2017-19 results

Register of pathologists

Under the Coroners Act, medico-legal autopsies may be performed only by pathologists who are appropriately credentialed and registered by the OFPS. On the basis of their qualifications, registered pathologists may be approved to perform:

• all medico-legal autopsies including homicide and criminally suspicious cases (Category A)
• routine cases only (Category B)
• non-suspicious pediatric cases only (Category C)

In 2018, a total of 120 registered pathologists were active, including 41 Category A pathologists permitted to conduct all types of autopsies. These 41 pathologists are recognized as having additional experience, training and/or certification in forensic pathology.

Register Composition by Pathologist Category

The Credentialing Subcommittee of the Forensic Pathology Advisory Committee reviews applications and provides advice to the Chief Forensic Pathologist regarding acceptance and renewal to the register.

Pathologists are registered for a five-year term after which their appointments are considered for renewal. The Quality Team assembles data for review by the Credentialing Subcommittee, including:

• case load, cumulative over five years and year-by-year
• turnaround time for post-mortem examination reports
• peer review history
• complaints, incident reports and critical incidents, and remediation by the chief forensic pathologist and by the College of Physicians and Surgeons of Ontario (CPSO), where applicable

The OFPS Register is available publicly through the Ministry of the Solicitor General’s website.

Performance management of registered pathologists related to quality of medico-legal autopsies is the responsibility of the Chief Forensic Pathologist. When there is professional misconduct or incompetence, the Chief Forensic Pathologist is obligated by law to report the issue to the College of Physicians and Surgeons of Ontario.

Supervision and direction of pathologists

To promote consistent and high-quality practices across Ontario and to assist registered pathologists in their work, the OFPS provides a practice manual and toolkit, updated in 2014.

The practice manual includes the Code of Ethics, practice guidelines for medico-legal autopsies, and explanations of the peer review system and Register. Together, these documents provide the professional and policy foundation for the OFPS.

The Code of Ethics was adapted from the Forensic Pathology Section of the Canadian Association of Pathologists.

Pathology Information Management System (PIMS)

The OFPS uses the Pathology Information Management System (PIMS) to collect information about autopsies performed across Ontario. All registered pathologists contribute information to the system through the Post-mortem Examination (PME) Record. This record, an electronic form used to capture high level data about autopsies, is completed and submitted to the OFPS directly after the autopsy. The record is reviewed daily by a senior forensic pathologist to ensure that autopsies are done according to guidelines. The collected information is also used to evaluate resources, as well as provide statistics about performance and quality. PIMS, in conjunction with the PME record, facilitates accountability and the oversight of autopsies by the Chief Forensic Pathologist.

Caseload statistics

Caseload statistics are derived from Post-mortem Examination Records submitted during the reporting period.

Each OFPS case begins with a coroner’s request for an autopsy by warrant to a pathologist. Autopsies on homicides, criminally suspicious and pediatric cases, deaths involving firearms and routine (non-suspicious) autopsies are performed in Forensic Pathology Units by appropriately qualified forensic pathologists. Some non-suspicious (medical type) autopsies of children are performed at pediatric sites. Routine autopsies are conducted in community hospitals. Approximately 84 percent of all autopsies were performed in Forensic Pathology Units (FPUs) and pediatric sites, and 16 percent in community hospitals in 2017-18. Chart 1 shows the distribution of autopsies captured in the system by FPUs and Community Hospitals from 2017-18.

Chart 1: Distribution of autopsies by FPUs and community hospitals, 2017-18

• PFPU: 3224 (41.35%)
• Hamilton RFPU: 1276 (16.37%)
• Community Hospitals: 1241 (15.92%)
• London RFPU: 528 (6.77%
• Ottawa RFPU: 786 (10.08%)
• Sudbury RFPU: 380 (4.87%)
• Kingston RFPU: 244 (3.13%)
• Sault area RFPU: 118 (1.51%)

About 85 percent of all autopsies were performed in Forensic Pathology Units and pediatric sites, and 15 percent in community hospitals in 2018-19. Chart 2 shows the distribution of autopsies captured by the system by FPUs and Community Hospitals from 2018-2019

Chart 2: Distribution of autopsies by FPUs and community hospitals, 2018-19

• PFPU: 3741 (43.56%)
• Hamilton RFPU: 1386 (16.14%)
• Community Hospitals: 1244 (14.48%)
• London RFPU: 569 (6.62%)
• Ottawa RFPU: 764 (8.90%)
• Sudbury RFPU: 403 (4.69%)
• Kingston RFPU: 355 (4.13%)
• Sault area RFPU: 127 (1.48%)

Chart 3 shows the distribution of autopsies captured by the system for each year by Forensic Pathology Units (FPUs) and community hospitals. 

