 other week or so. So maybe twenty-five (25) or so a 13 year. 14 COMMISSIONER STEVEN GOUDGE: So most of 15 them are direct contacts? 16 DR. MICHELLE SHOULDICE: Most of them are 17 direct contacts. 18 That doesn't include, though, just 19 telephone consultations -- 20 COMMISSIONER STEVEN GOUDGE: 21 Consultations -- 22 DR. MICHELLE SHOULDICE: -- where we 23 would just provide advice around what medical work-up to 24 complete. 25 COMMISSIONER STEVEN GOUDGE: Right.

1 DR. MICHELLE SHOULDICE: Which would be 2 additional for those numbers. 3 COMMISSIONER STEVEN GOUDGE: Right. And 4 is there a treatment component today to what you do, or 5 is it mostly diagnostic? 6 DR. MICHELLE SHOULDICE: From a 7 psychosocial point of view, yes. 8 So we have a psychologist on our team now, 9 who does provide some direct intervention with -- with 10 families, with parents and children, with the respect of 11 the effects of experienced abuse or with respect to how 12 best to respond to particular types of behaviours, such 13 as sexual behaviours in children. 14 So there is a treatment component. 15 There's also a crisis support component from our social 16 workers. 17 COMMISSIONER STEPHEN GOUDGE: Thanks. 18 Thanks, Ms. Rothstein. 19 20 CONTINUED BY MS. LINDA ROTHSTEIN: 21 MS. LINDA ROTHSTEIN: But just to go back 22 to the history a little bit, Commissioner, if we can, and 23 with you, Dr. Driver, the second paragraph records that 24 prior to 1980, I think this reflects what you said, the 25 majority of referrals dealt with physical abuse and

1 neglect. And it was in 1981 that the issue of child 2 sexual abuse rose to the fore and that the Sexual Abuse 3 Team was formed. 4 Is that right? 5 DR. KATY DRIVER: That is correct. When 6 Dr. Mian joined the team? 7 MS. LINDA ROTHSTEIN: So that's Dr. 8 Marcella Mian? 9 DR. KATY DRIVER: Marcellina Mian, yes. 10 MS. LINDA ROTHSTEIN: Who eventually 11 became the director of the entire SCAN Unit for a period? 12 DR. KATY DRIVER: Yes, she started as the 13 director of the Sexual Abuse Team. When she became -- 14 when Dr. Bates left -- when Dr. Mian became the director 15 of the team, the two (2) teams were merged and then we 16 became the SCAN Team. 17 MS. LINDA ROTHSTEIN: All right. And I 18 understand that Mr. Mian joined, in fact, in 1981. 19 Is that approximately right? 20 DR. KATY DRIVER: Probably, yeah. 21 MS. LINDA ROTHSTEIN: Okay. And that she 22 became the director in 1984. 23 Does that accord with your recollection? 24 DR. KATY DRIVER: When Dr. Bates left, 25 yes.

1 MS. LINDA ROTHSTEIN: Okay. Because at 2 that point, although Dr. Bates was no longer the 3 director, he was -- he -- did he still have some 4 continued involvement to some degree with the team? 5 Am I right about that as well? 6 DR. KATY DRIVER: A little bit, yes. 7 MS. LINDA ROTHSTEIN: All right. Again, 8 the sort of continuity that Dr. Huyer spoke about -- 9 DR. KATY DRIVER: That's right. 10 MS. LINDA ROTHSTEIN: -- for transition 11 and so on. 12 All right. And then going back to the 13 website, just to sort of outline what it says about the 14 rule of the team. If you look at the second page of your 15 hard copy, page 5 at the top of the PFP document. So 16 again, it's 302432. 17 DR. KATY DRIVER: Yes. 18 MS. LINDA ROTHSTEIN: The list of 19 responsibilities includes reviewing cases of all children 20 you are known to been abused or suspected of being abused 21 that come to the hospital. 22 DR. KATY DRIVER: Yes. 23 MS. LINDA ROTHSTEIN: When necessary, the 24 SCAN Program reports the cases to the Children's Aid 25 Society. This is a legal requirement.

1 DR. KATY DRIVER: Yes. 2 MS. LINDA ROTHSTEIN: Makes appointments 3 for a doctor to physically examine children or 4 adolescents to find out whether or not they were sexually 5 physically abused. Conducts assessments of children and 6 their families in cases where a child may have been 7 abused, but no vague disclosures have been made. 8 These assessments occur at the hospital 9 and can take four (4) to fifteen (15) weeks to complete, 10 depending on the situation. And provides children who 11 have been abused and their families with treatment. And, 12 Dr. Shouldice, you've spoken about that. 13 Now, that's very brief. And I think it 14 would be useful if we took a moment and reviewed with all 15 of you the way you fulfilled those general functions over 16 the years, because I think it's fair to say that as your 17 expertise developed, your process changed. 18 Is that right, Dr. Driver? 19 DR. KATY DRIVER: Yes. 20 MS. LINDA ROTHSTEIN: All right. But 21 before we get to that, help us, Dr. Driver, you arrive in 22 this team, it's almost brand new, Dr. Bates has just 23 started it, what did you know about the issue of physical 24 childhood abuse? 25 DR. KATY DRIVER: Very little.

1 MS. LINDA ROTHSTEIN: Okay. So how did 2 you learn? 3 DR. KATY DRIVER: I think examining 4 patients, reading what was available in literature, which 5 was very little at that time, attending conferences. So 6 it was really on the job training. 7 MS. LINDA ROTHSTEIN: And -- and was that 8 the same with Dr. Bates or did he come with any sort of 9 repository of formal training at all? 10 DR. KATY DRIVER: No. 11 MS. LINDA ROTHSTEIN: All right. And I 12 take it that would have been the same even of the social 13 workers and the psychiatrist who became part of your team 14 over the years? 15 DR. KATY DRIVER: I guess. 16 MS. LINDA ROTHSTEIN: So you had no 17 formal training, is that right? 18 DR. KATY DRIVER: That is correct. 19 MS. LINDA ROTHSTEIN: Child abuse was not 20 part of your residency program, if I'm not mistaken? 21 DR. KATY DRIVER: That is correct. 22 MS. LINDA ROTHSTEIN: And when was your 23 first court experience? 24 DR. KATY DRIVER: Long ago. 25 MS. LINDA ROTHSTEIN: But how long after

1 you joined the SCAN Team? 2 DR. KATY DRIVER: I think probably within 3 a year or two (2), certainly. 4 MS. LINDA ROTHSTEIN: Am I right, Dr. 5 Driver, that at some point it did become one (1) of your 6 functions as a member of that team? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: And can you give 9 the Commissioner an idea of how frequently you would have 10 gone to court to speak to a case that had come to the 11 SCAN Team? 12 DR. KATY DRIVER: I think a lot of those 13 were family court issues when Children's Aid would either 14 apprehend a child because of injuries, and we were called 15 in to give the medical expertise as to why this child -- 16 why the Children's Aid was taking the step they were 17 taking. 18 MS. LINDA ROTHSTEIN: And how frequently 19 on an annual basis did you go to court? What's your best 20 estimate? 21 DR. KATY DRIVER: Probably about ten 22 (10). 23 MS. LINDA ROTHSTEIN: Ten (10) times a 24 year on average? 25 DR. KATY DRIVER: Probably.

1 MS. LINDA ROTHSTEIN: So you've been to 2 court many times? 3 DR. KATY DRIVER: I have been to court 4 many times. 5 MS. LINDA ROTHSTEIN: Qualified as an 6 expert witness? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: How was your 9 expertise described for -- for family courts or criminal 10 courts? 11 DR. KATY DRIVER: I think more for 12 physical abuse, not for sexual abuse. 13 MS. LINDA ROTHSTEIN: All right. And did 14 that continue throughout your career with -- 15 DR. KATY DRIVER: Yes. 16 MS. LINDA ROTHSTEIN: -- the SCAN Team, 17 Dr. Driver? 18 DR. KATY DRIVER: Yes. 19 MS. LINDA ROTHSTEIN: Okay. Turning to 20 you, Dr. Huyer, I take it it also became one (1) of your 21 responsibilities to testify in courtrooms about the cases 22 that you had reviewed in the SCAN environment? 23 DR. DIRK HUYER: Absol -- certainly, 24 because -- and also because I had a higher volume of 25 patients, I was going more often. I was also more able

1 and available to take the outside review cases, so I 2 would be involved in those cases very frequently as well. 3 My numbers, in listening to Dr. Shouldice, 4 I probably did, on average, I would think around one (1) 5 a week of the outside reviews, in addition to the 6 patients that I was seeing. That's an estimate, but I 7 think it's a fairly accurate one (1). 8 So I would attend court -- certainly in my 9 later years I was attending generally around, I would 10 say, one (1) to two (2) times a month in the area of -- 11 of various aspects. And I would be qualified, certainly 12 in the later years, -- it would vary in the -- in the 13 qualification, and I would defer to counsel as to what 14 they chose to qualify me in. 15 I would provide my past qualifications, 16 and they would be as broad as child abuse, and then 17 narrowing down to child physical abuse, child sexual 18 abuse, child neglect, and then probably more towards the 19 later years of my testimony, and up till today, because I 20 still testify not infrequently, it would be the medical 21 aspects of child maltreatment with specific focus on 22 evaluation and interpretation of injuries and their 23 causation. So that would be the more fine tuned one. 24 And similarly in sexual abuse, it would be 25 a similar sort of evaluation in -- of children where

1 sexual abuse concerns and interpretation of the findings, 2 something of that nature. 3 COMMISSIONER STEPHEN GOUDGE: And the 4 range of cases, Dr. Huyer; child protection, criminal 5 cases? 6 DR. DIRK HUYER: By far the majority of 7 my testimony has been in criminal cases. I've testified 8 in child protection much less frequently, because 9 generally the reports are accepted. And the reports 10 really -- I try to lay out the building block of my 11 opinion -- 12 COMMISSIONER STEPHEN GOUDGE: Right. 13 DR. DIRK HUYER: -- and -- and so there's 14 not as frequent testimony in that area. 15 COMMISSIONER STEPHEN GOUDGE: Did you do 16 criminal cases, Dr. Driver? 17 DR. KATY DRIVER: Yes. 18 19 CONTINUED BY MS. LINDA ROTHSTEIN: 20 MS. LINDA ROTHSTEIN: But your 21 recollection is the majority of the cases that -- where 22 you were called on to testify were in child protection 23 cases? 24 DR. KATY DRIVER: Initially. 25 MS. LINDA ROTHSTEIN: Okay.

1 DR. KATY DRIVER: Towards later years, it 2 was equal numbers. 3 MS. LINDA ROTHSTEIN: And I take it, Dr. 4 Driver, no one gave you any training about how to go to 5 court and be an expert witness, is that right? 6 DR. KATY DRIVER: I'm sorry? 7 MS. LINDA ROTHSTEIN: Did anyone give you 8 any training about how to go and present evidence in a 9 courtroom? 10 DR. KATY DRIVER: Not initially. I think 11 towards later -- after some cases, we -- SCAN Team had 12 its own lawyer, and we were then helped with how to give 13 evidence. 14 MS. LINDA ROTHSTEIN: Can you date the 15 time period for us when you obtained a lawyer and got 16 some help on giving evidence? 17 DR. KATY DRIVER: I think it was after 18 the Amber case. 19 MS. LINDA ROTHSTEIN: Okay. So we'll 20 come to that. We're talking about Amber's case, and 21 we're not going to use -- 22 DR. KATY DRIVER: Yes. 23 MS. LINDA ROTHSTEIN: -- those last 24 names, Registrar, if you can just catch that, please. 25 We have a non-publication order as you may

1 recall, -- 2 DR. KATY DRIVER: Sorry. 3 MS. LINDA ROTHSTEIN: -- Dr. Driver. 4 It's okay. But we're going to try and just refer to 5 cases by the first name of the deceased child if you 6 would. Thank you. 7 Dr. Huyer, can you enlighten us as to 8 what, if any, training you got about going to court and 9 whether you recall a lawyer for SCAN Team helping you 10 with those kinds of tasks? 11 DR. DIRK HUYER: The lawyer was a loose 12 relationship, and was -- I understood, my recollection 13 the earlier years when I started, was more of a 14 consultant to -- to help us to understand some legal -- 15 give us legal advice around assessments that were the 16 more complicated sexual abuse assessments. 17 It was always my understanding -- I didn't 18 gain a lot, that I recall, from the lawyer. I think the 19 way I learned was attending court and -- and observing 20 others testify, and meeting with more experienced Crown 21 attorneys who talked to me about, and prepared for my 22 testimony. 23 I think that though essentially I learned 24 from doing and -- and attending in court. And some of 25 them were more challenging than others shall we say. And

1 -- and now my -- I estimate that I've probably testified 2 more than a hundred and fifty (150) times at the criminal 3 level, and so now I teach others when asked on my 4 approach to -- to testifying in the area of an ex -- as 5 an expert witness. 6 MS. LINDA ROTHSTEIN: Have you ever, just 7 out of curiosity, Dr. Huyer, been called as a witness, 8 not because of your work as a SCAN physician, but because 9 of your work as a coroner? 10 DR. DIRK HUYER: Yeah, I've -- yes, I've 11 testified a number of times in my work as a coroner. 12 I've testified a number of times where adult injury 13 evaluation, as well. Because of my work as a coroner 14 I've seen a number of injuries in adults and so I've 15 actually -- I've testified a number of times in injury 16 analysis in adults. 17 And -- and I've testified as a fact 18 witness on occasion. Rarely does that happen, and that's 19 not my control, but the counsel seem to want to elevate 20 me to the point of an expert because of the fact of my 21 unique expertise, I guess, so it's more often that I'm 22 qualified as an expert. 23 COMMISSIONER STEPHEN GOUDGE: I take it 24 most of the testimony of both of you in criminal cases 25 would be for the Crown, rather than the defence?

1 DR. DIRK HUYER: Yeah, most of the time 2 I've been called has been by the Crown. I have testified 3 on at least one (1), if not two (2), occasions for the 4 defence, and I've sat in the -- in the body of the Court 5 during defence -- during testimony by experts called by 6 the prosecution to provide feedback to defence counsel, 7 and I've reviewed many cases on the -- at the request of 8 defence counsel, providing them opinions. 9 I haven't testified in many of those 10 cases, but I've given them my thoughts on what -- what 11 aspects I think -- I -- I understand that I'm on the list 12 of legal aid available that will work on the legal aid 13 rates to provide opinions in the area. 14 15 CONTINUED BY MS. LINDA ROTHSTEIN: 16 MS. LINDA ROTHSTEIN: What about you, Dr. 17 Driver, what experience did you have testifying for the 18 defence or providing defence opinions? 19 DR. KATY DRIVER: I think there have been 20 cases sent to us for review, not where we were personally 21 involved, have give an opinion, and sometimes the opinion 22 was not acceptable to the defence, and then they would 23 not use our defence, so I have not testified for the 24 defence a lot. 25 MS. LINDA ROTHSTEIN: Okay. Dr.

1 Shouldice, can you summarise for the Commissioner what 2 your experience has been to-date as an expert witness? 3 DR. MICHELLE SHOULDICE: I've testified I 4 think between -- around twenty-five (25) times in Court, 5 the majority being Criminal Court. I think two (2) or 6 three (3) of those would be Family Court. 7 Of the Criminal Court appearances, I think 8 three (3) were -- I was called by the defence, the 9 remainder by the Crown. And I have also provided 10 consultation to defence attorneys and written opinion to 11 defence attorneys separately from testimony in Court. 12 MS. LINDA ROTHSTEIN: And what, if any, 13 training did you get before you first walked into a 14 courtroom and was sworn -- and were sworn in as an expert 15 witness? 16 DR. MICHELLE SHOULDICE: During my 17 fellowship I attended Court whenever possible in order to 18 hear others testify. During my fellowship and since have 19 also attended sessions at conferences on providing expert 20 witness testimony. Those conferences have mainly been in 21 the States and obviously have been provided from -- from 22 that -- from the perspective of -- of those in the 23 States. 24 MS. LINDA ROTHSTEIN: Which is a little 25 different, perhaps.

1 DR. MICHELLE SHOULDICE: It is a little 2 different. I would also agree with Dr. Huyer that some 3 of the learning with respect to testifying in Court has 4 come from meetings with Crown attorneys, either prior to 5 testifying or occasionally obtaining some feedback after 6 the Court appearance has been completed. 7 MS. LINDA ROTHSTEIN: All right. Back to 8 the history a little bit; we got off it for awhile, Dr. 9 Driver. I just want to go back and complete the 10 development of the SCAN Program, if I can. 11 You've told us about Dr. Mian's arrival 12 and how that helped to develop the sexual abuse side of 13 the work of that program and how she became the Director 14 in 1984 following from Dr. Robert Bates. 15 I understand that at some stage SCAN 16 actually got their own designated sco -- social worker to 17 work with the group. 18 DR. KATY DRIVER: Yes. 19 MS. LINDA ROTHSTEIN: All right. And by 20 1989 there were three (3) social workers. 21 DR. KATY DRIVER: We had three (3) full 22 time social workers. 23 MS. LINDA ROTHSTEIN: And that there was 24 a period of time rather brief, I think, when there was 25 also an art therapist who was part of the team.

1 DR. KATY DRIVER: Yes. 2 MS. LINDA ROTHSTEIN: Tell us about that, 3 would you, please? 4 DR. KATY DRIVER: I think the art 5 therapist started with -- when Dr. Mian became the 6 Director. 7 She was working -- her hours were 8 increased after Dr. Mian became a Director, and she 9 worked with -- primarily where there were allegations of 10 sexual abuse. 11 And she attended all our team meetings, 12 and gave us an input as to what she felt. 13 MS. LINDA ROTHSTEIN: What was her 14 function? Was she actually treating children, or was she 15 helping in the assessment function, or both? 16 DR. KATY DRIVER: I think primarily it 17 was assessment, but I think she did some treatment also. 18 MS. LINDA ROTHSTEIN: And I understand 19 that the team was sort of not in a position to hang onto 20 a -- a psychiatrist for its entire tenure. You had 21 someone by the name of Dr. Kreindler initially working 22 with the team, if I understand it correctly. 23 DR. KATY DRIVER: That is correct. 24 MS. LINDA ROTHSTEIN: And then at some 25 point, I believe around 1985 or '86, Dr. Kreindler left,

1 and you weren't able to replace -- is it him or her? 2 DR. KATY DRIVER: Him. 3 MS. LINDA ROTHSTEIN: Him, thank you. 4 Have I got that right, Dr. -- 5 DR. KATY DRIVER: Yes. 6 MS. LINDA ROTHSTEIN: -- Driver? But 7 there was some ability to use someone by the name of Dr. 8 Harvey Armstrong? 9 DR. KATY DRIVER: A little. Dr. 10 Armstrong was never formally part of the team. With 11 sexual abuse, we've had Dr. Wittenberg (phonetic) 12 involvement. There were some psychiatric involvement, 13 but not very much. 14 MS. LINDA ROTHSTEIN: Okay. All right. 15 The composition of the team during your tenure, Dr. 16 Huyer, tell us about that, if you would. 17 DR. DIRK HUYER: When I started in late 18 1989, there was the three (3) full time social workers. 19 There was three (3) physicians. Dr. Driver, I think 20 point two (2) -- 21 DR. KATY DRIVER: Two point three (2.3). 22 DR. DIRK HUYER: -- of a full time -- 23 point three (.3) of a full time equivalent. I was point 24 two (.2) of a full time equivalent; and Dr. Mian, at that 25 point, I think was point five (.5) of a full time

1 equivalent. 2 So we had one (1) full time equivalent 3 medical staff. If was a nurse who was working, I think 4 three (3) days a week at that point, a program 5 coordinator, who was an administrative support, a 6 secretary, and the art therapist was working a number of 7 days. 8 And that changed over time somewhat, but 9 essentially it was departure of staff. The art therapist 10 was no longer with the program at around 1996, if I 11 recall correct. It might have been a bit earlier than 12 that, or a little later. Somewhere around 1996. The 13 program coordinator left the hospital as well around that 14 time, and we enhanced -- took two (2) secretaries. 15 And that's sort of what occurred prior to 16 my move into the Director role. And with my move into 17 the Director role, we did a couple of things. One (1), 18 we had more nursing staff actually around that time -- I 19 can't remember if it was before or after I took over -- 20 and we also had a group of nurses who were -- who we had 21 providing acute care. So children who are adolescents 22 who were brought to the emergency department where there 23 was an acute concern of sexual abuse, so a new concern, 24 would allow forensic evidence collection, and assessment 25 of those kids and adolescents in the acute setting. So

1 that team was associated with us. 2 And we moved from having nursing support 3 during our examinations in sexual abuse to a nurse 4 practitioner role, where that nurse practitioner could 5 take on the -- the work of assessing those children. And 6 so the nurse practitioner, as I understand -- Michelle 7 can -- or Dr. Shouldice can speak more to the volume of 8 work that they now do, but the goal was to have them 9 doing the majority of the sexual abuse work within the 10 team, as far as assessing went. 11 Again after I moved into the role, we were 12 able to obtain and get stable funding for a psychologist, 13 and so with advertising we were able to hire a full time 14 psychologist, which Dr. Shouldice has commented upon, and 15 still remains with the team. 16 And the physician time -- by the time I 17 had left -- I'm trying to think -- I enhanced a point -- 18 a point eight (.8) in 1993, so our numbers increased to 19 one point three (1.3) full time equivalence between '93 20 and certainly '98. I don't think we had an increase 21 until somewhere around '99/2000, where we again had a few 22 -- a little bit more provided when Dr. Shouldice came 23 onboard. 24 But again, it wasn't a substantial 25 increase in full-time equivalence. I can't remember

1 exactly the number. 2 And during the time of my taking over 3 there were changes in personnel in the social work role, 4 but we maintained three (3) initially, but we were then 5 lost to two (2) -- two (2) and maybe a little bit. I 6 can't remember exactly. Not a full-time extra social 7 worker, but our numbers went down. This was the time of 8 cost cutting at the hospital, and we took, I would say, 9 our fair share of hits for a small program. 10 MS. LINDA ROTHSTEIN: And how strained 11 were your resources, Dr. Huyer? 12 DR. DIRK HUYER: I guess it's how you 13 define "strained." We were very busy, we had a large 14 volume, and we had calls coming endlessly. We tried to 15 meet the service the best we could, and -- and we were 16 very reluctant to turn -- turn away things. 17 So I guess I don't know how to measure 18 that in any effective manner. I guess in -- in -- 19 similar to my answer to the Commissioner earlier, is 20 what's a full-time job as a coroner? I don't really know 21 the numbers that would make it. So we felt under- 22 resourced, and we felt that we could certainly use more. 23 Everybody feels that and so it's -- it's a 24 challenge for me to answer that question with any numbers 25 or -- or certainty.

1 MS. LINDA ROTHSTEIN: Dr. Shouldice, upon 2 becoming the director of the SCAN Team, can you describe 3 for the Commissioner the course of the composition of 4 that team? 5 DR. MICHELLE SHOULDICE: Yes. We -- when 6 I initially came to the SCAN Program the situation was as 7 Dr. Huyer described. When Dr. Huyer left the program 8 there, at that time, had been three (3) physicians: 9 myself, Dr. Huyer, and Dr. Mian. 10 Dr. Mian then went on sabbatical for a 11 year, so for a year, I was virtually the only physician 12 with the program, with some additional support from Dr. 13 Huyer for a short period of time, and a physician from 14 the Niagara region who came in one (1) to two (2) days a 15 week to -- to see cases. 16 During that time, we trained another 17 fellow, who subsequently came on staff and since them 18 have trained a further fellow. So we're now back to 19 three (3) physicians providing the majority -- three (3) 20 pediatricians providing the majority of the clinical work 21 in the area of physical abuse in the SCAN Program. 22 Our component assigned to SCAN adds up to 23 1.6 full-time equivalents. We also have one (1) 24 pediatrician and pediatric opthamologist who -- Dr. Alex 25 Levin (phonetic), who provides some after-hours call for

1 us. So evenings and weekends. 2 So that's the situation with respect to 3 physicians. The nurse practitioner role has continued to 4 grow with the SCAN Program, and we currently have two (2) 5 nurse practitioners comprising 1.6 full-time equivalent. 6 That role has mainly expanded within the area of sexual 7 abuse evaluation. 8 And the two (2) nurse practitioners 9 provide the majority of direct sexual abuse evaluation in 10 our program now. They also provide an enormously large 11 role with respect to education in the Province, because 12 there has been establishment of a provincial network of 13 sexual assault and domestic violence centres that provide 14 assessment of -- of both adults and children who may have 15 been sexually abused. So they provide educational role, 16 ongoing education. They've coordinated peer review 17 amongst the provincial network. And so they play quite a 18 large role within our program. 19 The -- 20 MS. LINDA ROTHSTEIN: Stopping there for 21 a moment. 22 DR. MICHELLE SHOULDICE: Yeah. 23 MS. LINDA ROTHSTEIN: Just -- we're going 24 to spend most of the time on physical abuse cases because 25 it's closer, if you will, to our mandate. But on sexual

1 abuse, you say that the nurse practitioners now perform a 2 very important role in the evaluation process. 3 Does that include doing the physical 4 examination of the young patient and making the physical 5 findings? 6 DR. MICHELLE SHOULDICE: Yes, it does. 7 MS. LINDA ROTHSTEIN: All right. And 8 help the Commissioner and -- and I and others in the room 9 understand how that sort of responsibility can be 10 undertaken by a nurse practitioner as opposed to a -- a 11 physician? 12 DR. MICHELLE SHOULDICE: Yeah. So the 13 nurse practitioner role is an -- what's called an 14 advanced practice nursing role where nurse who obtain 15 specific training and expertise within a focussed area of 16 medicine are given responsibilities within that area 17 which allow them to order medical evaluations, order 18 tests within that prescribed role under what's called 19 "Medical Directives". So the physicians with whom those 20 nurse practitioners work -- and those nurse practitioners 21 work together to define specifically their role, and the 22 extent of that role and provide ongoing consultation as 23 those nurse practitioners require, and support for that 24 role. 25 So the nurse practitioners currently with

1 our program do provide -- they take the necessary medical 2 history in cases of suspected sexual abuse, they do 3 physical examinations including genital examinations. 4 They do documentation of their findings with photo 5 documentation as well as written documentation. They 6 provide opinions in those cases, and they do testify in 7 court as expert witnesses. 8 MS. LINDA ROTHSTEIN: That's interesting. 9 DR. MICHELLE SHOULDICE: And they undergo 10 similar training as a physician would in the area as well 11 as ongoing continuing education in the area. 12 MS. LINDA ROTHSTEIN: Okay. 13 COMMISSIONER STEPHEN GOUDGE: And for 14 these nurse practitioners the defined area is -- 15 DR. MICHELLE SHOULDICE: Pediatric -- 16 COMMISSIONER STEPHEN GOUDGE: -- 17 suspected sexual abuse? 18 DR. MICHELLE SHOULDICE: Pediatric -- 19 COMMISSIONER STEPHEN GOUDGE: Pediatric 20 sexual -- 21 DR. MICHELLE SHOULDICE: -- and 22 adolescent, yeah. 23 24 CONTINUED BY MS. LINDA ROTHSTEIN: 25 MS. LINDA ROTHSTEIN: But, Dr. Shouldice,

1 you do not have nurse practitioners doing the same kind 2 of function when it comes to physical abuse cases? 3 DR. MICHELLE SHOULDICE: No. 4 MS. LINDA ROTHSTEIN: Why is that? 5 DR. MICHELLE SHOULDICE: In physical 6 abuse cases, the -- the knowledge base with respect to 7 general pediatrics, the role of child development, the 8 medical complexity is significantly greater and more 9 expansive, and much more difficult, I think, to -- to put 10 into a nar -- a narrower focus of practice. 11 So that general body of knowledge is 12 required really to do those assessments. I don't know if 13 you would have anything to add to that? 14 DR. DIRK HUYER: No, I think that's a -- 15 that's a fair way to explain it, describe it. 16 MS. LINDA ROTHSTEIN: So it's a 17 principled reason, as opposed to -- by virtue of what 18 kind of money you have or staffing that you're not using 19 nurse practitioners in the physical abuse cases. 20 Am I right about that? 21 DR. MICHELLE SHOULDICE: Yes. 22 MS. LINDA ROTHSTEIN: Okay. 23 DR. DIRK HUYER: I will -- 24 MS. LINDA ROTHSTEIN: Well, we just need 25 to understand.

1 DR. DIRK HUYER: I will comment that 2 there are various locations, both within the United 3 States and I think some within Canada, that are moving 4 towards a forensic nursing approach, and would -- and 5 have response to physical abuse evaluations. 6 And I'm not sure of the dynamics of all of 7 that in the support and the training that they receive, 8 but those programs are out there and there are certainly 9 some that are doing that work. 10 DR. MICHELLE SHOULDICE: I would say 11 particularly within adult domestic violence. 12 DR. DIRK HUYER: Yes. 13 MS. LINDA ROTHSTEIN: Okay. All right. 14 Well that's really helpful. 15 Okay. What I'd like to do then, doctors, 16 is review with you the process changes over the years 17 when it comes to case assessment of a physical abuse 18 case. We'll stay with that as our -- as our prototype 19 for the moment, because my understanding is, is that the 20 process by which assessments have been made by the SCAN 21 program have changed, evolved and developed over the 22 years. 23 But I want to start then with you, Dr. 24 Driver. In the early days of this program, and indeed I 25 understand that it was -- the process by which one would

1 do assessments was really -- there were no models out 2 there, is that fair? 3 DR. KATY DRIVER: That is correct, yes. 4 MS. LINDA ROTHSTEIN: And do you remember 5 at what stage you became aware of how other programs in 6 other jurisdictions were doing their assessments, how 7 long after? 8 DR. KATY DRIVER: I think we started 9 attending meetings mainly in States, and developed ideas 10 about how the teams there were working. 11 MS. LINDA ROTHSTEIN: Right. 12 DR. KATY DRIVER: But there was always -- 13 mainly it was in-patient first. We would examine the 14 child, get the history from the resident. We didn't work 15 as a team. We didn't have a designated social worker, so 16 the social worker would often get involved after the 17 fact. During our meeting we would discuss, and perhaps 18 the social worker. 19 The process became more formalized with -- 20 as we -- the Team grew. There was always then two (2) 21 people on call, always attended as a team and would do 22 assessment and follow-up. 23 MS. LINDA ROTHSTEIN: All right. Well 24 certainly by the time you testified in Amber's Case, and 25 we actually have your evidence -- I don't think we need

1 to go to it in any great detail, Dr. Driver, but in case 2 you want to refresh your memory, it's at Tab 43 of Volume 3 IV -- sorry, Volume I. Thank you. 4 And it's PFP122356, and I see reference to 5 it particularly at page 19. 6 By the time you were testifying in that 7 case in the early '90's, Dr. Driver, you described the 8 process by which your program made an assessment as 9 comprising three (3) functions, if you will, a physical 10 examination, you'll see this in the middle of the page, a 11 history, a medical history, and -- 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: -- a psychosocial 14 assessment. Do you see that in the middle of page 19? 15 DR. KATY DRIVER: Yes. 16 MS. LINDA ROTHSTEIN: All right. So 17 let's walk through those three (3) components, if we 18 will, and get some further detail. The physical 19 examination, I take it that was always done by a 20 physician in the SCAN Program, so either you and Dr. 21 Bates, or eventually Dr. Mian, Dr. Huyer, and others. 22 Is that right? 23 DR. KATY DRIVER: Yes. 24 MS. LINDA ROTHSTEIN: All right. And I 25 don't think a whole lot needs to be said about that.

