Society for Pediatric Pathology - SPP Summer 2002 Newsletter

It appears that there is little going on this summer relative to Society activities. Or little going on that anyone is willing to share with the editor of this newsletter. I was able to extract a small amount of content from some of our able committee chairs and this information appears below.

Plans are set for the fall meeting in Dallas and the registrations are already coming in. If you are planning on attending the Dallas meeting and staying at the Fairmont Hotel, you should make your reservations as soon as possible; rooms are filling up fast. We are working hard to surpass the entertainment level achieved at the Dallas fall meeting in 1986. And there will be a bit of science, for those of you who are into such things.

In my Spring message, I commented about the “important overlap of pediatric and forensic pathology.” We live in a modern medicolegal environment challenged by ancient antipathies of honor and shame as well as charity and greed. Even though there has been an ever-increasing recognition of the physical findings of child abuse and neglect, unscrupulous physicians and lawyers counter it using newly recognized or manufactured genetic and medical disorders to defend perpetrators. However, not all of pediatric forensic pathology is litigious. Accurate diagnoses contribute significantly to the healthy grieving of a deceased child and planning of future pregnancies. Therefore, the Society should accept the challenge to further integrate these disciplines as another outreach opportunity. Pediatric and forensic pathologists can and should work together to elevate the levels of expertise in pediatric forensic pathology in medical examiners offices and hospitals, to enhance diagnostic accuracy, and to improve the quality and integrity of medicolegal testimony. In the United States, there are apparently only four individuals who are board certified in both pediatric and forensic pathology.

A recent editorial despairing of chronic problems in forensic pathology in the UK appropriately opined that the quality of forensic pathology services must be guaranteed (BMJ 2002; 324:1408-9). Obviously, hospital-based autopsies must be held to a high standard as well. Although there are auditing mechanisms for hospital-based anatomic pathology autopsies, such as from the College of American Pathologists, they do not focus on cases with specific medicolegal importance. Tissue findings with forensic importance in hospital practice may not be recognized depending upon the particular interest and expertise of the examining pathologist. For example, the unexpected finding of a thin subdural hematoma and brain swelling in a child undergoing hospital autopsy with proper parental consent may signify clinically unrecognized nonaccidental trauma, and should prompt notification of the medical examiner. Or failure of the forensic pathologist to recognize the potential significance of lipid deposition in the liver and muscle tissues during performance of a medicolegal postmortem examination may preclude identification of a genetic disorder important for future pregnancy planning. These scenarios can be minimized when pediatric and forensic pathologists share their expertise. It is important that surgical pathology specimens can also generate findings of medicolegal or genetic significance.

With these thoughts in mind, I asked our members to complete a brief survey, the results of which I am now pleased to report. There were 131 responses from 6 continents, 10 countries, 34 US states and 79 cities. Seventy three percent were from the United States; with most from Texas, California and Ohio. Canada and the United Kingdom were represented more than other countries. Among respondents, 99% resided in a community with a medical examiner or coroner. Forty eight percent of our pediatric pathology groups had at least 1 member actively engaged in forensic pathology.

The responses document the widespread contributions of our Society members to forensic pathology. Although some “preferred not to”, 99% of the respondents believed it was important to consult with forensic pathologists, and 74% did so with 53% consulting less than 5 times per year and 20% greater than 10 times per year. Congenital heart disease, other congenital anomalies, and sudden infant death led to consultations in 51% to 63% of responses; neoplasms and nonaccidental injuries were less common.

Forty nine percent served as expert witnesses with 23% and 37% of the respondents testifying in criminal and civil trials, respectively. Twenty four percent refused to testify as an expert witness - the flip side: 76% would make themselves available given the circumstances. A few respondents commented on their frustration with the ethics of attorneys who asked for their consultations. But it is important to remember that successful unscrupulous behavior on the part of an attorney requires the complicity of an equally unscrupulous physician!

Forty five percent participated in Child Death Review Teams. Having served on such a committee in San Diego for several years, the need for a pediatric pathologist is not only necessary, but also welcomed as is the expertise of individuals in other areas pertaining to child death, the causes and manner of which bring them under the jurisdiction of the medical examiner or coroner. Only a minority of deaths discussed in these committees is a result of homicide.

Given our members’ extensive interest and involvement in pediatric forensic pathology, I discussed with the SPP Executive Committee and with Dr. Joni McLean, the President of NAME, the advantages of creating a closer relationship of our Society with the National Association of Medical Examiners (NAME) and the advantages of formalizing the relationship between the SPP and NAME. We agreed that designation of liaisons could be an important first step to communicate the interests and goals common to both organizations. Therefore, we are fortunate indeed that Drs. Jeff Hubbard and Wendy Gunther, both of whom are members of the SPP and NAME, have accepted appointment as co-liaisons reporting on matters of interest and importance in pediatric forensic pathology to the governing bodies of both societies at their annual business meeting.

Jeff and Wendy will also explore ways to bring to fruition a pediatric forensic pathology focus group into the Society as favored by 58% of the survey respondents. The desirability of developing this group is perhaps best reflected in the following response from one survey respondent: “I am very much in favor of a forensic focus group in SPP to provide guidance and advice in a subject I feel very ill-equipped for but I have to deal with willy-nilly.”

In collaboration with the SPP Education and Practice Committees, the liaisons will work with members of the SPP and NAME to develop workshops for both societies, to encourage members to submit abstracts to SPP and NAME meetings, and to submit manuscripts with forensic themes to Pediatric and Developmental Pathology. Hopefully the latter will increase subscriptions to our journal from medical examiners’ and coroners’ offices.