Chart 3: Distribution of autopsies by year - Total/FPUs/community hospitals

• 2010/11: 5360/3534/1826
• 2011/12: 5568/3937/1631
• 2012/13: 5963/4417/1546
• 2013/14: 5728/4529/1199
• 2014/15: 6105/4990/1115
• 2015/16: 6419/5312/1107
• 2016/17: 7279/6206/1073
• 2017/18: 7797/6556/1241
• 2018/19: 8589/7345/1244

Pediatric autopsies (for children five years of age or under) are often complex, requiring additional ancillary testing and/or consultation with other medical specialists. Pediatric autopsies of a criminally suspicious nature are all performed in Forensic Pathology Units.

In 2017-2018, there were a total of 182 pediatric cases completed across the province where children were less than five years of age (Chart 4). In 2018-2019, there were a total of 197 pediatric cases completed for the same reporting age (Chart 5).

Chart 4: Pediatric cases under five years old by locations, 2017-18

• PFPU: 59
• Community Hospitals: 38
• Hamilton RFPU: 35
• Ottawa RFPU: 20
• London RFPU: 20
• Sudbury RFPU: 8
• Sault Area RFPU: 2

Chart 5: Pediatric cases under five years old by locations, 2018-19

• PFPU: 60
• Community Hospitals: 50
• London RFPU: 39
• Hamilton RFPU: 24
• Ottawa RFPU: 18
• Sudbury RFPU: 4
• Sault Area RFPU: 2

Charts 6 & 7 provide a breakdown of autopsies by case type for 2017-19. The category ‘sudden’ includes non-homicidal gunshot wounds, drug overdoses and other cases not specified in the captured categories.

Chart 6: Distribution of autopsies by case type, 2017-18

• Sudden: 65.42%
• Collision: 7.72%
• Hanging: 6.98%
• External: 4.94%
• Decomposed: 4.57%
• Homicide: 2.77%
• Water: 2.66%
• Fall: 2.03%
• Other: 1.73%
• Suspicious: 1.12%
• Fire: 1.00%

Chart 7: Distribution of autopsies by case type, 2018-19

• Sudden: 67.22%
• Hanging: 8.56%
• Collision: 6.93%
• Decomposed: 4.94%
• Homicide: 2.80%
• Water: 2.66%
• Fall: 2.47%
• External: 1.92%
• Other: 1.78%
• Suspicious: 1.20%
• Fire: 0.96%

In some cases, the decision is made to limit an autopsy to an external examination where sufficient information can be obtained from a limited examination. There were 346 such cases performed in Forensic Pathology Units and 39 in community hospitals in 2017/18; and there were 161 such cases performed in Forensic Pathology Units and four in community hospitals in 2018/19.

Forensic pathologists at the Provincial Forensic Pathology Unit (PFPU) rely on imaging technology (i.e. Computed Tomography (CT) Scans) to inform their decisions about targeted examinations. In 2017-2018, 60 percent of cases were targeted examinations (Chart 8) and in 2018-2019, 48 percent were targeted (Chart 9).

Chart 8: Distribution of autopsies by autopsy type in PFPU, 2017-18

• Full: 60.3%
• Targeted: 25.1%
• External: 14.6%

Chart 9: Distribution of autopsies by autopsy type in PFPU, 2018-19

• Full: 48.7%
• Targeted: 36.0%
• External: 15.3%

Quality management

The OFPS has a robust quality assurance program comprised of the following:

• Pathologist Register
• practice guidelines, including standardized reporting templates, forms and standard operating procedures
• consultation in difficult or challenging cases
• collection of standardized case information through the Post-mortem Examination Record
• peer review of all autopsy reports on homicide, criminally suspicious and Special Investigations Unit (SIU)^{footnote 1[1]}cases, and complex pediatric cases (deaths under five years of age) prior to report distribution.
• audit of autopsy reports on routine cases
• peer review of courtroom testimony
• detection and follow-up of significant quality issues and critical incidents
• reporting of key performance indicators to clients and stakeholders
• tracking of complaints to ensure timely resolution and corrective action 
• continuing medical education in forensic pathology to
  • maintain specialist competence as required by the Royal College of Physicians and Surgeons of Canada
  • address performance concerns

Peer review of autopsy reports for homicide, criminally suspicious, pediatric and SIU cases

There were 342 autopsy reports peer reviewed in 2017/18 and 360 in 2018/19. On average, about 11 reviews were completed by each reviewing forensic pathologist per year. The average turnaround time for peer review was 7.1 days in 2017/18 and 7.6 days in 2018/19. The standard OFPS turnaround time for peer review is 10 working days.

