The Pediatric Cardiac Surgery Inquest Report



Conflict over out-of-province referrals

Over the weeks following the first meeting of the Wiseman Committee, Giddins consulted with members of the Department of Anaesthesia to determine which cases were appropriate to take to surgery and which cases were to be classified as medium to high risk. Odim said that he did not participate in these discussions. The committee met weekly from mid-May through June. It is apparent that the question of whether a child was to be operated on in Winnipeg or sent out of province came to dominate many of the committee's discussions during this time. It is a sign of the rushed nature of the start-up of the committee that while it had a protocol stating that low-risk cases would be done in Winnipeg, there was no definition of low risk.

Odim testified that as the case reviews proceeded, there was an underlying and ongoing conflict over whether a child should be sent out of province or operated on in Winnipeg.

There always seemed to be a battle between the anaesthesia group and the rest of the Committee on issues and the battle always centered around who to operate on, when to operate on them. (Evidence, page 25,135)

Odim's suggestion that it was anaesthesia against everyone else on the committee is contrary to the evidence. The conflict over doing higher-risk cases seems clearly to have been between anaesthesia representatives Ullyot and McNeill on the one side and Giddins and Odim on the other.

McNeill gave this description of an exchange between herself and Giddins over one referral:

And he got angry with me and sort of jumped from his chair and leaned across the table straight at me, and raised his voice to me about what he was talking about, and took me aback at the time by, you know, the vehemence, if you will, of his statements. (Evidence, page 13,291)

Youngson testified that she witnessed the event. She said that Giddins "sort of came across the table" and "he just screamed at Ann." Youngson testified: "I just sort of sat back and I thought, well, that's it, I don't want that to happen to me." (Evidence, pages 8,555-8,556)

Odim also testified that it was never clear to him if the committee wanted to restrict operations to low-risk procedures or to low-risk patients. This was an important point that was never resolved.

In every operation, the risk of surgical complications is based on the operation itself, the condition of the patient and the interaction between the patient and the operation. A healthy patient generally presents a lower risk than one who is in poor health. While any patient having a minor operation would be at lower risk of having a complication, if the patient is in poor health, he may be considered a high-risk patient even if the operation is a low-risk procedure. Another patient, with no other medical problems, in good physical health and undergoing the same minor procedure, would be considered to be a low-risk patient. Therefore, two patients undergoing the same procedure may be viewed as presenting different risk levels.

It would appear that in assessing a patient for selection, Odim and Giddins considered only the risk associated with the procedure, while the anaesthetists also considered the risk associated with the patient's physical condition. Therefore, while from time to time, the surgeon and cardiologist wanted to perform a procedure that they saw as being one of low risk, the anaesthetists would object if they felt the risk was enhanced due to the condition of the patient.

Despite Ullyot's request at the start of the committee process, anaesthetists never became involved in the initial case-selection process. The only two members of the committee who attended the CVT conference continued to be Odim and Giddins. It was at this conference that Giddins presented cases to Odim for his consideration. The other members of the operating team were never invited to these conferences. Why Giddins and Odim never changed their procedures is a matter of speculation.


Current Home - Table of Contents - Chapter 7 - Conflict over out-of-province referrals
Next Swartz's notes
Previous The June 29 committee meeting
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
Table of Contents