Consent

On April 14, the cardiology resident, Doyle, on behalf of Giddins, noted in the chart that Giddins had "discussed with the parents the need for surgery. Dr. Odim to give impression regards surgery here or elsewhere." (Exhibit 12, page TER 25)

Odim and Hawkins met with Danica and Kiril Terziski that afternoon. They explained Daniel's heart defect. His mother was concerned about his prognosis and life expectancy and asked about post-operative complications. Hawkins indicated that she asked very pointed but appropriate questions. No final decision was reached at this meeting.

In her testimony, Danica Terziski indicated that she had asked about a transplant for her son, but had been told that a transplant was not practical in Daniel's case because of problems with rejection. She was also given a description of the defect that her son had. She testified that she was told that a reconstruction of his heart by way of a Norwood had a fifty-fifty chance of success. Odim and Hawkins also discussed comfort care with her.

The Terziskis were told it might be possible to have the operation done outside Winnipeg, in a centre such as Boston or Toronto. When Danica Terziski asked Odim where he would want a child of his operated on, she testified that he responded that it was not his place to comment on such a decision. She testified that Giddins indicated that the team in Winnipeg was as capable as any team elsewhere.

The Terziskis subsequently suggested that Dr. Christo Tchervenkov, a surgeon under whom Odim had trained in Montreal, come to Winnipeg to perform the operation. The idea had particular appeal to the Terziskis, since both Kiril Terziski and Tchervenkov were of Bulgarian descent.

Danica Terziski raised the idea with Hawkins, who according to Danica's testimony, said that it would not be possible for Tchervenkov to operate in Manitoba because his insurance would not cover the procedure. In her testimony, Hawkins said that she could not recall saying it would be impossible to have Tchervenkov perform the operation. However, she did recall saying that it would be difficult. Despite this, the Terziskis also raised the idea with Odim and Giddins. Danica Terziski testified that Giddins became very defensive at that point. She said no one suggested that they go to Tchervenkov in Montreal. Instead they were told that the Winnipeg team was capable of performing the operation. The Terziskis eventually consented to surgery in Winnipeg.

In his testimony Giddins said that he could only vaguely recall the conversation regarding Tchervenkov. He denied that he had been either impatient or angry with the Terziskis. He also testified that "intra-provincial licencing requirements, liability matters, scheduling of various individuals in various places" were, among other issues, matters that may have stood in the way of Tchervenkov operating in Winnipeg (Evidence, page 3,735). It would appear from the testimony that no efforts were made either to contact Tchervenkov or to discover whether or not these impediments would have actually prevented him from coming to Winnipeg to perform the operation.

In the death summary, Odim wrote, "All the management options were presented to the family including palliative medical therapy, heart transplantation, and the Norwood staged operative repair. The family was well informed about the natural history of each option and the risks and eventually decided upon the Norwood approach." (Exhibit 12, page TER 10) There was no mention that the family was actively seeking to have Tchervenkov come to Winnipeg to do the operation or that they were considering having the operation performed elsewhere, both of which the family considered, but from which they were dissuaded.