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Motherisk Questioned

November 6, 2014 permalink

The Motherisk program of Toronto's Hospital for Sick Children may be returning unreliable test results, leading the the false conviction of mothers or the needless separation of mother and child.



Lawyer seeks ‘reassurance’ on Motherisk drug tests

Child protection lawyers are raising concerns about the reliability of the Sick Kids testing program after an appeal court tossed the cocaine convictions of a Toronto mother.

Gideon Koren
Prominent toxicologist Gideon Koren, who is the founder and director of Motherisk, has defended the program's techniques.

Toronto lawyers who regularly handle child protection cases involving hair-strand analysis from the Hospital for Sick Children say more information is needed about the reliability of the testing after a court of appeal tossed the 2009 cocaine convictions of a Toronto mother.

Lawyer Tammy Law said the Motherisk program at Sick Kids is the go-to place for hair-strand analysis in family law cases where drug use is in question. She wants “to be reassured” the laboratory’s testing can be trusted, she said.

“The stakes are so high,” said Law. “To potentially lose your kid, for fairness’ sake, it has to be accurate … You have to have faith in the result. If we don’t believe it, we have a huge problem.”

Sick Kids did not respond to a request on Tuesday for a comprehensive list of cases that have relied on the type of hair-sample analysis performed in the case of Toronto mother Tamara Broomfield, or say whether Motherisk is still using this technique.

Motherisk’s hair-strand drug tests are routinely submitted as evidence in courts across the province “almost without question,” according to Anthony Macri, a former lawyer for the Children’s Aid Society of Toronto who now runs a family law firm.

In the face of the appeal court decision, Macri said it is “incumbent” on the government to determine the “standard of reliability.

“It shouldn’t just be a question floating in the air. It shouldn’t just be up to lawyers like me to challenge it in every court for the next 20 years,” he said. “The government needs to get ahead of this ball.”

Several Toronto criminal defence lawyers are calling for a review of the cases that relied on Motherisk’s hair-strand analysis.

The concerns come after fresh scientific evidence prompted a court of appeal to overturn Broomfield’s 2009 cocaine convictions for giving her 2-year-old son, Malique, a near-lethal dose of the drug in 2005.

A 2005 cocaine overdose left Malique, now 11, with permanent brain damage. The court of appeal did not comment on how he got the drugs.

Broomfield was found guilty, in part, on the basis of hair-strand analysis presented by Gideon Koren, a prominent toxicologist and the founder and director of Motherisk. Koren testified in 2009 that an analysis of Malique’s hair revealed he had regularly ingested very high doses of cocaine for more than a year leading up to the 2005 overdose.

The appeal court threw out Broomfield’s cocaine convictions after Craig Chatterton, deputy chief toxicologist in the office of the chief medical examiner in Edmonton, criticized the way Motherisk prepared the hair sample, the methodology used to analyze it and the validity of the results.

Broomfield served more than half of her seven-year sentence before being released on bail last year, pending appeal. She has abandoned her appeals of convictions for failing to seek medical care for Malique’s broken wrist and for inflicting multiple rib fractures.

The Ministry of the Attorney General has not yet responded to questions about whether it will launch a review of the criminal cases involving Motherisk, or whether the Crown will continue to rely on the laboratory’s hair-strand analysis.

Tammy Law, who has also worked for the Children’s Aid Society of Toronto, said lawyers like her, who depend on Motherisk’s testing, need answers.

“I want to understand the technique they use, why they think it’s reliable … whether there are other theories,” she said. “It’s a big black hole right now.”

In a report filed in court, Chatterton maintained it is “not possible” to conclude whether Malique ingested cocaine over an extended time period based on the type of analysis Motherisk conducted.

He said the testing Motherisk conducted is intended only to provide preliminary analytical results, that it was not performed in a forensic toxicology laboratory and that the “gold standard technique was not used.” He also pointed out that no hair sample was retained for independent analysis.

Koren, for his part, defended his choice of testing as “highly specific, valid and accurate” and said that at the time of the analysis, his lab used “the best clinical toxicological test available to us,” according to a report filed in court as part of the appeal process.

He said the test he used in the Broomfield case yields “results comparable” to the so-called gold-standard technique Chatterton referenced in his report, and dismissed Chatterton’s claims as “wrong and misleading.”

Both Koren and Sick Kids CEO Michael Apkon have declined multiple interview requests. In an email earlier this week, Apkon said, “It is not unusual for experts to disagree on matters before the courts,” and pointed out that there were three experts consulted in the Broomfield case during the appeal process.

A report by a toxicologist from Utah, who supports Motherisk’s analysis, was filed in court during the appeal process, along with reports from Chatterton and Koren.