Peer review of courtroom testimony by forensic pathologists

Forensic pathologists who testify submit one transcript of courtroom testimony each year for review by another forensic pathologist. Courtroom testimony is assessed for:

• accuracy and evidence-base
• professionalism and objectivity
• clear language
• presentation of limitations, uncertainties and alternate hypotheses

No problems have been identified in courtroom testimony reviewed to date.

Audit of autopsy reports for routine cases

Autopsy reports for routine cases are audited for administrative and technical accuracy by directors of Forensic Pathology Units. Reports from community hospitals are audited by the Chief Forensic Pathologist or designate.

The administrative audit focuses on completeness and adherence to guidelines. All community hospital reports undergo administrative audit and 10 percent of routine autopsy reports from Forensic Pathology Units undergo this type of audit.

The technical audit focuses on the content of the report to ensure that the approach, conclusions and opinions derived from the evidence are reasonable.

A technical audit is done for all reports that fall into the following categories:

• cases with an undetermined cause of death
• non-traumatic and non-toxicologic deaths of individuals younger than 40 years old
• reports from pathologists performing fewer than 20 autopsies per year

Key Performance Indicators

Key Performance Indicators for autopsy reports such as submission compliance, completeness, turnaround time and validity are collected from the administrative and technical reviews and reported.

Tables 1 and 2 show the indicator, target outcome and overall performance for Forensic Pathology Unit and community hospital pathologists from 2017-2019.

Table 1: Key Performance Indicators for autopsy reports, 2017-18

Table 2: Key Performance Indicators for autopsy reports, 2018-19

Turnaround time may be influenced by case complexity and availability of ancillary testing

Pathologists in community hospitals are expected to follow the best practices set out in the practice manual. Pathologists are provided feedback from routine audits with the goal of improving report quality. Note: Community hospitals may use their own institution’s report templates if they include the required template fields.

Charts 10 and 11 illustrate consistency of the content and opinion of autopsy reports as assessed by the reviewing pathologist during the period, as shown by a technical audit.

Chart 10: Consistency Measures as Shown by Technical Audit, 2017-18

• Appropriate Ancillary Testing: Hospitals 99.6%; RFPUs 100%
• COD Reasonable: Hospitals 97.7%; RFPUs 100%
• Free of Language Errors: Hospitals 99.8%; RFPUs 100%
• Independently Reviewable: Hospitals 100%; RFPUs 100%
• Opinions are Reasonable: Hospitals 98.5%; RFPUs 100%
• Satisfactory Descriptions: Hospitals 99.6%; RFPUs 100%

Chart 11: Consistency measures as shown by technical audit, 2018-19

• Appropriate Ancillary Testing: Hospitals 99.6%; RFPUs 100%
• COD Reasonable: Hospitals 93.3%; RFPUs 100%
• Free of Language Errors: Hospitals 99.6%; RFPUs 100%
• Independently Reviewable: Hospitals 99.8%; RFPUs 100%
• Opinions are Reasonable: Hospitals 98.2%; RFPUs 100%
• Satisfactory Descriptions: Hospitals 99.0%; RFPUs 100%

Significant issues

Significant issues include substantial errors, omissions and other deficiencies.

A critical incident is a significant issue that contributes to a serious error in a death investigation. All critical incidents are analyzed to determine root cause and corrective action. There were no critical incidents for the reporting period.

If the reviewing forensic pathologist detects a significant issue during the technical review, feedback is provided to the case pathologist. For the given reporting period, there were significant issues detected in routine case reports from Forensic Pathology Units or community hospitals.

The purpose of quality assurance is to improve the quality of autopsies and reports. When a significant issue is detected, the reviewing pathologist contacts the original pathologist directly to discuss and recommend changes to the report. Continual improvement of autopsy practice and report writing is supported with:

• continuing education events such as the annual education course for coroners and pathologists and special workshops on autopsy practice
• resources such as the 2014 practice manual for pathologists and toolkit, including synoptic reports, annotated autopsy report templates, and Chief Forensic Pathologist’s guidance with case examples

Turnaround time

Timeliness of autopsy reports is a key performance indicator. Turnaround time is influenced by case complexity, return of ancillary test results, pathologist workload and staffing levels. The OFPS policy regarding turnaround time is:

• 90 percent of autopsy reports are to be completed within 90 days of the day of the post-mortem examination
• cases involving homicides, pediatric deaths, deaths in custody and those in which the coroner has requested that the report be prioritized (due to requests from family or other parties) are to be expedited as a matter of routine
• no more than 10 percent of cases should be greater than six months old without a justifiable reason for delay (e.g., delays caused by molecular autopsy for channelopathy)

Chart 12 depicts the turnaround time for community hospital pathologists and forensic pathologists in forensic pathology units for over the last nine years. The longer turnaround time for forensic pathologists may be explained by the more complex nature of the autopsies performed.