1 Obviously you conducted as thorough a physical 2 examination as you could. 3 Is that right? 4 DR. KATY DRIVER: As thorough as 5 possible. When children were covered up with post- 6 surgery it wasn't always possible to determine the extent 7 of external bruising, so it was limited in that sense. 8 MS. LINDA ROTHSTEIN: In those days was 9 it the practice to take photographs in the SCAN physical 10 assessment process or not? 11 DR. KATY DRIVER: I'm -- I'm sorry? 12 MS. LINDA ROTHSTEIN: Did you take 13 photographs or not? Was it the practice? 14 DR. KATY DRIVER: There was -- 15 photographs were taken, but not routinely. 16 MS. LINDA ROTHSTEIN: And do you remember 17 what the protocol was as to when you would and when you 18 wouldn't? 19 DR. KATY DRIVER: We would request 20 medical photography to come down and take the pictures. 21 MS. LINDA ROTHSTEIN: On that issue, Dr. 22 Huyer, what -- what was the practice during your tenure 23 as the Director? 24 DR. DIRK HUYER: I -- I can't say when it 25 changed, but it was my practice to have photos as often

1 as possible. I would make it routine. And in fact, 2 again, the hospital in cut back times cut back the 3 photography availability after hours, but we were able to 4 creatively strike a deal with the director of the 5 photography group that he would provide after hours 6 service for us. 7 So if we saw a child in the Emergency 8 Department, he would come in and do that on his own time. 9 And I mean he may have been paid, but he sacrificed his 10 time to come in and do that. 11 But we would try to do that routinely. I 12 don't remember the timeframe of when I -- when I moved to 13 that, but certainly it -- it was a routine. 14 MS. LINDA ROTHSTEIN: All right. And 15 what about during your tenure, Dr. Shouldice, was the 16 practice with respect of photography? 17 DR. MICHELLE SHOULDICE: Well, in 18 physical abuse cases where, following our assessment, 19 their concern of possible abuse remains, which would only 20 be about half the cases that we would be asked to provide 21 a consultation in. 22 In those con -- in those cases where there 23 were external injuries, we always have photographs taken 24 either at the hospital, or if photography is not 25 available at the hospital because of restrictions in our

1 availability of a medical photographer, we would ask that 2 investigators, usually the police, take the photographs 3 and provide copies to us. 4 COMMISSIONER STEPHEN GOUDGE: And I take 5 it that's for what you referred to as forensic purposes. 6 That's part of the forensic side of the work you do? 7 DR. MICHELLE SHOULDICE: And also, I 8 think it's the best form of documentation of skin 9 findings. It would be photo -- photographs will be 10 considered in all areas of pediatrics where documentation 11 of skin findings is required. 12 COMMISSIONER STEPHEN GOUDGE: Right. 13 DR. MICHELLE SHOULDICE: So in 14 dermatology, as well -- 15 COMMISSIONER STEPHEN GOUDGE: Right. 16 DR. MICHELLE SHOULDICE: -- for example. 17 COMMISSIONER STEPHEN GOUDGE: But where 18 you've been the -- in the 50 percent of the cases where 19 had excluded the possibility -- 20 DR. MICHELLE SHOULDICE: Yes. 21 COMMISSIONER STEPHEN GOUDGE: -- of 22 abuse, you wouldn't photograph? 23 DR. MICHELLE SHOULDICE: Correct. 24 DR. DIRK HUYER: There would be occasions 25 where we might do that and then seek -- seek permission

1 to use those as teaching cases because they may be a very 2 unusual circumstance -- 3 COMMISSIONER STEPHEN GOUDGE: Right. 4 DR. MICHELLE SHOULDICE: Yeah, that's 5 true. 6 DR. DIRK HUYER: -- that was referred to 7 us as an abuse concern -- 8 COMMISSIONER STEPHEN GOUDGE: Right. 9 DR. DIRK HUYER: -- and that far -- 10 following our evaluation we in fact felt that it was not 11 an abuse concern and that the Children's Aid and police 12 were informed of that, and yet a very unusual finding 13 which -- which would then utilise later as an educational 14 tool -- 15 COMMISSIONER STEPHEN GOUDGE: Right. 16 DR. MICHELLE SHOULDICE: Yeah. 17 DR. DIRK HUYER: -- with the appropriate 18 permission. 19 COMMISSIONER STEPHEN GOUDGE: Is that 50 20 percent number a number that's remained relatively 21 constant or has it changed over the years? I mean if I 22 said to each of you over time, what would that number of 23 cases that present that turn out to be probable child 24 abuse, would that have remained at about 50 percent of 25 the cases presenting, or has that number gone up, or

1 down, or...? 2 DR. KATY DRIVER: I think the -- in 3 sexual abuse, a lot of times we would say that the 4 findings neither confirmed nor denied the allegation. 5 COMMISSIONER STEPHEN GOUDGE: Okay, what 6 about physical abuse? 7 DR. KATY DRIVER: In physical abuse I 8 think we -- more like 50 percent. 9 COMMISSIONER STEVEN GOUDGE: What would 10 you say, Dr. Huyer? 11 Is that number constant? 12 DR. DIRK HUYER: I don't know -- I don't 13 think you can use the word "constant", but certainly I 14 think it -- I -- I'd like to re-frame it a little bit for 15 you -- 16 COMMISSIONER STEVEN GOUDGE: Sure. 17 DR. DIRK HUYER: -- in the fact that 50 18 percent of the time, we do not feel, or we did not feel, 19 that it's a child abuse concern. 20 Of that other 50 percent, it may not all 21 be specifically a diagnosis of child maltreatment or 22 child -- child abuse, but we have not eliminated that as 23 a potential. 24 COMMISSIONER STEVEN GOUDGE: Okay. 25 DR. DIRK HUYER: So that number may still

1 be larger as far as what the investigators may sort 2 through, but our evaluation has not allowed us to reach 3 that conclusion. 4 COMMISSIONER STEVEN GOUDGE: Okay. And 5 does the 50 percent that may still be possibly child 6 abuse, is that a number that over your time at SCAN 7 remained about constant? 8 DR. DIRK HUYER: Yeah, I would say that 9 that was the number. I think, in fact, it probably 10 increased from my early days. 11 So my earlier days, I think, that are -- a 12 referral pattern was to receive referrals where there 13 were more significant concerns, so a -- a more severely 14 injured child and -- and people -- we were more willing 15 at that point to open the door only a little bit, and so 16 we would screen out cases that may not have been as 17 serious. 18 And, so our door opened with more 19 resources. We saw more -- we recognized the value of 20 seeing more, and recognized that more times -- our -- our 21 numbers increased to the fact that we were saying, Oh no, 22 that doesn't -- that -- that seems to make sense, and 23 that doesn't seem to be a child abuse concern. 24 COMMISSIONER STEVEN GOUDGE: Right. 25 There were --

1 DR. DIRK HUYER: So I would say our 2 numbers -- 3 COMMISSIONER STEVEN GOUDGE: -- there 4 were more possible cases, but less that passed through 5 your first screening? 6 DR. DIRK HUYER: I think that that's a 7 fair thing. 8 I don't think we know the end, which -- 9 COMMISSIONER STEVEN GOUDGE: Okay. 10 DR. DIRK HUYER: -- you know, the number 11 of what's out there. 12 COMMISSIONER STEVEN GOUDGE: Right. 13 DR. DIRK HUYER: So it's very challenging 14 to -- to be definite on an answer. 15 But yeah, I would say from nine (9) -- 16 eighteen (18) -- 1989 until I left in 2001, the numbers 17 for sure increased, as far as percentage goes to 18 believing it's not child maltreatment. 19 COMMISSIONER STEVEN GOUDGE: But the 20 overall numbers of possible cases presenting increased as 21 we've seen -- 22 DR. DIRK HUYER: But I think -- even with 23 that overall increase, I think that we have over -- with 24 more literature; more knowledge; more experience; we've 25 come to recognize that probably earlier on we may have

1 been calling something child maltreatment; with more 2 knowledge, and more experience, and more literature, is 3 now recognized as not being so. 4 So I think it's changed for many reasons. 5 COMMISSIONER STEVEN GOUDGE: Thank you. 6 DR. DIRK HUYER: Welcome. 7 MS. LINDA ROTHSTEIN: So -- so that's the 8 first aspect what we've talked about, which is the 9 physical examination. 10 And I take it when you were doing those in 11 the early years, Dr. Driver, and maybe even into the 12 '90s, there were no written protocols that helped you 13 work through the tasks that one should do to complete a 14 thorough physical examination, am I right about that? 15 DR. KATY DRIVER: I don't think that 16 there was a written protocol per se, but we certainly had 17 identification of high risk factors, and just 18 documentation of the physical findings. 19 MS. LINDA ROTHSTEIN: All right. Dealing 20 with the second aspect of your assessment process, taking 21 the history from the caregivers, who was responsible for 22 that when you started out? 23 Was it the pediatrician? Was it the 24 social worker? Did you do it in combination? 25 DR. KATY DRIVER: It -- it was the

1 physician who took the history. 2 Initially the social worker was not even 3 present. And then most of the time when we worked as a 4 team, if it was possible for the social worker to be 5 present also, so there would be two (2) people. 6 But certainly the history was always taken 7 by the physician. 8 MS. LINDA ROTHSTEIN: All right. And 9 just so we're clear for the Commissioner that the history 10 that was taken by the physician included taking a history 11 from someone who might be in the category of persons who 12 would be suspects of -- or potential perpetrators of the 13 abuse, is that right? 14 DR. KATY DRIVER: Sometimes. Not all 15 cases. 16 Often the person who was giving the 17 history, himself or herself would not have been present 18 at the time of the injury. 19 MS. LINDA ROTHSTEIN: Right. 20 DR. KATY DRIVER: So it may -- we were 21 getting a second-hand version. 22 MS. LINDA ROTHSTEIN: Right. 23 DR. KATY DRIVER: But sometimes -- or 24 quite often, it would be the person that we're taking 25 from -- history from might have been the perpetrator.

1 MS. LINDA ROTHSTEIN: Right. And, Dr. 2 Huyer, I understand that when you started in 1990 -- 3 1989, it was still the practice to take a history from 4 family members who were present at the hospital, whether 5 or not they were persons who might be suspected of 6 engaging in the abusive behaviour. 7 Isn't that right? 8 DR. DIRK HUYER: Correct, again. 9 MS. LINDA ROTHSTEIN: So if -- if we take 10 a look at just one (1) example from those early years 11 that we have from the XXXX case. If you turn to Tab 4, 12 Dr. Huyer, or rather Volume IV, Tab 29. 13 Sorry. Gaurov, excuse me. 14 Can you make that correction, please, 15 Registrar. 16 DR. DIRK HUYER: Which, I'm sorry, Ms. 17 Rothstein? 18 MS. LINDA ROTHSTEIN: It's the Gaurov 19 case, and it's Tab 29 of Volume IV, 001505. 20 DR. DIRK HUYER: Yes. 21 MS. LINDA ROTHSTEIN: We have here a 22 document that wasn't prepared by you, Dr. Huyer, but I'm 23 hoping you can shed some light on it because you are 24 listed as being involved in this case. And it looks like 25 the -- in this case, the social worker conducted an

1 interview of both parents, and she's written, "as well as 2 Dr. Huyer." 3 So do I read that to say that that was an 4 occasion where you and the social worker sat down 5 together and did the interview together? 6 DR. DIRK HUYER: It's my recollection, 7 around that time, that the process was that there was a 8 team; a social worker/physician team that evaluated cases 9 where the children were admitted to hospital. And I 10 think that it would be either a joint interview done by 11 the physician and social worker or it may be that the 12 social worker did the interview and then the physician 13 provided further evaluation around the medical history, 14 and the -- the presenting history may be done by 15 either/or, or both. 16 And so absolutely there was a -- there was 17 a team, there was a process, and that was the -- the 18 process was to interview people who were the parents of 19 the child. 20 MS. LINDA ROTHSTEIN: Mm-hm. 21 DR. DIRK HUYER: And that would include 22 where parents were potentially suspects of causing the 23 injuries in the child. 24 MS. LINDA ROTHSTEIN: And what were the 25 purposes of that interview?

1 DR. DIRK HUYER: The purposes, as 2 articulated at that time by the team, were to -- 3 because we had the ability to spend more time in a 4 evaluating how the child might have presented to the 5 hospital because we weren't as active in the treatment 6 provision. 7 That would be up to the intensive care 8 unit or the neurosurgeons. And we were the evaluators of 9 trying to sort through how the injury might have 10 happened. And so given that increased amount of time 11 then we could then evaluate the circumstances of the 12 injury more effectively, theoretically providing a better 13 avenue to the treatment of the child. 14 And that was the theory that I understood 15 was being utilized in -- in seeking that additional 16 information. The second approach was that we were going 17 to be better off doing the interview ourselves and 18 getting firsthand information to be able to provide a 19 more solid opinion as to how the injury might have 20 happened. 21 And ultimately provide an opinion about 22 the potential nature as far as whether it's accidental or 23 non-accidental. And sorry, the last part was from the 24 social worker point of view. They would be gathering 25 psychosocial information to help to look for risk factors

1 or factors that may indicate that this is a higher risk 2 kind of situation. 3 MS. LINDA ROTHSTEIN: Okay. Would it be 4 fair to say, Dr. Huyer, that at that time, when this was 5 the process, that one (1) of the factors that played in 6 these interviews was the attempt to determine the extent 7 to which the caregiver's version of events appeared, 8 based on their telling and based on their presentation, 9 to be credible? 10 DR. DIRK HUYER: Yes. 11 MS. LINDA ROTHSTEIN: Okay. So that if, 12 for example, we look at page 5 of 001505, we see here -- 13 this is the social worker's words, I understand it that 14 there's a description of the care -- one (1) of the 15 caregivers, Mr. Kay (phonetic), as obviously distressed 16 when told about the pending death of his son, and quite 17 obviously distressed and broke down upon the child's 18 extubation and ultimate expiration. 19 And then referring to one (1) of the other 20 caregivers as noted lack of affect was somewhat 21 concerning. So those kinds of observations, I take it, 22 were typical at the time following this sort of interview 23 of the caregivers, is that right? 24 DR. DIRK HUYER: I think it's a very fair 25 comment, and I think that -- thinking back, there was --

1 there appeared -- in my recollection to be weight put on 2 that -- appear -- on appearances of people around 3 challenging times and how they might of presented 4 information. 5 I'd have to say that over my years in 6 meeting with families at very tragic times, whether it be 7 death or significant injuries in children, I've seen such 8 a wide range that I don't put much heed on that -- that 9 presentation. I've just seen such a wide variety of 10 people presenting in various tra -- very tragic times, so 11 I really think that an abundance of caution is required 12 in interpreting that -- those appearances. 13 Clearly in my earlier days that was 14 occurring -- 15 MS. LINDA ROTHSTEIN: Right. 16 DR. DIRK HUYER: -- and that can be 17 reflective, I think, in other -- other reports that will 18 likely be put to me, but clearly in my earlier days I was 19 doing that. 20 MS. LINDA ROTHSTEIN: Right. Yeah, 21 indeed, just to complete this paragraph, Commissioner, 22 for the record, it's recorded that this caregiver 23 exhibited a great deal of control over her feelings, 24 expressing some sadness but exhibiting a great deal of 25 anger.

1 Bot parents were obviously upset at the 2 apprehension of their second child after the death of 3 their first, so together with the -- this is a situation, 4 is it not, Dr. Huyer, where parents and other caregivers 5 are confronted not only with the -- the grief that would 6 follow or the huge emotions that would follow the 7 sickness, illness, or injury of their child, but also a 8 variety of other legal concerns, such as the -- as in 9 this case, the apprehension of one (1) of their other 10 children? 11 DR. DIRK HUYER: Absolutely, and I think 12 that there was a lot of focus in that area of 13 psychosocial evaluation and -- and the appearances of 14 people at that time, and I think that that was reflective 15 of the field at that stage. 16 I think that, in my opinion, the field has 17 grown from there, but there still is -- not uncommon for 18 me to hear comments from investigators that focus on the 19 appearances of people and both in my coroner's work in 20 the non-criminally suspicious areas, but also in 21 criminally suspicious areas. 22 And I continue to remind the investigators 23 that there can be many factors that -- that lead to that, 24 so I think it's a very important area you're raising. 25 MS. LINDA ROTHSTEIN: Okay. Let's go

1 back, though, to the third process that was used in the 2 early days of the SCAN Program to come to conclusions 3 about whether or not injuries were accidentally caused or 4 not. 5 So, back to you, Dr. Driver, you'll recall 6 again your evidence in the Amber case referring to the 7 third aspect which was the psychosocial assessment. Who 8 in the SCAN Program in 1991, when you gave this evidence, 9 was responsible for conducting that psychosocial 10 assessment, you, or the social worker, or both? 11 DR. KATY DRIVER: Probably both, but with 12 more emphasis on the social worker with their training. 13 MS. LINDA ROTHSTEIN: And what does that 14 mean, "psychosocial assessment"? 15 DR. KATY DRIVER: It was to look at high 16 risk indicators, the parent's background, or the 17 caregivers background. Were there risk factors for the 18 child that were identified, in just general knowledge, 19 that led to often child maltreatment, so it was looking 20 at those issues, whether it was a family that was 21 isolated, there were financial problems; that there were 22 stress factors that could have resulted in. 23 And certainly my interview would touch on 24 it, but the social -- it was the primary responsibility 25 of the social worker.

1 MS. LINDA ROTHSTEIN: Okay. So in 1991, 2 what was the prevailing thinking as to what those risk 3 factors were in a case of physical abuse of a young 4 child? 5 DR. KATY DRIVER: In abuse in general? 6 MS. LINDA ROTHSTEIN: Well, physical 7 abuse, particularly, but by all means, give us the list 8 for -- 9 DR. KATY DRIVER: Physical abuse, that 10 this was peop -- stress, stress was a main factor. 11 Financial hardship was another factor; bonding between 12 the child and the caregiver, the parent's own -- 13 MS. LINDA ROTHSTEIN: How did you -- 14 DR. KATY DRIVER: -- background. 15 MS. LINDA ROTHSTEIN: Okay. But stopping 16 there for a moment on bonding. How did the SCAN Team 17 make an assessment as to the quality of the bonding 18 between the parent and the child? 19 DR. KATY DRIVER: I think, again, that 20 primarily was the social worker's assessment, but also 21 looking at the parent's own background, their parenting 22 skills, how they were parented, so the whole psychosocial 23 history primarily was taken by the social worker. 24 MS. LINDA ROTHSTEIN: So, again, we need 25 a little bit more detail to make sure that we understand,

1 what sort of things, what sort of features, of the 2 parent's background would have been viewed as significant 3 by the social worker in the subject of her interview of 4 the parents. Their criminal background pot -- 5 potentially? 6 DR. KATY DRIVER: Not necessarily. 7 MS. LINDA ROTHSTEIN: All right. 8 DR. KATY DRIVER: No. 9 MS. LINDA ROTHSTEIN: Previous 10 involvement with the Children's Aid Society -- 11 DR. KATY DRIVER: Yes. 12 MS. LINDA ROTHSTEIN: -- would have been 13 one (1), am I right? 14 DR. KATY DRIVER: Yes. 15 MS. LINDA ROTHSTEIN: All right. What 16 other aspects of the parental background were seen as 17 sufficiently significant that they would have been the 18 subject of an interview in those days? 19 DR. KATY DRIVER: I think whether it was 20 a single parent or a two (2) parent family. 21 MS. LINDA ROTHSTEIN: Right. 22 DR. KATY DRIVER: If it was a two (2) 23 parent family, was the bulk of parenting fell to one (1) 24 parent resulting in, theoretically, a single parent 25 family?

1 Financial hardships, number of children in 2 the family, the housing situation, social network -- 3 often you found there were new arrivals in Canada with no 4 social network -- mothers or caregivers, mental status; 5 whether there was any evidence of depression. Those were 6 all looked at as high risk factors. 7 MS. LINDA ROTHSTEIN: And in -- in 8 identifying what these risk factors were, do you recall, 9 Dr. Driver, whether the refereed literature spoke about 10 these issues and was, if you will, the repository of the 11 information that was being used to develop your 12 identification of these risk factors? 13 DR. KATY DRIVER: Yes. 14 MS. LINDA ROTHSTEIN: Yes? Okay. All 15 right, so we know that -- that things change for a 16 variety of reasons in terms of the process that was used. 17 Dr. -- Dr. Huyer, can you walk us through, sort of from 18 your perspective, what was the impetus to change the 19 process that Dr. Driver's described when you bec -- what 20 were the impetus -- what was the impetus to change the 21 process? 22 DR. DIRK HUYER: It's hard to put my 23 finger on that impetus, but clearly, as I sat with these 24 parents and asked them questions about potential injury 25 scenarios, or their history about potential events that

1 could, in my mind, be criminal -- criminal behaviours, I 2 felt that I was uncomfortable in taking charge of an 3 investigation. 4 I think that in the hospital and in the 5 medical setting, traditionally, we are the helpers and 6 the healers, and we have a significant power in that. 7 And at times, we feel we are very powerful and feel that 8 we are -- well, very powerful in that area, and -- and 9 probably the most knowing about that particular problem. 10 And so I've seen that when the children in 11 hospital, physicians, health care providers take charge 12 of that and feel they can answer all of the questions 13 which, in reality in a child maltreatment situation, 14 we're, to some extent, a small player. 15 We may analyse the injury, but we're not 16 going to go on to make decision about the protection of 17 that child or other children. We're not going to go on 18 to be the deciders of whether a criminal investigation 19 occurs, the outcome of that criminal investigation -- 20 albeit, we may be a significant player in some of those 21 by our opinion, and we're not going to be the Criminal 22 Justice System deciding about guilt. 23 So from my perspective, I felt that we 24 should be giving the lead of an investigation and the 25 charge of that investigation to the appropriate personnel

1 which would be the police and the Children's Aid. 2 So long answer, and I'm going to carry 3 forward, but what I recognized that we were doing, is we 4 would be called into these cases after the children were 5 in hospital. So a nurse at the emerge had already talked 6 with the family; a resident physician, maybe a staff 7 physician, maybe the ICU doctor, had all got information 8 from the family, perfectly to get help for that child. 9 With -- that was their reason. They 10 weren't out there to try to sort through these injuries, 11 'cause they just -- not their role, nor would they take 12 that on as their role in the vast majority of situations. 13 There's a few rare situations, but the 14 vast majority, not. So by the time we were in there, the 15 medical history was pretty well-documented and there was 16 clear information about what was said to more than one 17 (1) person. 18 So reiterating that interview for me 19 seemed to be taking on a role on the -- as a hospital 20 treater and trying to tease out more information, and 21 theoretically, people would be more willing to tell me 22 that because I'm a physician, and I'm in a help -- 23 helping environment. 24 I thought that was theoretical, and I 25 thought that looking at it from my perspective and my

1 colleagues perspective, we were, in fact, -- were in -- 2 potentially in a position of authority at a time when 3 significant concerns of maltreatment may already be 4 present. 5 So if we have those concerns -- and this 6 is the way we changed our process -- we got to a concern 7 where there was a significant concern of maltreatment 8 present, we would not interview the family for the 9 circumstances of the injury. 10 We may collect information about the 11 medical presentation. So what was the child like before? 12 Any health problems? What were the symptoms around this? 13 Those sorts of aspects to help us -- help guide us on 14 potentially -- other medical problems that could -- led 15 to this presentation. But not to delve into what we 16 interpreted the investigators would be delving into. 17 So the social work role became -- we did 18 not do psychosocial evaluations in those cases because 19 that again, would be delving into areas that we felt was 20 beyond our scope at that point if there was a child abuse 21 concern. Now, if we had a grey case -- so the case 22 presents -- a child presents with an injury, say a 23 fractured femur, a broken leg, in a -- in a one (1) month 24 old -- or in a -- in a seven (7) month old. 25 An uncommon injury by far, and certainly

1 one must be considerate about potential mechanisms of 2 that. But if we have information that's been presented 3 to the hospital staff already that suggests this might be 4 an accident or there might be some medical problem, we 5 would then treat that as, what we would call, a grey 6 case, whereas there might be concerns of abuse, but there 7 might not. 8 So we would then take a medical history 9 and do a psychosocial evaluation that was literature- 10 based as much as the literature could base it. And those 11 would be the ones that -- we may then turn and say, Oh, 12 you know what, that does sound like it's maltreatment, 13 and then we would lead to Children's Aid and police 14 involvement. 15 Or we may determine that it's not. And 16 the majority of those would not be, but it would allow a 17 psychosocial evaluation to understand the environment 18 that that child may be in. And it may then lead to an 19 ability to build some supports into that family to help 20 prevent a similar type of injury in the future. 21 So those were the -- that's the way we 22 changed our process. Albeit, it was met with reluctance 23 by some of my colleagues. 24 MS. LINDA ROTHSTEIN: Because...? 25 DR. DIRK HUYER: Because of the reasons

1 that I gave before. That getting the history firsthand 2 is better than getting it second or thirdhand; and -- and 3 some of my colleagues thoughts. Sorting through this is 4 important for us to sort through these things. 5 And that we may be better at getting that 6 information then a Children's Aid worker or police 7 officer who don't know all of the medical intricacies of 8 it. So that we may be more sophisticated in our 9 knowledge about medicine. So we'd be more effective at 10 that. 11 My response to that was, we'll be 12 available to those investigators. So when they're doing 13 their interviews, Call me, page me, I'll talk with them 14 about what they've received in that information and guide 15 them on what I think the relevance of that is or whether 16 that new history that's come forward makes sense for the 17 type of injury that we have. 18 And I tried to make it that we have that 19 availability on a -- on a regular basis to bounce these 20 ideas by, but let the investigators lead their 21 investigations as opposed to us leading the 22 investigations. 23 MS. LINDA ROTHSTEIN: So I'm going to try 24 and get you to help us date those changes, if you can, 25 Dr. Huyer, by taking a look at Volume number IV, Tab 2,

1 which is a decision of the Honourable Mr. Justice 2 Campbell in the Tyrell case. And it's dated January the 3 16th of 2001. And I take it you're familiar with this 4 decision, Dr. Huyer? 5 DR. DIRK HUYER: Not in detail, but the 6 general -- general thrust of the decision, yes. 7 MS. LINDA ROTHSTEIN: So in other words, 8 you are aware that this was a case in which -- 9 DR. DIRK HUYER: Yeah, I know the case 10 specifics, generally, yeah. 11 MS. LINDA ROTHSTEIN: I'm just going to 12 do it for the record. 13 DR. DIRK HUYER: Okay. 14 MS. LINDA ROTHSTEIN: That Justice 15 Campbell was in a position of having to rule on whether 16 or not an interview that had been conducted by Dr. Mian 17 and Elain MacLachlan of the SCAN Program of a caregiver 18 was an interview that should be tested for its 19 voluntariness because as a matter of law they were 20 persons in authority; not how they thought of themselves, 21 it's clear from reading their evidence. 22 And indeed at the end of that decision, 23 Justice Campbell concludes that, indeed, they are persons 24 of authority who, therefore, must be able to establish 25 that they have ensured the voluntariness of any

1 information that they get from the caregiver before that 2 information becomes admissible in the court. 3 So you're -- you're generally aware with 4 that -- of that concept, are you not, Dr. Huyer? 5 DR. DIRK HUYER: Absolutely. 6 MS. LINDA ROTHSTEIN: Right. And some 7 would argue that that decision, although it was case 8 specific and wasn't saying that in every case that would 9 be the determination, would have necessitated some 10 changes in the process by which the SCAN Team formulated 11 assessments, right? Some would have argued that? 12 DR. DIRK HUYER: Some would have argued. 13 I would have said it was already done. 14 MS. LINDA ROTHSTEIN: That was my 15 question. 16 DR. DIRK HUYER: Yeah. 17 MS. LINDA ROTHSTEIN: So you -- your 18 recollection is that prior to this decision becoming -- 19 well, having been made, you had already effected the 20 changes that you've described? 21 DR. DIRK HUYER: Oh, it's not my 22 recollection. 23 I know that it happened -- 24 MS. LINDA ROTHSTEIN: Okay. 25 DR. DIRK HUYER: -- before.

1 MS. LINDA ROTHSTEIN: How much sooner? 2 DR. DIRK HUYER: That's tough to say, but 3 I would say that it was probably early on in my 4 Directorship, so probably -- I don't think it was before 5 I took over. I think it was probably in the Fall of 6 1998, if not 1999. That would be my -- my recollection 7 of it. 8 It was something I'd felt strongly about 9 over the years, and I think I tried to change that 10 approach earlier. 11 I don't know if I changed it earlier. I 12 think I may have been personally changing my approach, 13 but I don't know when the effective policy changed. 14 MS. LINDA ROTHSTEIN: Okay. 15 DR. MICHELLE SHOULDICE: I can probably 16 just add a little to that. 17 When I was a -- a Resident with the 18 program in '97/'98, I think psychosocial evaluations were 19 still occurring by some -- when some staff were involved 20 in cases. By the time I became a Fellow in 1999, the 21 practice had changed. 22 MS. LINDA ROTHSTEIN: Okay. And what 23 about today, Dr. Shouldice? 24 Can you bring us up to date as to what, if 25 any, changes have been implemented since Dr. Huyer made a

1 paradigm shift, if you will, and decreased the reliance 2 of psychosocial assessment and changed the interview 3 process. 4 Have there been any other changes to your 5 assessment protocol since then? 6 DR. MICHELLE SHOULDICE: Not substantial 7 changes. I think the only thing would be an increasing 8 attempt to work in coordination with the investigators, 9 so that I would -- when I initially refer to CAS, and 10 speak with CAS and police around the concerns, let them 11 know the type of information which would be helpful in 12 terms of the injury history in interpreting the fin -- 13 the history with respect to the findings, and then 14 ensuring that there's ongoing feedback from the 15 investigators around the relevant history that I would 16 require in order to make a medical opinion. 17 So I think, you know, increasing attempts 18 to coordinate that information exchange that's relevant 19 to the medical opinion. 20 MS. LINDA ROTHSTEIN: All right. 21 COMMISSIONER STEVEN GOUDGE: Both you and 22 Dr. Huyer have used the phrase "investigators". 23 I take it you mean by that either police 24 investigators, or CAS investigators in a family case? 25 DR. MICHELLE SHOULDICE: Yes.

1 DR. DIRK HUYER: That's correct. 2 And -- and if I can make one (1) comment, 3 Ms. Rothstein. 4 I don't think that we've thrown out a 5 psychosocial assessment. It's in the cases where there's 6 belief that the information that's presenting at the time 7 we're getting involved, that there's a significant belief 8 of child maltreatment. That's when the psychosocial 9 assessment will not occur. 10 But in the grey cases, or in neglect 11 cases, or other cases where it may not be at the level of 12 specific concern at that point, the psychosocial 13 evaluation still plays a significant role in helping to 14 plan for the future for those kids, and evaluate what's 15 gone on within that environment. 16 So I think that that's separate from the 17 cases that would typically -- what I understand to be the 18 mandate of -- of the Commission, but I think it's very 19 important to understand that -- that that still plays a 20 significant role, as I understand it -- 21 DR. MICHELLE SHOULDICE: Yep, I would 22 agree. 23 DR. DIRK HUYER: -- Dr. Shouldice. 24 MS. LINDA ROTHSTEIN: But help us with 25 that then, if you would, Dr. Huyer.

1 What does the literature say about the 2 value of that sort of assessment in making a diagnosis of 3 whether or not injuries have been caused intentionally or 4 not? 5 DR. DIRK HUYER: Un -- unfortunately by 6 the question, I haven't made my points clear before. 7 So I don't think that it plays a 8 significant role in deciding that. 9 MS. LINDA ROTHSTEIN: No, I understand as 10 a process matter. 11 I'm asking what the literature says about 12 it. I'm asking -- 13 DR. DIRK HUYER: Oh, that -- 14 MS. LINDA ROTHSTEIN: -- because you made 15 a comment in passing, Dr. Huyer -- 16 DR. DIRK HUYER: Yep. 17 MS. LINDA ROTHSTEIN: -- that as much as 18 it can be literature-based, so it's really a follow-up of 19 my question of Dr. Driver. 20 DR. DIRK HUYER: Yeah. 21 MS. LINDA ROTHSTEIN: What does the 22 literature tell us about the value of that sort of 23 evidence, if you will, in making any such assessment? 24 DR. DIRK HUYER: I don't believe that 25 there's a significant -- well, my interpretation of the

1 psychosocial evaluation and usefulness in making a 2 diagnosis, I don't think that that plays a large role in 3 making a diagnose at this stage; in making a diagnosis of 4 non-accidental injury. 5 But it plays a large role in understanding 6 the environment the child's in. So not -- so two (2) 7 separate things. 8 Diagnosis of injury; a psychosocial 9 evaluation may help to understand the environment, but 10 I'm a strong -- strong voice in being very cautious, as I 11 did earlier, about the appearances of people. 12 The psychosocial evaluation may show 13 seventeen (17) risk factors, and of those, there are 14 strong literature-based ones that really increase the 15 risk of child maltreatment. 16 But even if those seventeen (17) risk 17 factors are present, if the injury scenario makes sense, 18 and fits with what's going on, that does not change the 19 diagnosis that that's an accidental injury. 20 It changes the environment that that child 21 is in, and may lead to future planning to make the 22 environment better for the child from a child 23 environment, but not to direct the diagnosis per se. 24 Now, as I said earlier, in the past those 25 risk factors, I have in my reports, utilized those risk

1 factors and those things to help to guide my diagnosis. 2 That clearly is a -- a change of mine over 3 the -- over the years. 4 COMMISSIONER STEPHEN GOUDGE: Diagnosis 5 of non-accidental? 6 DR. DIRK HUYER: Yes, I've used those as 7 considerations within -- in making a diagnosis. I -- 8 I've changed that. Again, I may speak to them in my 9 reports as far as the environment of the home, but not to 10 guide specifically my diagnosis; a pattern I may comment 11 upon, but not specifically the psychosocial. 12 COMMISSIONER STEPHEN GOUDGE: I hear you 13 to say, I changed my practice, Dr. Huyer, largely because 14 of a recognition that those kinds of risk factors are not 15 much help in the determination of non-accidental? 16 DR. DIRK HUYER: I think that as we've 17 grown in the field, we've recognized that -- that there's 18 many reasons why those factors may be present and -- and 19 how those factors directly impact on the individual 20 injury event. 21 So I think that that's what happened with 22 the field and my own practice and experience with the 23 type, yes. 24 COMMISSIONER STEPHEN GOUDGE: Thanks, Ms. 25 Rothstein.

1 2 CONTINUED BY MS. LINDA ROTHSTEIN: 3 MS. LINDA ROTHSTEIN: Commissioner, I'm 4 going to turn to a new area, so perhaps this is the time 5 for the morning break. 6 COMMISSIONER STEPHEN GOUDGE: Sure. 7 We'll be back then at 11:30. 8 9 --- Upon recessing at 11:12 a.m. 10 --- Upon resuming at 11:32 a.m. 11 12 THE REGISTRAR: All Rise. Please be 13 seated. 14 COMMISSIONER STEPHEN GOUDGE: Ms. 15 Rothstein...? 16 17 CONTINUED BY MS. LINDA ROTHSTEIN: 18 MS. LINDA ROTHSTEIN: Dr. Huyer and Dr. 19 Shouldice, as I reflected over the break, I actually have 20 a few more questions about this issue of the role of a 21 psychosocial assessment. 22 Dr. Huyer, my question, probably very 23 badly put before the break, was intended to ask you about 24 what, if any, guidance one could obtain from looking at 25 the literature on the value of the psychosocial

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1 assessment in either confirming or refuting an allegation 2 of physical abuse. 3 Can you tell us, did the literature change 4 to your knowledge? What -- what, if anything, do you 5 know about that, sir? 6 DR. DIRK HUYER: I'm not an expert in 7 psychosocial evaluation, I'll put that out first, but my 8 understanding of the literature in attending conferences 9 and talking with my colleagues in the field, is that it 10 has evolved and continues to evolve significantly on an 11 ongoing basis. 12 It's my understanding, around the time 13 when I first started with SCAN and with the information 14 that Dr. Driver was -- the time of Dr. Driver's initial 15 involvement, that the psychosocial evaluation was, in the 16 literature and in the field, felt to be a very important 17 factor in determining whether a child had been injured 18 intentionally or not. 19 So at that point, in the early '90s, 20 sorry, yeah, the early '90s, it was a very important 21 factor; literature supported and field supported was my 22 understanding. 23 That has continued to evolve to the point 24 that as my understanding now, and I may not have 25 articulated it effectively, at this point, and in

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1 certainly in my last years with SCAN, so 2000 and -- and 2 the years -- the late '90s -- I don't know the exact time 3 frame, but the late '90s for sure, it was recognized that 4 that is not a -- the literature and the field do not 5 support that that's a main player or a main contributor 6 to determining a diagnosis about an injury; so the 7 diagnosis of the injury itself. 8 It plays a significant role in 9 understanding what the environment that that child's in, 10 and the potential risk of harm that that child may be in 11 within that environment, but it doesn't allow a direct 12 conclusion as to -- 13 COMMISSIONER STEPHEN GOUDGE: It's not a 14 diagnostic tool? 15 DR. DIRK HUYER: Correct. And similarly, 16 the lack of risk factors, which I've come up against in - 17 - in many cases, or not come up against, but I've 18 experienced in many cases, the lack of risk factors by no 19 means is a diagnostic tool either. 20 And it is frequently used by the 21 investigators as a diagnostic tool. 22 COMMISSIONER STEPHEN GOUDGE: I hear you 23 saying, Dr. Huyer, that not only was this a, sort of, 24 view that you came to through your own experience, but 25 that it was supported by the evolution of the literature

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1 as well, is that correct? 2 DR. DIRK HUYER: Absolutely, that's my 3 understanding, and then that the literature's continuing 4 to evolve. 5 COMMISSIONER STEPHEN GOUDGE: So the 6 current state of the literature starting from the late 7 '90's through to today would -- would kind of be in 8 conformity with what you've articulated as -- I don't 9 want to put it too strongly, but -- 10 DR. DIRK HUYER: Right. 11 COMMISSIONER STEPHEN GOUDGE: -- it, at 12 least, would tend in the direction of saying psychosocial 13 reporting is not that helpful as a diagnostic tool of 14 non-accidental injury? 15 DR. DIRK HUYER: I'd have to say I don't 16 use it as a tool. And it's my understanding, not being 17 an expert in the psychosocial literature, but my 18 understanding of the psychosocial -- 19 COMMISSIONER STEPHEN GOUDGE: I see, 20 okay. 21 DR. DIRK HUYER: -- psychosocial 22 literature, it's not to be a tool. But I would defer to 23 an expert in the psychosocial literature to be more 24 concrete on that answer, but I don't use it as a 25 significant diagnostic tool at this point.

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1 COMMISSIONER STEPHEN GOUDGE: Right. 2 3 CONTINUED BY MS. LINDA ROTHSTEIN: 4 MS. LINDA ROTHSTEIN: Dr. Shouldice, do 5 you have any comments to add? 6 DR. MICHELLE SHOULDICE: The only thing I 7 would add is that we, in forming a medical opinion with 8 respect to an injury concern, I don't use a psychosocial 9 evaluation at all where there is significant suspicion of 10 child abuse raised so just to be very clear about that. 11 And I -- I would agree with everything 12 that Dr. Huyer has said. The literature has really 13 progressed beyond sort of simple listing of risk factors, 14 to how those risk factors interplay in risk 15 constracts,(phonetic) and also looking at risk and 16 protective factors together with respect to how an 17 environment may place a child at risk of harm separate 18 from injury evaluation as a medical concern. 19 COMMISSIONER STEPHEN GOUDGE: But the 20 literature then would seem, at least implicitly, to 21 confirm the lack of utility -- psychosocial factors -- as 22 diagnostic tools for non-accidental injury. 23 DR. MICHELLE SHOULDICE: Correct. 24 DR. DIRK HUYER: Yeah. 25 DR. MICHELLE SHOULDICE: Yes.