A database of select Canadian court cases shows Motherisk’s hair sample tests were included as evidence in more than 15 child welfare cases and at least one other criminal case since 2009.

Source: Toronto Star

According to the Canadian Association of University Teachers, Dr Koren has engaged in some "childish, vindictive and dishonest" misbehaviors in the past.



Koren Reprimanded by Ontario College of Physicians & Surgeons

The Ontario College of Physicians and Surgeons has formally reprimanded University of Toronto professor of medicine Dr. Gideon Koren. He had written anonymous harassing letters about Dr. Nancy Olivieri and three colleagues during Olivieri's dispute with the Hospital for Sick Children, the University of Toronto and Apotex Inc. He then had lied repeatedly to conceal his responsibility. The college also cited him for additional misconduct, in research.

The penalty had been jointly proposed to the college discipline committee through prior agreement between counsel for Koren and counsel for the college. In its decision, the discipline committee said it was "deeply troubled by this case" and "seriously considered administering a more severe penalty" than that proposed to it, as it wished "to express unequivocally its condemnation of Dr. Koren's misconduct."

"It defies belief that an individual of Dr. Koren's professed character and integrity could author such vicious diatribes against his colleagues as he did in the 'poison pen letters'," the committee wrote in its decision.

The committee described Koren's actions as "childish, vindictive and dishonest" and noted that "only when confronted with irrefutable scientific evidence of his guilt did he admit he was the perpetrator" of the letter campaign.

Although Koren's lawyer said his client felt "extreme remorse," the committee pointed out that it "did not hear directly from Dr. Koren as to his remorse and the agreed statement of facts were silent on this issue."

The college's finding of research misconduct was in relation to a study on a drug to treat a blood disorder in children that Koren and Olivieri had once collaborated on. Olivieri identified risks that the drug was ineffective and caused liver damage, and voiced her concerns despite legal warnings from its maker, Apotex. Koren differed and, contrary to accepted norms, published an article on the drug using data from other researchers, including Olivieri, without their knowledge or consent.

The Koren case only came to the college's discipline committee after three of the victims of the anonymous letter campaign appealed the decision of the college's complaints committee not to refer the Koren matter for discipline. The independent appeal board agreed with Drs. Peter Durie, Brenda Gallie and Helen Chan, and ordered the college to forward the matter to the discipline committee.

The facts before the discipline committee on research misconduct were confined by the prior agreement between legal counsel to a public report University of Toronto dean of medicine David Naylor had made to his faculty council. Dean Naylor reported that Koren had violated university policy in publishing his article on Apotex's drug without the "consent, review or participation" by Olivieri and two others who had generated the data. Naylor directed Koren to arrange for the journal's editor to have the article deleted from the scientific record and to send appropriate personal letters of apology.

The discipline committee did not have before it the facts that Koren had violated additional university and international norms of conduct in this publication. In The Olivieri Report, the committee of inquiry found that in this publication, Koren failed to disclose Apotex's financial support for his research. He also failed to cite previous publications by Olivieri and others on risks of the drug, even though he was fully aware of this information.

In a recent journal article, the Report's authors, Jocelyn Downie, Patricia Baird and Jon Thompson note that in his statement to the faculty council, Naylor did not address the additional, serious aspects of research misconduct by Koren. They note that Koren had received hundreds of thousands of dollars in funding from Apotex after the company had terminated the drug trials in its efforts to prevent Olivieri from disclosing risks to patients, as well as the hundreds of thousands of dollars in funding he had received during the trials.

They further note that Naylor's public statement did not address the fact that Koren had earlier appeared as senior author of conference abstracts favourable to the drug that had been drafted and coauthored by Apotex staff. His statement also did not address the fact that Koren had failed to disclose the source or purpose of a grant of $250,000 he had received from Apotex, in the same academic year the trials were terminated and the abstracts published at a conference where the company had tried through legal warnings to prevent Olivieri's participation.

The Olivieri Report found that, ever since Apotex's dispute with Olivieri over disclosure of risks of its drug began in 1996, the company has been relying on Koren's scientific opinions to defend its drug's reputation with regulatory agencies and in court actions. This reliance results in Koren's misconduct, addressed and unaddressed, continuing to be a matter of public interest.

Source: CAUT Bulletin

Addendum: The OACAS publishes a letter defending Motherisk (local copy pdf).

And Catherine Frei wrote to her MPP about her experience with Motherisk.



Catherine Frei

Here is the correspondence which I sent MPP Jim McDonell today regarding Motherisk, in light of the Toronto Star article today where had raises the concerns.

Hello Mr. McDonell,

First, I would like to thank you for standing up and addressing the concerns of test results produced by Motherisk at Sick Kids Hospital. Sadly, this very issue is one which I have raised numerous times over the past five years.

