Medical departments

For the purposes of this inquest, the three key medical departments were Anaesthesia, Surgery, and Pediatrics and Child Health. During all of 1994, Dr. Douglas Craig was the Clinical Head of Anaesthesia and Dr. Robert Blanchard was the Clinical Head of Surgery. Until June 1, 1994, Dr. Agnes Bishop was the Clinical Head of Pediatrics and Child Health (and therefore the head of the Children's Centre). She left on that date for a position with the federal government. For the summer months of 1994, the position rotated among various medical staff, including Dr. John Bowman. On September 15, 1994, Dr. Brian Postl became Clinical Head of Pediatrics and Child Health.

Before June 1, 1994, these three heads all reported to Sutherland. After that date, the heads of Anaesthesia and Surgery reported to VanDeVelde-Coke, while the head of Pediatrics and Child Health reported to Helen Wright.

According to the medical staff bylaws, department heads had the following responsibilities:

• To develop and maintain high standards of patient care, teaching and research within the department;

• To supervise the work of departmental members in all matters relating to patient care;

• To prepare a departmental budget when called upon to do so and maintain expenditures within that allocated budget;

• To develop departmental policies in consultation with the Department Council;

• To act as the official channel of communication between the administration and the department;

• To report to their respective VP on the work of the department when called upon to do so;

• To conduct investigations of departmental members, or assign such investigations as required within medical staff disciplinary procedures;

• To recommend to the Board, through the Medical Advisory Committee, the appointment, reappointment, delineation of privileges and other changes in status of departmental members;

• To recommend to the Board, through their respective VP and the President, the appointment, reappointment or termination of section heads.

• To immediately suspend, or otherwise limit, the privileges of a member of the department, for a period of up to 10 working days, for conduct that the department head reasonably believed might negatively affect patient care or which constituted a serious breach of ethical standards, or breached Centre policies and procedures; and

• To exercise such other powers and perform such other duties as might from time to time be conferred by the Board.

Surgical sections

There were a number of sections within the Department of Surgery. They all reported to Dr. Robert Blanchard, the head of surgery in 1994. Each section had its own section head, and each subsection also had a subsection head. For the purposes of this Report, the primary section of interest is the Section for Cardiovascular and Thoracic Surgery and the Pediatric Cardiac Surgery service within it.

Cardiovascular and Thoracic Surgery

The Department of Surgery had a section known as Cardiovascular and Thoracic (CVT) Surgery, with a section head. During 1994 the acting head of the CVT section was Dr. Helmut Unruh. The pediatric cardiac surgeon, Dr. Jonah Odim, reported to Unruh, who reported to the head of surgery. Odim was referred to as a service chief for Pediatric Cardiac Surgery. A service in a hospital consists of a group of doctors providing the same kind of medical service. Each service is usually assigned a number of residents, interns and medical students who are posted there for a period of time. However, the pediatric cardiac surgical service headed by Odim was not so fortunate. For all intents and purposes, Odim was the only member of the pediatric cardiac surgery service and had no residents assigned to him for training as pediatric cardiac surgeons. However, residents did occasionally provide assistance at pediatric cardiac operations.

Odim's contract specified that he was being offered a position as associate professor in the Department of Surgery of the Faculty of Medicine, University of Manitoba, as well as a position on the medical staff of the Health Sciences Centre. In the former position, he was responsible to the head of the Department of Surgery. The contract stated that in relation to his duties on the medical staff:

You will undertake the responsibilities of Service Chief, Pediatric Cardiac Surgery at the Health Sciences Centre . . . and other duties as assigned by the Section Head, Cardiothoracic Surgery, under the Surgeon-in-Chief, HSC. (Exhibit 178)

Odim's job description included the following passage:

1. Title: Service Chief, Pediatric Cardiac Surgery

2. Responsible to: Section Head, Cardiovascular & Thoracic Surgery

3. Description of area of responsibility

   a. General Purpose of Program

   To provide the citizens of Manitoba with a high standard of care and specialty expertise in the area of pediatric cardiothoracic surgery. This program is partly supported by the Variety Children's Heart Centre which is primarily an ambulatory service providing consultations on a referral basis, to pediatricians and family practitioners throughout the Province of Manitoba and Northwestern Ontario; occasional referrals are received from the eastern part of Saskatchewan. Children with significant heart lesions are followed on a regular basis before and after heart surgery.

   As the surgical component of the service expands there is increasing hospital involvement, although as a rule the in-hospital commitment is in consultation on the wards and Intensive Care Unit of the Children's Hospital. Other nurseries and pediatric units in city hospitals are visited in consultation on occasion.

   Nursing staff and technologists work both in the Heart Centre itself and in the heart catheterization laboratory (which is located in the Radiology Department of the Children's Hospital), as well as providing services on the wards of the Children's Hospital. There is considerable after-hours activity, with physicians, nurses and technologists providing 24 hours hospital coverage, seven days a week.

   The Heart Centre itself incorporates examination rooms and the non-invasive laboratories, where electrocardiography (ECG), echocardiography (echo) and exercise testing is performed. A 'drop-in' service for ECG's is provided for city practitioners, otherwise these laboratories support only the clinical activities of the Heart Centre staff.

   b. Area of Responsibility

   Responsible to organize and direct a broad spectrum of pediatric cardiac services and to promote a high standard of patient care, teaching and research activities. The Service is also responsible for directing the surgical component of the Variety Children's Heart Centre. (Exhibit 178)

Odim also held a secondary hospital appointment in the Department of Pediatrics. However, the Pediatric Cardiac Surgery Program was primarily a surgical (as opposed to a pediatric) program.