Chart 12: Turnaround time, 2010-19

Average turnaround time by location and years:

• 2010-11: Hospitals 85; FPUs 165
• 2011-12: Hospitals 55; FPUs 91
• 2012-13: Hospitals 66; FPUs 121
• 2013-14: Hospitals 75; FPUs 121
• 2014-15: Hospitals 67; FPUs 99
• 2015-16: Hospitals 72; FPUs 101
• 2016-17: Hospitals 75; FPUs 115
• 2017-18: Hospitals 100; FPUs 112
• 2018-19: Hospitals 117; FPUs 100

Clinical forensic medicine

At present, qualified expert opinions and testimony by forensic specialists are usually available only in cases of violent death. However, cases of serious assault with a surviving victim can often benefit from the review and interpretation of injuries by a forensic expert, and the expert’s opinion can be useful to the criminal justice system. Forensic pathologists consult by reviewing medical records and digital photographs.

Forensic anthropology

Forensic anthropologists are experts in the study of skeletal remains in the medico-legal context. Forensic anthropologists make an important contribution to death investigations where the remains are skeletonized, burned, decomposed, mutilated or otherwise unrecognizable. Forensic anthropologists act as part of the death investigation team. They are the experts at determining whether found bones are human or non-human by examining digital photographs or the remains themselves. They help to plan for multiple fatality events and manage identification when they occur. They are also the experts who determine whether found remains are of recent forensic interest or are archaeological or historical in nature. 

One full-time forensic anthropologist works in the OFPS along with several fee-for-service consultants.

Other professional consultants

The OFPS relies on the expert contributions of other professionals, including cardiovascular pathologists, neuropathologists, forensic odontologists, radiologists and a forensic entomologist.

Histology

Histology is the preparation of microscope slides from tissues obtained at autopsies for examination by a pathologist. The number of slides prepared for each case varies with the type of case and the pathologist’s preference.

Histology services are provided by laboratories at community hospitals and Forensic Pathology Units located in hospitals. At the PFPU, two full-time Histotechnologists are employed to process more than 2,900 tissue specimens each month in 2017/18 and over 3,400 in 2018/19.

Toxicology

Toxicological analysis of post-mortem samples are performed by scientists at the Centre of Forensic Sciences (CFS). In many cases, pathologists rely on the results and interpretive notes provided by toxicologists in coming to an opinion about the cause of death.

During the reporting period, toxicological analysis was requested in approximately 9,985 death investigations. The average time to issue a toxicology report by the CFS was 56.7 days. In cases where toxicology was required, 77.3 percent of the autopsy reports were issued within 90 days of receiving the toxicology reports.

Molecular autopsy/cardiovascular pathology

Many natural disease processes are now recognized to have a genetic underpinning. For a number of these conditions, characterization of the genetic mutations involved is becoming the standard of care in hospitals for living patients and is part of the movement towards targeted therapy and personalized medicine. The first significant manifestation of such a disease may be sudden and unexpected death, which may be first recognized and diagnosed following the autopsy. Thus, particularly for young people, the identification of a genetic contribution to sudden death can have huge implications for the surviving family members as well as the health care system.

A large proportion of cases where genetic disease may have contributed to death involve the heart and blood vessels. The OFPS provides high-quality cardiovascular pathology services to investigate sudden cardiac and vascular deaths in Ontario and occasionally by request from across Canada. In cases that may have an underlying genetic predisposition, DNA banking and genetic testing will also be performed (the molecular autopsy). With the results of the post-mortem examination and clinical investigation, DNA analysis can help define the underlying disease that caused death, facilitate screening in surviving family members and sometimes contribute prognostic information for affected relatives.

High-quality pathological diagnoses are essential. Through the OCC, we communicate with families to give them information about a potential genetic condition and their options for care in subspecialty hospital clinics. Next of Kin Clinics have also set up between the PFPU and the OCC to improve communication with family members. Families meet with coroners, forensic pathologists and the Family Liaison Coordinator at the Forensic Services and Coroner’s Complex (FSCC) in person, via video or teleconferencing to review the findings of a death investigation and answer questions.

It is also being increasingly accepted that unrecognized genetic disease may play a role in deaths following interactions with correctional officers or police, or in the course of a criminal act. In these circumstances, a molecular autopsy can help provide answers in these challenging death investigations and contribute to coroner’s inquests and the criminal justice system.

Child injury interpretation committee

In 2017, the OFPS formed a new committee to provide enhanced peer review of criminally suspicious pediatric deaths.  Membership includes forensic pathologists from across Ontario, particularly those with special interest in pediatric deaths, as well as pediatricians from the SickKids SCAN (Suspected Child Abuse and Neglect) team, neuropathologists, cardiovascular pathologists, and forensic pathologists from other provinces. The peer review takes place before the autopsy report is released to provide a broad spectrum of specialist opinions for each case to ensure the quality of these challenging death investigations. 