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1 DR. DIRK HUYER: And our -- and our 2 approach in -- in the grey cases that I was talking about 3 earlier where there is a psychosocial evaluation, that 4 psychosocial evaluation was developed by our colleagues, 5 the soc -- the Social Worker team and the Psychology Team 6 -- based upon the literature that was available at that 7 particular time, so it was a literature-informed 8 approach. 9 And so I would suggest that my colleagues 10 who were -- were brought into the program because I 11 thought they were quality people, and Michelle -- or Dr. 12 Shouldice has a similar opinion, I would believe, would 13 have informed us if, in fact, they were diagnostic tools. 14 COMMISSIONER STEPHEN GOUDGE: Right. 15 Thanks. 16 17 CONTINUED BY MS. LINDA ROTHSTEIN: 18 MS. LINDA ROTHSTEIN: And then, Dr. 19 Huyer, you also mentioned an example of a case where, in 20 retrospect, you used the factors in a way you wouldn't 21 anymore and certainly for some time. 22 If you would turn to Volume II, tab 81, 23 it's the Kenneth case. 24 DR. DIRK HUYER: What tab, sorry? 25 MS. LINDA ROTHSTEIN: Tab 81. And the

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1 PFP number is 047840. This is a report dated November 2 9th, 1993, again, reflecting the early '90s and the 3 practices at that time, and it is indeed authored by you, 4 is it not, Dr. Huyer? 5 DR. DIRK HUYER: Yes, it is. 6 MS. LINDA ROTHSTEIN: All right. And if 7 you turn to the last paragraph of that document, page 10 8 of the PFP image, you conclude in the penultimate 9 paragraph as follows: 10 "In summary, Kenneth suffered a fatal 11 asphyxial injury which remains 12 unexplained medically or by history 13 provided by his mother. Non-accidental 14 asphyxiation in the form of suffocation 15 is consistent with the clinical 16 picture, ie; the ischemic brain injury, 17 the lack of external markings, the 18 description of the child during the 19 episode, and the lack of a medical 20 explanation. Other concerns suggestive 21 of non-accidental injury are the 22 continued supervision order maintained 23 by CAS." 24 Would that have been one (1) of the risk 25 factors that would have been something you would have

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1 used in the psychosocial evaluation at that time, Dr. 2 Huyer? 3 DR. DIRK HUYER: That was rec -- was and 4 continues to be a risk factor identified within the -- of 5 -- of risk of harm, but yes, at this point I was 6 utilizing it in -- in the way and the way I believe that 7 it's written, and my intent in -- in writing at the time 8 was to bolster my diagnosis. 9 I believe that it was a contributor to the 10 diagnosis; not bolstering, but to be supportive that the 11 diagnosis was correct. 12 MS. LINDA ROTHSTEIN: 13 "2. Previous placement in foster care 14 for more then one (1) three (3) month 15 period because of: A) admitted 16 inability to care for the child, B) 17 observed inappropriate care of Kenneth, 18 i.e., involvement in the car chase." 19 Again, the same question. Those -- that 20 would have been a recognized risk factor? 21 DR. DIRK HUYER: Again, I would speak to 22 the -- a potential pattern within Kenneth's life and the 23 care giving of Kenneth, so a risk factor in the fact that 24 there was previous difficulties may therefore indicate an 25 ongoing pattern of problem.

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1 And again, recognized as a risk factor 2 within the psychosocial evaluation in the current 3 literature, as well as the past; however, with the same 4 comments as earlier. 5 MS. LINDA ROTHSTEIN: 6 "Number 3. Previous unexplained facial 7 bruising." 8 The same question. 9 DR. DIRK HUYER: No, that would be 10 consistent with a consideration within the medical 11 diagnosis because that may be a pattern of ongoing 12 unexplained medical injury. So this probably -- this 13 would stay in, likely. I mean, depending on the case 14 specific -- that's why I say likely -- but within this 15 case, I do believe that I would have left that in my 16 conclusion paragraph today. 17 MS. LINDA ROTHSTEIN: And if I follow 18 your logic then, "Number 4. The recent femur fracture", 19 that would definitely stay in today? 20 DR. DIRK HUYER: You say definitely with 21 that. I would use the same -- same level of -- of 22 concern with the facial bruising and the femur. So I 23 wouldn't say definitely for either. They both would be 24 in. 25 MS. LINDA ROTHSTEIN: Okay. The lawyer

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1 occupational hazard of overstating. Thank you for that. 2 "Number 5. History of poor anger 3 control in mother." 4 DR. DIRK HUYER: That wouldn't be in. 5 MS. LINDA ROTHSTEIN: And number 6. But 6 it was a recognized risk factor and still is, what about 7 that? 8 DR. DIRK HUYER: You know what, I don't - 9 - I don't know if it was recognized at that point as a 10 literature-based risk factor. And this would have been 11 an example of what we talked about earlier, which is 12 appearances within parents and their approaches to 13 things. So I think it's separate from risk factors. 14 MS. LINDA ROTHSTEIN: Okay. And then 15 finally, mother's behaviour during Kenneth's end-stages 16 in the ICU at HSC, and I think that refers to 17 observations of the ICU nurses about her affect and 18 demeanor during that process. Again, was that one (1) of 19 the risk factors that, at least in the '90s, was used to 20 formulate the psychosocial evaluation or was that 21 something else? 22 DR. DIRK HUYER: Probably not. It was 23 probably again the -- the appearance -- my understanding 24 of the appearance -- so referring to number 5 and number 25 6 that you're commenting on -- or I'm commenting upon the

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1 poor anger control in mother's behaviour -- I would put 2 those at that stage they were -- and -- and still now -- 3 were very extreme on the continuum of behaviour, within 4 my experience. 5 But now I wouldn't have put either of 6 those in my report as they were. 7 MS. LINDA ROTHSTEIN: Now -- 8 DR. DIRK HUYER: But I don't think they 9 were specifically risk factors that were identified in 10 the literature. 11 MS. LINDA ROTHSTEIN: Now, would you even 12 think it was relevant to know about that? 13 DR. DIRK HUYER: Knowing -- see there's 14 this -- I -- I -- I've had this kind of question a number 15 of times. The knowing stuff from my perspective, I have 16 no -- I don't believe there's an issue with my 17 professional practice of knowing this information. 18 I know a lot of information about a lot of 19 things, and I feel I have the ability -- I'm not trying 20 to be arrogant about this, but I feel I have the ability 21 to tease this information -- 22 MS. LINDA ROTHSTEIN: Right. 23 DR. DIRK HUYER: -- out and to say, Look, 24 that really is not a factor that's important in my injury 25 evaluation here. So I think working in a vacuum is a

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1 problem, and who can decide what should be known and what 2 shouldn't be known, and what literature supports, what is 3 best to know, and what's best not to know in what 4 practice; I think that could vary from -- from piece of 5 information to other. 6 MS. LINDA ROTHSTEIN: Right. 7 DR. DIRK HUYER: So I think it's -- it's 8 more important that the professional or the expert have 9 the ability to understand the significance of the 10 different information that's available and to be able to 11 tease that out and put that into different categories. 12 So I think that that's far more important 13 than false -- potentially falsely eliminating certain 14 information being provided to people. 15 MS. LINDA ROTHSTEIN: Okay. So if I hear 16 what you're saying, Dr. Huyer, you're saying a couple of 17 things. First of all, you're saying you don't see any 18 need to have that information screened out before it gets 19 to you, that -- that you're being clear about? 20 DR. DIRK HUYER: Correct. 21 MS. LINDA ROTHSTEIN: And that we should 22 be relying on professionals, such as you, to be able to 23 filter out information that's clearly irrelevant to ones 24 diagnostic conclusions? 25 DR. DIRK HUYER: I think that that speaks

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1 to an expert. 2 MS. LINDA ROTHSTEIN: Right. 3 DR. DIRK HUYER: And I think that's the 4 quality of the expert that I think should be something 5 that's an important quality. 6 MS. LINDA ROTHSTEIN: All right. But 7 having said that, when -- since you don't know when you 8 first confront a case whether or not it's going to fit 9 within a grey case zone or not, can you answer the 10 question as to whether 5 and 6 are relevant or not? 11 DR. DIRK HUYER: They could be relevant 12 in the long-term safety of that child's environment if, 13 in fact, it turns out to be that this is -- this child 14 died. There may be other children, so what is the safety 15 of that environment for the other children and their 16 future. 17 If this turned out to be a non -- non- 18 child maltreatment issue, those factors could have 19 significant relevance and there could be interventions, 20 potentially, put in place to assist that family -- pot -- 21 potential future children and that mother -- with the way 22 that they approach things in the future. 23 So I think there is relevance in -- in 24 those areas, because these are, as I say, to the extreme 25 of the continuum, in my -- this case was, those

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1 behaviours were to the extreme of the continuum of my 2 experience, I think there, interventions could be 3 provided to help with that. 4 MS. LINDA ROTHSTEIN: Dr. Shouldice, your 5 views on what information of this nature and kind ought 6 to be provided to you, needs to be provided to you, ought 7 not to be provided to you? 8 DR. MICHELLE SHOULDICE: So, I don't know 9 this particular case, but I'm assuming that it would have 10 fallen within the category of case which comes to us with 11 significant concern of -- of child -- of the possibility 12 of child abuse. 13 So it would not be the type of case, 14 currently, I don't think, from my limited understanding 15 of the case, that we would even do a -- a psychosocial or 16 consider a psychosocial assessment in. 17 I agree with Dr. Huyer that as experts who 18 try to provide a medical opinion based on the relevant 19 medical facts that we can, to some extent, filter out or 20 to a great extent, filter out the unnecessary information 21 in order to come to an objective opinion. 22 My practice has been, and continues to be 23 that I don't seek out that psychosocial information 24 currently, particularly in -- in cases where there is a 25 significant susp -- degree of suspicion of -- of the

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1 possibility of child abuse. And -- 2 MS. LINDA ROTHSTEIN: Stopping there for 3 a moment. 4 DR. MICHELLE SHOULDICE: Yeah. 5 MS. LINDA ROTHSTEIN: Does that reflect a 6 view which says, I would prefer not to know this 7 information? 8 DR. MICHELLE SHOULDICE: I think a little 9 bit. 10 MS. LINDA ROTHSTEIN: Okay. 11 DR. MICHELLE SHOULDICE: Also it's not -- 12 I see it as not necessary to coming to my medical 13 opinion. So to some extent, I would prefer not to have 14 that unnecessary information as -- in case it, somewhere 15 unconsciously, may have some effect on my interpretation 16 of the facts as I see them. 17 You know, I think, truthfully, we are able 18 to separate out those things, and I agree with what Dr. 19 Huyer is saying, but I don't see the necessity or the 20 relevance in that information so I certainly don't seek 21 it out. 22 And in fact, I will often -- if a lot of 23 that information is coming forward, I will often stop the 24 investigators from providing it for me and ask for the 25 information which I need in order to provide my opinion.

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1 DR. DIRK HUYER: And I can just comment 2 on that further in my present day practice. I -- I would 3 be very similar to Dr. Shouldice as I'm not going out 4 there and asking for that information. 5 But from a broader perspective of the 6 investigators and that particular information, they will 7 get that information through a child protection 8 evaluation, and so I'm talking broader, not specifically 9 myself as a diagnostician for the injury. 10 If they happen to tell me that because 11 they keep telling me stuff and they feel that it's 12 important, then that's where I'm talking about screening 13 that out. So I wouldn't be going and pulling up the 14 Children's Aid in the model that we were talking about 15 earlier where the investigators collect the information 16 and phone us about the injury story. I wouldn't be 17 saying, So, what's mom's anger control like? 18 I wouldn't be asking that kind of 19 information in -- in seeking it out. 20 MS. LINDA ROTHSTEIN: All right. I -- I 21 want to turn then to a different subject which is the 22 relationship between the SCAN program and some of the 23 other departments in the hospital starting with the 24 Department of Pathology. 25 And again, I want to look at it

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1 historically and try and track the evolution of that 2 relationship if there is a change. So starting again 3 with you, Dr. Driver, when you first became a member of 4 the SCAN Team, what, if any, relationship did you have 5 with the Department of Pathology or any of the 6 pathologists? 7 DR. KATY DRIVER: We didn't. No 8 pathologist was a member of our team. Pathologists 9 became involved if there was an autopsy, if the child 10 died, and we certainly would connect with them at that 11 time to seek out the information -- the findings that the 12 pathology -- the autopsy provided. 13 And that was the sum total of our 14 involvement with the Pathology Department. 15 MS. LINDA ROTHSTEIN: Okay. So how 16 frequent was your contact with members of that department 17 such as Dr. Smith or -- or other pathologists? We're 18 going to make sure that we can hear you, Dr. Driver. 19 DR. KATY DRIVER: Okay, thank you. Yes. 20 It was very minimal contact. We had an average of about 21 ten (10) deaths in a year, and the autopsy of those would 22 be the only contact that we would have -- that I would 23 have had with -- if it was my case. 24 If it was not the case I was directly 25 involved with I would just hear about it at the team

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1 meeting. 2 MS. LINDA ROTHSTEIN: All right. Did you 3 attend autopsies yourself, Dr. Driver? 4 DR. KATY DRIVER: Sometimes. That was 5 more out of interest than required. If it was my case, 6 whenever possible I did attend. 7 MS. LINDA ROTHSTEIN: All right. And 8 does that mean that indeed you attended autopsies that 9 were conducted by Dr. Charles Smith? 10 DR. KATY DRIVER: All autopsies, no. 11 Some, some. 12 MS. LINDA ROTHSTEIN: How many would you 13 say over the years of Dr. Smith's autopsies did you 14 attend? 15 DR. KATY DRIVER: I can think of about 16 three (3) or four (4). 17 MS. LINDA ROTHSTEIN: Okay. And how many 18 autopsies over the number of years did you attend in 19 total? 20 DR. KATY DRIVER: That's very difficult. 21 MS. LINDA ROTHSTEIN: Yes. 22 DR. KATY DRIVER: I don't think I can put 23 a number to it; maybe ten (10), fifteen (15), but with 24 Dr. Smith, probably about four (4). 25 MS. LINDA ROTHSTEIN: And what, if any,

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1 role did you play in the autopsy room, Dr. Driver? Did 2 you have a formal role at all? 3 DR. KATY DRIVER: There was no formal 4 role. It was more for my own interest. It wasn't 5 required that I attend the autopsy. It was more personal 6 interest to see what the pathologist's findings were. 7 MS. LINDA ROTHSTEIN: Did the pathologist 8 seek out your views on any issues in conducting an 9 autopsy? 10 DR. KATY DRIVER: Not usually. They 11 would point out to findings at the autopsy if there were, 12 but asking specifically -- because the history would 13 already be on the record and would be known to the 14 pathologists. 15 MS. LINDA ROTHSTEIN: Okay. What about 16 you, Dr. Huyer, what was your experience with the 17 Department of Pathology; frequency of contact with them, 18 and how many autopsies did you attend while you were a 19 member of the SCAN Team? 20 DR. DIRK HUYER: I had very frequent 21 contact. It pair -- or fits with my interest in the area 22 of -- of death evaluation and forensic medicine, both in 23 the live and deceased, and so I -- there was no formal 24 relationship when I was working and when I was a Director 25 with pathology.

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1 There was some -- the relationship, as I 2 have termed it before, was me. I would go down to the 3 autopsy suite and -- and observe autopsies, both in cases 4 that I was involved with to try to put a clinical 5 pathological correlation on my findings. 6 In other words, what I saw clinically is 7 that what was observed in the pathology at the autopsy so 8 that I could learn and improve my practice. 9 COMMISSIONER STEPHEN GOUDGE: These were 10 children who had died in the hospital after admission? 11 DR. DIRK HUYER: That I had been involved 12 with as a SCAN physician prior to and so that would help 13 me to inform my practice. And in addition, I would 14 attend on other cases that I learned about from various 15 methods. 16 By hearing about them from different 17 people, I would attend to observe and learn, and -- and 18 again, gain experience in the area of child death 19 evaluation and injury evaluation. 20 And so I was there fairly frequently. 21 Number wise, it's very -- it's a challenge to give that 22 number, but I would say probably at least five a year, 23 plus cases that I was directly involved with as a 24 coroner. I would attend those cases, and I would -- at 25 that point, was dealing with a smaller number of deaths

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1 per year, proba -- of children because separate from my 2 child maltreatment work, I still was seeing children die 3 -- maybe three (3) or four (4) a year, so I'm guessing at 4 the number. 5 I don't know how often I went or the exact 6 number. I would also get con -- in my paper reviews and 7 my work at the request of both Crown counsel and defence 8 counsel, there would be times when children had died, and 9 I would be asked to assist with those cases. 10 So I felt quite confident that I could 11 talk about injuries that were documented within those 12 cases, but things such as the microscopic interpretation 13 or other interpretation of the histopathology, I didn't 14 feel confident with and so at times, I would go down and 15 have conversations with Dr. Smith -- primarily with Dr. 16 Smith -- to talk about what the significance of those 17 might be as far as the overall case evaluation that I 18 might be doing in a paper review. 19 And -- 20 21 CONTINUED BY MS. LINDA ROTHSTEIN: 22 MS. LINDA ROTHSTEIN: Stopping there for 23 a moment -- 24 DR. DIRK HUYER: Sorry. 25 MS. LINDA ROTHSTEIN: -- Dr. Huyer. So

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1 if we -- if we look at some of the cases in which you 2 attended the autopsy, Dr. Smith was the pathologist. You 3 had been involved as a member of the SCAN Team, it was 4 your case, and assessing the case prior to the death of 5 the child. 6 What was your role in the autopsy room, 7 whether it was formal or not, what was your actual role? 8 DR. DIRK HUYER: Yeah, my role was -- my 9 interpretation of my role was to learn and to -- to gain 10 from that. I would off -- also offer the learners, the - 11 - the residents or medical students that were with the 12 program at that time, to -- to come and observe autopsies 13 'cause I thought that that was part of the overall 14 learning of forensic medicine; not necessarily did they 15 need to, but I offered that as a learning experience. 16 So I -- I felt that that was my -- my 17 role. I would sometimes bring some of the information 18 that I had observed clinically and some of the 19 information I had gained through my initial involvement 20 as a SCAN physician and share that -- 21 MS. LINDA ROTHSTEIN: Mm-hm. 22 DR. DIRK HUYER: -- with not only Dr. 23 Smith, but the investigators that might be there. But 24 they usually had that information by the time they were 25 there because that would have already been transmitted by

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1 me prior to the death. 2 MS. LINDA ROTHSTEIN: Were there 3 occasions when Dr. Smith or one (1) of the other 4 pathologists conducting the autopsy actually sought out 5 your opinion on an issue? 6 DR. DIRK HUYER: Yes. There was at least 7 two (2) occasions, maybe more, where I was asked to 8 examine the genitalia of the children prim -- females, 9 and provide an opinion as to whether I thought the -- the 10 pelvic organs, the hymen -- so the area of the vagina -- 11 was normal or abnormal to suggest potential sexual abuse. 12 So I was asked on at least two (2) 13 occasions, maybe -- I can think of two (2), maybe more 14 where I was asked to specifically provide that role. 15 COMMISSIONER STEPHEN GOUDGE: Dr. 16 Smith...? 17 DR. DIRK HUYER: Yes. 18 19 CONTINUED BY MS. LINDA ROTHSTEIN: 20 MS. LINDA ROTHSTEIN: And did the 21 opinion that you were asked to provide take the form of a 22 written opinion or was it verbal? 23 DR. DIRK HUYER: In the two (2) cases 24 that I can recall, I -- I did written opinion, I believe, 25 in both of them.

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1 MS. LINDA ROTHSTEIN: Okay. We'll come 2 back to a couple other examples of your being in the 3 autopsy room. I just wanted to deal with that -- that 4 general sort of scene-setting, if you will. 5 But help us with this, Dr. Huyer, are 6 there some reasons why, in your view, clinicians who were 7 involved in doing sus -- suspected child abuse work 8 should, at least, have some exposure to the autopsy 9 suite? 10 DR. DIRK HUYER: Hmm, I don't think 11 there's a definite reason why they need to be. It's not 12 a procedure that -- that is easy to -- to observe or easy 13 to participate in. It's a -- it's a distressing 14 procedure, and unfortunately, I have the experience in 15 dealing with that and am okay as far as okay can be, in 16 dealing with the procedure. 17 But I'm not sure that there's a huge 18 benefit in seeing a liver that may have a -- cut in it or 19 a -- a tear in it. I'm not sure that that's going to 20 enhance a lot for a clinician because they're not going 21 to see that anyways. They're going to see it on a CAT 22 Scan or an MRI or they're going to view it by -- by blood 23 testing. 24 So I'm not sure there's a huge benefit to 25 that. I think the clinical-pathological correlation is

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1 important for the clinicians, so I think that if Dr. 2 Shouldice or Dr. Driver thought there was a liver 3 laceration, and that was confirmed, I think that that's 4 an important thing to know. 5 But to see it, I don't think they need to 6 see that. 7 MS. LINDA ROTHSTEIN: Right. But is 8 there an independent role, albeit limited, for clinicians 9 in the autopsy room, say in a case of sexual assault? Do 10 you see that as being a value add? 11 DR. DIRK HUYER: Oh, I think there is -- 12 there can be a role for the clinician in -- in 13 participation in a death evaluation. Generally speaking, 14 the clinician who does not have experience with death 15 evaluation or a body of a child who's passed away, I 16 don't believe there's a significant role in that in the 17 autopsy suite. I'm different -- 18 MS. LINDA ROTHSTEIN: And that's because 19 -- just -- 20 DR. DIRK HUYER: Yeah. 21 MS. LINDA ROTHSTEIN: -- I want to make 22 sure I'm with you on this. 23 DR. DIRK HUYER: Yeah. 24 MS. LINDA ROTHSTEIN: That's because 25 someone who isn't familiar with post-mortem changes might

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1 make mistaken conclusions about the significance of what 2 they see in the autopsy suite, is that what you're 3 saying? 4 DR. DIRK HUYER: Absolutely. There's a 5 lot of things that happen after death, and -- and those - 6 - you need to have experience and knowledge in 7 understanding what things happen after death to be able 8 to app -- appropriately and accurately, if you can, 9 provide a diagnosis of what you're seeing. 10 And there's -- I'm -- you may see in my 11 CV, I've written in that area because of the fact that 12 things get misinterpreted after death. And day-to-day in 13 my coroner's work on the scene in children and adults, 14 there's many things that have been misinterpreted by 15 investigators, by paramedics, by other physicians where, 16 in fact, they are post-mortem changes, and I felt 17 confident in that. 18 So on that background, having a clinician 19 -- and I use Dr. Shouldice because she's right beside me 20 -- attending into the autopsy suite, I think, would be 21 challenging for her, and the ability for her to sort 22 through the post-mortem change would be very chal -- 23 would be very difficult, whereas I have a comfort level 24 and experiential level of seeing many, many different 25 things.

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1 I'm comfortable to go into the autopsy 2 suite and talk about findings on the external body of 3 those children or adults; albeit, it may not be that I'm 4 going to then comment on the mechanism of death related 5 to that individual external finding because, while I've 6 got a lot of experience looking internally, I'm not a 7 pathologist and I'm not a histopathologist, so I don't 8 have the ability to look under the microscope and provide 9 any true analysis. 10 I understand it because I read them all 11 the time, but I'm not an expert, nor do I -- 12 COMMISSIONER STEPHEN GOUDGE: So you'd 13 leave it to the pathologist to diagnose cause of death. 14 You might have information to give the pathologist about 15 your clinical observations prior to death. 16 DR. DIRK HUYER: Yes, generally. 17 Although there are a number of cases where I would 18 provide the cause of death, taking the pathologist's 19 report and putting that into my overall coroner's 20 investigation, so... 21 COMMISSIONER STEPHEN GOUDGE: I see, so 22 you're now speaking of yourself as a coroner. 23 DR. DIRK HUYER: Exactly. 24 COMMISSIONER STEPHEN GOUDGE: As opposed 25 to yourself as --

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1 DR. DIRK HUYER: Exactly. 2 COMMISSIONER STEPHEN GOUDGE: -- the 3 Director of the SCAN Team. 4 DR. DIRK HUYER: Right, so there's -- 5 there's those two (2) that overlap at different times. 6 7 CONTINUED BY MS. LINDA ROTHSTEIN: 8 MS. LINDA ROTHSTEIN: Right. So -- but 9 would it be fair for the Commissioner to conclude, Dr. 10 Huyer, that you may well be uniquely positioned in terms 11 of the contribution that you could play in the autopsy 12 room because of your experience as a pathology assistant 13 and a coroner? 14 DR. DIRK HUYER: I think it's completely 15 fair, and it -- and it's not just in the autopsy suite, 16 but also in death investigation. 17 MS. LINDA ROTHSTEIN: Right. 18 DR. DIRK HUYER: So I -- I think that 19 that's completely fair. I think that -- yes. 20 MS. LINDA ROTHSTEIN: All right. Dr. 21 Shouldice, start with a broad question. What is the 22 relationship between your program and the Pathology 23 Department, if any, today? 24 DR. MICHELLE SHOULDICE: No formal 25 relationship. And I would say, in general, very little

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1 interaction between our two groups. 2 MS. LINDA ROTHSTEIN: So you don't see 3 there being a lot of need for, am I -- I'm being right 4 about this, for, sort of, cross pollination of -- of 5 information and expertise between those two (2) groups? 6 DR. MICHELLE SHOULDICE: I wouldn't say 7 that necessarily. I think there may be some value to 8 increased interaction between the two (2) groups, in 9 general, with respect to research in the area, education 10 in the area, and so on, but with respect to specific 11 cases, there may be specific occasions where some 12 interaction may be of benefit, as -- as Dr. Huyer's 13 already said. 14 But in general, I don't see a role for the 15 SCAN pediatricians, in general, within the autopsy room, 16 and there currently is no role -- there is no -- we don't 17 attend autopsies currently. We don't provide opinions 18 with respect to, for example, skin injuries in children 19 who have died -- so post-mortem skin injuries. We don't 20 provide opinions in those types of cases and would refer 21 those to somebody with expertise in the area. 22 MS. LINDA ROTHSTEIN: And have you ever 23 been to the autopsy suite? 24 DR. MICHELLE SHOULDICE: No. 25 MS. LINDA ROTHSTEIN: Dr. Huyer, you had

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1 something to say. 2 DR. DIRK HUYER: I'm just going to 3 comment that the other role that a clinician can provide 4 is understanding how pre -- injuries that predate the 5 death. I think there can be a significant role that the 6 clinician with expertise in the area of child 7 maltreatment can provide on -- in that area. 8 So if the autopsy shows healed rib 9 fractures, that would not be concurrent with the mode of 10 death at that point necessarily, and that the clinician 11 can therefore provide an opinion as to how rib fractures 12 typically occur in an infant or a child. 13 And if there's historical findings of 14 photographs of the child or other medical records that 15 predate it -- again, the death -- I think the clinician 16 can provide significant input in the fact similar to 17 other cases of child maltreatment in the live child, so I 18 think it would fit within the lifetime of the now 19 deceased child. 20 That, I think, the clinician should and, 21 well, could and often -- and many times should provide 22 because the pathologist doesn't deal with these children 23 in their -- in their life -- life period, so I think that 24 that's an area where there's significant assistance can 25 be provided.

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1 MS. LINDA ROTHSTEIN: Now, Dr. Driver, 2 back to you. Did I understand you to say that there was 3 a period of time in which it was normal and typical to 4 get some understanding of the autopsy findings from the 5 pathologist communicated back to the SCAN physician? 6 DR. KATY DRIVER: Yes. 7 MS. LINDA ROTHSTEIN: All right. Did 8 that change? 9 DR. KATY DRIVER: Obviously, it has 10 changed. 11 MS. LINDA ROTHSTEIN: Dr. Huyer, do you 12 want to speak to that? 13 DR. DIRK HUYER: The -- when I was 14 attending there was -- it was an academic-clinical- 15 pathological correlation approach and my practice changed 16 when a very seasoned OPPCIV investigator called me after 17 I had released some information to -- during a meeting 18 with the Children's Aid Society. I had released all of 19 the autopsy findings because I felt that it was important 20 for the Children's Aid to know in their investigation. 21 And the OPP officer called me to remind me of the 22 Coroners Act and how that I was not authorized to release 23 that particular information. 24 And so my practice changed at that point, 25 and I stopped -- I included, prior to that, autopsy

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1 findings within my reports that I had written to the 2 Children's Aid and police shortly after the time of 3 death. And after that, I stopped releasing that 4 information to others. 5 MS. LINDA ROTHSTEIN: But was there 6 actually also a change in that the information from 7 pathology about the post-mortem findings did not find its 8 way back to SCAN? 9 DR. DIRK HUYER: It -- my recollection 10 was I don't recall it ever finding its way back to SCAN 11 except as I read some of the documents in preparation, 12 I'm aware that it did. And there was a couple cases that 13 I was involved with where I did, as well, but I didn't 14 recall that because it had been my ongoing recollection 15 that that information was not shared back. 16 And I think the only reason it got back in 17 those other cases is that Dr. Smith was invited to our 18 team to provide some feedback of the autopsy findings. 19 And then after that, the information was coming back 20 through my direct observations in my non -- my learning 21 role as opposed to the SCAN role. 22 MS. LINDA ROTHSTEIN: Okay. Well, you 23 foreshadowed my next subcategory, which is SCAN meetings 24 and the relationship between the pathology department and 25 your SCAN Team meetings. You've made reference to Dr.

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1 Smith attending. 2 Was that a practice? Was that an 3 exception? How frequently did Dr. Smith or the other 4 pathologists come back to SCAN, join your regular 5 meetings and talk about a case of a child that had been 6 seen by SCAN but had since died? Dr. Driver, do you want 7 to start with your day, please? 8 DR. KATY DRIVER: Sure. Almost never. 9 MS. LINDA ROTHSTEIN: Okay. 10 DR. KATY DRIVER: Very, very, very 11 rarely. I don't remember any other pathologists. Very 12 occasionally, Dr. Smith has attended some of our 13 meetings. 14 MS. LINDA ROTHSTEIN: Can you remember 15 what it was that precipitated an attendance by Dr. Smith? 16 Was it a particularly contentious case? Were you working 17 on cases -- were you both going to become witnesses? Can 18 you help us at all? 19 DR. KATY DRIVER: I think in the 20 particular case I'm thinking of -- this was even before 21 the autopsy was done. So that was one (1). But where 22 the team felt that an autopsy would have contributed, and 23 Dr. Smith was present at that time of the discussion. 24 So very, very, occasional pathology 25 involvement with SCAN Team at the meetings.

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1 MS. LINDA ROTHSTEIN: Dr. Huyer, what are 2 your comments? 3 DR. DIRK HUYER: Yeah, best that I can 4 remember, it would be a very unusual circumstance, but 5 one (1) of the practices that we had from a SCAN 6 prospective, at that stage, was to have case conferences. 7 And that was a -- a common occurrence, and so we would 8 invite a variety of professionals who were involved to 9 help sort through what the ultimate diagnosis may be. 10 And so, for example, in the Gaurov case, 11 Dr. Smith -- again in my preparation for testimony, Dr. 12 Smith came to a -- a team meeting, which we had twice a 13 week, by the way. We'd have these team meetings twice a 14 week where we would discuss all of our cases. 15 And Dr. Smith came to the -- to the Gaurov 16 one. And again, my reading, my recollection was -- and - 17 - and the approach we took in case conferences was to try 18 to -- to work to -- to come up with a diagnosis from a 19 consensus -- not necessarily a consensus, but taking all 20 the information and coming with a diagnosis. 21 COMMISSIONER STEPHEN GOUDGE: Was that 22 prior to Gaurov dying or...? 23 DR. DIRK HUYER: No, that was -- Dr. 24 Smith came after Gaurov died. 25

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1 CONTINUED BY MS. LINDA ROTHSTEIN: 2 MS. LINDA ROTHSTEIN: But did -- when you 3 said, prior to your testifying, were you -- were you 4 suggesting that you had looked at this and recalled this 5 meeting in preparation for your testimony here or -- 6 DR. DIRK HUYER: Correct. 7 MS. LINDA ROTHSTEIN: -- were you suggest 8 -- yes. 9 DR. DIRK HUYER: Correct. 10 MS. LINDA ROTHSTEIN: You weren't 11 suggesting that Dr. Smith came to the SCAN case 12 conference 'cause you were about to testify in the Gaurov 13 case? That's not -- 14 DR. DIRK HUYER: No. 15 MS. LINDA ROTHSTEIN: No. 16 DR. DIRK HUYER: No, no. 17 MS. LINDA ROTHSTEIN: Okay. 18 DR. DIRK HUYER: It was before I -- it 19 was shortly after the autopsy, from what I recall. 20 MS. LINDA ROTHSTEIN: Right. 21 DR. DIRK HUYER: And so it was another 22 piece of information that would be of value to -- to 23 myself, as a diagnostician, in providing a diagnosis as 24 to how the child might or might not have suffered an 25 injury. That's my recollection of -- his role would have

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1 been -- 2 COMMISSIONER STEPHEN GOUDGE: That would 3 have been the purpose of the SCAN case conference? 4 DR. DIRK HUYER: That's my recollect -- 5 that would be my -- 6 COMMISSIONER STEPHEN GOUDGE: Even though 7 the child had since died? 8 DR. DIRK HUYER: Correct. Because I was 9 involved as the initial physician -- 10 COMMISSIONER STEPHEN GOUDGE: Right. 11 DR. DIRK HUYER: -- seeing the child in 12 the ICU. 13 COMMISSIONER STEPHEN GOUDGE: Right. 14 DR. DIRK HUYER: And I needed to -- or it 15 was -- yeah, I would have provided an opinion in both -- 16 nowadays, I probably would be much more reliant in -- in 17 deferring to a pathology opinion at this stage of my 18 career, but at that stage, it was -- I was going to 19 provide an opinion and the autopsy was going to inform my 20 opinion. And so he was like -- and again, I don't have 21 specific recollection, but that was generally the 22 approach we were taking on certain cases for case 23 conferences, and that would fit within that model. 24 So I believe that's likely why things 25 happened. I can't say that for sure. Although

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1 Commission Counsel may have some help for -- 2 MS. LINDA ROTHSTEIN: Yeah, no, I'm going 3 to help -- 4 DR. DIRK HUYER: -- my recollection here. 5 MS. LINDA ROTHSTEIN: -- everybody if I 6 can, with Ms. -- with Ms. McAleer's help. Volume II, Tab 7 -- Tab 21 I think is the note you must have refreshed 8 your memory with, Dr. Huyer. 9 It's handwritten notes. The PFP number is 10 154395. Top left hand corner is scrawled, "Charles Smith 11 case conference", and it refers to Gaurov's case. 12 DR. DIRK HUYER: Correct. 13 MS. LINDA ROTHSTEIN: So whose -- whose 14 notes are these? 15 DR. DIRK HUYER: That's my writing. 16 MS. LINDA ROTHSTEIN: All right. 17 DR. DIRK HUYER: It's rather distinctive. 18 MS. LINDA ROTHSTEIN: Okay. So that -- 19 but that's a relief, because otherwise we wouldn't have a 20 chance of understanding what these say? 21 DR. DIRK HUYER: Excuse me? 22 MS. LINDA ROTHSTEIN: So -- so this is 23 the note that you saw in preparation for your testimony, 24 Dr. Huyer, that reminded you that this was one of the, 25 you say few occasions in which Dr. Smith was at a case

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1 conference and provided some information that assisted 2 you in forming your final diagnosis, is that right? 3 DR. DIRK HUYER: In fact, if you tab 4 through a number of these tabs, -- 5 MS. LINDA ROTHSTEIN: Yep. 6 DR. DIRK HUYER: -- that would -- there's 7 not just that one (1) that reminds me of it, but there's 8 others. 9 MS. LINDA ROTHSTEIN: There's Tab 23 as 10 well. 11 DR. DIRK HUYER: Right, which you might 12 be able to read better. 13 MS. LINDA ROTHSTEIN: 154389. 14 DR. DIRK HUYER: Correct. 15 MS. LINDA ROTHSTEIN: So this is -- this 16 is taken by the formal note recorder of case conferences, 17 is that right? 18 DR. DIRK HUYER: This was the 19 administrative -- Administrative Coordinator named Brenda 20 Rau who -- who noted this, yes. 21 MS. LINDA ROTHSTEIN: Right. And -- and 22 just while we're on that small point, because it will 23 help the Commissioner understand other notes like this 24 that are in these binders. Ms. Rau -- one (1) of her 25 jobs was to try and record in as detailed a form as

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1 possible, what was discussed during a case conference, am 2 I right? 3 DR. DIRK HUYER: That's correct, and team 4 meetings as well. 5 MS. LINDA ROTHSTEIN: All right. So if 6 we turn to the second page of Tab 23, again it's 154389, 7 in this particular case, Dr. Smith it would appear, is 8 offering his view of his findings, and she records: 9 "Changed his viewpoint since autopsy 10 and a closer review old and recent 11 injury and so on." 12 And so that would have all been 13 information that was communicated to your Team? 14 DR. DIRK HUYER: Correct. 15 MS. LINDA ROTHSTEIN: If I understand 16 you? 17 DR. DIRK HUYER: Correct. 18 MS. LINDA ROTHSTEIN: And would have been 19 information that you received prior to preparing your 20 final report in this case? 21 DR. DIRK HUYER: If you can find my final 22 report, we can figure that out. 23 MS. LINDA ROTHSTEIN: Yep. 24 DR. DIRK HUYER: The date -- 25 MS. LINDA ROTHSTEIN: I can.