I myself was the victim of fraud by this very lab and I can tell you that there is plenty of evidence collected by parents across the province to support my claims. This evidence has been gathered by way of independent testing being done at other labs.

When my first test result came back I was suspect to the methods and/or motives behind the results of that test. I began doing witnessed urine screens, 7 panel tests, at my local methadone clinic. I have never been on methadone but it was suggested by my lawyer that I utilized this lab as they are the only ones which have an actual person accompany you to the washroom, as opposed to a camera which many of the lifelabs and various others use.

I had to sit in my living room and listen to a CAS worker accuse me of catheterizing myself and not accepting that my urine screens were valid. Dr. Ralph Stemeroff was the doctor in charge of this particular methadone clinic and has provided his expertise in many of the various courts, not just child protection cases .... criminal, civil and labour related issues as well. Despite the Children's Aid Societies claims in today's Toronto Star article that they are concerned about the tests, I am going to suggest that they were fully aware of the fraud taking place.

I say this because in the past I have made it a point to look at Dr. Gideon Koren's annual newsletters which he sends out to the societies, where he addressed them as "Dear Friends," and would continue on enthusiastically explaining all of his new testing and how excited he was of the upcoming year and how they would have an even better year than the last. Friday night just past, I spent upwards of six hours searching for those documents on the internet only to find that there is absolutely no trace of those newsletters anywhere. This itself, also supports the many claims by parents that the societies and Motherisk have worked together to perpetrate crimes against children and their families.

After the horrors of disgraced coroner Charles Smith, the questionable background and conduct of Gideon Koren, and the ongoing call from parents in this province for child protection reform and accountability, it is my belief that the province should be aggressively pursuing this matter as it is in the public's best interest to ensure that illegal means have not been used to profit off of the backs of innocent children and their families. I shudder to think of how many children have potentially been separated (some permanently) due to the results provided by this lab. The College of Physicians and Surgeons has an equally important role in ensuring that trust can be maintained by the public where this issue is concerned. Do they want a repeat of the horrors of Charles Smith? In my opinion (and it is shared by many) it is quite possible that hundreds if not thousands of families have already been victim to this labs faulty research and perverse incentives.

It is not surprising that the hospital and Koren are declining to comment on this issue. It is also not surprising that those annual newsletters have literally vanished from the internet after being easily accessible to the public for the past several years. I will thank you again for your efforts in shining light on an issue which warrants much review for the public's best interests to be maintained and safety from institutionalized abuses.

I am a university student and I am currently being stone-walled by the very school which I attend. I made requests to the ethics board of the social work department regarding research being done by a senior staff employee of the children's aid society completing his thesis. I in no uncertain terms made it clear that I had concerns that there was perhaps subversive lobbying taking place on behalf of the children's aid in yet another effort to extend legislative powers to the children's aid. As many are already aware, they have a shameful record of inadequately caring for this province's most vulnerable citizens.

I would like to thank you in advance for reviewing my correspondence to you today, and I eagerly await the outcome of the issues which you are so admirably addressing on behalf of Ontario citizens and their families. I sincerely thank you for your efforts.

Kindest Regards,

Catherine Frei

Source: Facebook, Stop the CAS ...

Then another mother replied that in a case in which CAS accused her of drug abuse, the chain of custody for the hair sample went through the accusing CAS worker.



Jennifer Joy

In fact, most CAS Workers cut the hair follicle off parent's or care giver's heads right at the CAS offices where it could easily be swapped with some one else's. This test is to be done at the Lab by a qualified lab technician. Tell me why CAS Workers are made to cut people's hairs like a technician? they are under qualified. Even made so many mistakes along the way. Even I was threatened to submit or else the CAS Worker told me she would place my grand daughter into Foster Care immediately if I don't submit right at the spot at that CAS Office. I got threatened and that's extortion in my books. I brought her home the same day I gave them my hair for testing and it went to Mother Risk and it came back clean. Of course it would be clean cause I told her I would get a second test done by a Doctor or another Lab. Even my Doctor told me he was shocked how they collected the samples, as it should not be on a paper, it should be in a plastic lab bag or container with a receipt given to the person. Of course probably money were exchanged to ensure dirty drug tests on other Families and that is why I suggest the others to go get a second opinion, get a second test done at the Life Labs.

Source: Facebook, Stop the CAS ...

The press is taking an interest in Motherisk, as shown by a message to Catherine Frei:

Catherine Frei

Okay, it is official, Rachel Mendleson from The Star contacted me this evening and anyone with questionable results from their hair follicle tests at Motherisk, or anyone that has had a CAS worker try and take the sample themselves at your home or at their office, could you please let us know? Thank you, it is a good sign that she had made contact so let's use this opportunity wisely

Source: Facebook, Coalition for Ombudsman Oversight