The two-page handwritten note that Ullyot prepared on behalf of the anaesthetists identified three points: input into the decision-making process, communication and follow-up.

Input into the decision-making process

The anaesthetists wanted to know if the cardiologist, Giddins, declined to refer any patient whom he initially saw to the surgeon, and on what basis such decisions were made. A related question was whether or not the surgeon, Odim, declined to perform surgery on any of the patients Giddins referred to him, and on what basis. The document asked if the anaesthetists could be included in the process of accepting or rejecting patients for surgery in Winnipeg. The anaesthetists recommended that case selection be made by a committee of representatives from cardiology, surgery and anaesthesia, before a decision was made to offer surgery in Winnipeg to the parents. Ullyot testified that during Duncan's tenure there had been extensive discussion between Dr. George Collins, Dr. Kim Duncan and herself before the first Norwood operation was attempted.

Communication

Under 'Communication', Ullyot's document noted that communication appeared to depend on individual initiative. For example, the anaesthetists had questions about why the intra-operative lines were changed in certain cases. The document contained the recommendation that there be weekly review meetings with an agenda and presentations. One of the issues that the anaesthetists wanted to see resolved in these meetings was whether X-rays would be taken in the operating room or in intensive care. It had been Duncan's practice to take X-rays in the OR, while Odim preferred to have them taken in the ICU. The anaesthetists preferred the OR, since it allowed for an immediate correction of problems in the OR if necessary. Odim preferred the ICU because it provided an opportunity to check for problems that might have arisen during the transfer from the OR to the ICU.

Follow-up

Under 'Follow-up,' the anaesthetists stated that the Morbidity and Mortality Rounds were "heavy on pathology, light on physiology and do not address morbidity." (Exhibit 203) They were concerned that only cases involving deaths were discussed, while there was ongoing concern about the extent of post-operative care needed for children who survived.

The anaesthetists recommended that each case be reviewed "to look for ways of smoothing the process. Deaths should be carefully examined to see if there were any difficulties with how the case was managed." In addition, they believed that it was important to look at more than the cases in which the patient died, since "not all good outcomes indicate a good approach." (Exhibit 203)

Ullyot testified that she hoped the committee would determine if the mortality and morbidity rates for the program were higher than they ought to have been. This could have been done, she felt, by matching children on a case-by-case basis with similar children who were cared for in other centres. In her testimony she noted that she believed it ought to have been possible to maintain a continuous record that would indicate, among other matters, the mortality rate. Nothing this rigorous was, in fact, undertaken.

It should be noted that this list did not address the anaesthetists' concern with surgical competence. The anaesthetists' reticence on this point continued.