I want to close by emphasizing that the other good work and activities of the Society and its officers and committees are not being neglected despite my focus on pediatric forensic pathology issues. My efforts are a continuing response to Ron Jaffe’s challenge to Society presidents to “pick a theme and to try and implement an enduring program.” No doubt, Derek deSa, your President-Elect, will do the same.

Any pediatric pathology fellowship program director wishing to update information about their training program now posted on the SPP web site should contact Alba Greco.

The Practice Committee gratefully acknowledges the contributions made by Drs. Gareth Jevon and Debra Heller, who completed their terms on the Committee, and Dr. Leon Metlay, who completed his term on the Slide Survey Subcommittee at the Spring Meeting.

Current activities of the Practice Committee include finalizing the Position Paper on Pediatric and Perinatal Autopsies, gathering data on pediatric pathology practice patterns with the Staffing and Activities project, and putting together the SPP Slide Survey for next year.

A draft of the position paper is posted in the "Members Only" section of the SPP website, together with links to supporting documents on the websites of the College of American Pathologists and the Royal College of Pathologists. SPP members are encouraged to review the position paper and send comments to Dr. Pysher at pctpyshe@ihc.com. Members with consent forms or informational brochures that might be of use to others, or who know of other useful links on this subject, are encouraged to contact Dr. Leon Metlay at leon_metlay@urmc.rochester.edu who has been coordinating the links attached to the position paper.

Members who want to participate in the Staffing and Activities survey should contact Dr. Gareth Jevon at gjevon@cw.bc.ca.

The Slide Survey Subcommittee, chaired by Dr. Gloria Kohut, is soliciting input for improving the survey, and, as always, welcomes submission of instructive cases. Please contact Dr. Kohut at gloria.kohut@spectrum-health.org.

The Long Range Planning Committee report is brief. The committee will meet in September at the Dallas meeting. As the new committee chair, I welcome suggestions and feedback from the membership about strategic planning issues. Correspondence can be emailed to me at pcccoffi@ihc.com. Although the committee itself is small, broad input from the membership is vitally important.

The Resident Clinical Presentation Award is a new program that was initiated by our Society this year to promote the interest of pathology residents in our subspecialty. Applications, which consisted of one-page case reports that highlighted differences between pediatric and adult pathology, were solicited from residency programs throughout North America. A total of 22 applications were received and these were reviewed by an ad hoc committee of pediatric pathologists from four institutions, none of whom were given the identities of the applicants. Based on the committee's review, the following three individual's received awards:

The awards will fund travel expenses for each of the recipients to attend the fall meeting of the SPP in Dallas. At that meeting, they will present their cases to the Society and participate fully in the camaraderie that characterizes our field. I know that you join me in congratulating these future pediatric pathologists and I hope that you will introduce yourselves to them at our interim meeting.

Two new members of the Bylaws Committee include Stephanie Young and Faisal Qureshi. Maureen Sander (interim chair) presented reports at the SPP Council and Business meetings in Chicago in February. The committee has pursued no new matters in the interim.

In keeping with the Articles and By-laws of the Society, the Nomination Committee invites nominations, from the membership of the Society, for the position of President-Elect, and 2 (two) Councilors. It is expected that the nominee will have indicated his/her consent to be nominated and willingness to serve. Nominations may be made in writing to the committee chair (desa@cw.bc.ca) or to any member of the Nomination Committee (Susan Simonton, Cheryl Coffin, Ricardo Drut, Ron Jaffe, Claire Langston ).

The committee is also soliciting names of individuals who are interested in serving on SPP committees, as positions become available. Names should be provided to me no later than September 1, 2002 since the committee's recommendations must be submitted to Council at the fall 2002 meeting of the SPP.

Please remember that the success of our Society depends upon the diligence, commitment and hard work of the individuals who fill these positions, whether as officers or committee members.

I am sure I speak on behalf of the entire Society in expressing our profound sadness and sense of loss on the passing of one of our most distinguished members, Dr. Larry Becker, from the Hospital for Sick Children in Toronto.

Larry was a rare combination of the consummate gentleman, treasured friend, insightful scholar, outstanding neuropathologist, inspiring teacher, and effective administrator. He was the ideal physician, a role model for all of us in so many ways. I am sure many of us have fond memories of our experiences and friendship with Larry. In addition to many other experiences, I particularly remember a week with Larry in Australia where he dazzled us with his illuminating lectures, witty humor, great dancing - the best North America had to offer to those "down under" at a conference on SIDS that was markedly enhanced by Larry's contributions. Our thoughts and prayers go to his family, friends and colleagues during these very sad times.

It is my hope that many of you will contribute to the lectureships to be established in Larry’s name. Donations will be welcomed at:

The home address for Dr. Becker's family is Dr. Edna Becker, 1 King George's Road, Etobicoke, Ontario M8X 1K6 Canada.

Larry Becker Memorial Page

Dear Colleagues:

We are pleased to announce a new Web site devoted to pediatric laboratory medicine at www.childx.org. Children's Health Improvement through Laboratory Diagnostics (CHILDx, pronounced "Child Diagnostics") is a multi-institutional, multidisciplinary group of pediatric pathologists, laboratory medicine specialists, laboratory scientists, and pediatric subspecialists that seeks to improve the healthcare of children by working with pediatric laboratory medicine and other healthcare professionals. CHILDx is supported by ARUP Laboratories and the University of Utah Department of Pathology. The Web site includes a variety of information about resources, current issues, and CHILDx activities. Resources on the Web site include:

We invite you to visit the Web site and to contact one of us or CHILDx with your questions, comments, suggestions for additions to the FAQ list, Web site links, and literature resources. We want this to be a useful clinical, educational, and academic resource for pediatric pathologists and other laboratory medicine and healthcare professionals. We welcome your candid feedback and suggestions for further improvements.

Thank you for your consideration. We look forward to hearing from you.