Pre-operative condition-first admission

On April 18 Alyssa was admitted to the HSC. A nurse on the cardiac surgical ward noted that Alyssa tired easily, especially during meals. She also noted that Alyssa had a congested cough.

That same day, a physiotherapist assessed Alyssa's pre-operative respiratory status. Donna Still told her that the baby still had a congested-sounding cough following her cold. On examination, the physiotherapist heard breath sounds equally in both lungs. She also heard a low-pitched expiratory wheeze, which was greater in the right upper lobe of the lungs than the left upper lobe. She concluded that Alyssa was not in respiratory distress, but had some upper airway congestion.

The findings of an April 19 heart catheterization confirmed previous studies and measured a large VSD. Specifically Alyssa had an acyanotic Tetralogy of Fallot with a small muscular VSD, in addition to a large subaortic VSD. There was severe sub-pulmonary muscular obstruction, pulmonary valve stenosis and mild right pulmonary artery stenosis. The coronary arteries appeared normal. At the end of the catheterization report, Giddins wrote, "Case to be discussed with the surgical team within next 24 hours." (Exhibit 11, page STI 147)

While Alyssa was in hospital, her mother and grandmother met with Odim. Donna Still testified that the heart problems were explained and she was left with the sense that the operation was common and usually successful. Again, it would appear that there was no discussion of the surgical team's experience.

A nurse recorded on the evening of April 20 that she had completed pre- and post-operative teaching with the child's mother and grandmother. She commented that both women asked questions and seemed to understand the information given to them.

That evening, Giddins and Odim concluded that in view of the recently resolved respiratory infection and the right middle lobe infiltrates seen on the chest X-ray, the operation should be postponed for two to three weeks (Exhibit 11, page STI 149). In his testimony, Odim said:

At the point at which this was brought to my attention, which was in the evening, Dr. Giddins and his staff had spent time with the mom and patient and gotten a history, and examined the patient, and they were of the opinion that given a history of pneumonia, or some pneumonic process, and their own clinical assessment, they felt that they wanted to postpone the case. And when he brought that to my attention, he took me down to take a look at the films, and I went on with his-concurred and deferred to his clinical judgment. (Evidence, page 24,874)

The next day, April 21, Alyssa was discharged to Ronald McDonald House to await surgery. The discharge summary noted that while Alyssa was afebrile and had good air entry in her lungs, when she breathed she did have some abnormal sounds in her upper airways and a "rattly cough." (Exhibit 11, page STI 150)