The matrix concept

The VCHC was what was referred to informally at the HSC as a matrix. Within the administration of the hospital, a matrix was a program that brought together a number of disciplines and services-in this case, cardiology, surgery and nursing. However, what was not very clear when it came to a matrix was how the lines of authority and responsibility worked, and the degree to which necessary alterations to the usual lines needed to be made to accommodate the matrix.

During the course of evidence, differing explanations were given as to the lines of responsibility at the VCHC. At times, witnesses, who should have been clear as to the lines of responsibility and authority, said they found the lines to be confusing.

For example, when asked who his 'boss' was, Duncan identified Collins in day-to-day matters, but said that in official terms it was Barwinsky and Dr. Robert Blanchard, the chief of surgery. Duncan then added that one might also consider the chief of the pediatric surgery division, then Dr. Mervin Letts, as his "immediate boss." (Evidence, page 23,412)

Collins told the Inquest:

Kim Duncan was the director of the surgical program. He reported to Bob Blanchard, or when there was a division head of cardiac surgery like Jary Barwinsky, or later on Helmut Unruh, he reported through him to Blanchard. (Evidence, page 32,993)

Dr. Helmut Unruh who was the acting chief of CVT surgery from 1991 until January 1995, said:

I did not have any direct responsibility for the day to day activities of Dr. Duncan or any other cardiac surgeon at the Children's Hospital. (Evidence, page 34,958)

When asked what, if any responsibility he had had for the pediatric cardiac surgery program, Unruh said:

A. I had none.
Q. You had none?
A. No.
Q. Okay. When Dr. Duncan was here, who did have responsibility for the pediatric surgery program and/or Dr. Duncan's clinical activity in that program?
A. The director of the pediatric cardiac program, Dr. George Collins. (Evidence, page 34,959)

Unruh suggested the situation was similar to the HSC having placed Duncan in another hospital on a secondment. In such a situation, he pointed out, it would be up to that institution to monitor the surgeon's medical practice.

During the Collins era, however, such confusion over lines of authority did not create any significant problems, since Collins himself played a significant role in monitoring the program's performance and surgical results. However, this issue was a recurring matter during 1994.