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1 DR. DIRK HUYER: -- of this conference is 2 the 26th of March. 3 MS. LINDA ROTHSTEIN: Right. 4 DR. DIRK HUYER: And I can't remember 5 what date I -- if you know what tab my report's at, I -- 6 MS. LINDA ROTHSTEIN: I'm just looking 7 for that. I... 8 DR. DIRK HUYER: April -- oh that's not. 9 MS. LINDA ROTHSTEIN: Certainly April '92 10 is when -- 11 DR. DIRK HUYER: That's a sibling. 12 MS. LINDA ROTHSTEIN: -- Dr. Hilliard 13 (phonetic) is doing a report. 14 DR. DIRK HUYER: That's a sibling. 15 MS. LINDA ROTHSTEIN: Yeah. Just give us 16 a moment, Dr. Huyer. 17 DR. DIRK HUYER: I could look in the 18 overview. That might answer it. 19 MS. LINDA ROTHSTEIN: It would be in the 20 overview report for sure. They can be relied on to tell 21 us such things. So paragraph 44 of the overview report, 22 Commissioner. 23 You're going to need the white volumes, 24 Dr. Huyer. We're going to pull them up. 25 DR. DIRK HUYER: Overview report number?

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1 MS. LINDA ROTHSTEIN: And it's number 6. 2 COMMISSIONER STEPHEN GOUDGE: 6. 3 4 CONTINUED BY MS. LINDA ROTHSTEIN: 5 MS. LINDA ROTHSTEIN: And if you turn to 6 paragraph 44 -- 7 DR. DIRK HUYER: I don't see number 6, 8 sorry. 9 MS. LINDA ROTHSTEIN: You'll -- it should 10 be two (2) volumes, sorry. Volume I, Tab 6. 11 DR. DIRK HUYER: Okay, thank you. 12 MS. LINDA ROTHSTEIN: 143828, Registrar. 13 DR. DIRK HUYER: And page? I'm sorry. 14 MS. LINDA ROTHSTEIN: Page 15, paragraph 15 44, it would appear that your report to Dr. Margaret 16 Robertson, the CAS Medical Director is dated the 23rd of 17 March, 1992. 18 DR. DIRK HUYER: So it would have been 19 prior to the conference then. 20 MS. LINDA ROTHSTEIN: 44. 21 22 (BRIEF PAUSE) 23 24 DR. DIRK HUYER: And I saw the child 25 initially on the 19th in the hospital.

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1 (BRIEF PAUSE) 2 3 MS. LINDA ROTHSTEIN: So putting that all 4 together, Dr. Huyer, what is -- what does that help you 5 reconstruct for us in terms of how this worked? 6 DR. DIRK HUYER: The -- it -- it doesn't 7 specifically help me. I know that there was another 8 child -- 9 MS. LINDA ROTHSTEIN: Mm-hm. 10 DR. DIRK HUYER: -- involved -- 11 MS. LINDA ROTHSTEIN: Mm-hm. 12 DR. DIRK HUYER: -- and I know there 13 would have been pressure from the Children's Aid Society 14 to provide an opinion and to provide that opinion in 15 writing because they would have potentially apprehended 16 the child and then wanted to have a piece -- a document 17 to take to Court with them, and so I suspect there was 18 some pressure on. I don't know that, but I suspect so; 19 that would be common occurrence. 20 COMMISSIONER STEPHEN GOUDGE: 21 Circumstances would be consistent with that, I take it. 22 DR. DIRK HUYER: Yeah. Yes. 23 COMMISSIONER STEPHEN GOUDGE: So, would 24 they have wanted a report, both from you, about your view 25 of pre-death injury and Dr. Smith as to the cause of

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1 death? 2 DR. DIRK HUYER: They probably would have 3 wanted both, but the reality is, they wouldn't have got 4 both. 5 COMMISSIONER STEPHEN GOUDGE: Why not? 6 DR. DIRK HUYER: Dr. Smith would not have 7 been preparing a report in that time frame, five (5) days 8 after, for a number of reasons, but most significantly, 9 the histopathology would not have been available. 10 COMMISSIONER STEPHEN GOUDGE: Right. 11 DR. DIRK HUYER: And my evaluation would 12 have been available because I would have been providing 13 it based upon the clinical findings. In that particular 14 report, and it would be helpful again to find that 15 report; I don't know if it's -- 16 17 CONTINUED BY MS. LINDA ROTHSTEIN: 18 MS. LINDA ROTHSTEIN: Dr. Smith's? 19 DR. DIRK HUYER: No, my specific -- not 20 just the excerpt from my report, but the -- and, well, 21 the excerpt itself. 22 MS. LINDA ROTHSTEIN: But we can pull up 23 the actual document from which that's excerpted. 24 DR. DIRK HUYER: That would be helpful. 25 MS. LINDA ROTHSTEIN: It's your letter of

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1 March 23rd, PFP, if you look at your screen now -- 2 DR. DIRK HUYER: Thank you. 3 MS. LINDA ROTHSTEIN: -- 001546. There 4 you go. So take a moment -- 5 DR. DIRK HUYER: Page down. And page 6 down. 7 COMMISSIONER STEPHEN GOUDGE: You want to 8 go to the next page? 9 DR. DIRK HUYER: Yes, please. 10 MS. LINDA ROTHSTEIN: Registrar, can we 11 go to the next page, please? 12 DR. DIRK HUYER: And go back a page. 13 COMMISSIONER STEPHEN GOUDGE: Back -- 14 MS. LINDA ROTHSTEIN: And then go back a 15 page. 16 DR. DIRK HUYER: And so what I've noted 17 in the last paragraph, Commissioner and -- commish -- and 18 Counsel, is preliminary autopsy results are consistent 19 with the diagnosis. 20 So I've provided a clinical interpretation 21 based upon the evidence that was available to me from my 22 evaluation, and then commented on the -- the autopsy 23 report where there -- or the autopsy findings, because I 24 was there, without being detailed in what those were. 25 And that -- and as commented earlier by

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1 the Commissioner, a situation would be consistent with me 2 doing this quickly to enhan -- to support or to meet the 3 request of the Children's Aid Society. 4 COMMISSIONER STEPHEN GOUDGE: Would you 5 have been able to reach this conclusion, Dr. Huyer, 6 without the information from Dr. Smith and the 7 preliminary autopsy results? 8 DR. DIRK HUYER: In 1992 and in March, I 9 felt confident that that was the appropriate opinion and 10 diagnosis based upon the information that was available 11 to me at that time and my knowledge. 12 COMMISSIONER STEPHEN GOUDGE: Excluding 13 from your information bank at that point -- 14 DR. DIRK HUYER: Yeah. 15 COMMISSIONER STEPHEN GOUDGE: -- and 16 autopsy. 17 DR. DIRK HUYER: And that's reflected in 18 my writing because I've termed that carefully in the fact 19 that preliminary autopsy results are consistent with this 20 diagnosis. 21 So I've already made the diagnosis and I, 22 for lack of a better term, I've put that in to say, And 23 even the autopsy supports what I'm saying, sort of thing 24 in -- in this letter; that's the way I -- 25 COMMISSIONER STEPHEN GOUDGE: Right.

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1 DR. DIRK HUYER: -- read that letter. 2 COMMISSIONER STEPHEN GOUDGE: Right, 3 right. 4 MS. LINDA ROTHSTEIN: What does -- 5 COMMISSIONER STEPHEN GOUDGE: That's 6 certainly the way you've written it. 7 8 CONTINUED BY MS. LINDA ROTHSTEIN: 9 MS. LINDA ROTHSTEIN: What, if any, 10 changes in your practice would you effect today? 11 DR. DIRK HUYER: Changes in my practice 12 is that if a child is deceased, I may write a letter 13 stating, if I believed that that was the initial 14 diagnosis clinically, I may say, This was my clinical 15 diagnosis based upon whatever factors might be -- 16 COMMISSIONER STEPHEN GOUDGE: Right. 17 DR. DIRK HUYER: -- present, stepping 18 aside from this case, so, these are the factors that led 19 me to a medical diagnosis of this. However, if a post- 20 mortem examination has been completed, that will be -- 21 but that may allow or may lead to a more conclusive 22 opinion based upon further testing and evaluation by the 23 forensic pathologist and a neuropathologist. 24 So, I would give my clinical opinion based 25 upon what I knew and then lead to a deferral to the cause

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1 of death by the -- by the clinicians -- I mean, by the 2 forensic pathologist. 3 COMMISSIONER STEPHEN GOUDGE: By the 4 pathologist. 5 DR. DIRK HUYER: Yeah, because they have 6 the material in their hands, they have a microscope to 7 analyse things, which I wouldn't have had. It doesn't 8 mean that my clinical diagnosis is wrong -- 9 COMMISSIONER STEPHEN GOUDGE: Right. 10 DR. DIRK HUYER: -- but that -- 11 COMMISSIONER STEPHEN GOUDGE: Given that 12 we're talking about one (1) sequence of events that 13 results in the injury you see and then the death, that 14 the cause of death analysis is going to be more fully 15 informed? 16 DR. DIRK HUYER: Correct, that's my 17 belief. But I -- but I also would -- depending on the -- 18 the case, I would potentially provide -- 19 COMMISSIONER STEPHEN GOUDGE: Right. 20 DR. DIRK HUYER: -- my clinical opinion 21 ahead of time, depending on the case. 22 23 CONTINUED BY MS. LINDA ROTHSTEIN: 24 MS. LINDA ROTHSTEIN: Would there be some 25 where there would be sufficient lack of certainty that

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1 you just wouldn't opine at that early stage? 2 DR. DIRK HUYER: Absolutely, many cases 3 that there would be a lack of certainty. There would be 4 many -- there's many cases within head injuries of 5 children that are very complex and -- and are -- have a 6 number of aspects that need to be looked at. And I think 7 we're going to talk about that later, -- 8 MS. LINDA ROTHSTEIN: We are. 9 DR. DIRK HUYER: -- but -- but just to 10 put that -- 11 COMMISSIONER STEPHEN GOUDGE: Yes, yes. 12 It is -- 13 DR. DIRK HUYER: -- it's not a black and 14 white thing. 15 COMMISSIONER STEPHEN GOUDGE: This 16 particular example is complicated by the Shaken Baby 17 Syndrome issue? 18 DR. DIRK HUYER: The -- the general -- 19 COMMISSIONER STEPHEN GOUDGE: Yes. 20 COMMISSIONER STEPHEN GOUDGE: Yes. 21 DR. DIRK HUYER: -- not even -- not even 22 necessarily talking shaken baby. 23 COMMISSIONER STEPHEN GOUDGE: I just -- 24 DR. DIRK HUYER: Oh, this particular 25 case --

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1 COMMISSIONER STEPHEN GOUDGE: Ferreting 2 your language in that -- 3 DR. DIRK HUYER: Yeah. 4 COMMISSIONER STEPHEN GOUDGE: -- yes. 5 DR. DIRK HUYER: I mean, that's another - 6 - another smaller controversy which I think is actually 7 smaller than the bigger ones. 8 COMMISSIONER STEPHEN GOUDGE: Right. 9 10 CONTINUED BY MS. LINDA ROTHSTEIN: 11 MS. LINDA ROTHSTEIN: What about SCAN's 12 interaction with other departments? To what extent were 13 there close relationships with radiology, other units in 14 the hospital, and to what extent are -- are those kinds 15 of relationships necessary to make the work of the SCAN 16 Team optimal? 17 DR. DIRK HUYER: When I joined the 18 program in -- or the team, it was a bit of an eye opener 19 for me, I guess, for lack of a better term. When we were 20 consulted by a group within the hospital, we sort of -- 21 they -- there, sort of, was an attitude that we were -- 22 we were going to be -- it was problematic, it was 23 challenging, it was going to raise a number of issues 24 with the patients and the family. 25 It was an area that was almost distasteful

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1 to talk about. And people were reticent to contact us 2 because of what would -- what might happen after. And -- 3 and some of the things that would happen would be we'd 4 interview the family, as we talked about before, and -- 5 and you can certainly understand how families who are 6 being interviewed and asked all these questions about 7 injuries at a time when their child might be close to 8 dying is going to be very challenging. 9 And -- and that interview might last an 10 hour or two. And so that was hard for the other staff 11 members to understand and accept at times. And then 12 they'd be left with this very upset patient, and we'd be 13 gone. So there would be this, sort of, support that'd be 14 required by the -- the other staff to try to help the 15 people through the challenging interview that we might 16 have done. 17 Now, granted that was their attitude. We 18 tried to be supportive through these and tried to be as 19 helpful as we could. But there seemed to be a reluctance 20 at times to -- to notify us and -- and a misunderstanding 21 of what role we really provided. 22 And I'll use the burn -- the plastic 23 surgery department and the team, the Burn Team, as an 24 example. They were very reluctant to notify us and felt 25 that we were, you know, out to dig up child abuse, and

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1 that we really were very disruptive and -- and really 2 didn't want to involve us. So I joined the Burn Team. 3 And that was my -- the best approach that 4 I could come up with to help them become familiar with 5 what we do. And I would attend every burn rounds every 6 Tuesday morning with the team. And initially, there was, 7 shall we say, a stand-offishness which I managed to get 8 past in my gregarious way. 9 And they adopted and accepted and now 10 include us -- and Dr. Shouldice can speak to this, but by 11 the time I departed, we were an active member of the team 12 not only to analyse injuries, but to think about some 13 pediatric approaches; other ways that we can help to deal 14 with illnesses with these -- in these children. 15 So we became an active player of that 16 team. And now, referral to us, in fact -- they're 17 probably over-referring to us, but it's not a significant 18 issue because it can be dealt with between the teams. 19 Radiology were again, very reluctant to get involved in 20 our cases because it meant a potential involvement in 21 court, a potential medicolegal opinion, and so came up 22 with a -- a plan to increase that interaction by having 23 regular radiology rounds. 24 And I'm not sure if Paul Babyn was 25 suggested as the person or whether by his Chief, at the

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1 time, or whether he has shown an interest; I think it was 2 a little bit of both. And so I developed a relationship 3 with Paul Babyn -- who's now the Radiologist and Chief at 4 the Hospital for Sick Children. And we developed a 5 regular radiology rounds where we could have teaching for 6 the radiology Fellows and ourselves in talking about 7 radiological findings. 8 And that enhanced our relationship with 9 radiology. Did that in other areas as well; not only by 10 education sessions to these individual teams, like the 11 neurosurgery group. We did educational sessions. We'd 12 interact with them more; tried to develop projects 13 together with different groups. 14 And really tried as much as possible to 15 familiarize all the different departments as possible 16 with the services that we provide, and opened our door 17 again, to consults in very complex cases that weren't 18 necessarily abuse related, but challenges with parents, 19 and refusal of therapy in some peoples minds and, sort 20 of, became, I guess, a middle -- middle of the -- a 21 mediator almost to try to -- parents were on one side, 22 hospital staff were on another side and we would try to 23 work through these problems. 24 So I think it's a long answer to your 25 question, but I think we spent a lot of time trying to

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1 enhance the recognition of the role that we can provide 2 within the hospital. 3 MS. LINDA ROTHSTEIN: Dr. Shouldice, what 4 about today? What are the relationships between your 5 program and other departments in the hospital like? 6 DR. MICHELLE SHOULDICE: I think along 7 the lines of what Dr. Huyer has said. We have tried to 8 continue to promote relationships wherever possible 9 between those areas that we interact with on a regular 10 basis. 11 So we continue to have a good relationship 12 with Radiology. We -- you know, we would -- they have 13 been very available to us to quickly review with us 14 radiology findings in cases which are concerning so that 15 we can provide timely information back to Child 16 Protection Services who require that information in order 17 to make decisions. So that relationship has been very 18 good and very close. 19 I think we've continued to promote 20 relationships between ourselves and the Intensive Care 21 unit, for example; between ourselves and neur -- 22 Neurosurgery. So those -- I -- in those areas, in the 23 clinical areas, the relationships have continued. 24 MS. LINDA ROTHSTEIN: Okay. Good. I 25 want to talk about, Doctors, your involvement and

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1 relationship with Dr. Smith. I guess really, 2 principally, Doctors Driver and Huyer on this point. 3 Dr. Driver, how well did you get to know 4 Dr. Charles Smith over the years? 5 DR. KATY DRIVER: I think prior to Dr. 6 Smith taking on the role of doing the forensic pathology, 7 we were dealing with different physicians so whoever was 8 on call doing autopsy. 9 It's like Dr. Babyn developing an interest 10 and doing radiology. It was nice to have one person to 11 go to with our questions, or for him to come back to us 12 with the findings. So in that sense, it -- it was a very 13 refreshing change. 14 MS. LINDA ROTHSTEIN: So you're talking 15 about in 1991 when Dr. Smith became the Director of the 16 Forensic Pathology Unit at the Hospital for -- 17 DR. KATY DRIVER: That's right. 18 MS. LINDA ROTHSTEIN: Okay. And that 19 that -- that constituted some -- some kind of cementing 20 of the relationship with Dr. Smith, is that what I hear 21 you to say? 22 DR. KATY DRIVER: Yes. 23 MS. LINDA ROTHSTEIN: All right. So how 24 frequent was your own contact with Dr. Smith thereafter? 25 DR. KATY DRIVER: Not very often; just

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1 when a case I was concerned -- where I was involved, the 2 child died, and there was an autopsy. So that would be 3 my only really contact with him. 4 MS. LINDA ROTHSTEIN: And what were your 5 impressions of him, Dr. Driver? Of his expertise, of his 6 responsiveness, of -- 7 DR. KATY DRIVER: He was extremely, you 8 know, easily available. Willing to talk to us, very 9 responsive to questions from the SCAN Team. And it felt 10 very good that we had somebody that we could go to and -- 11 because we're in so far. 12 MS. LINDA ROTHSTEIN: And what was his 13 degree of interest in the work of your team, the SCAN 14 program? 15 DR. KATY DRIVER: I'm not sure per se 16 whether he was interested in general, but certainly on 17 the cases where the autopsy was done, we would go and 18 talk to him. 19 As I said, he did not attend our rounds. 20 MS. LINDA ROTHSTEIN: Dr. Huyer, how well 21 did you get to know Dr. Smith over the years, and explain 22 if you will, how that came about? 23 DR. DIRK HUYER: I thought I knew him 24 pretty well. I didn't have a -- a relationship with him 25 outside of the hospital, but I would see him fairly

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1 frequently within the hospital. 2 And we would talk, mostly around cases, 3 but around a variety of things fairly often. I can't 4 quantitate it, but I would say at least monthly, if not 5 more often than that. 6 And generally it would be, I'd be 7 approaching him or he'd approach me with a case and to 8 discuss some aspects of that case. And that -- that can 9 be all kinds of different cases that were discussed. 10 MS. LINDA ROTHSTEIN: So should we have 11 in our heads, and by all means this may not be right, but 12 that as you're developing and understanding of some of 13 the injuries that can result from child maltreatment, he 14 would be someone that you would talk about those issues 15 with, generally, or not? 16 DR. DIRK HUYER: Generally, the 17 conversations I would be having would be around 18 evaluation of findings in the -- in the deceased. 19 MS. LINDA ROTHSTEIN: So a specific case 20 as opposed to a subject area of whiplash injuries in 21 children? 22 DR. DIRK HUYER: Right. We would have 23 had some conversations that would be more general and 24 more broad, and that certainly did occur post-mortem. 25 As -- as you know, as I talked about

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1 earlier there, the article that was written around 2 interpretation of post-mortem findings -- 3 misinterpretation -- he was a co-author with me, so -- so 4 we would discuss things such as that, which -- but it 5 would be generally more case specific. 6 MS. LINDA ROTHSTEIN: Right. 7 DR. DIRK HUYER: He was very responsive 8 to me. I had the feeling that I was one (1) of the few 9 people he answered the phone for. I don't know that, but 10 I had that feeling. He was always willing to give me 11 time and always discussed things with me. 12 A very nice man, seemed very respectful, 13 fairly portrayed his strong religious beliefs frequently 14 to me, not -- not preaching to me, but I was quite aware 15 that he had strong religious feelings. And -- 16 MS. LINDA ROTHSTEIN: How did he make you 17 aware of that? 18 DR. DIRK HUYER: By sometimes commenting 19 on some aberrant behaviour of myself, such as swearing in 20 his office. 21 MS. LINDA ROTHSTEIN: Okay. 22 DR. DIRK HUYER: Occasionally, he would 23 point out that that really was not a proper thing to do 24 or a respectful thing to do. And he talked about his 25 church-going and -- and other things such as that. So it

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1 -- it was quite evident to me in that -- in those ways. 2 He seemed very genuinely interested in me 3 as a person and me as a -- as a professional and was 4 willing to provide assistance if I had questions, as I 5 say. My -- 6 MS. LINDA ROTHSTEIN: And looking back, 7 Dr. Huyer, did you draw any distinction between Dr. Smith 8 as a certified pediatric pathologist and as someone who 9 didn't have formal training as a forensic pathologist? 10 Was that a meaningful distinction to you 11 back then? 12 DR. DIRK HUYER: I don't think I was 13 aware of that. Not that -- I -- I don't know. 14 MS. LINDA ROTHSTEIN: You weren't aware 15 that he -- he wasn't trained as a forensic pathologist? 16 DR. DIRK HUYER: No, he was -- he was 17 portrayed to me as a forensic pathologist, and I 18 interpreted that he was a forensic pathologist. I don't 19 know if I ever reviewed his CV or -- or understood 20 specifically the training that he had. He was in the 21 role as the pathologist dealing with cases where there 22 was significant concern and suspicion prior to my arrival 23 is the understanding that I -- that's what I remember, 24 anyways. 25 And so he was held out to me -- in fact,

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1 the first time I was on-call, all of my colleagues -- and 2 this was early 1990, all of my colleagues were away in 3 San Diego at a conference, and Dr. Smith was my backup. 4 And I had a very challenging case in the Intensive Care 5 Unit -- 6 MS. LINDA ROTHSTEIN: Your backup in 7 SCAN? 8 DR. DIRK HUYER: Yeah. 9 MS. LINDA ROTHSTEIN: Okay. 10 DR. DIRK HUYER: -- yeah, there was no 11 other colleagues, so he was my backup. So that to me 12 sent a message from my colleagues that he was somebody to 13 be looked at as a -- a knowledgeable person -- a very 14 complex case which he came down to evaluate on the 15 weekend. 16 A very -- the outcome was not one of 17 death, but that was an example of how I initially met him 18 and how I was aware of him. And -- and that to me gave 19 my initial message that he is someone to be -- that my 20 colleagues respected, so learning on the job, as I was, 21 that was the kind of message that I got from that. 22 So I don't think I ever knew the -- the 23 formal training that he had or not. 24 COMMISSIONER STEPHEN GOUDGE: I take it 25 you assumed that he had some kind of formal training in

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1 forensics or was that an issue for you? 2 DR. DIRK HUYER: I honestly don't know 3 the answer to that, Commissioner. I -- I can't recall 4 thinking that through at the time, so I don't know the 5 answer to that. 6 COMMISSIONER STEPHEN GOUDGE: 'Cause if - 7 - I mean by forensics, that is cases that may be involved 8 with the legal system. I guess you, as a member of the 9 SCAN Team, were involved in those cases without any 10 formal training in forensics, as well? 11 DR. DIRK HUYER: Absolutely, yeah. So I 12 don't know if I thought that through at the time. I 13 certainly knew what I was doing, -- 14 COMMISSIONER STEPHEN GOUDGE: Right. 15 DR. DIRK HUYER: -- but -- but I don't 16 know if I thought that through from -- from his 17 perspective. 18 COMMISSIONER STEPHEN GOUDGE: Right. 19 20 CONTINUED BY MS. LINDA ROTHSTEIN: 21 MS. LINDA ROTHSTEIN: Dr. Huyer, do you 22 remember what year it was that you last saw Dr. Smith? 23 DR. DIRK HUYER: I suspect it was 2001. 24 MS. LINDA ROTHSTEIN: All right. And you 25 would have first met him then 1989?

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1 DR. DIRK HUYER: In January, 1990. 2 MS. LINDA ROTHSTEIN: 1990. During that 3 period, at any stage, did you develop any concerns about 4 Dr. Smith, as a professional, of course? 5 DR. DIRK HUYER: There were a number of 6 times where I was notified about issues relating to Dr. 7 Smith. Primarily, those were issues about timeliness of 8 reports. And that was a recurrent pattern for me, and 9 timeliness of -- of findings. 10 So, for example, I've done some talks out 11 West, where police and Children's Aid have been there and 12 made -- and I developed some acquaintances. 13 And I had been contacted by a RCP -- RCMP 14 officer -- and I can't remember from which province -- 15 who said to me, you know, I sent something to Dr. Smith 16 for an opinion. It's been a year and a half, and I can't 17 get him. He won't answer my call. I -- and I need that 18 material, because court's coming up. And can you help 19 me, because otherwise I'm going to have to call the 20 College to -- to get that stuff back. 21 And so I would go to Charles -- or I went 22 to Charles and I said, Charles, you know, this officer 23 has called me. What -- what's up? And then I didn't 24 hear anything more of it following that time, so I made a 25 presumption that he returned the material.

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1 I had heard various things, as I say, 2 about delay and -- and opinions being provided. And I 3 had heard, although I have no -- no ability to sort 4 through this, that at times his opinion might be 5 different at the time of the autopsy and then his final 6 report. 7 MS. LINDA ROTHSTEIN: Without -- without 8 wanting, for a moment, to get into the truth of that, I 9 just want to try and have an understanding of why you 10 were hearing these things. So can you help us with that? 11 Why a SCAN physician, or the Director of 12 SCAN at the Hospital for Sick Children, was that kind of 13 information making its way to you, Dr. Huyer? 14 DR. DIRK HUYER: I don't think it was 15 making its way that way. I think, again, it was the 16 uniqueness of me -- 17 MS. LINDA ROTHSTEIN: Okay. 18 DR. DIRK HUYER: -- being out there and 19 teaching at a number of Crown Attorney courses, 20 testifying in court in many different places, being 21 available for consultation on various things, various 22 times. And -- and different Crown Attorneys or police 23 officers would have these conversations about this. 24 You know, I -- my -- 25 MS. LINDA ROTHSTEIN: So, we'll --

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1 stopping there for a moment. What you say is you're 2 really very involved in forensic work? 3 DR. DIRK HUYER: Yes. 4 MS. LINDA ROTHSTEIN: And you had a lot 5 of contacts in the broadly described justice community? 6 DR. DIRK HUYER: Yes. 7 MS. LINDA ROTHSTEIN: Is that -- okay. 8 DR. DIRK HUYER: Yes. Now, my direct 9 observations of Dr. Smith in the autopsy suite, to me, 10 seemed very thorough, very patient, very methodical in 11 his approach in doing the autopsies and watching the 12 autopsies. I never developed a concern about that. And 13 -- and as -- as you know, I have a very broad experience 14 in watching autopsies with a variety of different 15 pathologists. So I did not develop any concerns during 16 that time. 17 Reading his reports, which I had done on a 18 frequent basis, again, concerns didn't jump out to me in 19 -- in the spectrum of other pathology reports that I 20 read. Obviously, I can't analyse or understand the 21 histopathology, so I couldn't evaluate that in any -- to 22 any -- any degree. But I -- things were not jumping out 23 to me as being a concern. 24 His office was pretty cluttered and pretty 25 much on the extreme end of what I would describe as

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1 cluttered. But I'll tell you, I've been in a lot of 2 cluttered offices and that, to me, isn't a definite 3 marker of a problem. 4 I know that I had also heard that he'd 5 provided clinical testimony at times. So he would be 6 asked to talk about, sorry, the child in a live situation 7 and -- and provided opinions in that area. 8 And I know that that changed around the 9 time of the Tamara case. And that's where a protocol 10 changed, such that we would provide our services as SCAN 11 physicians, or my services and -- and others in -- in 12 providing a clinician opinion about the live injuries so 13 that that would make more sense from an expert's point of 14 view, as opposed to a forensic pathology providing that. 15 So I would -- that's how I was aware of that sort of an 16 issue. 17 But I don't think that was Dr. Smith. I 18 think he was being asked that, as well, and the Crown 19 Counsel were seeking that, and -- and judges were 20 accepting that as well. 21 MS. LINDA ROTHSTEIN: What about areas of 22 controversy in infant injury assessment, whether it's 23 live children or deceased children? 24 Do you remember ever having any 25 conversations with Dr. Smith about what might be seen as

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1 some of the evolving issues in that area? 2 DR. DIRK HUYER: I don't remember a 3 specific conversation with Dr. Smith around that area. I 4 have a general recollection at times that I didn't 5 necessarily agree with his opinions about things -- 6 MS. LINDA ROTHSTEIN: Okay. 7 DR. DIRK HUYER: -- but I would have a 8 general recollection with other colleagues of that, that 9 at times we did have some degree of disagreement. I 10 don't remember them being dramatically different. 11 I know that we talked at times around the 12 controversial areas. I know we talked around the issues 13 of head injuries in kids. But I don't have specific 14 recollection of how those conversations went, or were 15 they way out there. I don't remember them being way out 16 to the extreme of -- of -- from my opinion. 17 Whether he was seeking mine or I was 18 seeking his or we were having a general discussion, I'm 19 not sure. 20 MS. LINDA ROTHSTEIN: All right. Dr. 21 Huyer, you're aware that one of the issues that has been 22 the subject of testimony at this Inquiry is the issue of 23 diagnosing the significance of anal dilation post-mortem 24 in a young child? 25 DR. DIRK HUYER: Yes.

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1 MS. LINDA ROTHSTEIN: All right. And can 2 you assist us as to when it was that you first became 3 aware, as a SCAN physician, that that was a potential 4 pitfall in one's diagnosis of sexual abuse or not? 5 DR. DIRK HUYER: As -- as far as live 6 children or deceased children? 7 MS. LINDA ROTHSTEIN: Deceased children. 8 DR. DIRK HUYER: Well, I was aware of it 9 as live children as soon as I started, so -- 10 MS. LINDA ROTHSTEIN: Okay. 11 DR. DIRK HUYER: -- January of 1980 -- or 12 January, 1990. Actually a course in September, 1989, was 13 the first course I took in sexual abuse. I suspect it 14 was mentioned there. I don't know that. But there was 15 controversy from England in the years prior to that. 16 So I was aware of that as an issue early 17 on in my clinical practice. And while it would be an 18 issue in live, it'd certainly be an issue in deceased. 19 MS. LINDA ROTHSTEIN: All right. 20 DR. DIRK HUYER: So I was -- I think I 21 was aware of that early on. 22 MS. LINDA ROTHSTEIN: And are you 23 familiar with the work of Dr. McCann, who did a study on 24 that very issue? For -- certainly, for deceased 25 children?

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1 DR. DIRK HUYER: Yeah. Dr. -- Dr. McCann 2 is a colleague and an acquaintance of mine. We've had a 3 -- a number of conversations. And in fact, in that 4 study, he and I conversed on that during the process of 5 that study. 6 MS. LINDA ROTHSTEIN: Let me stop you 7 there for a moment -- 8 DR. DIRK HUYER: Sure. 9 MS. LINDA ROTHSTEIN: -- and let's just 10 pull it up so we can help date this, if we can, Dr. 11 Huyer. 12 Registrar, can you pull up PFP004202? 13 It's not in the binders, Commissioner. But it is our -- 14 our copy of the McCann study that was referred to in the 15 evidence of Dr. Pollanen. 16 4202. There we go. Is that not going to 17 work? 18 Let's go to the next page, if you can. 19 Oh, I guess it's referred to at the very back. Yeah, 20 Appendix 1, so I'm not quite sure how we'll find that. 21 But I can -- but if you look there, you 22 can see that it -- the actual published study is 1996, 23 and -- 24 COMMISSIONER STEVEN GOUDGE: It is listed 25 as Appendix 1 at the bottom --

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1 MS. LINDA ROTHSTEIN: It's listed as 2 Appendix 1. 3 COMMISSIONER STEVEN GOUDGE: I do not 4 know whether it is attached after page 20. 5 MS. LINDA ROTHSTEIN: I think it is, 6 actually. Can we just try and go to page -- 7 COMMISSIONER STEVEN GOUDGE: If you want 8 to go about 20 pages in, yeah. 9 MS. LINDA ROTHSTEIN: -- 22 or something? 10 Yeah. 11 COMMISSIONER STEVEN GOUDGE: See if we 12 get to it. A couple more. 13 14 CONTINUED BY MS. LINDA ROTHSTEIN: 15 MS. LINDA ROTHSTEIN: There we go. Yeah. 16 I think if you go through that, Dr. Huyer, 17 it reveals that the study was conducted between 1990 and 18 1992, ultimately not published until 1996. 19 So with that to assist us in dating this, 20 you were about to tell us about your discussions with Dr. 21 McCann, I take it, about this study. 22 DR. DIRK HUYER: I -- I think that he had 23 presented that he was doing this study at a -- at a 24 conference down in San Diego, which I would not have been 25 in -- at in 1990, because I was interacting with Dr.

