Who was in charge?

Before moving on to the events of 1994, it is worthwhile to review two points: the approach that was taken to restarting the program and the degree of confusion that existed as to who had responsibility for Odim's surgical performance.

It is worth comparing the 1994 restart with the manner in which Barwinsky and Collins handled Duncan's arrival. In that case, a senior surgeon with considerable experience in pediatric cardiac surgery and a senior cardiologist believed that it was crucial to move the program forward at what could best be described as a very deliberate pace. They were determined to make sure that the problems associated with de la Rocha's tenure did not recur.

While it appears that many senior figures at the HSC in 1994 believed that such a pace was appropriate, they also believed that someone else was responsible for ensuring that the pace was followed.

This relates as much to the confusion over the lines of authority as it does to anything else. Odim said:

I knew I had been recruited to replace Dr. Kim Duncan in the established program. I knew that I was under the aegis of the Department of Surgery and the Department of Cardiothoracic Surgery, therefore, I reported to Dr. Blanchard and Dr. Unruh. I knew that I was also a physician in the Variety Heart Centre and reported to the chief of that centre, which was Dr. Giddins.

Q. You said, okay, Dr. Giddins, right?

A. So it was sort of a three-pronged or three-headed relationship through cardiac surgery, the Department of Surgery and the Variety Heart Centre. And I guess you could add a fourth head, Dr. Wiseman, as the surgeon in chief of the Children's Hospital. And I was one of the-so these were my bosses, at least my perception of who my bosses were. (Evidence, page 23,937)

On the need to phase a new surgeon into the program, Unruh said that he was not disturbed by the fact that, aside from the first six months of 1993, Odim had largely been away from surgery for four years when he came to Winnipeg. He said he expected that Odim would have the insight to recognize that he had been away from the operating room for a while and would act on this insight. As a result, he never passed these views on to Odim. While he believed that it was important for someone in Odim's position to phase himself into surgery slowly, he did not think it was necessary to communicate this view to Odim. Nor did he speak with Giddins about the start-up of the program.

The unit had functioned so well up until that point in time that I really didn't have an understanding of the relationship between the cardiologist and the surgeon. I assumed that Dr. Giddins would take the leadership role that had been given to him and would phase in the program. But I never specifically gave any directives to him as to how to phase it in. (Evidence, page 35,038)

Unruh's job description makes no differentiation between adult and pediatric services. However, Unruh said:

I didn't have any direct responsibility. That historically and de facto went to the program, so I didn't have any direct responsibility, but I ultimately did have some responsibility for the surgical aspects of that program. (Evidence, page 37,735)

Unruh said he believed that Giddins would be responsible for Odim. However, he never confirmed that understanding with Giddins. In his testimony, Giddins said he believed that Unruh was responsible for the surgical program. He believed his responsibility was for medical care, not surgical. He said:

I think my responsibility is to ensure that that process by which that the patient gets to the operating room is appropriate, and to the best of my knowledge, that that operating room that the patients are headed to is capable. (Evidence, pages 36,405-36,406)

Unruh further testified:

I saw my responsibilities as ensuring there was an acceptable peer review process in place. That peer review process was somewhat unique in this situation because we were bringing a surgeon in to a multi-disciplinary program. The responsibility which I exercised over other cardiac and thoracic surgeons was not exercised to the same extent over Dr. Odim, because I had delegated de facto that responsibility to the Director of the Variety Heart Centre. That is how I saw my responsibility. (Evidence, pages 37,858-37,859)

This was not a view that Giddins shared.

Blanchard told the Inquest that, when Odim arrived, he encouraged him to focus his work on completing his Ph.D. and not become overwhelmed by clinical matters. However, Blanchard also never met with Odim and Giddins to discuss their plans for restarting the program.

It would be fair to say that at the institutional level, the Pediatric Cardiac Surgery Program had a number of problems relating to both planning and communication. When the rough start that Tchervenkov had worried about materialized, other planning and communication problems impeded an efficient resolution of the ensuing issues.