During the reporting period, 15 cases were peer reviewed by this committee.

Forensic imaging

Forensic Pathologists at the PFPU incorporate advanced post-mortem imaging findings (computed tomography (CT) and magnetic resonance imaging (MRI)) into their case management decisions. Incorporation of these non-invasive techniques into forensic pathology practice has resulted in increased numbers of external and targeted examinations leading to efficiencies and benefits to families.

Senior residents from the University of Toronto’s Diagnostic Radiology Residency Program spend one month at the PFPU where they are integrated into daily service work. During a rotation preparing them for practice, radiology residents learn about lethal injury and disease as well as changes in the body after death. They report post-mortem CT and MRI scans, and are able to see pathologic lesions in the autopsy room in a way that is not possible in the clinical setting.

Tissue recovery for donation

The OFPS and OCC are committed to facilitating and increasing the availability of tissue for transplantation through the Trillium Gift of Life Network (TGLN). The FSCC houses a dedicated Tissue Recovery Suite that is used exclusively for obtaining donor tissues including corneas, heart valves, skin and bones. After consent by the family, tissues are recovered by trained staff from TGLN as well as the OCC and OFPS.

For the reporting period, there have been 166 tissue recoveries. These include bones, skin, eyes and heart valves. 

OFPS-based education

Annual education course for coroners and pathologists

This two-and-a-half-day course is offered jointly by the OCC and OFPS each autumn. This meeting qualifies as continuing education for the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.

The 2017 course was held from November 15-17 and was attended by 27 registered pathologists.

The topics covered included:

• death scene management
• wellness and mindfulness
• Perinatal and Maternal Death Review Committee, maternal deaths and placental pathology
• opioid deaths
• cardiomyopathies
• elder abuse and dementia
• bodies from fire

The 2018 course was held from November 7-9 and was attended by 26 registered pathologists.

The topics covered included:

• opioid deaths
• violent deaths
• elderly death investigations and long-term care

Department of Laboratory Medicine and Pathobiology, University of Toronto

The Department of Laboratory Medicine and Pathobiology (LMP) at the University of Toronto has a goal to advance teaching and research in forensic medicine. Many of the forensic pathologists working in the OFPS are faculty for the University’s continuing educational programs.

Continuing education events

LMP hosts continuing education events that bring national and international experts to University of Toronto to discuss topics in forensics. The courses are attended by academics, those working in forensic disciplines, other medical and legal professionals, and law enforcement practitioners. Since the last annual report, the following courses were offered:

Dr. Frederick Jaffe Memorial Lectureship

A special lecture series was created in memory of Dr. Frederick Jaffe, one of the first forensic pathologists in Canada. Dr. Jaffe authored a textbook, Guide to Pathological Evidence, which was used for many years by attorneys and judges. He was also the first director of a province-wide forensic medical service.

The lecture in October 2018 was given by the Chief Specialist: Forensic Pathology Service (Pretoria), Professor Gert Saayman where he described the unusual and novel medical cases from South Africa.

Training Canadian forensic pathologists

The PFPU, in partnership with the Forensic Pathology Residency Training Program at University of Toronto and with funding support from the Ministry of Health and Long-term Care, has the first training program in Canada leading to certification in forensic pathology by the Royal College of Physicians and Surgeons of Canada. Since 2008, 17 pathologists have completed training, 14 of whom are now working within the OFPS. The PFPU has improved the RCPSC-accredited residency program and has implemented Competency by Design (CBD). The Hamilton Forensic Pathology Unit also trains forensic pathology residents in partnership with McMaster University.

In 2018, one new resident began training in forensic pathology in the University of Toronto program:

Tyler Hickey MD, PhD received his BSc.H degree from the University of Guelph, his PhD from the University of British Columbia (UBC) and then completed his MD and Anatomical Pathology Residency at UBC also. In 2019, Dr. Hickey successfully completed the RCPSC-accredited Forensic Pathology training program administered through the PFPU and the University of Toronto.

One resident began training in forensic pathology in the McMaster University program:

Jennifer M. Dmetrichuk MBChB PhD received her Bachelor of Medicine and Bachelor of Surgery from the University of Aberdeen, Scotland, and her PhD in Biological Sciences (Neurobiology and Physiology) at Brock University. She has been a General Pathology resident at McMaster University’s Department of Pathology and Molecular Medicine.

Clinical fellows in forensic medicine

We are committed to developing global forensic medicine and have outreach activities and training collaborations with Jamaica, the Middle East, Sri Lanka, Chile and soon, Zambia. Since 2007, 11 international fellows have trained in forensic pathology at the PFPU. Since 2016, clinical fellows are eligible to write the Royal College of Physician and Surgeons of Canada examination in Forensic Pathology, through the Subspecialty Examination Affiliate Program.