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1 Smith in the ICU in that January 2 So it would have been January, 1991, I was 3 likely in San Diego and learned of this. And in my ever 4 enthusiastic way, I interacted with Dr. McCann, and said, 5 Oh we see a lot of children at Sick Children's in Toronto 6 and probably could offer potential subjects for the 7 study. 8 And so Dr. McCann was quite excited by 9 that, as I recall, and sent me up the protocol. And I 10 interacted with Dr. Smith, and said, you know, Here's a 11 study. 12 And my recollection of that was Dr. Smith 13 thought that that would be something that he may 14 participate in. And I provided the protocol of how they 15 approached these cases. 16 And -- and it is my understanding that no 17 subjects were -- were provided from Sick Children's 18 Hospital. And clearly by the authors, there -- there 19 likely weren't, because there would have been Dr. Smith 20 or others as an author. 21 So that -- my -- I -- I can't tell you for 22 sure, but it would have likely been January, 1991, and in 23 the period of time after that, that I likely would have 24 facilitated that protocol coming -- coming up. 25 MS. LINDA ROTHSTEIN: And do you know why

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1 it was that Dr. Smith ultimately declined to participate 2 in the study? 3 DR. DIRK HUYER: No. I don't -- I don't 4 know that he did decline. I just know that there weren't 5 -- it may have been human subjects -- 6 MS. LINDA ROTHSTEIN: Okay. 7 DR. DIRK HUYER: -- a Research Ethics 8 Board. It may have been approval of that way. There may 9 be a variety of reasons. It may have been the Coroner's 10 Office that didn't accept that. There could be a number 11 of reasons why. I don't know why. 12 MS. LINDA ROTHSTEIN: Okay. I think it's 13 a good time for the -- 14 COMMISSIONER STEVEN GOUDGE: Sure. 15 MS. LINDA ROTHSTEIN: -- lunch break, 16 Commissioner. 17 COMMISSIONER STEPHEN GOUDGE: We will 18 rise then until two o'clock. 19 20 --- Upon recessing at 12:46 p.m. 21 --- Upon resuming at 2:04 p.m. 22 23 THE REGISTRAR: All rise. Please be 24 seated. 25 COMMISSIONER STEPHEN GOUDGE: Ms.

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1 Rothstein...? 2 3 CONTINUED BY MS. LINDA ROTHSTEIN: 4 MS. LINDA ROTHSTEIN: Thank you, 5 Commissioner. Dr. Driver, I want to turn now, if we can, 6 to discuss some of your involvement in the Amber case, 7 which we've touched on briefly. And for this purpose, I 8 think it would helpful to you, Dr. Driver, if you pulled 9 out the white volume, the overview reports, Volume I. 10 And it's Tab 1, 143724. 11 12 (BRIEF PAUSE) 13 14 MS. LINDA ROTHSTEIN: And -- have you got 15 that, Tab 1? Turn to page 1, and let's just 16 contextualize this very briefly, if we can, Dr. Driver. 17 You'll recall that Amber was born in 18 Timmins in '87, and that she died on July the 30th of 19 1988 at the age of sixteen (16) months at the Hospital 20 for Sick Children. 21 You -- you recall those basics about the 22 case? 23 DR. KATY DRIVER: Yes. 24 MS. LINDA ROTHSTEIN: And the SCAN Team 25 was involved in doing an initial assessment on Amber

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1 before her death. Am I right? 2 DR. KATY DRIVER: That is correct. 3 MS. LINDA ROTHSTEIN: And you were one of 4 the people that were involved in that assessment? 5 DR. KATY DRIVER: That's right. 6 MS. LINDA ROTHSTEIN: And if we turn to 7 Tab 34 of Volume I, not of the overview reports, but of 8 the black volume. Dr. Huyer's going to help you to have 9 two (2) volumes going at the same time. 10 11 (BRIEF PAUSE) 12 13 MS. LINDA ROTHSTEIN: You'll see there 14 the SCAN intake form? 15 DR. KATY DRIVER: Yes. 16 MS. LINDA ROTHSTEIN: Do you see that? 17 DR. KATY DRIVER: Yes. 18 MS. LINDA ROTHSTEIN: And that was the 19 form that was used at the time to do the initial intake 20 of a client? 21 DR. KATY DRIVER: Yes. 22 MS. LINDA ROTHSTEIN: Did you fill that 23 out? 24 DR. KATY DRIVER: This is not my 25 handwriting.

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1 MS. LINDA ROTHSTEIN: All right. And 2 then we have, following that, at the next Tab, 35, 3 153169. We have the final clinical death note. 4 That would have been prepared by Dr. 5 Keeley -- 6 DR. KATY DRIVER: Keeley, yes. 7 MS. LINDA ROTHSTEIN: -- is that right? 8 Who was that? 9 DR. KATY DRIVER: Yes. 10 MS. LINDA ROTHSTEIN: Who was Dr. Keeley? 11 That -- the physician who was -- 12 DR. KATY DRIVER: The -- 13 MS. LINDA ROTHSTEIN: -- in which 14 department? 15 DR. KATY DRIVER: -- intensive care 16 physician looking after the child. 17 MS. LINDA ROTHSTEIN: All right. And 18 more notes from Dr. Keeley at the next Tab, 36 -- 19 DR. KATY DRIVER: Right. 20 MS. LINDA ROTHSTEIN: -- 153172. 21 DR. KATY DRIVER: Yes. 22 MS. LINDA ROTHSTEIN: We then have at Tab 23 37 a note from -- or a note from Dr. Smith, as I 24 understand it. Is that right? 25 DR. KATY DRIVER: Yes.

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1 MS. LINDA ROTHSTEIN: And that's at 2 153168. And finally, we get to some notes, which I 3 understand you indid -- you indeed did prepare, Dr. 4 Driver -- 5 DR. KATY DRIVER: Yes. 6 MS. LINDA ROTHSTEIN: -- at Tab 38, 7 153080. That's your handwriting, is it not? 8 DR. KATY DRIVER: That is my handwriting. 9 MS. LINDA ROTHSTEIN: Am I correct, 10 Doctor, that you prepared these notes some time after the 11 death of Amber? 12 DR. KATY DRIVER: That is correct. 13 MS. LINDA ROTHSTEIN: These weren't 14 prepared contemporaneously with the events they record? 15 DR. KATY DRIVER: No. 16 MS. LINDA ROTHSTEIN: And indeed, I 17 understand, Dr. Driver, that you prepared these to help 18 refresh your memory about some of the key events? 19 DR. KATY DRIVER: About the sequence of 20 events. 21 MS. LINDA ROTHSTEIN: All right. Do you 22 -- can you assist us at all as to when it was that you 23 prepared that document? 24 DR. KATY DRIVER: No, I'm not sure 25 exactly when.

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1 MS. LINDA ROTHSTEIN: All right. I -- I 2 gather, Dr. Driver, just to summarize here quickly, that 3 you were involved in the discussions of the SCAN Team 4 about the exhumation of this child? 5 DR. KATY DRIVER: I was. 6 MS. LINDA ROTHSTEIN: Because you were 7 one of the people who first appreciated that this child 8 had not been autopsied? 9 DR. KATY DRIVER: That is correct. 10 MS. LINDA ROTHSTEIN: And am I right in 11 understanding that you were troubled by that? 12 DR. KATY DRIVER: Yes. And I brought it 13 back to the team, and the whole team was upset by it. 14 MS. LINDA ROTHSTEIN: And can you 15 describe for us very briefly why that was? 16 DR. KATY DRIVER: Because this child had 17 presented with severe head injury with a relative -- 18 history of a relatively minor fall. 19 The -- when I examined her, she had -- had 20 boreholes done, and the head was covered with bandages 21 and all. So there was no firsthand knowledge of any 22 bruising or anything that would substantiate the story of 23 the fall. 24 MS. LINDA ROTHSTEIN: Okay. And what, if 25 any, discussions did you have directly with Dr. Smith

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1 about the need for an exhumation? 2 DR. KATY DRIVER: I think my first 3 contact was to call him to find out the autopsy findings, 4 at which point discovered that there had been no autopsy. 5 I took it back to the team. We discussed 6 it, and we felt we needed -- that autopsy would, in the 7 team's opinion, help to clarify the issues. And so 8 another meeting was set up. 9 MS. LINDA ROTHSTEIN: And -- and that was 10 a meeting in which Dr. Smith was asked to attend? 11 DR. KATY DRIVER: That is right. 12 MS. LINDA ROTHSTEIN: And was that 13 unusual, to have a meeting where you were actually 14 inviting a pathologist with a view to ensuring that an 15 exhumation was done? 16 DR. KATY DRIVER: It was an unusual 17 meeting, yes. 18 MS. LINDA ROTHSTEIN: Okay. And do you 19 remember what Dr. Smith's view was at that second meeting 20 of the SCAN Team? 21 DR. KATY DRIVER: I think the meeting -- 22 at that meeting the consensus was that an autopsy would 23 contribute to our knowledge. 24 MS. LINDA ROTHSTEIN: Mm-hm. And from 25 that point forward did the ball sort of get passed or the

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1 baton get passed to Dr. Smith to take the appropriate 2 steps -- 3 DR. KATY DRIVER: And the Coroner's 4 Office, yes. 5 MS. LINDA ROTHSTEIN: -- to have the body 6 disinterred and so on? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: So am I right, 9 then, in understanding that you didn't get significantly 10 re-involved until sometime before the trial? 11 DR. KATY DRIVER: That is correct. 12 MS. LINDA ROTHSTEIN: All right. And can 13 you assist us with that, Dr. Driver? Do you remember how 14 much in advance of the trial you became re-involved? 15 Did people prepare you -- any of the 16 lawyers prepare you for the trial, the Crown or anyone 17 like that? 18 DR. KATY DRIVER: No. 19 MS. LINDA ROTHSTEIN: Okay. We know that 20 you testified at some considerable length then. If you 21 go to the overview report, starting at paragraph 126 of 22 page 50 of 143724. 23 DR. KATY DRIVER: Yes. 24 MS. LINDA ROTHSTEIN: There is, I think, 25 a fair summary of the evidence that you gave during that

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1 trial. 2 Have you had a chance to review that, Dr. 3 Driver? 4 DR. KATY DRIVER: I have. 5 MS. LINDA ROTHSTEIN: And does it fairly 6 summarise the evidence you gave? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: All right. And 9 looking back, can you give the Commissioner a picture of 10 what sort of the extent of your knowledge and training 11 and understanding was of infant head injury back at the 12 time that you testified? 13 DR. KATY DRIVER: I think my knowledge 14 was what was at that time an acceptable theory. There 15 were always been controversy over whether Shaken Baby 16 Syndrome is a valid entity or not. 17 And overall, literature also pointed at 18 that time that simple falls did not result in massive 19 injury. There were always exceptions, but by and large, 20 a simple fall within the house did not result in a 21 massive head injury that resulted in death. 22 MS. LINDA ROTHSTEIN: Okay. And how 23 would you come to obtain the expertise and knowledge that 24 you had about Shaken Baby Syndrome? 25 DR. KATY DRIVER: From direct involvement

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1 with cases, from attending conference, from reading the 2 literature. 3 MS. LINDA ROTHSTEIN: Okay. We know that 4 that resulted in a decision from Justice Dunn, and indeed 5 we have the entire decision excerpted in the binders. 6 You can find a copy of that, Dr. Driver, at Tab 44 of 7 Volume I. It's 001118. 8 DR. KATY DRIVER: Yes. 9 10 (BRIEF PAUSE) 11 12 MS. LINDA ROTHSTEIN: These are the 13 reasons for judgment of Justice Dunn. Can you assist the 14 Commissioner, Dr. Driver, as to when it was that you 15 first had an opportunity to read the written decision, 16 the reasons for decision, of Justice Dunn? 17 DR. KATY DRIVER: I think soon after it 18 came out. 19 MS. LINDA ROTHSTEIN: If we look in the 20 top right-hand corner of that document, I'm wondering if 21 you can help us with this. It's -- there's an insignia 22 of the Province of Ontario, "For your information, Dr. 23 Robin Williams," R-O-B-I-N, "with the compliments of 24 Regional Senior Judge Campbell." 25 Who is Dr. Robin Williams? Was he a

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1 physician at the Hospital for Sick Children? Do you 2 know, Dr. Huyer? 3 DR. KATY DRIVER: Pathology. 4 DR. DIRK HUYER: She. 5 MS. LINDA ROTHSTEIN: She? 6 DR. DIRK HUYER: She -- she's a physician 7 that works in the Niagra Falls area. I'm not sure if she 8 was working at Sick Children's at that time, but she 9 was -- 10 DR. KATY DRIVER: I don't think so. 11 DR. DIRK HUYER: -- she was a colleague 12 of -- of ours working in Niagra Falls, would do child 13 maltreatment work out of Niagra Falls. She's now, I 14 think, a Medical Officer of Health out that way, a very 15 respected pediatrician. 16 MS. LINDA ROTHSTEIN: Dr. Driver, we've 17 heard something by the by about there being some kind of 18 informal process by which the SCAN Program received 19 decisions of the court that involved physicians from the 20 program. 21 Do you recall anything about that? 22 DR. KATY DRIVER: It was a very informal 23 process. No, I don't recall. 24 MS. LINDA ROTHSTEIN: So during your 25 tenure at the SCAN Program, there was no formal process

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1 you were aware of by which any written decision of a 2 court that spoke about testimony given by a member of the 3 team made its way to the team for its consideration? 4 DR. KATY DRIVER: I think I can remember 5 about three (3) or four (4) cases where I remember 6 reading decisions, but that was not overall policy that I 7 am aware of. 8 MS. LINDA ROTHSTEIN: What about during 9 your tenure, Dr. Huyer? 10 Was there anything more formalized? Any 11 more efforts made to ensure that the team got the fruits 12 of any court or -- got any court decisions that were 13 reached after testimony given by a SCAN physician? 14 DR. DIRK HUYER: I don't think we had any 15 formal -- formal process for that. In -- in many cases 16 the Crown or the -- the family courts would feed back to 17 us, as to what judgments might have been. 18 But I don't recall any formal process of 19 judgments. Apart from Justice Campbell's other judgment 20 that we've talked about earlier this morning, I don't 21 recall a formal feedback process. 22 MS. LINDA ROTHSTEIN: What about during 23 your tenure, Dr. Shouldice? Have you got a -- any kind 24 of a system in place that assists you and your team in 25 keeping track of decisions that are reached in courts

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1 about cases in which your team has been involved? 2 DR. MICHELLE SHOULDICE: No, nothing 3 formal. 4 MS. LINDA ROTHSTEIN: And can you see 5 some benefit in that, going forward? 6 DR. MICHELLE SHOULDICE: I -- I think it 7 -- there may be some benefit to -- to receiving those 8 judgments, yes. 9 MS. LINDA ROTHSTEIN: Okay. In any 10 event, you do think in this case, Dr. Driver, that at 11 some point shortly after this decision was made that you 12 had an opportunity to review a copy of it? 13 DR. KATY DRIVER: That is correct. 14 MS. LINDA ROTHSTEIN: And I know that 15 you've had many occasions since to at least be referred 16 to it in some way, but I want you to try and take 17 yourself back to this time -- when this decision was 18 reached in 1991 -- and give the Commissioner the benefit 19 of your best recollection as to what your reaction was 20 upon reviewing this decision. 21 DR. KATY DRIVER: I -- I think my best 22 recollection is that after reading it, I felt that it 23 wasn't exactly what I would have expected, that there 24 were things pointed out that I hadn't done that were not 25 within my area to do.

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1 And I think that is why we sort of had a 2 meeting where -- then at that point we felt we needed a 3 lawyer for the team who would prepare us, who would 4 explain to us the scope and how to deal with it. 5 So overall feeling at that time was that, 6 you know, that I was being singled out, at least for my 7 part of the involvement in the case. 8 MS. LINDA ROTHSTEIN: Okay. And I take 9 it that you're also saying that you felt, at the time 10 anyway, that you were being singled out at least somewhat 11 unfairly? 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: Okay. And do you 14 recall specifically what examples struck you as being -- 15 DR. KATY DRIVER: I think there was -- 16 MS. LINDA ROTHSTEIN: -- of that nature? 17 DR. KATY DRIVER: Yes. I think there was 18 one about abdicating the responsibility to the 19 pathologist, which I don't think was a fair comment. 20 I felt, and always feel, that when there 21 is an autopsy, the autopsy findings speak for themselves. 22 And I had been given a verbal that there was no evidence 23 of accidental injury. I never had a chance to see the 24 pictures or anything until much later, but the verbal was 25 that this was definitely a non-accidental injury.

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1 The second area where I felt again was 2 about the psychosocial history lacking. 3 MS. LINDA ROTHSTEIN: Right. 4 DR. KATY DRIVER: And again that was part 5 of a) the social worker's job; b) the child passed away 6 within twenty-four (24) hours of being admitted. There 7 wasn't a chance to really go into details. And see as 8 now in retrospect we know that, you know, there isn't all 9 that much psychosocial history that is of importance. 10 MS. LINDA ROTHSTEIN: All right. And so 11 you've made reference, Dr. Driver, to a -- a meeting that 12 was held in order to discuss that decision. And indeed 13 we have a variety of documents that shed light on what 14 took place during that meeting. 15 So if I could ask you to turn to Tab 49, 16 again, of Volume I. 17 DR. KATY DRIVER: Yes. 18 MS. LINDA ROTHSTEIN: And it's 153134. 19 And we have a conference date of January the 30th, 1992, 20 at 12:00, with respect to the Amber Case. 21 And again, this appears to be notes taken 22 by, is it Barbara Rau, BR, at the bottom? 23 DR. KATY DRIVER: Brenda Rau, yes. 24 MS. LINDA ROTHSTEIN: Brenda Rau, thank 25 you. So it's -- it's definitely some time afterwards --

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1 DR. KATY DRIVER: Yes. 2 MS. LINDA ROTHSTEIN: Referring agency, 3 it refers to "Crown Attorneys, HSC Staff, see attached 4 list." And indeed, if you turn up the tab at Tab 52 of 5 that same Volume, 153142 entitled, "Amber Conference," 6 again, on the same date of January the 30th, 1992. 7 Does that set out a list of those who 8 attended this case conference? 9 DR. KATY DRIVER: Yes, right. 10 MS. LINDA ROTHSTEIN: And indeed you are 11 listed there as the second person after Ms. Rau? 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: And I see, Dr. 14 Huyer, that you were in attendance as well? 15 DR. DIRK HUYER: Yes. 16 MS. LINDA ROTHSTEIN: And, sir, that 17 would be because you were a SCAN physician at that time? 18 So the fact that you hadn't been directly involved in the 19 case was of no moment. This was going to be of some 20 importance to the Team going forward. 21 Is that the sense? 22 DR. DIRK HUYER: That's fair. 23 MS. LINDA ROTHSTEIN: Okay. Can you -- 24 can either of you help me as to who the rest of the 25 participants are at this conference? It may be self-

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1 evident, but Jacqueline Jay, ATR SCAN, I'm not -- 2 DR. KATY DRIVER: She's our therapist. 3 MS. LINDA ROTHSTEIN: All right. 4 DR. KATY DRIVER: She was. 5 MS. LINDA ROTHSTEIN: And we know that 6 Terri Regimbal was the Crown in this case. Dr. Smith is 7 indicated as being present. Frank, I believe it is 8 Sarah, was the Master's of Social Work student? 9 DR. KATY DRIVER: Student, yes. 10 MS. LINDA ROTHSTEIN: All right. Elaine 11 MacLachlan we know is not only the social worker -- 12 DR. KATY DRIVER: Elaine, Leslie, and 13 David were our team social workers. 14 MS. LINDA ROTHSTEIN: Okay. Elaine 15 actually testified at the trial if I'm not mistaken? 16 DR. KATY DRIVER: No. 17 MS. LINDA ROTHSTEIN: Oh, she didn't. 18 But she's the one who authored the psychosocial report? 19 DR. KATY DRIVER: No. 20 MS. LINDA ROTHSTEIN: No. Okay -- 21 DR. KATY DRIVER: That -- that social 22 worker had left the team by then. 23 MS. LINDA ROTHSTEIN: Okay. 24 DR. DIRK HUYER: She -- she was involved 25 in the Gaurov case.

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1 MS. LINDA ROTHSTEIN: I've gotten that 2 mistaken. 3 DR. DIRK HUYER: And she was also -- 4 testified in the Tyrell case. 5 MS. LINDA ROTHSTEIN: Thanks for that, 6 Dr. Huyer -- 7 DR. DIRK HUYER: You're welcome. 8 MS. LINDA ROTHSTEIN: Thanks for that, 9 Dr. Huyer. Sorry. 10 Mary Hull is a Crown Attorney from 11 Scarborough. She hadn't been directly involved in the 12 case. Can either of you assist us as to why she was 13 attend -- in attendance? 14 DR. KATY DRIVER: I think we -- the team 15 had previous dealings with her and wanted her expertise. 16 MS. LINDA ROTHSTEIN: And the same 17 question with respect to Sandy Kingston? 18 DR. DIRK HUYER: Both Ms. Hull and Ms. 19 Kingston had exp -- my recollection -- had demonstrated 20 an interest in child maltreatment and in our team and had 21 been supportive of our team and -- and were -- had I 22 think, Dr. Biena (phonetic) had testified in cases with 23 him and had developed a relationship. 24 And I think that's what drew the two (2) 25 of them as -- as adv -- advisors isn't the right term,

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1 but assisters in understanding the legal process. 2 MS. LINDA ROTHSTEIN: And Lori Batherson? 3 DR. KATY DRIVER: She was our nurse. 4 MS. LINDA ROTHSTEIN: And then you've got 5 an ICU physician, Dr. Jeff Barker, and that's because he 6 had given evidence in the case? 7 DR. KATY DRIVER: Yes. 8 MS. LINDA ROTHSTEIN: Got that one right. 9 And then of course Dr. Mein -- 10 DR. KATY DRIVER: Mr. Mein. 11 MS. LINDA ROTHSTEIN: -- who was the 12 director of the team -- 13 DR. KATY DRIVER: Of the SCAN Team. 14 MS. LINDA ROTHSTEIN: -- at that time. 15 All right. We then have a variety of notes, including 16 Ms. Rau's notes, which I've shown you. And I'm going to 17 just take you to certain aspects of those. But starting 18 with Ms. Rau's notes, she says: 19 "KD reviewed medical information." 20 So we're at 153 -- Registrar, 134. 21 "KD reviewed medical information as 22 presented to SCAN and medical 23 procedures carried out. Trial was 24 twenty-nine (29) days. Defence, twenty 25 (20) odd experts."

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1 And then there's a line: 2 "Judge [quote] "strange" [closed 3 quote], his [I'm not quite sure what 4 the next word is] family court. Known 5 to be strange, not used to criminal 6 standards." 7 Can anyone -- either you Dr. Huyer, or you 8 Dr. Driver -- assist me as to who was the author of those 9 comments? 10 DR. KATY DRIVER: It wasn't me. 11 DR. DIRK HUYER: Well, the author was 12 Brenda Rau, I can say that. 13 MS. LINDA ROTHSTEIN: No, the actual -- 14 DR. DIRK HUYER: No, that's -- I -- I 15 understand -- understand that. It -- it was not myself, 16 because I didn't know Justice Dunn at that point. 17 DR. KATY DRIVER: I didn't. It wasn't at 18 me. 19 DR. DIRK HUYER: I don't know. 20 MS. LINDA ROTHSTEIN: So then the Crown 21 reviewed the judgment and goes through things. And then 22 there's some notes: 23 "Records, record-keeping, no reference 24 to shaking on -- or child abuse, 25 communication, the network internal and

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1 external, access to autopsy report for 2 the team, advert mind to defence 3 position, know what defence position 4 is. Organize review, own opinions 5 without review, with other..." 6 I'm not quite sure what that means -- 7 DR. DIRK HUYER: Experts. 8 MS. LINDA ROTHSTEIN: -- with other 9 experts. 10 "Everyone working independently." 11 DR. KATY DRIVER: Other experts. 12 MS. LINDA ROTHSTEIN: So: 13 "Conversations need to be documented, 14 history, organize file review." 15 Can you assist us, Dr. Driver, as to what 16 that list is? 17 DR. KATY DRIVER: I think these were some 18 of the shortfalls and some of the concerns that came out 19 during that meeting. 20 MS. LINDA ROTHSTEIN: Okay. And perhaps 21 they're even more -- they're in more detail at the next 22 document, 153135. 23 Again, it appears to be in Ms. Rau's hand. 24 Am I correct about that? 25 DR. KATY DRIVER: Yes, I think so.

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1 MS. LINDA ROTHSTEIN: And should we 2 consider this a continuation of her notes of that 3 meeting -- 4 DR. KATY DRIVER: Yes. 5 MS. LINDA ROTHSTEIN: -- Dr. Driver? 6 DR. KATY DRIVER: Yes. 7 MS. LINDA ROTHSTEIN: Do you agree about 8 that, Dr. Huyer? 9 DR. DIRK HUYER: I can't say. 10 MS. LINDA ROTHSTEIN: Okay. 11 DR. KATY DRIVER: I think the first page 12 was the conclusion, and I think these are then what 13 happened actually at the meeting. 14 MS. LINDA ROTHSTEIN: And so can you tell 15 us based on a -- a look at those notes and the extent 16 they refresh your memory what the sort of tenor of the 17 meeting was, what the thrust of the conversation was? 18 Or if -- if that's not possible to do and 19 you want to just tell us about what your own sense of the 20 meeting was, please do. Dr. Driver...? 21 22 (BRIEF PAUSE) 23 24 MS. LINDA ROTHSTEIN: Dr. Driver, was 25 there a sense that members of the team were trying to

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1 understand how this decision had been arrived at? 2 DR. KATY DRIVER: Yes. 3 MS. LINDA ROTHSTEIN: All right. And was 4 there an attempt made to identify what some of the 5 concerns were of His Honour, Justice Dunn, and to see if 6 there needed to be any lessons taken away from that? 7 DR. KATY DRIVER: I think the feeling was 8 that we were trying to understand why the judgment had 9 gone the way it had. Overall feeling was that there were 10 a number of experts who testified on behalf of the 11 defence and that -- that carried a lot of weight. 12 MS. LINDA ROTHSTEIN: And, Dr. Huyer, you 13 were newer to this at that stage. Without the benefit of 14 these notes, what, if any, independent recollection do 15 you have of this post-Amber conference? 16 DR. DIRK HUYER: None. 17 MS. LINDA ROTHSTEIN: Why is that? 18 DR. DIRK HUYER: I know that -- I -- I'm 19 postulating why that is, but I know that after this -- 20 after the judgment was released, I know that on many 21 occasions the judgment was put to me in cross-examination 22 by various defence counsel, as -- as I interpreted it, to 23 suggest that there were issues with the SCAN Program and 24 that -- that the credibility of the opinions from the 25 SCAN Program may not have been -- or maybe shouldn't be

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1 given the weight that sometimes they are. 2 And so numerous discussions through cross- 3 examination, mostly, where this was put to me. I think 4 that I can't differentiate which of those cases it would 5 be. And I think that those discussions have clouded any 6 recollection I may have of this meeting, which I clearly 7 was at, because that's my handwriting and signing in the 8 sheet. 9 I suspect that's why I don't have any 10 specific recollection of it. 11 MS. LINDA ROTHSTEIN: Let me ask you 12 this, though, just so we have the context. How commonly 13 -- in your entire tenure with the SCAN Program, how 14 common was it to have a -- a meeting for the sole purpose 15 of reviewing a decision that had been reached by a court? 16 DR. DIRK HUYER: I don't have a memory of 17 other specific sam -- things, but this wouldn't be unique 18 to the fact that we'd have meetings about various issues. 19 So we'd have meetings about cases that 20 didn't necessarily go as well as might have been expected 21 by the Children's Aid Society; cases that didn't go well 22 in -- in police investigations. 23 So many times, we would have case 24 conferences, or case discussions, de-briefing about 25 events that had occurred. So this, in my perspective,

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1 wasn't different -- in a different category than those 2 other case discussions. 3 So that would be an ongoing on a fairly 4 regular basis, that we would have those kinds of post- 5 issue discussion. So I think that that's probably why 6 this doesn't stand out different than other cases may 7 stand out, and a long time ago. 8 And my general recollection, prior to 9 reviewing this document in preparation for testimony 10 today, my general recollection was this was a -- a Court 11 hearing where there was a discussion and a difference of 12 opinion between experts. 13 And that is not an uncommon or unusual 14 thing, for the field of child maltreatment. So this 15 didn't stand out in my general recollection of the case. 16 This is where it is in my memory; that 17 this is an example of difference of opinion between 18 experts that would not be different than many other 19 situations. 20 In reading the judgment in preparation, I 21 recognized that that's not necessarily the correct 22 recollection at this stage, and -- and if I had read that 23 judgment in the detail that I -- and, I may well have, in 24 the past, I would have come up, I believe, with the same 25 opinion many years prior, that I have now.

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1 MS. LINDA ROTHSTEIN: Which opinion is 2 that? That this is about more than a simple difference 3 of opinion between experts? 4 DR. DIRK HUYER: Well, this is a -- a 5 difference of opinion, but this is a diagnosis that's 6 incorrect -- 7 MS. LINDA ROTHSTEIN: Right. 8 DR. DIRK HUYER: -- in my mind. 9 MS. LINDA ROTHSTEIN: Okay. Well, I'll 10 come back to that in a moment. 11 But just -- just with you, Dr. Driver, 12 while I can. What, if any, changes were made to SCAN's 13 procedures or policies as a result of your team's review 14 of this Decision? 15 DR. KATY DRIVER: I think more 16 documentation. Even the consult received -- often we 17 would get verbal -- a kind of consultation to come and 18 see a child. We formalized a process that everything 19 should come in writing; who was asking the SCAN team to 20 get involved and the reason why. 21 I think we -- more formalized opinions of 22 the experts to give us in writing; used to review 23 radiology -- x-ray after it was taken with the first 24 available radiologist and act on basis of that. 25 When the final record -- written report

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1 came, there were some changes, and so there was more 2 formalized consultation process from all the experts that 3 we consulted as well as our involvement; when was the 4 contact made, the timing, who was present, what happened. 5 So there was a lot more formalization of 6 the pros -- procedure. 7 MS. LINDA ROTHSTEIN: Okay. There are 8 another set of notes in handwriting, difficult to 9 identify the author, at least for me, at Tab 53, of 10 Volume I; 153138. 11 DR. DIRK HUYER: That's Dr. Mian's 12 writing. 13 DR. KATY DRIVER: That's Marci -- 14 MS. LINDA ROTHSTEIN: That's Dr. Mian's 15 writing? 16 DR. DIRK HUYER: Yes. 17 MS. LINDA ROTHSTEIN: Thank you. And 18 they make reference a little bit to what Dr. Smith may 19 have said during this conference on the third page of 20 that document in the middle of the page: 21 "CS feels he was misunderstood. Felt 22 autopsy done to..." 23 DR. DIRK HUYER: Check. 24 MS. LINDA ROTHSTEIN: 25 "... check for other findings."

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1 Do you remember, Dr. Driver, first what 2 Dr. Smith's reaction was to this judgment, as he 3 communicated in that meeting, or to you? 4 DR. KATY DRIVER: I think -- to the best 5 of my recollection, the reaction was that experts defer 6 and that he felt his opinion was correct. 7 MS. LINDA ROTHSTEIN: Okay. Dr. Huyer, 8 do you have any recollection of what Dr. Smith's reaction 9 was to this decision, whether it communicated in that 10 meeting or thereafter? 11 DR. DIRK HUYER: I don't recall it being 12 at that -- I don't recall the meeting specifically, as 13 I've mentioned earlier, but I do recall at some point, 14 and I don't -- I can't articulate when it was or remember 15 when, that Dr. Smith felt that he had the correct 16 diagnosis and that the Judge, in fact, believed his 17 diagnosis. 18 MS. LINDA ROTHSTEIN: What does that 19 mean? 20 DR. DIRK HUYER: He had understood that 21 the Judge -- I had understood that the Judge had 22 articulated to Dr. Smith that he thought Dr. Smith was 23 correct. 24 MS. LINDA ROTHSTEIN: In what setting? 25 DR. DIRK HUYER: I don't know.