Pediatric sections

There were also a number of sections within the Department of Pediatrics and Child Health that reported to the head of that department. For the purposes of this report, the sections with which we are most concerned are Pediatric Cardiology, Pediatric Surgery, Pediatric Intensive Care and Neonatal Intensive Care.

Pediatric cardiology and the Variety Children's Heart Centre

Pediatric Cardiology services were delivered through the Variety Children's Heart Centre. In 1994, the acting medical director of the VCHC and the acting section head of Pediatric Cardiology was Dr. Niels Giddins.

According to a job description dated October 1993 and prepared by the previous VCHC medical director, Dr. George Collins, the medical director of the VCHC was required to:

Provide overall supervision of the medical diagnostic and therapeutic activities occurring at Variety Children's Heart Centre and Children's Hospital, ensuring the highest possible standard of care

With the Surgical Director [of the VCHC], and Directors of the Cardiac Catheterization and Non-Invasive Laboratories:

Develop and maintain appropriate guidelines for pre-operative evaluation, perioperative care, and post-operative management of children referred for congenital and acquired heart disease

Maintain free and open communications with other sections (i.e. Neonatology, Intensive Care) and departments including (i.e. Anaesthesia, Radiology) within Children's Hospital, Health Sciences Centre, and the University of Manitoba

Oversee staffing assignments within VCHC

Establish standards for staff safety and conduct. (Exhibit 71)

Pediatric surgery

Pediatrics and Child Health also had a section known as Pediatric Surgery. Dr. Nathan Wiseman was the head of Pediatric Surgery during this period. He reported to the head of Pediatrics, as well as to the head of Surgery (Exhibit 296). His responsibilities consisted primarily of co-ordinating the surgical services provided by the Children's Centre, ensuring that the scheduling of cases occurred in an appropriate manner and that the operating rooms at the Children's Hospital were properly used.

Wiseman's job description stated that he was "responsible to: Department Head, Department of Surgery and the Department of Pediatrics and Child Health." Under the heading of "Description of Area of Responsibility," the job description stated:

To provide the citizens of Manitoba with a high standard of care in areas of Pediatric Surgery.

b) Area of Responsibility

Responsible to organize and direct a broad spectrum of pediatric surgical programs and to promote a high standard of patient care, teaching and research in the field of Pediatric Surgery. Overall, Pediatric Surgery includes Pediatric Ophthalmology and Pediatric ENT as it impacts on Pediatric Surgery.

c) No. of physicians:

CVT 3, Dentistry 11, Plastics 3, Urology 3, Neurosurgery 5, General Surgery 4, Ophthalmology 8, Orthopaedics 5, Otolaryngology 12. (Exhibit 296)

Under the heading of "Personnel," it stated that the head of Pediatric Surgery:

Coordinates the selection process and recommends to the Department Head office the appointment of and reappointment of staff who are adequately qualified to deliver a high standard of care, research and education in the different specialty areas. (Exhibit 296)

Pediatric Intensive Care

Pediatrics and Child Heath had a section known as pediatric intensive care. This section was always referred to as the pediatric intensive care unit (PICU). The head of the PICU in 1994 was Dr. Murray Kesselman. The doctors who worked in the unit were referred to as intensivists and specialized in the treatment of intensive care for children from the age of six weeks to 18 years. The other intensivists who worked in the unit during 1994 were Dr. Fiona Fleming, Dr. B. J. Hancock and Dr. Jo Swartz. Hancock also worked in the Department of Surgery as a pediatric surgeon and Swartz was also an anaesthetist and was a member of the Department of Anaesthesia.

A description of the services provided in this unit is found in Chapter Three.

Neonatal Intensive Care

Pediatrics and Child Health had a section known as neonatal intensive care. This section was always referred to as the neonatal intensive care unit (NICU). The doctors who worked within it were referred to as neonatologists and had been trained in the special care of newborn children aged up to six weeks. In 1994, the head of this section was Dr. Molly Seshia. The other neonatologists were Dr. J. Belik, Dr. R. Caces, Dr. O. Casiro, Dr. R. Alvaro, Dr. H. Rigatto, Dr. C. Fajardo, Dr. G. Cronin and Dr. R. Savani.

A description of the services offered by this section is found in Chapter Three.

Anaesthetic sections

The Department of Anaesthesia was responsible for providing anaesthetic services within the hospital. The head of the Department of Anaesthesia was Dr. Douglas Craig. The department had two sections, one for adult anaesthesia and one for pediatric anaesthesia. Both sections reported to the head of Anaesthesia.

Pediatric anaesthesia

The head of the section of pediatric anaesthesia was Dr. Suzanne Ullyot. The section provided anaesthetic coverage for all surgical and some diagnostic procedures involving pediatric patients in the hospital. There was also a pediatric cardiac anaesthesia subsection.

Pediatric cardiac anaesthesia

The subsection of pediatric cardiac anaesthesia was responsible for providing all anaesthetic coverage for pediatric cardiac patients at Children's Hospital during 1994. The subsection did not have a subsection head until May 16, 1994, when Dr. Ann McNeill was appointed to that position. She reported to Ullyot. Four specialists provided pediatric cardiac anaesthetic care during 1994: McNeill, Dr. Jo Swartz, Dr. Heinz Reimer and Dr. Harley Wong.