In 2018, one clinical fellow from Sri Lanka trained at the PFPU:

Arasaratnam Elangovan MD, DLM received his Doctor of Medicine at Tver State Medical Academy in Russia. He also completed a Diploma in Legal Medicine and Doctorate of Forensic Medicine at the Postgraduate University of Colombo. Arasaratnam will be a Clinical Fellow at PFPU.

Some trainees benefit from the G. Raymond Chang Forensic Pathology Fellowship through the University of Toronto’s Department of Laboratory Medicine and Pathobiology. This is the first fund in the world that enables young physicians from the developing world to train and ultimately strengthen forensic capacity in their own countries. This fellowship provides financial support to trainees whose countries may not be able to fund a year of training in Canada, particularly those from the West Indies.

In keeping with the Chang Foundation’s philanthropic vision, the partnership was enhanced in 2017 through the addition of a Catalyst Fund to broaden the strategy to focus on critical infrastructure development in Jamaica, training of West Indian non-physician learners, and extension to other global areas in need.

In 2018, two international Chang Foundation fellows trained at the PFPU:

Ransford Fearon MBBS, MSc; MD Pathology received his Bachelor of Medicine Bachelor of Surgery degree at the University of the West Indies (UWI), Mona. He then received a MSc Forensic Science from UWI and was awarded a Doctor of Medicine in Pathology at UWI, Mona.

Mucheleng’anga (Adam) Luchenga BSc HB, MBChB, MMed Anatomical Pathology received his Bachelor of Science in Human Biology and then a Bachelor of Medicine and Bachelor of Surgery, as well as a Master of Medicine Anatomical Pathology from the University of Zambia. He has also worked as a Consultant Histopathologist at the University Teaching Hospital and as Forensic Pathologist in Zambia.

The Raymond Chang Foundation

The Raymond Chang Foundation is named for the late Toronto-based businessman and philanthropist who had a passion for adult education and was dedicated to improving opportunities where it was most needed. Born in Jamaica, Mr. Chang was a proud and active member of the Caribbean-Canadian community. He was appointed to the Order of Jamaica in 2011 and as an officer of the Order of Canada in 2014.

Raymond Chang understood the relevance of forensic pathology as a truth-seeking tool for justice. The fellowship is a legacy that lives on through ‎the dedication of his children, Andrew Chang and Brigette Chang-Addorisio. Their generosity and shared vision have ensured a sustainable fellowship training program at the University of Toronto. 

Recruitment of forensic pathologists

The capacity of the OFPS has been enhanced through the recent addition of talented new recruits:

Christopher (Toper) G. Ball MBBS MScEng FRCPC received his Bachelor of Medicine and Bachelor of Surgery from the University of Wollongong in Australia in 2011.  He completed training in Anatomical Pathology at the University of Ottawa in 2017 and training in Forensic Pathology at the Provincial Forensic Pathology Unit (PFPU) in 2018.  He then joined the PFPU as a Forensic Pathologist in July 2018.   Before entering medicine, he enjoyed his career, in both industry and academia, in Mechanical Engineering.

Liza Boucher MD is a Forensic Pathologist at the Provincial Forensic Pathology Unit since November 2018, after working at the Laboratoire de sciences judiciaires et de médecine légale in Montreal (LSJML) for just over five years. Liza received her Doctor of Medicine from the University of Montreal in 2004, followed by three years of training in General Surgery and an Anatomical Pathology residency at Laval University. She completed her residency training in Forensic Pathology at the University of Toronto/Provincial Forensic Pathology Unit program in June 2012. Liza is also a Fellow of the Royal College of Physicians and Surgeons of Canada in Anatomical and Forensic Pathology.

Forensic Pathology Units

Sault Ste. Marie Forensic Pathology Unit

The Sault Ste. Marie Forensic Pathology Unit is led by Medical Director, Dr. Michael D’Agostino. Approximately 120 autopsies were performed per year.

The unit teaches students from medical schools around the province, pathologist assistant students from Western University on an elective rotation, as well as police and Centre of Forensic Sciences staff.

The unit provides regional forensic service with two pathologists, two pathologists’ assistants and administrative staff to support their work.

Eastern Ontario Regional Forensic Pathology Unit (Ottawa)

When the Ontario Forensic Pathology Service was established in 2009 the Eastern Ontario Regional Forensic Pathology Unit had two full-time forensic pathologists (Drs. Milroy and Parai). It is now staffed by four full time forensic pathologists, Dr. Milroy the Medical Director and Drs. Kepron, Parai and Walker. In addition, Dr. Hamilton works in both the Unit and in pediatric and adult neuropathology and is qualified in neuropathology as well as Forensic Pathology. The workload has increased from under 600 cases annually to more than 770 medic legal autopsies per year. As well as covering Eastern Ontario, the Unit also provides a service for Nunavut.

