The evidence presented to this Inquest gave rise to the following questions:

• Could Aric's pulmonary vein stenosis have been identified before surgery?
• If it could have been detected earlier, could Aric have benefited from a heart-lung transplant?
• Was Aric a high-risk patient at a time when the program was not undertaking high-risk cases?
• Were his parents provided with sufficient information to allow them to give informed consent to the procedure?
• What was the cause of death and was it preventable?

These are also the questions that the Baumann family wished to see addressed.

Could Aric's pulmonary vein stenosis have been identified before surgery?

Cornel questioned why the pulmonary vein stenosis was not identified pre-operatively. In his evidence, he stated that he was aware that pulmonary vein stenosis can be difficult to detect and may not manifest itself as a serious condition until the child is older. However, generally, with close observation, the onset of the disease can be identified relatively soon. Cornel also felt that the condition could have been identified sooner than it eventually was. If it had been, the difficulties experienced by the family in watching their son deteriorate might have been alleviated.

He agreed with Giddins and Odim that the fact that Aric had pulmonary vein stenosis would not necessarily have meant that the operation should not have proceeded. Cornel stated that, although it can be a fatal condition and is not treatable, sometimes pulmonary vein stenosis can stop progressing on its own for no known reason. He felt that the decision to operate on Aric, even in the face of that information, would not necessarily have been an incorrect one.

Giddins indicated that in retrospect he could detect signs of the stenosis on the May 1994 catheterization. In contrast, Dr. Walter Duncan stated that after reviewing the pre-operative reports, he could not find any evidence that would have led him to conclude at that time that Aric had pulmonary vein stenosis.

Finding

It would have been desirable, particularly from the parents' perspective, to have been aware of the stenosis. However, it appears from the evidence that it was not unreasonable for Giddins to have failed to detect the stenosis in May. Furthermore, it also appears that medical staff would have recommended the course of treatment that was carried out, even if the stenosis had been identified.

Would Aric have benefited from a heart-lung transplant?

On this point Duncan and Cornel stated that "This would have been a difficult judgment call with regard to operability. Only other option would have been no treatment or heart and lung transplantation - {virtually not available in Canada in this age range....}." (Exhibit 354, page 10) In his testimony, Giddins said that such transplants are still very experimental.

Finding

It does not appear that a transplant would have been a realistic option in this case.

Was Aric a high-risk patient at a time when the program was not undertaking high-risk cases?

Finding

Questions of risk are not easy to quantify. Aric underwent a relatively low-risk procedure. However, he was a higher than usual risk patient. Both Odim and Giddins maintain this was, relatively speaking, a low-risk case. Given the circumstances of the program and the circumstances of the patient, Giddins should have consulted with McNeill about whether or not to transfer Aric to another heart centre. However, no consulting witness has identified any surgical issues that led to Aric's death or suggested that this was a high-risk case. While the risk may have been higher than for a simple ASD, it is fair to conclude that this was not a high-risk case.

Were Aric's parents provided with sufficient information to allow them to give informed consent to the procedure?

Finding

While it may have been appropriate to undertake this operation in Winnipeg, the Baumanns ought to have been clearly informed of all risk factors involved in this case before being asked to consent to surgery. For there to be informed consent they would have had to have been told of the specific risk in Aric's case and of the slowdown in the program. The evidence tends to suggest that Aric's parents were not provided with sufficient information to allow them to give informed consent to the procedure.

What was the cause of death and was it preventable?

Finding

In this case, there is no dispute over the cause of Aric's death. He died as a result of pulmonary vein stenosis. In his report, Duncan stated simply that this was an unavoidable death and not a surgical or management issue. Dr. Christian Soder felt that the cardiac condition from which the child was most at risk (the pulmonary vein stenosis, which was only identified in retrospect) was inoperable.

Aric's death was not preventable.