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1 MS. LINDA ROTHSTEIN: Okay. So if I 2 understand what you're saying, Dr. Huyer, and I want to 3 make sure I do, at some point after this decision was 4 handed down, you spoke to Dr. Smith about it? 5 DR. DIRK HUYER: I can't say it was a 6 specific conversation about this case, but within a 7 conversation at some point, yes. 8 MS. LINDA ROTHSTEIN: And this decision 9 came up in a conversation? 10 DR. DIRK HUYER: Yes. 11 MS. LINDA ROTHSTEIN: And Dr. Smith said 12 something that suggested that he had spoken to Justice 13 Dunn about the decision, and the Judge had let him know 14 that he, Dr. Smith, was right. 15 DR. DIRK HUYER: That's the recollection 16 I have. 17 MS. LINDA ROTHSTEIN: Okay. Dr. Huyer, 18 back to what you started to tell us about, which is your 19 view once you finally did review the entirety of this 20 decision in a careful way, that it discloses a mis- 21 diagnosis. Help us with that; what's your thought 22 process? 23 DR. DIRK HUYER: I -- I believe this 24 child suffered, excuse me, a unilateral or a single side 25 subdural hematoma, and that, in fact, is the -- the cause

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1 of her death. 2 I think that there's a number of factors 3 that contributed to her suffering such an extreme injury 4 that led to her death, and those factors include that, as 5 I understand, based upon Justice Dunn's information only. 6 And I can't speak to the voracity of that, 7 but based upon the -- the judgment, the child fell; the 8 child demonstrated some symptoms of illness or 9 abnormality; was taken and placed into a bad location, 10 then the mother of the babysitter was contacted. 11 That then led to, I believe, the -- the 12 mother of the child being contacted. All of this going 13 on prior to the child being driven to hospital and then 14 preparations being made for the child to be transferred 15 to Toronto. 16 During that time frame, which I can't 17 quantitate, but just knowing processes such as that, that 18 was not a short period of time; bleeding would have 19 continued, increasing the size of the subdural likely in 20 this child's head leading to significant brain damage to 21 the point that the general surgeon felt that it was so 22 severe he required -- he was -- he did a neurosurgical 23 procedure while still in Timmins prior to departure. 24 That information, according to Justice 25 Dunn, was that it was a unilateral or a single-sided

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1 bleed. And then similarly, when the child rec -- was 2 received at Sick Children's, Dr. Drake, the neurosurgeon, 3 also commented that it was a unilateral bleed. 4 Those kinds of bleeds definitely can occur 5 from a short fall. The distance of this child's fall is 6 unclear, from reading Justice Dunn's various theories of 7 how the fall might have occurred, suffice that it could 8 be five (5) steps which I would not characterize as a 9 short fall. 10 A short fall, I would characterize as 8 11 inches, 2 to 8 inches. I'm not -- I'm not sticking to 12 that number by any -- but that's a short fall for me, so 13 even if the child fell two (2) steps, it still would not 14 be necessarily a short fall. 15 It would be a household fall, but not 16 necessarily a short fall. So the injury presentation in 17 this child and the effects of delay on treatment -- not 18 in a bad way, just by factual -- by the time it took for 19 the child to get some treatment, all of those things can 20 lead to an increasing size of bleeding inside the -- can 21 cause -- first of all, cause the bleeding inside the 22 brain, and then increase the size of bleeding, increase 23 the severity of the brain injury, and then ultimately 24 lead to this child's death. 25 So I do believe this is incorrectly

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1 characterized as a Shaken Baby Syndrome death. 2 MS. LINDA ROTHSTEIN: Okay. You say that 3 today in 2008. 4 DR. DIRK HUYER: Yes. 5 MS. LINDA ROTHSTEIN: How early on in 6 your development as a SCAN physician could we be 7 confident that you would have reached that same 8 conclusion? 9 DR. DIRK HUYER: It's a challenge to ask 10 that, but I suspect mid to late '90's, I would think -- 11 MS. LINDA ROTHSTEIN: So not 1991, when 12 this decision -- 13 DR. DIRK HUYER: Not -- I don't know in 14 1991. Are you asking me confidently? 15 MS. LINDA ROTHSTEIN: Well, no, I'm not. 16 I'm -- I'm really just asking the question. 17 DR. DIRK HUYER: Yeah. 18 MS. LINDA ROTHSTEIN: I -- lawyers always 19 sound confident -- that doesn't mean that they should be. 20 DR. DIRK HUYER: I can't answer 1991. I 21 can't think -- I can't remember enough cases around that 22 time to draw a comparison with. 23 MS. LINDA ROTHSTEIN: Right. 24 DR. DIRK HUYER: But I know that sort of 25 mid -- mid to late '90s, I would be characterizing this

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1 as a space-occupying lesion or -- sorry, an expanding 2 blood clot that could occur from a small fall. 3 COMMISSIONER STEPHEN GOUDGE: The key 4 factor is the unilateral bleed? 5 DR. DIRK HUYER: Not necessarily the 6 unilateral nature of it, but the size and the quantity of 7 it. 8 COMMISSIONER STEPHEN GOUDGE: Right. 9 DR. DIRK HUYER: Yeah. 10 COMMISSIONER STEPHEN GOUDGE: Right. And 11 this bleed with its size and quantity was unilateral? 12 DR. DIRK HUYER: Correct. But you can 13 see unilateral small smear hemorrhages as well. 14 COMMISSIONER STEPHEN GOUDGE: Right. 15 DR. DIRK HUYER: So smear being just a -- 16 a small layer over top -- 17 COMMISSIONER STEPHEN GOUDGE: Right. 18 DR. DIRK HUYER: -- which wouldn't have a 19 huge mass affect, so -- because the -- the head being a 20 closed -- 21 COMMISSIONER STEPHEN GOUDGE: Right. 22 DR. DIRK HUYER: -- container, there's 23 not as much of -- of an affect from that small smear of 24 hemorrhage as there would be from a -- a large expanding 25 lesion, as -- as I interpret Justice Dunn is saying was

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1 here. 2 COMMISSIONER STEPHEN GOUDGE: Right. 3 4 CONTINUED BY MS. LINDA ROTHSTEIN: 5 MS. LINDA ROTHSTEIN: How early on in 6 your career, Dr. Huyer, were you giving diagnoses of 7 Shaken Baby Syndrome? 8 DR. DIRK HUYER: Very early. Probably 9 within the fist six (6) months would be my -- my best 10 recollection. I would say within the first six (6) 11 months. 12 MS. LINDA ROTHSTEIN: And -- and how did 13 you go about the process of acquiring what you felt at 14 the time was a sufficient knowledge-base upon which to 15 render those opinions? 16 DR. DIRK HUYER: When things are many 17 years before, I -- documents help me substantially. And 18 in preparation, again, for the trial -- or the testimony 19 today -- not for the trial, for the testimony, Gaurov is 20 well-documented. And my notes of Gaurov -- well, others 21 may not be able to read them -- I can. 22 And in that case -- so that's March 1992, 23 so I can only tell you that's two (2) years essentially - 24 - two (2) years, three (3) months after I was hired, I 25 was meeting with all of the different professionals

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1 involved. I suspect I was doing that before because from 2 my point of view, I had no training in this area, and I 3 was learning as I was going. 4 And so one (1) of my best sources of 5 learning was to go to the neurosurgeon and say, What do 6 you think of this. You know, this is what I've read 7 about shaken baby or this is what I've read about abusive 8 head trauma, what's your thoughts on this? 9 I'd go to the neuroradiologist and say, 10 This is what I've read about CAT Scans and -- and head 11 imaging, can you help me to understand what you see here? 12 And does this fit with what I'm thinking? So -- and the 13 neurologist as well. 14 So in -- in Gaurov, I know I met not just 15 one (1) neuroradiologist, I met three (3) of them. I 16 talked with the neurosurgeon. I talked with the 17 neurologist around formulating my opinion. I suspect -- 18 because that's what I remember doing always through my 19 time even in the years prior to leaving. And even still 20 now, at times, I'll talk to various colleagues and -- in 21 -- in trying to understand their opinions from the 22 medical aspects, especially, again, given that I'm not a 23 pediatrician. 24 So there was, again, I felt, an increased 25 need to ensure that without my pediatric training that I

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1 was understanding things effectively from a pediatric 2 point of view as well. So I would talk to a variety of 3 people. 4 MS. LINDA ROTHSTEIN: Just looking at the 5 last document that we were, which is 153138. On page 2 6 of that document, it's the third point from the bottom. 7 Dr. Mian's handwriting. She records these words: 8 "No presidential value, re: medical 9 evidence. Family court judge at bottom 10 of heap. Error may be brought up in 11 another case. Acceptable to say we 12 disagree with judge's judgment." 13 Dr Driver, are you able to assist us as -- 14 as to who it was that may have said those things? You're 15 shaking your head, is the answer no? 16 DR. KATY DRIVER: I mean, it's probably 17 Dr. Mian's conclusion. 18 MS. LINDA ROTHSTEIN: But do you know who 19 was actually saying -- 20 DR. KATY DRIVER: Saying. 21 MS. LINDA ROTHSTEIN: -- those things in 22 the meeting? 23 DR. KATY DRIVER: I don't recall. 24 MS. LINDA ROTHSTEIN: Okay. But indeed, 25 Dr. Huyer, from what you've told us that did come to

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1 light. This -- this case did, in fact, spawn questions 2 of you and other members of the team in subsequent cases? 3 DR. DIRK HUYER: I'm not sure about other 4 members of the team, but certainly for myself. But it 5 was not isolated. There were other things that were put 6 forward to me, as well; previous transcripts, other case 7 examples, literature. 8 So this is not the only thing that was put 9 forward in -- in cross-examination or in -- in testimony. 10 But this is one (1) of the -- one (1) thing that was put 11 forward, yes. 12 MS. LINDA ROTHSTEIN: All right. And in 13 -- in light of that, did -- did it -- did you feel it 14 behoved you to actually go through the judgment in some 15 detail so you felt that you could meaningfully and 16 helpfully respond to any such questions? 17 DR. DIRK HUYER: I -- as I said earlier, 18 I may well have earlier, and I don't recall doing that. 19 I know that when I would be cross-examined, I would 20 respond to the areas, and I may well have said that the 21 diagnosis I didn't agree with at that point, I don't 22 know. 23 I haven't reviewed transcripts or anything 24 of that nature to -- to explore how I responded to this 25 in my testimony. I don't have -- this was not an

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1 infrequent occurrence, and so I -- they -- I don't have 2 anything that stands out specifically for me. 3 MS. LINDA ROTHSTEIN: Okay. And as a 4 result of this meeting, or not -- not necessarily as a 5 result, but after this meeting, were there other 6 discussions that either of you recall with lawyers that 7 you've, sort of, described as lawyers for your team, to 8 talk about going to court; how you deal with issues like 9 this? 10 Do either of you remember meetings of that 11 sort? 12 DR. KATY DRIVER: I think we certainly 13 had the lawyer attending -- not every meeting, but once a 14 month or Judy Beeman (phonetic) would come in, and we 15 would discuss some of the concerns that we would have had 16 over different cases, different court appearances of 17 anyone of us. 18 MS. LINDA ROTHSTEIN: And what was, Ms. 19 Beeman's practice area? 20 DR. KATY DRIVER: I think just helping us 21 in how to answer the questions. 22 MS. LINDA ROTHSTEIN: No, sorry, what -- 23 do you know what area of practice was -- she specialized 24 in, was she a family court lawyer? Am I right about 25 that?

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1 Yes, Dr. Huyer is nodding. 2 DR. KATY DRIVER: Yes. 3 DR. DIRK HUYER: She was a family court 4 lawyer. 5 MS. LINDA ROTHSTEIN: And how long did 6 she continue in her role as giving advice to the team, 7 Dr. Huyer? 8 DR. DIRK HUYER: I don't remember, but it 9 was an intermittent thing that last for a maybe a year or 10 two (2). 11 DR. KATY DRIVER: Yeah. 12 DR. DIRK HUYER: I'm not sure exactly how 13 long. And I -- 14 MS. LINDA ROTHSTEIN: Now -- 15 DR. DIRK HUYER: -- my recollection was 16 not that she was there to help us address how to testify, 17 but to interpret -- sort of provide advice on maybe 18 opinions that are being provided by us in -- in more 19 complex sexual abuse assessments. 20 I don't recall that much assistance in the 21 criminal court matter. Albeit the frequent involvement 22 with criminal court and family court, and the regular 23 meetings with multiple attorneys, it would blur into -- 24 into that, because my preparation, and I'm sure Dr. 25 Driver's preparation for testimony in trial would be

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1 similar to other comments that you've asked. 2 So it's not an uncommon thing that -- as I 3 say, we'd be learning from other attorneys as to aspects 4 of how they're going to -- 5 COMMISSIONER STEPHEN GOUDGE: In most of 6 the cases, Dr. Huyer, that you or others on the team 7 would give evidence in, would you have prepared a report 8 before hand? 9 DR. DIRK HUYER: Yes. It was our 10 approach that the reports were prepared both for child 11 protection authorities -- primarily for child protection 12 authorities -- 13 COMMISSIONER STEPHEN GOUDGE: Right. 14 DR. DIRK HUYER: -- and those would then 15 be disclosed to police or with consent of the child 16 protection authority -- 17 COMMISSIONER STEPHEN GOUDGE: Right. 18 DR. DIRK HUYER: -- if they had 19 apprehended, they would go to police. 20 COMMISSIONER STEPHEN GOUDGE: And did the 21 team have any -- ever discuss reviewing the reports 22 amongst yourselves before they were given to the Court 23 System? 24 DR. DIRK HUYER: Yes. There was a period 25 -- certainly in my early days, all of my reports were

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1 reviewed by Dr. Mian, before they were released, with 2 education about writing and approaches. 3 I don't know how long that lasted, I can't 4 remember. We then had a period of time where we would 5 send the reports out to our colleagues, the neurosurgeon, 6 and have them read the reports, and then our radiologist, 7 to see if they agreed with the substance. 8 That didn't seem to be too beneficial. 9 Rarely did we get significant comments back from those -- 10 those involved in the time when I was doing that. And -- 11 but we didn't have a formalized process to reviewing the 12 reports. 13 But what we did do is have bi-week -- 14 twice weekly meetings. So within those meetings we would 15 present the case to all of our colleagues, and there 16 would be discussion about the opinion and what's the 17 basis of that opinion. 18 And some of us would challenge more than 19 others as to the findings and suggestions -- 20 COMMISSIONER STEPHEN GOUDGE: Right. 21 DR. DIRK HUYER: -- and that's what these 22 examples of the team meeting notes that Brenda Rau has 23 documented -- 24 COMMISSIONER STEPHEN GOUDGE: Right. 25 DR. DIRK HUYER: -- would illustrate,

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1 sort of, the case presentation and how we did it. So we 2 had ongoing peer discussion and peer review. 3 COMMISSIONER STEPHEN GOUDGE: What's the 4 current practice, Dr. Shouldice, in the Unit? 5 DR. MICHELLE SHOULDICE: Very similar. 6 So ongoing during team meetings, peer discussion, peer 7 review of cases. Because of the period of time when our 8 personnel were significantly reduced, there weren't any 9 peers for a period of time. 10 So I attempted to make arrangements to get 11 peers to continue to participate in the review. So Dr. 12 Huyer came back for a period of time to participate in 13 those reviews so that we had additional input besides my 14 own. 15 And we did participate in a couple of peer 16 reviews that were done by videoconferencing in the 17 States; again, to see how they were conducting their peer 18 reviews, and to provide input in a couple of our cases. 19 But -- so that would continue to be the 20 practice now. 21 COMMISSIONER STEVEN GOUDGE: And so when 22 a report is done by you or a colleague on the team before 23 it gets into the system, is it fair to say it would be 24 peer reviewed? 25 DR. MICHELLE SHOULDICE: I think the

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1 content would be peer reviewed with respect to the 2 opinion, but the actual written report would not 3 necessarily be reviewed by another physician. 4 COMMISSIONER STEVEN GOUDGE: Okay. 5 Thanks. Thanks, Ms. Rothstein. 6 7 CONTINUED BY MS. LINDA ROTHSTEIN: 8 MS. LINDA ROTHSTEIN: That's fine. 9 I just want to complete this piece on 10 Amber's case, because I gather, Dr. Driver, that there 11 was at least one (1) other fairly formal involvement in 12 your review of this case arising from the complaint by 13 the father of the accused babysitter to the College of 14 Physicians and Surgeons. 15 Do you remember that? 16 DR. KATY DRIVER: Yes. 17 MS. LINDA ROTHSTEIN: And am I right, Dr. 18 Driver, that as a result of that, an investigation was 19 commenced into that complaint, and you and your 20 colleague, Dr. Barker, were interviewed by the College of 21 Physicians and Surgeons' investigator? 22 DR. KATY DRIVER: That is correct. 23 MS. LINDA ROTHSTEIN: And what we do have 24 in our data base to, sort of, help us place this in time 25 is -- are the -- what I understand to be the notes made

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1 by that investigator in preparation for a meeting with 2 you. If you would turn to Tab 61, and it's 153098. 3 And this would appear to reflect a 4 meeting; at least, that was proposed with you and Dr. 5 Barker for June 2 of 1992. And can you tell us, Dr. 6 Driver, whether that accords with your recollection? 7 That you indeed met with a College investigator to 8 discuss, sort of, SCAN's reaction to this case some time 9 in June of 1992? 10 DR. KATY DRIVER: I think I certainly met 11 with the College in -- on more than one (1) occasion. 12 There was a meeting with Dr. Barker and 13 myself. There was more than one (1) meeting. Yes. 14 MS. LINDA ROTHSTEIN: And can you tell us 15 what the purpose of those meetings was? 16 DR. KATY DRIVER: To go over the -- the 17 reasons for the complaint and our -- our response to 18 that. 19 MS. LINDA ROTHSTEIN: And indeed we have 20 a letter that eventually the investigator sent to the 21 complainant reporting, among other things, on her meeting 22 with you. If you turn to Tab 69 of the same Volume I, 23 148258. 24 Starting with the -- I suppose second to 25 last paragraph on that page:

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1 "With respect to Drs. Driver and 2 Barker, you had indicated at our 3 November 9th meeting that you wanted me 4 to provide certain specific 5 information, which I will detail later, 6 to these physicians and seek their 7 opinion of Amber's injuries after 8 review of the information. You were 9 also interested in determining what 10 changes, if any, had been made at Sick 11 Kids, and in particular, the SCAN team 12 as a result of this case." 13 And so on. And then continuing to the 14 next paragraph: 15 "In February of '97, the following 16 information at your request was sent to 17 Drs. Driver and Barker." 18 And then there's a listing there, Dr. 19 Driver, starting with the full written judgment that you 20 and I have just looked at; the transcript of Dr. Ommaya's 21 testimony; and then a further list including Dr. 22 Thibault's testimony; Dr. Rorke's testimony; police 23 statements; and so on, all listed on the second page of 24 that letter. 25 Does that refresh your memory as to what

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1 occurred? 2 DR. KATY DRIVER: Yes. 3 MS. LINDA ROTHSTEIN: And is that a fair 4 recitation of what was provided to you -- 5 DR. KATY DRIVER: That is -- 6 MS. LINDA ROTHSTEIN: -- for your review? 7 DR. KATY DRIVER: Yes, it is. 8 MS. LINDA ROTHSTEIN: And then the 9 dating, I -- I suggested to you before may be wrong, 10 because if we continue along here, it says: 11 "Both physicians had approximately one 12 (1) month to review the substantial 13 documentation prior to my meeting with 14 them, which took place on March 7th of 15 this year at Sick Kids." 16 Do you have any reason to doubt that date, 17 Dr. Driver? 18 DR. KATY DRIVER: No. That's -- 19 MS. LINDA ROTHSTEIN: 20 "Their lawyer, Ms. Elizabeth Stewart 21 (phonetic) was also in attendance at 22 your request. I detailed for them the 23 significant impact this case has had 24 upon you and your family. Both 25 physicians were well aware and

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1 acknowledged the hardships endured by 2 all concerned. I was able to confirm 3 that the hospital did receive, at the 4 time of its release, a copy of the 5 judgment, and in fact, this practice 6 continues today in all court cases 7 involving the hospital." 8 So having asked you that question -- I 9 knew I'd read it somewhere -- there seemed to be some 10 understanding on beh -- behalf of the author of this 11 letter, Ms. Mann that the hospital had a process for 12 receiving all court decisions. 13 Can you -- can you shed anymore light on 14 that for me, Dr. Driver? 15 DR. KATY DRIVER: I can't. 16 MS. LINDA ROTHSTEIN: Okay. It wouldn't 17 be something that would be historically be sent to the 18 HSC library? 19 DR. KATY DRIVER: I don't know. 20 MS. LINDA ROTHSTEIN: Okay. And then if 21 we continue, it says: 22 "These judgments are reviewed as a 23 means of educating staff and constantly 24 striving for quality improvement 25 measures."

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1 And, Dr. Shouldice, while we're on this, 2 looking forward, am I right in -- in assuming that you'd 3 have no objection if some process could be created to 4 make sure that judgments are delivered to you that 5 involve any member of your staff in court? 6 DR. MICHELLE SHOULDICE: Absolutely no 7 objection. 8 MS. LINDA ROTHSTEIN: Okay. 9 "I am satisfied that both physicians 10 had reviewed the material provided to 11 them for the meeting, and were able to 12 meaningfully reflect, retrospectively, 13 on this case. I also reviewed the 14 autopsy photographs with them in 15 detail. After review and discussion of 16 the totality of the information, both 17 physicians acknowledged evidence of 18 blunt trauma injury, but are unable to 19 establish the nature of its origin. 20 You requested to be apprised of any 21 changes which may have taken place at 22 Sick Kids specifically with the SCAN 23 Team as a result of this case. I am 24 able to tell you there have been many 25 changes at the hospital as a result of

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1 this case and others. 2 At the time of Amber's death in '88, 3 the SCAN Team was in its infancy. The 4 following changes which have been 5 implemented since 1988 include; the 6 autopsy as obligatory prior to 7 embalming on all cases where there's 8 been a SCAN Team involvement." 9 Is that still the case today, Dr. 10 Shouldice? 11 DR. MICHELLE SHOULDICE: Ahh -- 12 MS. LINDA ROTHSTEIN: Or is it not as 13 simple as that? 14 DR. MICHELLE SHOULDICE: So the autopsy - 15 - whether an autopsy is done or not wouldn't be 16 determined by the SCAN program, I guess is the easy 17 answer to that question. 18 MS. LINDA ROTHSTEIN: That -- that's what 19 I thought you'd say. So again, that may reflect some 20 misunderstanding on behalf of the investigator about the 21 process? Dr. Huyer, was it different in your day? 22 DR. DIRK HUYER: No, it would be 23 surprising that if there was an injury that we were 24 involved with, and the child went on to die, it would be 25 very surprising. Especially since 1995 when the Death

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1 Under Age Two protocol was released, it would be very 2 surprising there would not be an autopsy done. 3 However, SCAN is involved in a variety of 4 different cases. There may be a case, as I talked about 5 earlier, where parents may be not necessarily agreeing to 6 a form of treatment that the physicians think would be 7 something. 8 That may not proceed onto an autopsy. 9 Sexual abuse examination that may have occurred under the 10 SCAN program, that wouldn't necessarily proceed onto an 11 autopsy. So I think that if there's an injury, I think 12 it would be very surprising -- ext -- I think it would be 13 highly unlikely there wouldn't be an autopsy if there's 14 an injury. 15 MS. LINDA ROTHSTEIN: Which may be what 16 Ms. -- Ms. Mann meant, but the statement as it stands is 17 -- is overly broad, is it? Dr. Huyer...? 18 DR. DIRK HUYER: Yes. 19 MS. LINDA ROTHSTEIN: Thank you. 20 "Number 2. Kiddie-grams complete body 21 x-ray are mandatory." 22 What do you say about that today, Dr. 23 Shouldice? 24 DR. MICHELLE SHOULDICE: The word 25 "Kiddie-grams" would no longer be in use. The

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1 terminology that we use is called a skeletal survey, 2 which is a series of x-rays of each part of the -- of the 3 child's body. 4 And that would be considered part of the 5 medical evaluation in a -- in a case where child abuse is 6 suspected. 7 MS. LINDA ROTHSTEIN: Okay. 8 "Number 3. The most responsible 9 physician for the SCAN Team who 10 assesses the case originally, is 11 responsible throughout and is called 12 twenty-four (24) hours a day, even if 13 on call, in the event of the death of 14 the child." 15 What about that practice today, Dr. 16 Shouldice? 17 DR. KATY DRIVER: That was there even 18 there at that time. 19 DR. MICHELLE SHOULDICE: I -- I don't 20 know that that would automatically occur in every case. 21 I think if we had provided a clinical assessment in a 22 case, generally, I would ask to be informed if there were 23 any significant changes in the child's medical status, 24 either improvement or death. 25 And that may or may not actually happen.

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1 MS. LINDA ROTHSTEIN: Okay. 2 And number 4) "Any suspicion of child 3 abuse must be clearly recorded in the 4 chart and easily accessible." 5 And what's the practice today, Dr. 6 Shouldice? 7 DR. MICHELLE SHOULDICE: That would be 8 the practice today. 9 MS. LINDA ROTHSTEIN: And I take it, Dr. 10 Driver, that was the practice for some time before Dr. 11 Shouldice's tenure as the Director. 12 DR. KATY DRIVER: Yes. 13 MS. LINDA ROTHSTEIN: Okay, thank you. 14 So does -- does Ms. Mann fairly set out what she reviewed 15 with you and Dr. Barker in the course of her either 16 interview or interviews with the two (2) of you? 17 DR. KATY DRIVER: Yes. 18 MS. LINDA ROTHSTEIN: Okay, thank you. 19 Now, am I correct, Dr. Driver, that this case, the Amber 20 case, was not the only occasion on which a judge had some 21 critical words for the policies and procedures of the 22 SCAN Program? 23 DR. KATY DRIVER: Yes. 24 MS. LINDA ROTHSTEIN: And if you -- 25 COMMISSIONER STEPHEN GOUDGE: Before you

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1 move to another case -- 2 MS. LINDA ROTHSTEIN: Yeah. 3 COMMISSIONER STEPHEN GOUDGE: One (1) 4 question that I -- I'm sorry, Ms. Rothstein. 5 MS. LINDA ROTHSTEIN: Please. 6 COMMISSIONER STEPHEN GOUDGE: One (1) 7 question I wanted to ask, I guess, all three (3) of you. 8 I mean, Dr. Driver, in this case you gave evidence that 9 ultimately you proceeded to provide your view of the 10 cause of death. 11 DR. KATY DRIVER: Yes. 12 COMMISSIONER STEPHEN GOUDGE: Do any of 13 the SCAN Team members ever have any concerns about going 14 beyond what might be considered to be clinical treat -- 15 view of a child to the point of giving evidence about a 16 cause of death? Is that an issue, Dr. Huyer? 17 DR. DIRK HUYER: I'm -- probably having 18 the most experience in testifying in child death cases as 19 a -- amongst the three (3) of us because I frequently -- 20 as I commented earlier, frequently receive pictures and 21 autopsy reports to provide comment on the injuries that 22 the child may have sustained earlier in their lives prior 23 to death. 24 COMMISSIONER STEPHEN GOUDGE: Right. 25 DR. DIRK HUYER: I do not -- I

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1 specifically exclude the testimony on the death. And it 2 went to one (1) point where a defence counsel was trying 3 to have me declared an expert in providing death -- 4 COMMISSIONER STEPHEN GOUDGE: Cause of 5 death. 6 DR. DIRK HUYER: -- cause of death, which 7 I do as a coroner, of course, but -- 8 COMMISSIONER STEPHEN GOUDGE: Yes, but 9 setting aside your coroner's hat for the moment. 10 DR. DIRK HUYER: Well, even with my 11 coroner's hat on, if there's an injury-related death in a 12 child, I would defer to the forensic pathologist who has 13 more information than I do as far as the evaluation and 14 the examination. 15 So even as I'm testifying as a coroner in 16 a child death case, I would still defer to the forensic 17 pathologist if there's an injury related death. 18 COMMISSIONER STEPHEN GOUDGE: Was that 19 always the practice among the SCAN Team as -- 20 DR. KATY DRIVER: Yes, it was. 21 COMMISSIONER STEPHEN GOUDGE: Although 22 you gave evidence about cause of death here, Dr. Driver. 23 DR. KATY DRIVER: Yes, but with the 24 information supplied by the pathologist. So, if there is 25 an autopsy, we certainly defer to the pathologist's

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1 judgment. 2 COMMISSIONER STEPHEN GOUDGE: Right. And 3 I take it the practice today would be not to give 4 evidence about the cause of death, Dr. Shouldice. 5 DR. MICHELLE SHOULDICE: Yes. 6 COMMISSIONER STEPHEN GOUDGE: Thank you. 7 DR. DIRK HUYER: Just to expand, 8 Commissioner, on that -- on Ms. Rothstein's -- hearing 9 her cough, the -- I think that there are various people 10 within the Courts that re -- that ask for that evidence 11 to be given, so the Crown may and the defence may, and I 12 think that -- 13 COMMISSIONER STEPHEN GOUDGE: Now, I'm 14 sure you would get pushed one (1) way or the other to go 15 beyond your expertise -- 16 DR. DIRK HUYER: Sure, I think it's -- 17 COMMISSIONER STEPHEN GOUDGE: -- and one 18 (1) of the issues we've had to grapple with is what 19 that -- 20 DR. DIRK HUYER: Right. 21 COMMISSIONER STEPHEN GOUDGE: -- those 22 limits are and how best to ensure that they're observed 23 and -- 24 DR. DIRK HUYER: Yeah. 25 COMMISSIONER STEPHEN GOUDGE: -- it is

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1 obviously not only up to the practitioner to observe 2 them; that's a collective responsibility, it seems to me, 3 but... 4 DR. DIRK HUYER: I just wanted to make 5 sure -- 6 COMMISSIONER STEPHEN GOUDGE: Yes. 7 DR. DIRK HUYER: -- that we're on the 8 same page. 9 COMMISSIONER STEPHEN GOUDGE: Right. 10 11 CONTINUED BY MS. LINDA ROTHSTEIN: 12 MS. LINDA ROTHSTEIN: Okay. I think you 13 were the one who told me at some point when we were 14 meeting, before we got here -- I don't normally quote 15 people about what they say when we meet -- but -- 16 DR. DIRK HUYER: Great. 17 MS. LINDA ROTHSTEIN: -- it seemed to sum 18 it up well, Dr. Huyer. You said that, you know, the SCAN 19 Team over the years were no strangers to controversy. 20 DR. DIRK HUYER: Correct. 21 MS. LINDA ROTHSTEIN: And just cou -- if 22 you could just amplify on that statement, please. 23 DR. DIRK HUYER: I think earlier on in 24 the testimony in talking about how hospital staff are 25 reticent to call us, there's -- right there, that's an

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1 example alone in the fact that they're somewhat anxious 2 about the fact that we're going to get involved in a case 3 because emotions arise; because children may be taken 4 away, apprehended by the Children's Aid Society, because 5 of our invol -- following our involvement; not because of 6 our involvement, but following our involvement. 7 Opinions are provided that may lead to 8 children leaving homes or it may lead to children -- or - 9 - or people being charged criminally. Cases that we're 10 involved with are highly emotional; children who are 11 injured, children who die, children who suffer very 12 disfiguring injuries, as well. 13 So all of those things bring up a lot of 14 emotions which then -- then is, to some degree, fuel for 15 controversy being developed in that area. Because 16 there's not exact science in our area, and the fact that 17 we cannot do a randomized controlled study of injuries in 18 children, that leads to potential controversies in our 19 conclusions about how injuries might have happened. And 20 those conclusions may be challenged by various people who 21 are feeling the emotions of the case and yet may not be 22 soundly based in their opinions, but they're going raise 23 it as a potential controversy. 24 And various unusual theories are put 25 forward at times that really are -- really not based on

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1 any science at all that can cause controversy within. So 2 controversy is a very broad word, obviously as I'm using 3 it. 4 MS. LINDA ROTHSTEIN: Okay. And -- and I 5 guess the other issue I want to touch on, because perhaps 6 the three (3) of you can help shed some light on this 7 based on the combined experience that you've had, is how 8 you rise above those emotions and maintain objectivity 9 and also persuade those that are entrusted to make 10 decisions that that's indeed what you've done. 11 So it's really in that light, Dr. Driver, 12 that I'd be grateful if you would turn up Tab 18 of 13 Volume IV, which is a very brief decision or transcript 14 of reasons for judgment by His Honour, Judge Nasmith in a 15 child protection proceeding many, many years ago. Really 16 in the early, early days of your team. 17 DR. KATY DRIVER: Very early days. 18 MS. LINDA ROTHSTEIN: And indeed that may 19 be -- that may be something that is relevant for you to 20 point out. But if I can just go to this very issue of 21 objectivity. What we have here are the comments of -- of 22 Judge Nasmith starting on page 2: 23 "There is one (1) other thing that I 24 wanted to say because we have much 25 debate about what kind of evidence

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1 should be accepted in these cases..." 2 And so on. And then he wants to talk 3 specifically about your evidence, Dr. Driver, because: 4 "You are a key person in this 5 investigation and with the Child Abuse 6 Team and the approach it takes to these 7 kinds of medical problems as they 8 present themselves. She is as close as 9 anyone to identifiable decision maker 10 in that amorphous collection that is 11 called a Child Abuse Team, which can 12 include, I guess, any number of 13 people." 14 So stopping there for the moment. 15 Certainly I read these comments, Dr. Driver, as not 16 really being specific necessarily to you, but to an 17 approach that -- 18 DR. KATY DRIVER: Yes. 19 MS. LINDA ROTHSTEIN: -- he viewed as 20 being reflective of the SCAN Program's approach: 21 "They are all combatting child abuse. 22 I can see where it would be hard to be 23 objective when dealing with a helpless 24 infant who has sixteen (16) to twenty 25 (20) unexplained bone lesions.

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1 But based on my observations of 2 witnesses in other cases, and Dr. 3 Driver in this case, I have serious 4 concerns about professional objectivity 5 in the giving of evidence. And more 6 widespread concerns about some features 7 of this child abuse prevention process; 8 the process in which the Child Abuse 9 Team seems to be at the center. 10 I am referring, of course, to the 11 apparent resort to hearsay, gossip, 12 vague impressions, and the clash of 13 personalities. These people have a 14 fairly significant power to investigate 15 and to make decisions that drastically 16 affect the lives of people. Sometimes 17 their objectivity seems undermined by 18 their advocacy; their tendency to 19 promote a theory to sell it. There 20 seemed to me to be a kind of politics 21 of medicine and a politics of 22 combatting child abuse as demonstrated 23 in this case that deserves careful 24 scrutiny including scrutiny at these 25 hearings. Enough said about that."

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1 So stopping with the -- there for a 2 moment, Dr. Driver, and asking you the first and most 3 important question. Until you were being prepared to 4 give evidence at this inquiry had you ever had an 5 opportunity to even see that decision? 6 DR. KATY DRIVER: I had not seen that 7 before. 8 MS. LINDA ROTHSTEIN: Okay. So this is-- 9 DR. KATY DRIVER: But -- 10 MS. LINDA ROTHSTEIN: -- this is really 11 in many ways very difficult and arguably fair , but let 12 me ask you this. Did it ever come to your attention in 13 your tenure on the SCAN Team that judges were concerned 14 about the objectivity either of you or other of your 15 colleagues on the team? 16 DR. KATY DRIVER: I think this was one 17 (1) of the earlier cases, and part of -- as I recall, 18 this is a child with a lot of fractures, and it was our 19 radiologist who categorically said that in his vast 20 experience, this kind of injuries only had been seen with 21 child abuse. You know, I mean, he was that definite. 22 And the SCAN Team basically was 23 representing that opinion. I'm not a radiologist. I did 24 not have that -- benefit of that -- I -- I was following 25 in that case. We did have those issues -- the bone

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1 slides were sent out of the country. Eventually it did 2 turn out that this was a very rare medical condition. 3 But when the -- when SCAN Team said that 4 this was a case of child abuse, it was based solely on 5 the opinion of the radiologist. 6 MS. LINDA ROTHSTEIN: Okay. Dr. Huyer, 7 what about during your tenure, both as a physician on 8 SCAN and the Director? 9 What -- do you remember there being 10 concerns raised by judicial decision makers about the 11 objectivity of evidence of SCAN physicians? 12 DR. DIRK HUYER: I don't specifically 13 recall any. There may be some. You may surprise me with 14 some here, but -- 15 MS. LINDA ROTHSTEIN: I -- I would -- I 16 wouldn't do that. 17 DR. DIRK HUYER: -- but I do know that it 18 was a regular -- a regular day -- almost -- not daily, 19 but certainly when I went to court, very frequently in my 20 qualification as an expert and during my testimony there 21 would be a common pathway of that I'm an advocate, that 22 I'm out on a witch hunt to find the abused kids and to -- 23 to prosecute parents who cause abuse. And that really is 24 the goal that I have, was the message that would come out 25 in certain portions -- just in a portion -- of my

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1 qualification. 2 And that was not an uncommon -- uncommon 3 presentation by defence counsel and -- or parent's 4 counsel in family court matters. 5 It didn't seem to impact on the judgments, 6 or as -- in -- in my qualifications as an expert. I 7 wasn't rejected as an expert in those areas. 8 I acknowledged that people have that 9 opinion. But as a -- as both Dr. Shouldice and I, and Dr. 10 Driver's echoed, it's a far happier day for us when we 11 find that this is something that's accidental. 12 And so the 50 percent cases -- again we're 13 talking about an "N" here, so a research number, or a 14 number, and what's the denominator. 15 So the denominator of our cases, a small 16 percentage, probably less than a quarter, even maybe less 17 than that, would end up in a criminal court hearing. 18 So apart from that, 50 percent of those -- 19 not even -- we're extracting them from an investigation 20 where there's child abuse concerns. And -- and then 21 another percentage of those, we're recognizing as grey. 22 And so if that was the mode that we were 23 approaching, then I would think we would be a far greater 24 number of cases that would be proceeding towards a 25 criminal court or a family court matter.

