The Pediatric Cardiac Surgery Inquest Report



The relationship between Collins and Duncan

The controversy that had been generated by de la Rocha's experiences shaped the relationship between Collins and Duncan on the latter's arrival in Winnipeg. Duncan testified that after he arrived in Winnipeg, he was often told that there must not be a duplication of the de la Rocha experience. When asked what he understood the de la Rocha experience to be, he testified:

They had what people felt was unacceptable mortality, unacceptable conduct, unacceptable patient management. They emphasized the mortality, but the mortality by itself wasn't what I think really upset people the most. It was the lack of, the lack of ability of the individuals involved to communicate and to work together. (Evidence, pages 23,478-23,479)

Collins and Barwinsky worked together to ease Duncan into surgery in Manitoba. The two men arranged the surgical schedule to ensure that Duncan's first Winnipeg operations were on older children. Barwinsky made a point of assisting at Duncan's first operations. This attitude is reinforced by a letter from Collins to Dr. Agnes Bishop, the head of pediatrics and child health at the HSC, on March 6, 1986, in which he wrote:

However, this year Kim Duncan arrives in early July. While the start will be very gradual, there would be a real advantage to having him get used to the team by doing one operation a week working with Jary Barwinsky on simple cases, much like we are doing at present. (Exhibit 17, Document 44)

Although he had arrived in the summer, it was not until December 1986 that Duncan actually operated on an infant in Winnipeg. The operation was not a planned procedure. It took place because a plane en route from Sault Ste. Marie to Toronto, and carrying a child in need of an emergency operation, was diverted by a storm to Winnipeg. The operation went well.

Collins made it clear that he did not want the surgical program to take on more than it could handle. Duncan said:

He told me that he wanted to be able to do virtually everything in Winnipeg, every kind of case. And he said that he needed me to tell him when I was ready, or when I felt our team was ready, and when I felt that we needed to go slow or not do a case. And he also said that if he saw things happening that he would intervene and say, we should think about something else. (Evidence, page 23,347)

Collins was also concerned that Duncan not undertake surgery when he was in less than optimal condition. He once dissuaded Duncan from performing surgery one morning when Duncan had been up all night attending to a child in the intensive care unit. While Collins was concerned about the program's reputation, it is clear that his overriding concern was the patients' safety and well-being.



Current Home - Table of Contents - Chapter 5 - The relationship between Collins and Duncan
Next Collins's role in monitoring performance
Previous The matrix concept
Section 1 Chapter 1 - Introduction to the Issues
  Chapter 2 - Pediatric Cardiac Issues
  Chapter 3 - The Diagnosis of Pediatric Heart Defects and their Surgical Treatment
  Chapter 4 - The Health Sciences Centre
Section 2 Chapter 5 - Pediatric Cardiac Surgery in Winnipeg 1950-1993
  Chapter 6 - The Restart of Pediatric Cardiac Surgery in 1994
January 1, 1994 to May 17, 1994
  Chapter 7 - The Slowdown
May 17 to September 1994
  Chapter 8 - Events Leading to the Suspension of the Program
September 7, 1994 to December 23, 1994
  Chapter 9 - 1995 - The Aftermath of the Shutdown
January to March, 1995
Section 3 Chapter 10 - Findings and Recommendations
Appendix 1 - Glossary of terms used in this report
Appendix 2 - Parties to the Proceedings and counsel
Appendix 3 - List of witnesses and dates of testimony
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