As well as providing autopsy services, all the hold academic positions at the University of Ottawa and teach on the Anatomical Pathology Residency Training Program. In addition, teaching is provided for the Canadian Police College. Dr. Parai chairs the Canadian Association of Pathologists forensic pathology section and, along with Dr. Milroy, has organized the forensic pathology seminars at the annual meeting. Dr. Walker provides teaching at the University of West Indies and all members of the unit have been active at the American Academy of Forensic Sciences and the National Association of Medical Examiners.

Drs. Parai, Milroy and Kepron serve on the specialty committee of the Royal College of Physicians of Canada with Dr. Parai serving as Chair and Dr. Kepron as Chair Elect. Dr. Milroy serves as Chair of the Royal College panel of examiners in forensic pathology with Drs. Parai, and Kepron also being examiners. Dr. Hamilton also acts as an examiner in neuropathology.

All members of the unit have been active in publishing multiple academic papers and chapters as well as acting as referees for multiple journals over the last decade. Dr. Milroy currently edits the journal Academic Forensic Pathology.

Hamilton Forensic Pathology Unit

At the time of reporting, the Hamilton Forensic Pathology Unit at the Hamilton Health Sciences Centre is affiliated with McMaster University and performs on average over 1,300 autopsies during the reporting period. Forensic pathologists hold academic appointments and teach forensic pathology residents (PGY6), anatomical and general pathology, medical students and undergraduates.

Kingston Forensic Pathology Unit

The Kingston Regional Forensic Pathology Unit is based at Kingston General Hospital in the Department of Pathology and Molecular Medicine and is affiliated with Queen's University. Dr. Tanguay is a forensic pathologist and has been the Medical Director since May 2018. There are 16 Category B pathologists also performing autopsies. The unit performed about 300 medico-legal autopsies on average for last two years and participates in the education of anatomical pathology residents and medical students. In 2019, Dr. Tanguay became a member of the Royal College of Physicians and Surgeons of Canada Examiners Committee in Forensic Pathology.

London Forensic Pathology Unit

As the Provincial Forensic Pathology Unit is reaching its 10th year anniversary, the Regional Forensic Pathology Unit in London is reflecting on its 20th year milestone after consolidating autopsy services at the University Campus of London Health Sciences Centre back in 2000.

Over the years, the unit has been very successful in establishing and expanding its provision of high-quality forensic death investigation service to the Southwest Region of the province. Recent caseload demands continue to grow, as is the case throughout the province, partly attributable to the steady and persistent increase in opioid-related deaths. The unit performs over 550 medico-legal autopsies per year in 2017-18 and 2018-19.

The addition of Dr. Rebekah Jacques in 2019, joining the other three forensic pathologists Dr. Michael Shkrum, Dr. Elena Tugaleva, and Dr. Edward Tweedie, has helped to meet this challenge. In addition to postmortem examinations, all have other varied professional interests and activities.  Dr. Tweedie has succeeded Dr. Shkrum as Unit Director and is also involved with the Royal College Forensic Examination Board and cardiovascular pathology subspecialty work. Dr. Shkrum is a graduate student advisor and researches in the field of motor vehicle safety. Dr. Jacques’ extensive teaching interests include running an undergraduate forensic sciences course, and she also continues with death investigation bioethics research after completing a master’s degree. Dr. Tugaleva is director of our unique Pathologists’ Assistant Master’s Degree training program which has been very successful in training many PAs who now work in forensic pathology units throughout the country.

Northeastern Regional Forensic Pathology Unit (Sudbury)

The Northeastern Regional Forensic Pathology Unit (NERFPU) of Health Sciences North in Sudbury is affiliated with Laurentian University and the Northern Ontario School of Medicine (NOSM) and performs about 400 medico-legal autopsies each year for Sudbury and the greater North Bay region.

In 2018, Dr. Kona Williams joined the regional unit as a Forensic Pathologist and Laboratory Medical Director. As such, there are two full-time forensic pathologists and three pathologist’s assistants who manage the cases.

In addition, the Unit teaches NOSM medical students and each student is required to observe an autopsy as part of their graduation requirement.

International assistance and capacity development

Ontario has a proud history of providing leadership and support to international Disaster Victim Identification missions. These humanitarian missions are assembled following natural or human-caused disasters where help is needed to identify victims. The OFPS has participated internationally with Interpol, the International Committee of the Red Cross, the Federal Bureau of Investigation and other experts from the forensic community.