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1 I think it's -- I understand why that 2 issue is brought forward. I understand why people think 3 that, because this is -- can be -- it's a very disruptive 4 thing, when child protection occurs and criminal matters 5 occur in -- in an injury of a child. 6 And many people don't demonstrate their 7 features that would lead to them causing injuries in 8 kids. So people don't see those, and they see different 9 behaviour. So I can understand why people would find it 10 very surprising that the person next door caused these 11 injuries and -- and lead to this sort of an approach. 12 And I know that over the years, many in 13 our field have presented themselves as child advocates. 14 And I think that that word has been misinterpreted, where 15 I think they're advocating for the well-being of children 16 in general, not advocating for a child to find that 17 abusive person. 18 So I think that that word has -- has a 19 different meaning in medicine than it does in -- in the 20 courtroom. And I think that's an example of sometimes 21 how the language can -- can clash. 22 Albeit, I think that I understand and 23 respect that, the interpretation of the word "advocacy," 24 because I don't think that that's what we are here to do. 25 I understand Judge Nasmith's comment about

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1 how it's hard to separate from the child that's so badly 2 injured and not testify from the emotion of -- of wanting 3 to help that injured child, but -- 4 MS. LINDA ROTHSTEIN: So stopping there, 5 you accept that that's a reasonable observation to make 6 and a potential pitfall for those in your career path? 7 DR. DIRK HUYER: Absolutely. 8 MS. LINDA ROTHSTEIN: Okay. 9 DR. DIRK HUYER: And I make it a large 10 point of my presentations when I present in the area of 11 testimony and expert testimony and -- and being an 12 expert. I point this out to all professionals, about how 13 that's a very important factor to consider when 14 presenting an opinion. 15 It's also important to consider who's 16 calling you. If the prosecution's calling or if the 17 defence is calling, you may have multiple meetings with 18 certain counsel and develop a form of a relationship, 19 albeit professional. And you may want to help that 20 prosecution, because you've got that bit of a 21 relationship. 22 And I think that that's another important 23 thing that I illustrate in my -- in my sessions when I'm 24 teaching this area, because -- and I'm very aware of that 25 in myself, not that I do it, to remember that scenario on

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1 a -- on an ongoing basis, because our job is not to be 2 advocating for one side or another. 3 It's to give the medical information as we 4 understand it. But it -- it can be challenging. And I 5 think that certain people will not provide -- would not 6 become good experts and be able to withstand the -- the 7 rigours of -- of examination-in -- in-chief and cross- 8 examination. 9 And it's fairly clear, when I meet certain 10 investigators, who can deal with this area and who can't 11 and which physicians can deal with this area and not and 12 wouldn't be recruiting somebody like that. 13 Clearly we would recruit somebody like Dr. 14 Shouldice, who has the ability to look at those things 15 and put things into different compartments and -- and 16 recognise which compartment you're in. 17 MS. LINDA ROTHSTEIN: Now Dr. Shouldice, 18 what are your comments on the things one -- someone in 19 your position can do to guard against being swayed by the 20 emotions that swirl around you on a daily basis? 21 DR. MICHELLE SHOULDICE: So I -- I guess 22 a couple of things; one we've already spoken about, which 23 is, you know, keep -- what we strive to do is keep the 24 opinion to the medical facts and to providing a medical 25 opinion.

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1 In providing the opinion, you know, we 2 really try to break it down into each separate area of 3 concern, look at those separately rather than just making 4 a diagnosis based on the initial sort of constellation of 5 presentations. 6 And that helps to -- to really make us 7 think about the -- the medical findings separate from the 8 rest of the, what may be, very upsetting picture in 9 general. 10 And I think the only thing I -- I would 11 add is that I think it is extremely difficult for 12 physicians who are trained in a medical model to sit on 13 the witness stand and be asked so many questions about 14 their opinion with -- and maintain -- not -- prevent 15 yourself from becoming defensive or stronger in your 16 opinion as the questions come at you, because it's a 17 natural human reaction to become a bit defensive as 18 you're challenged. 19 And I -- I think that's the other piece 20 that I tell people, is, You are not on trial, but you 21 will be asked questions which make you feel like you are. 22 And it's important to keep trying to maintain your 23 objectivity and to maintain your, you know, your calm -- 24 COMMISSIONER STEPHEN GOUDGE: Detachment. 25 DR. MICHELLE SHOULDICE: -- detachment as

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1 much as possible from the emotions you may be feeling at 2 the time. And it's -- it's a difficult thing to -- to 3 try to do. 4 DR. DIRK HUYER: And I can give one (1) 5 illustrative sample or example of that. When we're 6 prepared to testify as an expert, the Crown Attorney, or 7 whoever's calling you, will stand up with my forty-two 8 (42) page CV. 9 And by the end of that you feel, Man, I'm 10 good. They're talking about my awards at grade 6, let 11 alone my awards last year. And you just feel great. 12 And the defence come forward, or the 13 prosecution, and basically at the end of that, you're 14 just a doctor, right. And so you kind of feel kind of 15 deflated by the end of it all. 16 And it's a -- it's quite challenging to -- 17 to be able to stand there, because that's not our model. 18 Our model is not to have such a thing in medicine. Even 19 in our rounds and education we don't get that. 20 MS. LINDA ROTHSTEIN: It's much more 21 collegial in it's -- 22 DR. DIRK HUYER: Much more collegial on 23 us. 24 MS. LINDA ROTHSTEIN: -- tone and purpose 25 and --

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1 DR. DIRK HUYER: You're not adversarial 2 to the extent. 3 DR. MICHELLE SHOULDICE: Especially in 4 pediatrics -- 5 DR. DIRK HUYER: Right. 6 DR. MICHELLE SHOULDICE: -- which is the 7 loving and caring specialty, where really there -- you 8 know, people don't challenge each other and confront each 9 other so directly. 10 11 CONTINUED BY MS. LINDA ROTHSTEIN: 12 MS. LINDA ROTHSTEIN: That's interesting 13 insight. Commissioner, on that note, should -- 14 COMMISSIONER STEPHEN GOUDGE: Yes. 15 MS. LINDA ROTHSTEIN: -- or do you want - 16 - I'm just wondering. 17 COMMISSIONER STEPHEN GOUDGE: Yes, I just 18 want to ask one (1) question before we break. And I want 19 to -- it has to do with the subject Ms. Rothstein's been 20 asking about, and that is the controversy that may have 21 been perceived to surround the SCAN Team in periods of 22 its existence. 23 And I guess I direct this more to Dr. 24 Driver and Dr. Huyer, since you may not have been there, 25 Dr. Shouldice.

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1 But in the mid-'90s we have seen on the 2 pathology side of our world the kind of "think dirty" 3 mentality that was reflected in a memo based on -- from 4 some people's perspective -- the presumption or in the 5 assumption that there was child abuse going undetected, 6 that that was an atmospheric. 7 Was there anything like that surrounding 8 the SCAN Team through the '90s? That is, the very name 9 SCAN suggests there is abuse going undetected possibly? 10 Does that resonate at all? And if it does, I would be 11 interested in your reaction. 12 DR. KATY DRIVER: I think -- I don't 13 think -- I -- I went in, and I don't think any one (1) 14 member of the team went in when we were called in with 15 our minds made up. We really went to look at the case 16 and collect as much information as we could, both from 17 the history of the injury as well as from various tests 18 that had been done to arrive at a conclusion. 19 There never was a, Aha, here's another 20 child being abused. No, it wasn't that. 21 COMMISSIONER STEPHEN GOUDGE: Dr. 22 Huyer...? 23 DR. DIRK HUYER: I -- in the time around 24 when I was going -- when I took over as Director -- I'm 25 not sure exactly when -- I was going to do one of those

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1 contests to have the -- the program renamed because of 2 the exact issue that you -- you articulated. 3 Frankly, I got too busy to -- to pursue -- 4 we had a number of discussions about other possible 5 names. There was no easy name that we could come up 6 with. I had difficulty with the name, especially when I 7 was going into a grey case -- 8 COMMISSIONER STEPHEN GOUDGE: Yes. 9 DR. DIRK HUYER: -- because the grey case 10 -- we weren't suspecting abuse. We were wondering about 11 what happened. And so I would start off by introducing 12 myself as one (1) of the team that deals with injuries in 13 children, and we have special expertise in injuries. I 14 want to let you know the name of our team is the 15 Suspected Child Abuse and Neglect Program, but that's the 16 name. But I'm here because your child has an injury, and 17 we're trying to sort that through. 18 So that's the way I dealt with it, my own 19 personal discomfort with the name. 20 COMMISSIONER STEPHEN GOUDGE: Right. 21 DR. DIRK HUYER: Yes, the -- the "think 22 dirty" comment or attitudinal thinking, which I think is 23 mis -- is -- is interpreted by many in different ways. 24 COMMISSIONER STEPHEN GOUDGE: Yes. 25 DR. DIRK HUYER: And I could talk about

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1 that in another -- 2 COMMISSIONER STEPHEN GOUDGE: Right. 3 DR. DIRK HUYER: -- another -- 4 COMMISSIONER STEPHEN GOUDGE: Right. 5 DR. DIRK HUYER: -- avenue. We -- and I 6 do teach that in child maltreatment, because in a typical 7 model of a medicine people come in wanting help. They 8 give the truth, so they get better. Parents aren't going 9 to bring their kids in and I say, I abuse my child. 10 So I do teach to have a high index of 11 suspicion. I -- that's Number 1 on my teaching slides. 12 But then I say, But that doesn't mean go in and -- and 13 take those parents aside, and interview that kid, and 14 interrogate them, or ask them a bunch of questions. 15 Just keep it in your mind that you want to 16 make sure that that injury fits with the story that's 17 being provided. If you can satisfy yourself in your mind 18 that that's what's occurred, perfect. But don't forget 19 the potential that that child could have been injured in 20 another way. 21 And so I make -- I definitely say high 22 index of suspicion. I'm -- definitely make that a high 23 priority in my talks in educating other healthcare 24 professionals. But I add in all of that other 25 information, because that's -- I don't think people

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1 should be using that high index of suspicion as a 2 process. It's what they should be thinking about, but 3 the process that they utilize will vary from case to 4 case. And so I would suspect Dr. Shouldice teaches in 5 the same kind of manner. 6 But clearly it was a challenge and -- and 7 -- but it's -- it wasn't that different from the mid-'90s 8 from the early '90s to the late '90s. 9 There still was this feeling of -- in -- 10 that people felt in a general conversation, say, in a 11 gathering I might be at, When I took my child to the 12 emergency department with a broken thumb, you should have 13 seen the way the nurse looked at me. Did you teach them 14 that? 15 I said, Well, I don't think I did. But 16 I'm not sure how you think the nurse looked at you, but I 17 think it's important from your son's perspective that we 18 understand how that broken thumb happened so that we can 19 make your son better. 20 And so I think that there was a lot -- 21 there's that -- that feeling that people are looking 22 around an injury in that kind of manner. And I think 23 that -- that's ubiquitous all over the place -- 24 COMMISSIONER STEPHEN GOUDGE: Okay. 25 DR. DIRK HUYER: -- depending on the

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1 personality. 2 COMMISSIONER STEPHEN GOUDGE: And in 3 terms of your described index of suspicion that is your 4 personal approach, Dr. Huyer, would you have said that 5 was shared throughout your experience on the SCAN Team by 6 your colleagues? Or were there variations? 7 DR. DIRK HUYER: As far as that 8 terminology or...? 9 COMMISSIONER STEPHEN GOUDGE: Well, as 10 far as that -- it is a very nebulous question. It had to 11 do with really attitude approach reflected in the kind of 12 general language that some read into the "think dirty" 13 phraseology that we have seen elsewhere. 14 DR. DIRK HUYER: I think it's hard to be 15 -- to give you a general answer to that. 16 COMMISSIONER STEPHEN GOUDGE: Yes, that 17 may be an unfair question. 18 DR. DIRK HUYER: I think it's very chall 19 -- I think that there are personality differences. 20 COMMISSIONER STEPHEN GOUDGE: Right. 21 DR. DIRK HUYER: I think there were 22 individual differences on how things were approached. 23 But I don't think there was "A" and "B," two (2) vastly 24 different approaches. 25 COMMISSIONER STEPHEN GOUDGE: Right.

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1 DR. DIRK HUYER: I think it would sit 2 closer, but to one (1) side of -- 3 COMMISSIONER STEPHEN GOUDGE: Right. 4 That is -- 5 DR. DIRK HUYER: -- that or the other. 6 COMMISSIONER STEPHEN GOUDGE: I am sure 7 that is right. Okay. Sorry, Ms. Rothstein, we will 8 break now then for fifteen (15) minutes. 9 MS. LINDA ROTHSTEIN: Thank you. 10 11 --- Upon recessing at 3:24 p.m. 12 --- Upon resuming at 3:41 p.m. 13 14 THE REGISTRAR: All Rise. Please be 15 seated. 16 COMMISSIONER STEPHEN GOUDGE: Ms. 17 Rothstein...? 18 MS. LINDA ROTHSTEIN: Thank you very 19 much, Commissioner. 20 21 CONTINUED BY MS. LINDA ROTHSTEIN: 22 MS. LINDA ROTHSTEIN: Dr. Huyer, I want 23 to turn your attention, if I may, very briefly to the 24 Jenna case, and deal with a couple of factual issues that 25 have arisen in relation to your involvement, or at least

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1 potential involvement in that case. 2 Just to again, orient everybody a little 3 bit with the time line, which is going to be of some 4 consid -- considerable assistance in this case, Dr. 5 Huyer. This was a case in which Jenna was born on April 6 21, 1995, and died on January the 22nd, 1997 at the age 7 of twenty-one (21) months in Peterborough. 8 And eventually her body was transported to 9 the Hospital for Sick Children, and an autopsy was 10 conducted there by Dr. Charles Smith. You're familiar 11 with those basic facts are you not -- 12 DR. DIRK HUYER: Yes. 13 MS. LINDA ROTHSTEIN: -- Dr. Huyer? 14 DR. DIRK HUYER: Yes, I am. 15 MS. LINDA ROTHSTEIN: Now we actually 16 know from looking at Dr. Smith's post-mortem report, 17 which is at PFP011066. I'll just ask you to look at the 18 screen, that the autopsy in this case started -- go to 19 the second page there. Here we go. 20 That the autopsy in this case started at 21 13:00 hours on the 22nd of 1997. And we know, Dr. Huyer, 22 that there have been a variety of inquiries over the 23 years about whether you were in attendance for any 24 portion for that autopsy. 25 And as you will know, Dr. Huyer, it has

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1 been Dr. Smith's contention at various stages of various 2 investigations, that you, indeed, were in attendance. If 3 I can just take you to one (1) aspect of the overview 4 report that makes that very pointed. Looking at the 5 overview report which you will find at Volume I, Tab 6 number 7. 7 DR. DIRK HUYER: Yes. 8 MS. LINDA ROTHSTEIN: 144684. This 9 certainly isn't the first occasion on which there's 10 evidence from Dr. Smith suggesting your involvement, but 11 if you look at paragraph 186, page 97, you will see that 12 some years after the autopsy, in 2004, Ms. Langford who 13 acts for Dr. Smith, provided the Office of the Chief 14 Coroner with handwritten notes from Dr. Smith of the 15 autopsy which stated, among other things, quote: 16 "Hymen examined with Dr. Dirk Huyer." 17 There's a handwritten note to that effect. 18 So that has brought into light this question of whether 19 or not you attended the autopsy, and we have, just to 20 complete this sort of documentation on this, we have a 21 variety of letters from you that make reference to the 22 issue. 23 The first one (1) I'd ask you to look at 24 is at Tab 30 of Volume IV, which is 053105. 25 DR. DIRK HUYER: Sorry, Tab 30?

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1 MS. LINDA ROTHSTEIN: Mm-hm, of Volume 2 IV. This is a letter that you wrote in response to 3 inquiries that were being made by Detective Constable 4 Charmley, do you remember that? 5 DR. DIRK HUYER: Yes. 6 MS. LINDA ROTHSTEIN: Dr. Huyer, 7 Detective Constable Charmley was re-investigating the 8 matter following the withdrawal of the criminal charges 9 against Ms. -- against the mother of Jenna, and he 10 requested some information from you and you wrote: 11 "This letter follows your letter and 12 convie -- and conversation today about 13 my involvement in the death 14 investigation of Jenna; specifically, 15 my attendance at the autopsy and 16 involvement in the examination of the 17 child at that time. 18 I am aware of the circumstances of the 19 death, and the investigation 20 surrounding the death. I have had 21 conversations with professionals 22 involved in the case since the death. 23 I cannot specifically recall attending 24 the autopsy, although I do recall 25 having conversation with the

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1 investigating officers around the time 2 of the death, discussing potential 3 suspects." 4 And then you go on to say: 5 "Well, I don't specifically recall 6 attending. I would frequently attend 7 autopsies at the hospital when deaths 8 involving traumatic injuries were 9 involved." 10 That's consistent with what you've told 11 us. Dr. Huyer, just before I get you to respond to some 12 questions about that, let me take you to the other 13 documentation that you have authored on this point, Tab 14 42. 15 DR. DIRK HUYER: Yes. 16 MS. LINDA ROTHSTEIN: There's a letter 17 that you wrote to the College and -- of Physicians and 18 Surgeons approximately a month later, on February the 19 19th of 2002, 147585. 20 A little longer elaboration here: 21 "This letter follows your request for 22 information in your letter dated 23 February 8th." 24 And then you proceed to explain who you 25 were. The next paragraph:

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1 "I would frequently attend autopsies at 2 the hospital when deaths involved 3 forensic evaluations. This attendance 4 related to my interest in the area of 5 forensic evaluation. 6 Dr. Charles Smith was most commonly the 7 pathologist completing the post-mortem 8 examinations. He and I would discuss 9 various aspects of the evaluation in a 10 collegial manner. 11 As I recall, in 1997, my typical 12 approach in considering the need for 13 completion of a sexual abuse evidence 14 kit, forensic evidence collection in a 15 patient who was alive would be based on 16 the clinical presentation." 17 And stopping there. You make note of the 18 -- "who was alive". Is that because, for the most part, 19 that was when that practice would be used by you? 20 DR. DIRK HUYER: Yes. 21 MS. LINDA ROTHSTEIN: Okay. 22 "The most important factors would 23 include history of sexual abuse 24 concerns, symptoms or signs of genital 25 -- genital injury, bleeding, pain,

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1 observed injury, and time since the 2 reported incident. When children would 3 present for a medical evaluation 4 because of concerns of physical abuse, 5 ie; unexplained traumatic injuries, 6 visual examination of the genitalia 7 would typically be included in the 8 physical evidence -- [excuse me] 9 physical examination, but without 10 additional factors, as noted above, 11 present, a forensic evidence kit would 12 not be completed." 13 Stopping there for a moment. Would the 14 location or identification of a hair in the pubic area of 15 a young child be one (1) of the factors that would 16 perhaps, based on your description of when you would do 17 sexual abuse evidence kits, be a triggering factor? 18 DR. DIRK HUYER: It could be, yes. 19 MS. LINDA ROTHSTEIN: Could be, should 20 be, would be, can you be anymore specific than that, sir? 21 DR. DIRK HUYER: There would be more -- 22 there may be more -- we would require more details to be 23 able to get to the level of should be, so I think that 24 the isolated hair, there could be various explanations 25 for that.

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1 So that in of itself, without some 2 additional information, may not lead me to that -- to 3 produce -- or proceeding with a sexual assault evidence 4 kit because there -- there may be various explanations 5 for it. 6 That's in a live child. We might be able 7 to get some additional information to have an 8 understanding of how the child got to us. 9 MS. LINDA ROTHSTEIN: What about in a 10 dead child, would it be different analysis? 11 DR. DIRK HUYER: Probably it would be a 12 different analysis. I mean a hair in a deceased child, 13 again in a deceased child and any time when a potential 14 sexual abuse concern arises, you have a short opportunity 15 and -- and sometimes only a opportunity to collect 16 potential evidence. 17 And so generally speaking, it's more often 18 that that evidence would be collected, even -- or the -- 19 sorry -- that there would be an effort to collect 20 potential evidence that may be there because that's the 21 only opportunity, but the same thing would -- it actually 22 doesn't differentiate between a live or a deceased child. 23 MS. LINDA ROTHSTEIN: I was going to say, 24 I'm not sure I see the difference, but... 25 DR. DIRK HUYER: No, the -- but the hair

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1 -- I may be able to get a better idea of how that hair 2 gets there on a live child because there might be more 3 information available from the child themselves. 4 MS. LINDA ROTHSTEIN: Okay. And then you 5 say: 6 "I have not found any notes or 7 documentation relating to my 8 involvement in the post-mortem 9 evaluation of Jenna XXXX -- [Oh, excuse 10 me] of Jenna. I am aware of the 11 circumstances of the death and the 12 investigation surrounding the death. I 13 have had conversations with 14 professionals involved in the case 15 since the death. I cannot specifically 16 recall attending the autopsy, although 17 I do recall having conversation with 18 investigating officers around the time 19 of the death, discussing potential sus 20 -- suspects. 21 When I would attend during autopsy 22 procedures, Dr. Smith and I would 23 generally examine the genitalia 24 together, and I would discuss the 25 findings verbally with him. It was my

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1 impression that he would document the 2 results of our examination. Given the 3 age of the child, if there were not 4 specific concerns of sexual abuse and 5 there was no evidence of gentle -- 6 genital injury, I would not have likely 7 recommended completion of specific 8 forensic testing to evaluate for sexual 9 contact. It is my opinion that without 10 specific injury to the hymen, forensic 11 finding of semen/sperm in the vaginal 12 vault would be unlikely in a child of 13 this age." 14 So as I say, that's the second letter. 15 And then the last letter that may speak to the issue is 16 August 27th, '04. It's 074309. Just look at your 17 screen. 18 DR. DIRK HUYER: Yes. 19 MS. LINDA ROTHSTEIN: And this is again a 20 followup letter you write some time later to Detective 21 Charmley actually about the events themselves. And if 22 you could just turn to the second page. 23 DR. DIRK HUYER: Not -- not the events of 24 my attendance at the autopsy, -- 25 MS. LINDA ROTHSTEIN: Sorry.

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1 DR. DIRK HUYER: -- but the findings. 2 MS. LINDA ROTHSTEIN: Not -- not your 3 attendance, but your findings. Thank you. 4 DR. DIRK HUYER: Yes. 5 MS. LINDA ROTHSTEIN: Right. So I'm not 6 sure that this sheds any light on whether or not you were 7 at the autopsy? 8 DR. DIRK HUYER: No, I don't believe it 9 does. It -- it allows me -- it allowed me the 10 opportunity to review the photographs, and I provided an 11 opinion as to whether I thought the examination findings 12 were representative of sexual abuse or not, as part -- as 13 an expert in the -- involved in the second -- or sorry, 14 the post-withdrawal of charges investigation. 15 MS. LINDA ROTHSTEIN: Okay. So looking 16 at all of that, Dr. Huyer, what can you tell us today 17 about whether or not you were in attendance at the 18 autopsy of Jenna for any portion of it? 19 DR. DIRK HUYER: Well, as -- as you've 20 commented in -- in initiating this conversation, the -- 21 Dr. Smith says that I was there. I don't have a reason 22 to doubt Dr. Smith saying that I was there. I don't 23 remember being there. 24 I don't have any recollection being there 25 at the autopsy, but I've had a number of conversations.

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1 I've been involved in a number of teaching sessions; 2 discussions with various professionals since the time of 3 the autopsy, so that again -- my attendance at the 4 autopsy could have blurred into those conversations. 5 MS. LINDA ROTHSTEIN: Sorry. About 6 Jenna's case? 7 DR. DIRK HUYER: About Jenna's case 8 specifically. I mean, I've done an expert report on the 9 area, but even these letters were before my expert report 10 and so I -- I just don't remember. I don't remember 11 being there. 12 And seeing the photographs -- I'd seen 13 them so many times, again, in different teaching sessions 14 that it honestly doesn't help me to remember if I was 15 there that day at the autopsy. 16 MS. LINDA ROTHSTEIN: Okay. Let's just 17 unpack that a bit. Why early on, if you were not at the 18 autopsy, might you or were you engaged in discussions 19 with the investigating officers about this case? This 20 was a death case. 21 DR. DIRK HUYER: Yeah. No, that suggests 22 that I could have been there at the time, but also I had 23 frequent involvement with the Peterborough Police, and it 24 may have been another case at the same sort of time. 25 That suggests I could have been there and would support

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1 me being there around the pre-autopsy discussions which 2 were common, and that the investigators may have been 3 there. 4 They may have seen me for some other 5 reason around that time as well 'cause Peterborough was 6 one (1) of the referral sources for us in injuries to 7 children, sexual abuse, that we would be receiving 8 informa -- children directly from Peterborough. 9 MS. LINDA ROTHSTEIN: Okay. And next 10 question. Why were you involved in so many discussions 11 of this case on a teaching basis over the years and 12 before very recently. Help us understand that. 13 DR. DIRK HUYER: There's some pretty 14 dramatic findings in this child and findings that are not 15 often seen in -- in child maltreatment or in death 16 evaluations of children. 17 And I have utilized this case as a 18 teaching case based upon the photographs, based upon the 19 autopsy findings, and my understanding of Dr. Smith's 20 evaluation, at that time, of what the findings were and 21 how the -- the case was a complicated case in trying to 22 sort through. 23 I haven't used it as a teaching case since 24 my involvement in '94. This was all pre '94 when I used 25 it.

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1 MS. LINDA ROTHSTEIN: How long after 2 January the 22nd, 1997, do you remember learning that 3 there was, indeed, a hair found in the pubic area of 4 young Jenna? 5 DR. DIRK HUYER: The first time I 6 remember it was it became -- oh, I may have learned about 7 it -- I don't think I knew about it at the time of the -- 8 I don't know. I'm trying to think to put a time on it. 9 I think there may have been conversation 10 between Dr. Cairns and myself relating to that, so I 11 suspect, although I -- I don't have independent 12 recollection of that timeframe, I suspect when Dr. Cairns 13 was aware of it then I was probably aware of it shortly 14 after that time. 15 MS. LINDA ROTHSTEIN: Okay. And do you 16 remember what your reaction was when you first heard 17 about that? 18 DR. DIRK HUYER: That there was a hair in 19 the office? 20 MS. LINDA ROTHSTEIN: Yes. 21 DR. DIRK HUYER: I was surprised. 22 MS. LINDA ROTHSTEIN: Not in the office, 23 no, no, no. 24 DR. DIRK HUYER: Sorry. 25 MS. LINDA ROTHSTEIN: Let's -- let's stop

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1 for a moment. There are different things here that can 2 easily -- 3 DR. DIRK HUYER: That's -- yeah. 4 MS. LINDA ROTHSTEIN: -- confused, so I 5 hope I don't add to it. When you first learned that 6 there had, indeed, been a hair that had been retrieved 7 from Jenna's body, and that had been identified as having 8 been located in her genital area, okay? 9 When you first heard about that, leave 10 aside where it was found and who had it and all the rest. 11 What was your reaction to that information? 12 DR. DIRK HUYER: That I would wonder what 13 the source of that hair was. 14 MS. LINDA ROTHSTEIN: You're speaking in 15 conditional language. Do you remember having a reaction 16 as opposed to -- 17 DR. DIRK HUYER: I don't remember the 18 reaction, no. 19 MS. LINDA ROTHSTEIN: Okay. All right. 20 And when you learned that, in fact, the hair had been 21 maintained by Dr. Smith in his office, do you remember 22 having a reaction to that news? 23 DR. DIRK HUYER: Yes. 24 MS. LINDA ROTHSTEIN: What was it? 25 DR. DIRK HUYER: Surprise, very

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1 uncharacteristic of a typical investigative approach, 2 couldn't believe it. Those would be -- probably 3 characterized my reaction to that. 4 MS. LINDA ROTHSTEIN: Okay. And do you 5 think that -- can you tell us anything about what you 6 think your practice would have been at the time, back in 7 19 -- in 2000 -- sorry, back in 1997, if a hair had been 8 located on this child? 9 What, if any, advice you would have given 10 about what should have been done with that hair, in the 11 circumstances of this case? 12 DR. DIRK HUYER: Well, any case, this 13 case included, that hair would typically be provided to 14 the police officers, and would typically be provided to 15 the Centre of Forensic Science. 16 There may or may not be testing of that 17 hair, but it would typically go to the Centre of Forensic 18 Science. 19 MS. LINDA ROTHSTEIN: Okay. And in light 20 of the fact that a male -- young male babysitter was one 21 (1) of the two (2) potential suspects identified by the 22 police very early on, as of the date of the autopsy of 23 this child, what would that have done to any 24 recommendation you would have made about whether to do 25 sexual abuse examination of this child and collection?

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1 DR. DIRK HUYER: Those factors lead, at 2 this time, for me to provide the comment that I would 3 have -- believed I would have likely recommended that a 4 sexual assault evidence kit be completed. I was doing 5 them independent of death investigations; clinically I 6 did those. 7 I made recommendations for those to be 8 done in various cases, including my death investigations 9 separate that I was directly involved in as a coroner. 10 So I'm surprised that I wouldn't have made that 11 recommendation, but I -- I can't recall what I did at 12 that particular time. 13 But I'd be surprised that I wouldn't have 14 given -- if I was aware of the finding of a hair, and if 15 I -- and I would have been aware of the fourteen (14) 16 year old, I know that I was aware of that. 17 MS. LINDA ROTHSTEIN: Okay. And -- 18 DR. DIRK HUYER: If I was at the autopsy. 19 I mean, I was aware of it around that time. 20 MS. LINDA ROTHSTEIN: And because you 21 tell us you don't remember whether or not you were indeed 22 at -- at the autopsy, is it fair to say, Dr. Huyer, that 23 you don't remember therefore there being any discussion 24 about the hair? 25 DR. DIRK HUYER: No, I don't.

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1 MS. LINDA ROTHSTEIN: At such an autopsy? 2 DR. DIRK HUYER: No, I don't remember 3 that. 4 MS. LINDA ROTHSTEIN: Thank you, Dr. 5 Huyer. I want to ask you as well, about the Gaurov Case. 6 DR. DIRK HUYER: Yes. 7 COMMISSIONER STEPHEN GOUDGE: Doesn't all 8 that suggest to you, Dr. Huyer, you weren't at the 9 autopsy? 10 DR. DIRK HUYER: My colleague says I was 11 at the autopsy. I mean, I can't dispute the fact that my 12 colleague has said that I was at the autopsy. I've 13 forgotten things. I forgot I was at the Amber 14 Conference. Could I have forgotten that I was at the 15 autopsy? Was I there maybe only part of the autopsy? 16 Maybe I came after the hair was collected; 17 maybe I came before the hair was collected; maybe I 18 looked at the genitals. Honestly, Commissioner, I don't 19 know. 20 COMMISSIONER STEPHEN GOUDGE: Okay. 21 DR. DIRK HUYER: And, I mean, somebody 22 has commented that I was there, I -- I can't challenge 23 the voracity of that, because I don't have independent 24 recollection -- 25 COMMISSIONER STEPHEN GOUDGE: Right.

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1 DR. DIRK HUYER: -- to being anywhere 2 else. 3 COMMISSIONER STEPHEN GOUDGE: Right. 4 5 CONTINUED BY MS. LINDA ROTHSTEIN: 6 MS. LINDA ROTHSTEIN: Okay. I just want 7 to pause briefly if we can, to talk about the Gaurov 8 Case. 9 Really -- really from the perspective, Dr. 10 Huyer, of how you might approach that same set of 11 findings today, and to use that perhaps as a way to segue 12 into a broader discussion about any views that you may 13 have, Dr. Shouldice, or others may have about the 14 necessity for and process by which a further review of 15 Shaken Baby Syndrome cases might be undertaken. 16 DR. DIRK HUYER: Okay. 17 MS. LINDA ROTHSTEIN: So if we go to 18 Gaurov's case it's -- again, we're going to have to 19 remind ourselves that it takes us all the way back to 20 1992, and if you look at Volume IV, Tab 28. 21 DR. DIRK HUYER: Yes. 22 MS. LINDA ROTHSTEIN: We have there a 23 copy of the report that you prepared to the Children's 24 Aid. You and I have touched on this briefly; March 23, 25 '92, at 001546. The second page of it sets out the

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1 thrust of your conclusions, starting in the middle of the 2 page: 3 "This clinical picture of retinal 4 hemorrhages, lack of signs of acute 5 external injury, intracranial 6 hemorrhage in the pattern observed on 7 the child's CAT scan and described 8 above, significant brain injury with 9 resultant sequelae, respiratory 10 difficulties, depressed level of 11 consciousness, seizures, and finally 12 death without any history of 13 significant trauma or other medical 14 problem is very suggestive of the 15 Shaken Baby Syndrome. 16 The Syndrome is classically described 17 to be present when the noted group of 18 clinical features are observed in a 19 child." 20 And then the last paragraph on that page: 21 "The clinical diagnosis in this child 22 was most likely Shaken Baby Syndrome. 23 Dr. McGreal, the staff neurologist 24 involved in the child's care, agreed 25 with this diagnosis. Preliminary

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1 autopsy results are consistent with 2 this diagnosis. 3 It is very -- it is a very concerning 4 injury and typically results from 5 violent, noticeable shaking of the 6 child. No history of shaking was 7 provided and shaking was denied on 8 direct questioning. The lack of 9 history to explain the clinical 10 diagnosis is very concerning, and 11 coupled with the known mechanism, is 12 very suggestive of non-accidental 13 injury." 14 I'm going to play lawyer with you, if 15 you -- 16 DR. DIRK HUYER: Certainly. 17 MS. LINDA ROTHSTEIN: -- if you'll allow 18 me, for a moment, Dr. Huyer. So you've got "very 19 suggestive of non-accidental injury." You've got "likely 20 Shaken Baby Syndrome." 21 Leaving aside the diagnosis itself for the 22 moment, what about that language, looked at through your 23 eyes in 2008, is -- would you use that language today, 24 "very suggestive of," "likely," in the same paragraph? 25 Do you see any difficulties in

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1 communicating with the justice system with that kind of 2 language -- 3 DR. DIRK HUYER: I think -- 4 MS. LINDA ROTHSTEIN: -- something the 5 Commissioner has been very interested in? 6 DR. DIRK HUYER: I think there's always a 7 challenge in communicating medical findings to the legal 8 system. And there's always a challenge in what words and 9 how to articulate the -- the certainty that we may have 10 or the strength that we may have. 11 In this case I likely was using that 12 language because of the fact that there was an autopsy 13 pending. I don't rem -- know for sure that that's the 14 case. But I think, looking backwards, that was likely 15 what was going on. 16 And in addition, I was new. And so I was 17 probably a little hesitant to go out and there say black 18 and white what the diagnosis might have been. So as 19 opposed to saying, My diagnosis is Shaken Baby Syndrome, 20 I was giving some hedge in that way so that there was -- 21 because I may not have been correct in my diagnosis. 22 I think that another example -- and I'm 23 going to digress just for a minute -- is "consistent 24 with." And in our terminology in medicine, "consistent 25 with" is anything, basically. I mean it's a little

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1 tighter link. But in your language, as I understand -- 2 and I don't pretend to have the dictionary that 3 translates between medicine and legal -- but my 4 understand is "consistent with" means that's it. It's a 5 pretty tight connection legally. 6 So recently I've been not using that 7 terminology because of the confusion that it -- that it 8 has led to. And similarly, my SCAN colleagues have 9 changed their approach. And we've been teaching various 10 other people to recognise the -- the confusion that may 11 occur from that language. 12 So in asking how -- I -- I think you're 13 asking me how I would articulate something. And I think 14 that I now testify in a building block kind of way. So I 15 would address, as Dr. Shouldice commented earlier about 16 if there's different injury types, talk about those 17 individually. 18 But here I would probably talk a little 19 bit about -- well, more than a little bit, what retinal 20 hemorrhages are and what is the significance of those 21 individually; then talk about subdural hemorrhage, then 22 talk about the significance of that individual; talk 23 about head injuries in general and -- and forces, talk 24 about that individual; and also talk about brain 25 swelling. So then -- and the lack of injury.

