COVID‑19 pandemic

Since the global COVID‑19 pandemic was declared by the World Health Organization in March 2020, the leadership role of the OFPS has been evolving and expanding.

During the initial phase of COVID‑19, the OFPS focused on maintaining ‘essential’ medicolegal autopsies for public death investigations. The primary consideration was to protect frontline staff through social distancing measures, the procurement and conservation of personal protective equipment (PPE) and the promotion of self-care and mental health wellness. The OFPS also managed temporary autopsy service disruptions at some community hospitals due to COVID‑19 health care pressures, with medicolegal autopsies being diverted to the PFPU.

Early on, the OFPS adopted special guidelines for autopsies to prioritize the safety of staff. If an autopsy on a COVID‑19-positive case was required to answer medicolegal questions, the procedures were modified to limit aerosolization. The application of forensic imaging technology at the PFPU was key to target procedures and examinations.

OFPS forensic pathologists were sharing timely knowledge about the pathological spectrum of COVID‑19, its effects on the human body and information about safe autopsy practices with colleagues across Canada and around the world.

PFPU forensic pathologists were also contributing to novel research and the peer review literature, including radiological and pathological findings of COVID‑19, epidemiology of deaths in Ontario during COVID‑19 and pathological features of COVID‑19 using immunohistochemistry.

During the reporting period, the PFPU collected swabs for COVID‑19 testing on 819 suspected cases. Of those, 109 were positive. Subsequently, 101 cases had limited examinations to reduce exposure.

Ontario Forensic Pathology Service contributions to pre-clinical studies for the first fully made-in-Canada COVID vaccine

In December 2020, Health Canada approved clinical trials for a COVID‑19 vaccine developed by a Canadian biotech company in Toronto. The OFPS collaborated with the University of Toronto to support pre-clinical work for the mRNA-based vaccine, based on knowledge gained from COVID‑19 autopsies and the effects of SARS-CoV-2 on the human lung. Throughout the pandemic, the OFPS was in a position to provide expertise to safeguard public health beyond its traditional role of providing medical expertise to the criminal justice system. At the time of publishing, Phase 2 clinical trials for the vaccine are ongoing.

The Ontario Forensic Pathology Service response to the recommendations from external reviews, reports and complaints

Since 2018, several external reviews, reports and complaints have resulted in 35 consolidated recommendations, including the 13 pathology-related recommendations from the 2019 Auditor General of Ontario (AGO) report about their review of the OFPS and the OCC. The recommendations are the basis of the 2020 OFPS Workplan.

Many of the recommendations have now been implemented, with a range of governance, policy, quality practice and information management improvements. The remaining recommendations have been substantially implemented or in progress. The progress on the recommendations that we have addressed is subject to third-party validation, including by the AGO.

In February 2021, the OCC/OFPS partnered with the Ontario Hospital Association to provide best practice guidelines for body management for hospitals

The OCC/OFPS approach to body management is anchored in the principle that all deceased people must be treated with dignity and respect. On this basis, the best practice guidelines address: systematic storage, inventory, risk management, continuity/security of criminally suspicious and homicide cases and contingency planning. These guidelines were shared at a time when many hospitals were experiencing pressures related to an increased number of deaths due to COVID‑19, as well as a surge in opioid-related deaths.

Other improvements implemented in the reporting timeframe include new autopsy guidelines for cases of elder abuse and neglect, web-based compliance management software for improved information sharing with registered pathologists, enhanced peer review for challenging cases and increased staffing at the PFPU to support body management and autopsies.

New forensic pathology residency training program in Ottawa

In February 2021, the Royal College of Physicians and Surgeons of Canada accredited a new forensic pathology residency training program at the University of Ottawa and the Eastern Ontario Forensic Pathology Unit. This augments the capacity of the two active training programs in Canada, in Toronto and Edmonton, and helps ensure the sustainability of the profession in Ontario and Canada.