Collins and de la Rocha

Collins had to determine whether or not he would continue to refer patients to de la Rocha, who was still operating at the HSC at the time of his arrival. Collins was aware of concerns with the poor surgical results in the operations in which de la Rocha had been involved and that Cumming was no longer referring patients to de la Rocha for surgery. After meeting with de la Rocha, Collins decided to refer patients to him. However, he restricted his referrals to de la Rocha to older children, sending his neonatal patients to Toronto's Hospital for Sick Children. Collins also urged de la Rocha to refrain from taking on difficult cases.

Collins felt from the outset that one of the reasons for Cumming's lack of confidence in de la Rocha and for the poor results was that de la Rocha did not exercise sufficient judgment in case selection. Rather, he allowed himself to be prevailed upon to try to perform miracles in hopeless cases. As a result, Collins felt that the reputation of the entire program of pediatric cardiac surgery at the Children's Hospital was suffering.

Collins had also felt that he and de la Rocha had developed an understanding as to which cases de la Rocha was to accept and how he was to handle patients referred to him by other doctors. However, de la Rocha was a member of the Department of Surgery at the HSC and was not accountable to Collins for the work he took on. In the fall of 1983 Collins came to the conclusion that de la Rocha was continuing to perform cardiac surgery on children who were not appropriate for such operations, and that he was also not enjoying particularly good results with those cases. The issue came to a head when Collins was called to the operating room after the start of an operation on one of his patients. This is how Collins described the scene.

. . . the whole team was disorganized. The pump wasn't working, there was too much blood in the heart, they couldn't see things, he was trying to repair a valve. And it was just a very disorganized event. (Evidence, page 32,955)

The next day Collins met with Dr. J. Haworth, the head of pediatrics (who was also head of the Children's Hospital), and Dr. Allan Downs, head of surgery, to discuss his concerns. Later that day he met with de la Rocha and told him that the next patient was going to be sent to Toronto. He then told de la Rocha that he was not going to refer any more patients to him and that he did not want de la Rocha operating on any more children with heart disease at the Children's Hospital.

This effectively ended de la Rocha's career as a pediatric cardiac surgeon in Winnipeg. Although he continued to perform adult cardiac surgery for several months in Winnipeg, he left the city the next year.

The program's poor results were reported in the media at the time. The program's future was at risk, particularly since Cumming had told the media that he did not believe that Manitoba had the population to support a full-scale Pediatric Cardiac Surgery Program (Exhibit 216).

Following his decision to stop referring patients to de la Rocha, Collins spoke with Barwinsky, who by that time was the chairman of the newly established provincial pediatric cardiac services program. He and Barwinsky developed a plan to reinstate pediatric cardiac surgery at the Children's Hospital, using Barwinsky's surgical services. Barwinsky had continued to perform simpler cardiac procedures at SBGH on older children, even after de la Rocha's arrival. As head of the Pediatric Cardiac Services Program, Barwinsky was aware of the plan to develop the program at the Children's Hospital as a full-service program.

After several months of planning and preparation, Barwinsky started performing pediatric cardiac surgery at the HSC in the spring of 1984. Collins and Barwinsky made a point of slowly restarting the program. This involved having preparatory meetings with the staff involved in the operations, including the nurses, and identifying their concerns. Collins also worked on establishing procedures governing how patients would be referred for surgery. Eventually a protocol was put into place that any medical referral for pediatric cardiac surgery from anywhere in Manitoba was to be made to the Variety Children's Heart Centre.

Barwinsky performed approximately thirty pediatric cardiac operations each year for a three-year period. However, Collins felt that it was essential to seek a surgeon who had been specially trained in pediatric cardiac surgery for the program.