The Provincial Advisory Committee
on Cardiac Services in Manitoba
On February 15, 1982, the Minister of Health for Manitoba, Larry Desjardins, appointed an Advisory Committee under the chairmanship of T. A. J. Cunnings of the Manitoba Health Services Commission (MHSC) to advise the Department on the establishment of a provincial cardiac service program. Departmental officials had long been aware that the delivery of cardiac services was driven by competition between the HSC and SBGH. The Cunnings Committee had representation from the HSC and SBGH, as well as from the Department of Health. A part of the Committee mandate was a requirement to advise the Minister on how cardiac services in Manitoba should best be developed, including how best to use the resources of the HSC and SBGH.
In July 1982, Collins submitted a proposal to the MHSC for the establishment of a centre for pediatric cardiology services at the HSC. This centre was eventually to become the Variety Children's Heart Centre. The report was the result of Collins's close work with the heads of other medical departments and of his briefings and training sessions with nursing staff. The proposal only addressed the development of a specialized pediatric cardiology service, and was silent on the question of pediatric cardiac surgical services. Collins apparently took the position that the delivery of surgical services was the responsibility of the HSC's Department of Surgery.
In its report of August 1982, the Provincial Advisory Committee recommended an integrated approach with respect to both adult and pediatric cardiac surgery. It recommended that St. Boniface General Hospital be the primary adult surgical centre, while pediatric cardiac services were to be centred at the Health Sciences Centre.
In the spring of 1983, the provincial cabinet approved a modified plan whereby SBGH and the HSC would share the adult cardiac surgery workload, while pediatric cardiac services would be established exclusively at the HSC's Children's Hospital. It was specifically recognized that the number of pediatric cardiac cases would not justify having pediatric cardiac surgery at more than one centre, while the adult caseload seemed to be of sufficient numbers to justify splitting them between the two hospitals.
The decision to locate all of the pediatric cases at the Children's Hospital was welcomed by that hospital's Department of Pediatrics and Child Health as support for its view that the Children's Hospital should become the major centre for child health in the province. It also reinforced Collins's overall plan for the development of the program he had been hired to establish. The fact that the HSC was able to acquire a share of the adult caseload was also seen as a major development, especially since the bulk of adult cardiac cases had been performed at St. Boniface previously.
The province's decision to establish the HSC as the centre for the Pediatric Cardiac Surgery Program was accompanied by a significant financial commitment and an assurance that the province would not condone competition for pediatric cardiac cases. This latter assurance was, however, almost unnecessary since the number of pediatric cases was so small and so financially unrewarding as to be almost unattractive to other hospitals.