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Doctors at Toronto's Hospital for Sick Children sounded internal alarms more than a decade ago that pathologist Charles Smith was misdiagnosing diseases and precipitating needless operations, the Goudge commission was told yesterday.

In a day of testimony that provided candid insights into stresses, rivalries and clashing philosophies within the hospital, two former colleagues testified that some of Dr. Smith's mistakes had grave consequences for young patients.

One little girl's cancer spread to other organs because Dr. Smith had misdiagnosed a kidney tumour as benign. A portion of another girl's intestine was removed in error after Dr. Smith misjudged biopsy results.

The horror stories were supplied by Ernest Cutz, an internationally recognized expert in sudden infant death syndrome, and by Glenn Taylor, director of the hospital's pathology division.

Dr. Taylor testified that in another case, Dr. Smith found that a growth on a child's face was benign. When it turned out to be malignant, a second surgery had to be scheduled to insert a "port" through which chemotherapy drugs could be administered.

Mr. Justice Stephen Goudge is probing how Dr. Smith rose to become a renowned pediatric pathologist despite making errors that caused a string of wrongful charges and convictions.

Dr. Cutz said yesterday that Dr. Smith sometimes saw potential foul play in deaths where the real cause was obviously innocent.

In one such case, he said a child had strangled on the cord of a Venetian blind left too close to its crib. Dr. Smith called the death suspicious and suggested the parents be looked at closely. "I found it quite ridiculous, knowing this was a recognized hazard, which had been documented in the literature, and even on television documentaries," Dr. Cutz said.

In another case, Dr. Cutz said, a child died after taking a small dose of cough medicine containing an ingredient that some children cannot metabolize properly. He said Dr. Smith theorized that a sibling might have given the child an overdose.

Dr. Cutz revealed that he had misgivings about Dr. Smith as far back as 1991, when Dr. Smith pushed hard to have a pediatric forensic unit created at the hospital as an adjunct to the chief coroner's office. "I didn't think he had the appropriate training to do these kinds of cases," Dr. Cutz testified.

Dr. Smith was soon doing the lion's share of the work because none of the other pathologists felt they were qualified, Dr. Cutz said.

He told commission counsel Jennifer McAleer that colleagues also resented this change of focus at the hospital, whose mission is to research and cure natural diseases.

Ms. McAleer filed a letter written in 1999 by Laurence Becker, director of the pathology division, to chief coroner James Young. Dr. Becker - who has since died - wrote that he intended to sever the hospital's relationship with the chief coroner's office.

"The Hospital for Sick Children has determined there is significant risk to the reputation of the Hospital and its pathology staff," Dr. Becker wrote in the letter, which was apparently never delivered.

Dr. Becker also expressed discontent with a police mindset that was resulting in the hounding of innocent parents whose children had obviously died of natural causes.