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1 And then I would come to bring those 2 together as a constellation and say that in medicine 3 these things that come together in a constellation are 4 written about in the literature, talking about the 5 diagnosis of Shaken Baby, so then I would get into that. 6 And in the meantime I would talk within that area about 7 some of the controversies. 8 So I think they want to give as much of a 9 big picture to this information. And at that time, the 10 controversies weren't as prevalent as they were, say, 11 mid-'90s, where they started to -- to -- their -- their 12 findings come forward. 13 And then I would talk about -- and this is 14 what I do when the cases -- or I was doing, until I 15 stopped doing the -- the head injury cases in 2001. And 16 I -- I believe, and Dr. Shouldice can speak for what they 17 do, but now -- but I would look at the controversies and 18 apply them to the cases. 19 And so in this particular case, the one 20 (1) area of controversy would be potential rebleeding. 21 So that would be a routine thing for me to do when I'm 22 clinically evaluating these cases, consider that. 23 And so in this particular case -- I 24 haven't heard all of the testimony, but I'm aware that 25 there was testimony about rebleeding in this case. The

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1 pattern of subdural, in my opinion, didn't match my -- up 2 until 2001. 3 So I'm going to -- because I haven't read 4 the literature since. 5 COMMISSIONER STEPHEN GOUDGE: Okay. 6 DR. DIRK HUYER: But up until 2001 the 7 pattern of bleeding, the new blood, in this case, was not 8 typical of what I understand rebleeding to be, which is 9 within an area of where the old blood is. So it's not 10 going to be spread in five (5) different places where 11 there's one (1) area of old blood. 12 So that controversy, based upon my 13 understanding to 2001, would not be a significant factor 14 here in this case, in my clinical evaluation. 15 16 CONTINUED BY MS. LINDA ROTHSTEIN: 17 MS. LINDA ROTHSTEIN: So do I hear you to 18 imply that as of the time you last familiarized yourself 19 with the literature, 2001, you likely would have come to 20 the same conclusion, albeit you would have expressed it 21 much differently? You would have considered other 22 things. You would have provided more foundation for your 23 opinion. 24 But you likely would have come to the same 25 fundamental conclusion about the cause of death?

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1 DR. DIRK HUYER: About the clinical 2 findings of the injury -- 3 MS. LINDA ROTHSTEIN: The clinical 4 findings, yes. 5 DR. DIRK HUYER: -- prior to death? 6 MS. LINDA ROTHSTEIN: Sorry, excuse me. 7 DR. DIRK HUYER: Yes. 8 MS. LINDA ROTHSTEIN: Quite so. 9 DR. DIRK HUYER: But -- but they're also 10 -- because I've read -- 11 MS. LINDA ROTHSTEIN: Was -- was that a 12 "yes," by the way? 13 DR. DIRK HUYER: That is a yes. 14 MS. LINDA ROTHSTEIN: Okay. 15 DR. DIRK HUYER: I don't know if I'd use 16 the word "much," and that's a relative term, so I can't 17 characterize how much "much" would be. 18 But the other thing that -- that has 19 happened here is that there's other data that I've 20 reviewed within the -- the binders that talk about -- and 21 contrary to what my paragraph says, which was there's no 22 history of shaking, there is additional information. 23 So I think that that would obviously be 24 something that, as Dr. Shouldice and I talked about, if 25 this -- let's -- one of the better things that could have

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1 happened is this child didn't die. 2 Let's say this child didn't die and we're 3 in that process of the new -- the new protocol, which is, 4 this is a case with injuries that would suggest no 5 involvement, as far as interviewing goes, by us, which is 6 not what happened on this one, by the way. 7 But say that happened and the police and 8 the Children's Aid were out investigating. And they 9 called us back and said, Hey, you know what? The 10 firefighters observed, the paramedic observed some 11 shaking. 12 Can -- well -- well, let's consider that. 13 We need to learn a little bit more about. And that 14 clearly would then be part of the diagnostic picture that 15 I added. So additional history or additional information 16 about potential traumatic injury -- whether it be a fall, 17 whether it be shaking, whether it be CPR or resuscitation 18 -- all of those things would be also included in my -- in 19 my reports at this stage. 20 So I look at the medical findings; provide 21 my thoughts on a building block way; what is the typical 22 sort of presentation in -- in, say, a bruise, a rib 23 fracture, whatever; then specify it to the injuries in 24 that case and talk about what I think around that; then 25 consider alternate explanations, whether it be medical

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1 explanations, whether it be -- and then information 2 that's provided historically, say a fall. And so 3 consider whether that fall could explain the injuries or 4 couldn't and my reasons why not. 5 So that would all be laid out in my report 6 prior to any close time to any -- any court involvement, 7 whether it be civil, whether it be family, whether it be 8 criminal. So that would be the difference of the 9 approach that I would take in -- in a case like this. 10 MS. LINDA ROTHSTEIN: Dr. -- 11 COMMISSIONER STEPHEN GOUDGE: So let me 12 just -- sorry, Ms. Rothstein. 13 But before Ms. Rothstein engages you in a 14 conversation about Shaken Baby precisely, Dr. Huyer, I 15 hear you saying that your report writing practice in any 16 case is one that has become more fulsome over time? 17 DR. DIRK HUYER: Absolutely. 18 COMMISSIONER STEPHEN GOUDGE: Okay. And 19 explaining as fully as you can your own thought process, 20 what you accept, what you dismiss, and why is now 21 something that you would do yourself and teach others 22 where you might not have been quite so fulsome ten (10) 23 years ago? 24 DR. DIRK HUYER: Ten (10) years ago, no. 25 Oh, wait, ten (10) years, 1998?

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1 COMMISSIONER STEPHEN GOUDGE: No magic 2 to the number. 3 DR. DIRK HUYER: Oh, no, fifteen (15) -- 4 fifteen (15) years ago. 5 COMMISSIONER STEPHEN GOUDGE: Yes, right. 6 DR. DIRK HUYER: Yeah. And my belief was 7 -- there's a couple reasons why we do it. One, I felt 8 that everybody needed to know what my building blocks are 9 so -- 10 COMMISSIONER STEPHEN GOUDGE: Right. 11 DR. DIRK HUYER: -- that they can 12 understand. 13 COMMISSIONER STEPHEN GOUDGE: Right. 14 DR. DIRK HUYER: And so they can -- 15 COMMISSIONER STEPHEN GOUDGE: Well, I 16 think it is entirely commendable, I must say. But carry 17 on. 18 DR. DIRK HUYER: It's -- it's a lot of 19 typing. 20 COMMISSIONER STEPHEN GOUDGE: Yes. 21 DR. DIRK HUYER: And it's a lot of volume 22 and a lot of paper. Secondarily for me, it was very 23 helpful, me personally, to put my thought process down on 24 paper so I knew what I was thinking at that time. 25 COMMISSIONER STEPHEN GOUDGE: Right.

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1 DR. DIRK HUYER: So when I got asked by 2 Ms. Rothstein, What did I remember from the Gaurov case? 3 I could say, Well, this is my report -- 4 COMMISSIONER STEPHEN GOUDGE: And how did 5 you come to your conclusion? 6 DR. DIRK HUYER: -- this is the way I 7 came to it, by looking at it even if I didn't have 8 detailed -- 9 COMMISSIONER STEPHEN GOUDGE: Okay. 10 DR. DIRK HUYER: -- memory of attending 11 conference. 12 COMMISSIONER STEPHEN GOUDGE: Okay. You 13 have been very helpful in describing that. The second 14 dimension of report writing I want to just talk with you 15 a bit about before Ms. Rothstein takes you into the 16 Shaken Baby Syndrome issue itself is you used the phrases 17 that she reviewed with you, "very suggestive," "most 18 likely," and so on. 19 Forget the diagnosis that follows that 20 level of expression of certainty. It could be Shaken 21 Baby; it could be any other diagnosis. 22 What does that kind of language reflect in 23 your own thought process about level of certainty? How 24 certain are you that when you use language like that -- 25 and let me ask the question in a more open-ended way.

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1 Is there a scale of language that you 2 typically turn to, to try to reflect the level of 3 certainty in a particular case? 4 DR. DIRK HUYER: Yes. Nowadays, probably 5 my testimony would be so -- or my report would be that 6 it's my opinion that this child suffered Shaken Baby 7 Syndrome, for example. So I would get now to, "it's my 8 opinion." 9 And then my opinion is then open for 10 testing. 11 COMMISSIONER STEPHEN GOUDGE: Do you give 12 in your report any indication of the certainty with which 13 you hold that opinion? 14 DR. DIRK HUYER: My opinion -- 15 COMMISSIONER STEPHEN GOUDGE: Because 16 opinions can vary in terms of the firmness that they have 17 in your head depending on the evidence you are using. 18 DR. DIRK HUYER: Absolutely, and it's -- 19 and it's a very good question. My building blocks would 20 lead to that, and then ultimately that would be my final 21 pathway to opinion. 22 If I did not feel that I could articulate 23 that that was what I believe the diagnosis would be, I 24 would say, It's suspicious for Shaken Baby Syndrome. So 25 I wouldn't get -- so that would be a lower level than

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1 opinion. 2 COMMISSIONER STEPHEN GOUDGE: Right. 3 DR. DIRK HUYER: And then below that, 4 There's non-specific findings -- 5 COMMISSIONER STEPHEN GOUDGE: Right. 6 DR. DIRK HUYER: -- I can not identify 7 what -- 8 COMMISSIONER STEPHEN GOUDGE: What is 9 there above that -- 10 DR. DIRK HUYER: -- the cause of this 11 was. 12 COMMISSIONER STEPHEN GOUDGE: -- as you 13 move towards absolute certainty? 14 DR. DIRK HUYER: I'd stay opinion. For 15 me now, opinion would be the -- the word -- 16 COMMISSIONER STEPHEN GOUDGE: Does that 17 mean -- 18 DR. DIRK HUYER: -- or diagnosis of -- 19 COMMISSIONER STEPHEN GOUDGE: -- more 20 likely than not, or -- 21 DR. DIRK HUYER: Absolutely. 22 COMMISSIONER STEPHEN GOUDGE: Does it -- 23 DR. DIRK HUYER: That's what I believe it 24 is. 25 COMMISSIONER STEPHEN GOUDGE: -- does it

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1 mean very, very likely? 2 DR. DIRK HUYER: I've tried to get away 3 from all of those, because I've found that there's -- 4 there's so many -- it's like the "much" word. Very, 5 very, very, very, very, I mean, I think each person has 6 it's own. 7 So I articulate in the fact that that's 8 what I believe it is based upon my information and my -- 9 my position as an expert in the area of child 10 maltreatment. I don't see an alternative explanation. 11 There's nothing else that I think this could be. 12 COMMISSIONER STEPHEN GOUDGE: Let me put 13 to you the comparison that Dr. Pollanen used -- 14 DR. DIRK HUYER: Yep. 15 COMMISSIONER STEPHEN GOUDGE: -- that for 16 me was quite graphic. Two (2) cases, one (1) is freshly 17 died body with a knife wound in the chest, nick in the 18 heart, chest cavity filled with blood. Opinion: cause of 19 death, stab wound. 20 The second case, nothing but a skeleton, 21 nick in the rib. Opinion: cause of death, stab wound. 22 Sounds to the lay listener to be opinions 23 held with the same level of conviction, yet, not so. 24 DR. DIRK HUYER: Right. 25 COMMISSIONER STEPHEN GOUDGE: How does

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1 one differentiate in report writing in your business 2 between paradigms like that? 3 DR. DIRK HUYER: Building blocks. So in 4 the stab wound to the heart, The autopsy was done on a 5 recently deceased victim who had an injury that, et 6 cetera, et cetera. The second -- 7 COMMISSIONER STEPHEN GOUDGE: So the 8 building blocks clarify the level of certainty? 9 DR. DIRK HUYER: Correct. 10 COMMISSIONER STEPHEN GOUDGE: Is that 11 where you're going? 12 DR. DIRK HUYER: Correct. And so -- 13 COMMISSIONER STEPHEN GOUDGE: Okay. 14 DR. DIRK HUYER: -- in the -- the 15 skeleton, Done on a skeleton, nick mark, nick mark seems 16 to -- or nick mark consistent with -- or would be 17 representative of a injury to the bone that was -- 18 COMMISSIONER STEPHEN GOUDGE: Fewer 19 building blocks, therefore less level of certainty? 20 DR. DIRK HUYER: Greater building blocks. 21 Or yeah, fewer concrete building blocks. 22 COMMISSIONER STEPHEN GOUDGE: Yes. 23 DR. DIRK HUYER: So I think that Dr. 24 Shouldice can probably comment, because it's always 25 easier to comment when you hear somebody running around

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1 with a -- 2 COMMISSIONER STEPHEN GOUDGE: Yes. 3 DR. DIRK HUYER: -- with the opinion 4 word. But I've used different terms over my time frame. 5 "Diagnosis" I've used -- 6 COMMISSIONER STEPHEN GOUDGE: Right. 7 DR. DIRK HUYER: -- so that it's my 8 diagnosis. And -- and that has been difficult. But the 9 value of using the diagnosis as a medical practitioner is 10 I would do a lot of things with a diagnosis. 11 If I diagnosed a breast lump, there may be 12 certain pathways that are -- that occur, including 13 surgery. If I diagnosis cancer, then chemotherapy may be 14 started. 15 COMMISSIONER STEPHEN GOUDGE: Right. 16 DR. DIRK HUYER: So that helps to 17 understand some certainty levels -- 18 COMMISSIONER STEPHEN GOUDGE: Yes. 19 DR. DIRK HUYER: -- of... 20 COMMISSIONER STEPHEN GOUDGE: Right. 21 DR. DIRK HUYER: But I think that these 22 cases themselves, Shaken Baby Cases, because of 23 controversies and because they're a little more 24 challenging and a little less black and white, I'm 25 probably going to be a little less strong in it.

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1 So I think that my building blocks are 2 going to tell you that. But in the end, in this 3 particular case, I would probably come to that opinion. 4 COMMISSIONER STEPHEN GOUDGE: Right. 5 DR. DIRK HUYER: Now, in a physical abuse 6 injury -- so an iron burn, It is my belief that -- or, 7 This injury is representative of an iron burn. So 8 there's a stronger one, "representative of an iron burn." 9 So I'm -- I'm slowly getting to your 10 answer, I think. A loop mark, so a belt that's looped 11 over, representative of a forceful impact from a belt. 12 COMMISSIONER STEPHEN GOUDGE: Okay. 13 DR. DIRK HUYER: So I would articulate 14 what I know, when I know. So this one, Shaken Baby 15 Syndrom speaks to the diagnosis of the constellation -- 16 COMMISSIONER STEPHEN GOUDGE: Right. 17 DR. DIRK HUYER: -- of findings. It 18 doesn't speak to how it happened, when it happened -- 19 COMMISSIONER STEPHEN GOUDGE: Right, 20 right. 21 DR. DIRK HUYER: -- necessarily, who 22 caused it, or any of that nature. 23 COMMISSIONER STEPHEN GOUDGE: Right, 24 right. 25 DR. DIRK HUYER: So I think each opinion

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1 will vary on the type of injury as well. 2 COMMISSIONER STEPHEN GOUDGE: Okay. 3 DR. DIRK HUYER: So there's no route 4 process, and I think that's a challenge for -- for the 5 justice system. 6 COMMISSIONER STEPHEN GOUDGE: Well it is 7 a challenge for the communication between -- 8 DR. DIRK HUYER: Absolutely. 9 COMMISSIONER STEPHEN GOUDGE: -- the two 10 (2) professions. 11 DR. DIRK HUYER: Yeah. 12 COMMISSIONER STEPHEN GOUDGE: Dr. 13 Shouldice, do you have any comment on that? 14 DR. MICHELLE SHOULDICE: All I can add to 15 that is that it's -- it's really an area that we've 16 really struggled with and I hear the rest of the medical 17 community who works in this field continuing to struggle 18 with. 19 There's ongoing discussions about how we 20 should word our opinions and what language to be used and 21 how that's interpreted. We've -- we've changed our 22 language over time, several times, when we hear how it's 23 been interpreted in a legal forum and realise, you know, 24 the differences in the way that we utilise language and 25 it's interpreted.

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1 So it is definitely an area of struggle, I 2 would say. 3 COMMISSIONER STEPHEN GOUDGE: Okay. 4 DR. MICHELLE SHOULDICE: I think we -- 5 you know, I would agree that we've tried to make it clear 6 where we're at with respect to an opinion by putting as 7 much description of the basis for that opinion into our 8 reports as possible. I would agree completely with that. 9 COMMISSIONER STEPHEN GOUDGE: Okay, 10 thanks. That is helpful. Sorry, Ms. Rothstein. I did 11 not mean to divert you. 12 13 CONTINUED BY MS. LINDA ROTHSTEIN: 14 MS. LINDA ROTHSTEIN: That's -- no, no. 15 I mean I actually just turned back for a moment, Dr. 16 Shouldice, to ask you today, 2008, how you and your team 17 approach a case of suspected Shaken Baby in light of all 18 of the controversies. 19 What's the process or methodology that you 20 employ to come to a determination, one way or the other? 21 DR. MICHELLE SHOULDICE: Practically, in 22 terms of what type of assessment do we use? 23 MS. LINDA ROTHSTEIN: Yes. 24 DR. MICHELLE SHOULDICE: So this would 25 fall in a type of case where the findings, once we're

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1 consulted, have already raised significant suspicion of 2 the possibility of child abuse -- 3 MS. LINDA ROTHSTEIN: Correct. 4 DR. MICHELLE SHOULDICE: -- and we would 5 not immediately take a direct history from the family, 6 but would review the chart information and speak to 7 physicians who have been involved in collecting 8 information from the family where possible. 9 I would directly examine the child as 10 thoroughly as possible based on the child's medical 11 condition; review all results of any tests and x-rays, et 12 cetera, that have been done. And then providing that 13 those -- that review continues to raise a significant 14 concern of the possibility of child abuse, a referral 15 would be made immediately to CAS. 16 CAS and police typically come in rather 17 quickly in these types of cases, particularly of the type 18 we're talking about, would interview the family. And 19 ongoing consultation between the two (2) of us would 20 ensure that we receive the information that we need about 21 any accidental explanations that have been provided and 22 any relevant medical history. 23 Then, you know, putting all that 24 information together, I -- 25 MS. LINDA ROTHSTEIN: What are the

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1 critical findings? What are the critical positive 2 findings from your perspective? What are the critical 3 negative findings that would support a diagnosis of 4 Shaken Baby Syndrome today? 5 DR. MICHELLE SHOULDICE: Well, the types 6 of medical findings which would raise the concern of 7 possible abuse of head trauma would be intracranial 8 hemorrhage -- so subdural hemorrhages -- retinal 9 hemorrhages, brain injury, and fractures, certain types 10 of fractures: skull fractures, fractures of the ribs, 11 fractures of the ends of the long bones, called 12 metaphyseal fractures. 13 Those would be the types of injuries which 14 would initially raise concern. 15 MS. LINDA ROTHSTEIN: Okay. 16 DR. MICHELLE SHOULDICE: However, in 17 looking at formulating an opinion around these cases, I 18 would look at each of those particular findings and the 19 characteristics of each of those findings and consider 20 possible medical explanations, as well as looking at any 21 accidental explanations that had been provided for each 22 of those findings. 23 So, in other words, just the presence of 24 retinal hemorrhages alone would not necessarily lead me 25 to an opinion of abusive head trauma. But I would need

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1 to look at other eye findings, whether they were present 2 or not, such as swelling of the optic nerve or 3 papilledema. I would need to know the characteristics of 4 those retinal hemorrhages with respect to their number, 5 their extent, the layers of the retina involved. 6 And all of those -- all of that 7 information would then determine how possible or 8 impossible an underlying medical condition or an 9 accidental explanation may be, underlying that finding. 10 So it would be taking each finding, 11 ensuring that the appropriate medical evaluation had been 12 done. I'm looking at specifically the characteristics of 13 each finding and then pulling the whole picture together. 14 I would also be consulting with other 15 people involved -- so neurosurgeons, Intensive Care Unit 16 specialists, opthamologists, radiologists -- and pulling 17 all of those pieces together as well. 18 MS. LINDA ROTHSTEIN: Okay. And to what 19 extent, if at all, would you -- are you familiar with in 20 the job that you do with the evolving nature of this 21 debate? 22 Is that something that, as a SCAN Team 23 physician, you think it's important to keep up to date 24 with? 25 DR. MICHELLE SHOULDICE: Absolutely.

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1 MS. LINDA ROTHSTEIN: Okay. And so where 2 do you position yourself in the debate, or can you? Is 3 that possible? 4 DR. MICHELLE SHOULDICE: I guess where I 5 position myself is that there -- you know, there are 6 clearly areas of controversy within this diagnosis, this 7 area of abusive head trauma. I think that a lot of the 8 questions that these controversies have raised are not 9 answered yet. 10 So I think I sit in the middle somewhere 11 between the two (2) pools of not believing that shaking 12 can ever result in injury and, you know, adamantly 13 believing that all cases of subdural and retinal 14 hemorrhage are caused by shaking injury. And I sit 15 somewhere in the middle there. 16 I -- I think that in any particular case 17 all of the controversies that are currently in the 18 literature and -- need to be considered and need to be -- 19 all of the findings need to be inval -- evaluated in 20 light of those controversies. 21 And I think a lot of the questions still 22 remain unanswered. 23 MS. LINDA ROTHSTEIN: Okay. Dr. Huyer, 24 you're aware that when Dr. Pollanen testified, he walked 25 the Commissioner and us through some of the controversies

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1 in the area and in particular made clear that we were all 2 familiar with the fact that those controversies have 3 precipitated a review of historic cases in Great Britain 4 and raised the question as to whether that should occur 5 in Ontario as well. 6 Do you have a view on that? 7 DR. DIRK HUYER: Well, I -- I just want 8 to expand a little bit more on -- 9 MS. LINDA ROTHSTEIN: Okay. 10 DR. DIRK HUYER: -- on Dr. Shouldice, as 11 far as the controversies go. 12 She talked about the -- the force issues. 13 So I think there's a number of controversies that I'm not 14 sure have fully been articulated. 15 So one is the type of force. So can 16 shaking alone do this, or does there need to be shaking 17 plus an impact? That's Number 1. 18 Number 2 is, how much force is required? 19 And I think there's some debate in that area, with the 20 far extreme being that a short fall -- and characterized 21 -- some people are characterizing it as low as a -- a 22 very minor fall, like a two (2) inch fall -- could lead 23 to these sym -- these findings, which I don't agree with. 24 But how much force is still an area of controversy. 25 Then there's the timing issue, which

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1 clearly speaks to an importance in criminal court and in 2 child protection court as to how quickly the child would 3 show symptoms and -- and leading to an exclusive 4 opportunity situation. 5 There's the rebleeding issue, which we've 6 talked about earlier. There's the -- there's about -- 7 and then there's some debate about the -- the rapidity or 8 the severity of brain swelling in response to a subdural 9 hematoma being present. 10 So I think all of those, and is there any 11 others? 12 DR. MICHELLE SHOULDICE: Specificity -- 13 DR. DIRK HUYER: Yeah. 14 DR. MICHELLE SHOULDICE: -- degree of 15 specificity of each individual component -- 16 DR. DIRK HUYER: Right. 17 DR. MICHELLE SHOULDICE: -- that's been 18 described as part of this. 19 MS. LINDA ROTHSTEIN: Yeah, how -- what 20 you mean by that is how much the particular 21 characteristics of the retinal hemorrhages matter -- 22 DR. MICHELLE SHOULDICE: Yes. 23 DR. DIRK HUYER: Right. 24 MS. LINDA ROTHSTEIN: -- or doesn't 25 matter?

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1 DR. MICHELLE SHOULDICE: Correct. 2 DR. DIRK HUYER: Exactly. That's the 3 other controversy, is -- is the retinal hemorrhages and 4 analysis of those. 5 So I think Dr. Shouldice has, and -- and 6 earlier it was articulated how important analysis of each 7 of the findings within each of those controversial areas 8 is important. 9 So with that background -- and I may have 10 been repetitive, and I apologize, Commissioner, if I was 11 -- but I think -- in looking at our review, I think when 12 considering a review of anything, from my perspective, 13 there needs to be -- the question that arises is: What 14 is the goal of the review? And then -- so that's Number 15 1. 16 Number 2, separate from the goal, is: Is 17 there something that you can do in that review when 18 looking backwards to say that is Shaken Baby Syndrome? 19 So can -- is there a gold standard to utilize, to 20 measure. 21 So for example, in DNA we've got a gold 22 standard when we're looking backwards at cases where 23 there's DNA samples available, because scientifically I 24 think that it's pretty solid evidence, very solid 25 evidence. In -- but in shaken baby cases, we don't have

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1 any new medical finding that's going to allow us to say 2 that's shaken baby. So I think that -- 3 MS. LINDA ROTHSTEIN: Or not? 4 DR. DIRK HUYER: Or not. So I think 5 looking back, we might find cases like Amber where the 6 diagnosis was incorrectly applied to medical findings 7 that, in fact, don't support the diagnosis of shaken 8 baby. 9 MS. LINDA ROTHSTEIN: And just stopping 10 there for a moment. By the way, Dr. Shouldice, do you 11 agree with Dr. Huyer's assessment and review of the Amber 12 case based on your knowledge of it? Or are you in a 13 position to say? 14 DR. MICHELLE SHOULDICE: My knowledge of 15 it is restricted to seeing this judgment for the first 16 time last week. 17 MS. LINDA ROTHSTEIN: Okay. 18 DR. MICHELLE SHOULDICE: But based on 19 what I can gather from the judgment, I would agree that I 20 -- you know, based on the limited facts I have, I -- I 21 would think that this injury could have been caused by a 22 fall down the stairs, which I would not have 23 characterized as a short fall. 24 MS. LINDA ROTHSTEIN: Okay. Sorry, Dr. 25 Huyer, I interrupted you. So there's -- you want to

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1 understand what the goal of the review is; you want to 2 make clear that this is an area in which there doesn't 3 appear to be a gold standard, at least as yet. You were 4 continuing. 5 DR. DIRK HUYER: And then secondarily, 6 what else could this review help with? So that's similar 7 to goal. I mean, some things that I can think of, it 8 could inform future practice. So it could help to add to 9 the field of knowledge that we have, albeit, there have 10 been other research studies done of similar -- similar 11 case volumes. 12 So I'm not sure how much it would add to 13 the field because it's not going to clarify any of the 14 controversies 'cause it's retrospective review, so I 15 doubt it would appear -- 16 COMMISSIONER STEPHEN GOUDGE: One (1) way 17 it has been put to -- 18 DR. DIRK HUYER: -- controversy. 19 COMMISSIONER STEPHEN GOUDGE: -- all of 20 us here, Dr. Huyer, is that a goal might be to ensure 21 that unjust outcomes are undone. 22 DR. DIRK HUYER: Yeah. 23 COMMISSIONER STEPHEN GOUDGE: From the 24 perspective not that there is now a gold standard where 25 there was not before. Not the DNA example. But really

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1 the mirror image of that. What we thought might have 2 been a gold standard has turned out not to be. 3 DR. DIRK HUYER: And I'm not sure that 4 there's substantial difference from fifteen (15) years 5 ago to now as far as -- 6 COMMISSIONER STEPHEN GOUDGE: But, there 7 is more controversy, yes. 8 DR. DIRK HUYER: There's definitely more 9 controversy. No question about that. 10 COMMISSIONER STEPHEN GOUDGE: And fifteen 11 (15) years ago, the sense I have -- you three (3) know 12 far better than I -- is that what we have called from 13 time to time the center of gravity of this debate was 14 much more at the point of if the triad exists that is 15 enough to diagnosis shaken baby. 16 Now, that is no longer seen as the gold 17 standard. 18 DR. DIRK HUYER: I wouldn't necessarily-- 19 COMMISSIONER STEPHEN GOUDGE: You 20 wouldn't characterize it that way. 21 DR. DIRK HUYER: -- say three (3) -- 22 fifteen (15) years ago that the triad being there would 23 automatically lead to that. The triad, as I understand 24 Michael Pollanen as -- as using that terminology, that's 25 not a terminology that I have used over the years.

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1 I've -- again, each individual feature is 2 important. So fifteen (15) years ago, maybe. Fifteen 3 (15) years ago would be 1992. 4 COMMISSIONER STEPHEN GOUDGE: Mid '90s. 5 DR. DIRK HUYER: Yeah, mid -- no, I would 6 say mid '90s, the controversies were definitely -- 7 COMMISSIONER STEPHEN GOUDGE: Were as 8 alive -- 9 MS. LINDA ROTHSTEIN: Were alive. 10 COMMISSIONER STEPHEN GOUDGE: -- then as 11 they are now? 12 DR. DIRK HUYER: I think they're more 13 alive now to some extent. 14 COMMISSIONER STEPHEN GOUDGE: You look 15 dubious about that, Dr. Shouldice. 16 DR. MICHELLE SHOULDICE: No, I think 17 they've really evolved over time, and I think initially 18 there was quite a lot of skepticism about -- about these 19 alternate theories of -- of explanation of how these 20 findings might appear. 21 COMMISSIONER STEPHEN GOUDGE: Of 22 shortfalls? 23 DR. MICHELLE SHOULDICE: Yeah. Yes, 24 shortfalls and the issue of whether impact was required 25 or not, and all of these other issues that we've spoken

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1 of. I think it's really been an evolution over time. 2 MS. LINDA ROTHSTEIN: Dr. Shoul -- 3 COMMISSIONER STEPHEN GOUDGE: But is it - 4 - would you be -- 5 DR. MICHELLE SHOULDICE: They were there. 6 COMMISSIONER STEPHEN GOUDGE: -- is there 7 any truth to the articulation that I offer as having been 8 given to us by at least some that we have moved from a 9 world of shaken baby where there, from some perspective 10 may have been perceived as a gold standard to one where 11 it is a far greyer world? 12 DR. MICHELLE SHOULDICE: I think it's a 13 far greyer world. 14 DR. DIRK HUYER: I would say -- I would 15 say generally, yes. 16 COMMISSIONER STEPHEN GOUDGE: Now, if 17 that is the case, what if there were outcomes based on 18 one (1) perceived gold standard that has turned grey on 19 us, what do we do? 20 DR. DIRK HUYER: And if the outcome is -- 21 as far as convictions and unjust, I have no dispute 22 whatsoever with that being a purpose and a goal for the 23 review. That's why -- what the goal is is something that 24 I need to understand as to how effective and how 25 beneficial a review would be.

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1 If the review is not -- is as -- looking 2 at diagnosis and can we enhance our diagnosis from this, 3 I don't think the review would necessarily help that 4 much. But as far as looking for potential errors and 5 potential unjust findings, absolutely. Then I think that 6 the review could certainly help with that. 7 Who leads that review and who -- more 8 importantly, you get to participate in that review, 9 especially after the articulation of the two (2) extremes 10 of the opinions that might be in any of the 11 controversies. 12 So do you pick the person on the one 13 extreme, or the person on the other extreme, or do you 14 have both? Or do you have someone in the middle? I 15 think that how the review would come out would be very 16 challenging, given the controversies that are there and 17 given, therefore, who do you seek out to provide that. 18 COMMISSIONER STEPHEN GOUDGE: And that 19 reflects some of the practical challenges -- 20 DR. DIRK HUYER: Exactly. 21 COMMISSIONER STEPHEN GOUDGE: -- in all 22 this that I am hoping to get some help from some of these 23 folk along the way. Do you have any comment on this? 24 DR. MICHELLE SHOULDICE: No, I would 25 agree. I think the challenge is the practical piece of

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1 how you do this in -- in a world where there's so much 2 controversy and eminent, you know, practitioners in the 3 field sitting on either sides. 4 MS. LINDA ROTHSTEIN: Dr. -- 5 DR. MICHELLE SHOULDICE: So deciding 6 which cases are -- 7 COMMISSIONER STEPHEN GOUDGE: So what do 8 we do, Dr. Shouldice? 9 DR. MICHELLE SHOULDICE: I don't know. 10 That's -- that's -- I think that's why you're here. 11 COMMISSIONER STEPHEN GOUDGE: Thanks. 12 13 (BRIEF PAUSE) 14 15 CONTINUED BY MS. LINDA ROTHSTEIN: 16 MS. LINDA ROTHSTEIN: Dr. Huyer, can you 17 help us with how many cases a year involving live 18 children the unit was involved in that -- that -- in 19 which there was a diagnosis of Shaken Baby? 20 DR. DIRK HUYER: In the time I was there 21 it -- 22 MS. LINDA ROTHSTEIN: Over your tenure? 23 DR. DIRK HUYER: -- was about one (1) a 24 month. 25 MS. LINDA ROTHSTEIN: Okay.

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1 DR. DIRK HUYER: Approximately one (1) a 2 month. Plus some cases referred in as outside reviews. 3 So somewhere between, to give a range, twelve (12) to 4 eighteen (18) probably would be the range that I would -- 5 that I can recall being the numbers when I was there. 6 MS. LINDA ROTHSTEIN: And do you have any 7 sense at all from colleagues about what that number would 8 represent in terms of the global numbers for the province 9 in -- on an annual basis? 10 DR. DIRK HUYER: I think that -- Dr. 11 Shouldice and I have talked about this, and I would think 12 it would be somewhere around 75 percent of the province 13 numbers. There has been a study done. I can't speak to 14 looking at the Canadian incidents, and I can't remember 15 the author's name out of Ottawa -- 16 DR. MICHELLE SHOULDICE: King. 17 DR. DIRK HUYER: King, that's right, 18 King. And I'm not sure the robustness of the study, 19 because I haven't looked at it for a long period of time. 20 But I know that they were seeking that information a 21 while back and looking at the incidents. 22 MS. LINDA ROTHSTEIN: Okay. And since 23 Dr. Huyer's departure and your assumption as the -- 24 assumption of the role of Director, has -- have those 25 numbers shifted, Dr. Shouldice? Are they --

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1 DR. MICHELLE SHOULDICE: No, I don't 2 think so. 3 MS. LINDA ROTHSTEIN: They're about the 4 same? 5 DR. MICHELLE SHOULDICE: I would say -- 6 MS. LINDA ROTHSTEIN: About one (1) case 7 a month? 8 DR. MICHELLE SHOULDICE: I would have 9 said ten (10) to fifteen (15) a year -- 10 MS. LINDA ROTHSTEIN: Okay. 11 DR. MICHELLE SHOULDICE: -- where concern 12 has arisen. And some of those we may have decided were 13 not concerning. 14 MS. LINDA ROTHSTEIN: All right. 15 DR. MICHELLE SHOULDICE: The only other 16 thing I can add is there's a current Canadian incidence 17 study going on through the Canadian Pediatric Society 18 Surveillance Program on abusive head trauma to get a 19 better sense of the -- the prevalence of -- of these 20 cases across the country. 21 MS. LINDA ROTHSTEIN: I missed the name 22 you gave us? 23 DR. MICHELLE SHOULDICE: It's the -- 24 MS. LINDA ROTHSTEIN: Under -- 25 DR. MICHELLE SHOULDICE: -- Canadian

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1 Pediatric Society, and it's called -- it's under a group 2 of studies called Canadian Pediatric Society Preven -- 3 Prevalence Studies. And the lead investigator is Dr. 4 Susan Bennett. 5 MS. LINDA ROTHSTEIN: Okay. Thank you 6 for that help. Well, Doctors, that completes my 7 questions for you. Commissioner, we're just a little bit 8 over your time. We'll see you all back tomorrow. Some 9 of my colleagues will have questions for you then, thank 10 you very much. 11 DR. DIRK HUYER: You're welcome. 12 13 (WITNESSES RETIRE) 14 15 COMMISSIONER STEPHEN GOUDGE: Thanks, Ms. 16 Rothstein. We will rise until 9:30 tomorrow morning. 17 18 --- Upon adjourning at 4:35 p.m. 19 20 Certified Correct, 21 22 23 ___________________ 24 Rolanda Lokey, Ms. 25