Some nations do not have a robust system of forensic medicine to support human rights and justice. Dr. Pollanen has worked to build forensic medicine capacity and support human rights investigations in areas such as the Middle East, South Asia, Africa and the Caribbean. Some of this work has involved United Nations agencies and the International Criminal Court, as well as the International Committee of the Red Cross.

In 2017-2019, the PFPU hosted numerous domestic and international guests and observers:

• Susan Karki
• Maryanne Zhu
• Dr. Babarinde Akintude Ojo, Nigeria
• Dinesh Fernando, Sri Lanka
• Raymond Khan, Saskatchewan
• Dr. Nnamdi S. Ozor, Nigeria
• Dr. Yosuke Usumoto, Japan
• Dr. Arther Naseemuddin, New Brunswick
• Dr. Eva Montanari, Italy
• Dr. Sophia M. Green, Jamaica
• Dennecia George, Trinidad and Tobago
• Pooneh Salkhordeh, Toronto

The PFPU has a Memorandum of Understanding with the Institute for Forensic Science and Legal Medicine (IFSLM), Ministry of National Security, Jamaica to support professional development in forensics. Professional and technical staff of the PFPU have visited Jamaica to instruct forensic pathologists, pathologist assistants, administrators and others from IFSLM to promote best practices in forensic medicine. In 2018, with support from the Chang Foundation, two groups of pathologist assistants and a forensic pathologist travelled to Jamaica to teach morgue assistants the steps in a medico-legal autopsy. The groups were provided with lectures and hands-on learning experiences.

From 2017-2019, Dr. Pollanen travelled to Uganda to examine living patients suffering from Nodding Syndrome, a little-understood, endemic neurologic disorder of young people in East Africa. This visit inspired a research initiative into the pathological basis of this disease, funded by the Chang Foundation. This is an exciting development that demonstrates the application of forensic science to global health problems and some of the work has been published in the peer review literature.

In January 2019, Dr. Pollanen travelled to Ouagadougou, Burkina Faso to assist the Royal Canadian Mounted Police (RCMP) with a case of a Canadian after kidnapping. 

Professional activities and outreach

Registered pathologists and forensic consultants enrich the practice of forensic science and medicine by participating in provincial, national and international professional organizations such as the Ontario Association of Pathologists, Canadian Association of Pathologists, National Association of Medical Examiners, Canadian Society of Forensic Sciences, American Academy of Forensic Sciences, the IAFS and other organizations. In 2017, the OFPS hosted the 21^st triennial IAFS Conference.

OFPS forensic pathologists participate in activities of the Royal College of Physicians and Surgeons of Canada that focus on the promotion and accreditation of forensic pathology and anatomical pathology in Canada.

OFPS pathologists lectured and delivered courses to audiences that included forensic pathologists and scientists, medical practitioners, the judiciary, lawyers, police, advocacy groups and others.

OFPS pathologists serve as members of editorial boards of international peer-reviewed forensic journals, and act as reviewers for other specialist journals.

Scholarly activities

Teaching

Most forensic pathologists and forensic consultants hold academic appointments at their respective universities. They teach undergraduate and graduate forensic science students, medical students, pathologist assistant and physician assistant students, dentists, nurses, medical artists, law students, medical imaging residents, and pathology and forensic pathology residents. Forensic Pathology Units also host many medical students and pathology residents from Canadian universities and elsewhere.

The PFPU participates in the University of Toronto’s Department of Laboratory Medicine and Pathobiology’s digital library by providing digital histological images of forensic interest for the educational purposes of pathology residents. 

Forensic pathologists also act as visiting faculty to foreign universities.

The PFPU partners with the “LAWS” initiative of the Toronto District School Board, the University of Toronto Faculty of Law and Osgoode Hall Law School to offer an educational program for Grade 11 students to understand forensic pathology, its intersection with the law, and the different career options available in the field. Case-based sessions, for more than 100 students each, are offered at the Forensic Services and Coroner’s Complex. The students are exposed to a wide range of forensic specialties involved in a case.

Research

Forensic pathologists contribute to and support research aimed at understanding causes of sudden death, Nodding syndrome and improving public safety.

Committees

Forensic Pathology Advisory Committee

The Forensic Pathology Advisory Committee provides advice to the Chief Forensic Pathologist regarding professional medico-legal autopsy practices. This committee includes the directors of the Forensic Pathology Units and the President (or delegate) of the Ontario Association of Pathologists.

Forensic Services Advisory Committee

The committee was created to strengthen the objectivity of the OFPS and improve communication with key external stakeholders such as police, Crowns and defense attorneys are represented on the committee, which meets as required to provide advice to the Chief Forensic Pathologist on topics that advance the quality and independence of medico-legal autopsies.