The Pediatric Cardiac Surgery Inquest Report



Approaches to Wiseman

In the spring of 1994 several individuals approached Dr. Nathan Wiseman with their concerns about the Pediatric Cardiac Surgery Program. Wiseman was the head of the Division of Pediatric Surgery at the HSC. In that position he reported to both Blanchard and Bishop. When asked if his responsibility to each head was equal, he testified that it was "Difficult to say." (Evidence, page 39,370) In his testimony, Dr. Brian Postl, who was the head of pediatrics and child health from September onward, said he thought that Wiseman had no reporting responsibilities to him.

Youngson spoke to Wiseman several times on an informal basis. She said she did this because he was the head of pediatric surgery and was both approachable and respected. She testified that she indicated that she was very worried about what was going on in the program. When Wiseman indicated that he had spoken to Hancock and been given a very positive description of what was happening in the program, Youngson urged him to scrub in for a procedure. He declined to do this. Youngson testified that Wiseman later explained that he declined because he did not take orders from nurses. Wiseman testified that he believed that if he simply came in to observe one of Odim's operations, it would change the atmosphere in the operating room and not be particularly useful as a tool for determining if anything untoward was going on. That view does not explain, however, why he did not take the concerns of the nurses more seriously.

Wiseman testified that while he did not supervise Odim's operations as a result of Youngson's request, he did assist Odim in an operation on April 15. He said at that time he had been made aware of the concerns over cannulation and observed Odim's progress. He said that he found it to be smooth and reminiscent of the work of Dr. Aldo Castaneda, the Boston surgeon with whom both Odim and Wiseman had once trained. After the operation, Youngson asked Wiseman about his assessment of Odim's cannulation. She testified that Wiseman described Odim's technique as cavalier. When asked about this description, Wiseman said:

Well, we better look it up in the dictionary, I may have misused that word. Cavalier, to me, is bold. Aldo's technique of cannulating was bold. The Boston technique of cannulating is bold. Bold is different from timid. Bold isn't bad, bold isn't good, bold isn't timid, bold is different.

Bold, in this case, means to cannulate without the presence of a clamp on the vessel. That's the Boston technique. It is just the technique, cavalier. (Evidence, page 39,540)

Dixon also spoke to Wiseman on a number of occasions. At one point she met with him informally at the scrub sinks and asked him if he would scrub in for an operation with Odim. She testified that he declined to do this, saying that Hancock was present to assist Odim. Dixon testified that she approached Wiseman because she thought Odim reported to Wiseman.

Hinam also testified that she spoke to Wiseman about her concerns and asked him to observe one of Odim's operations. She testified that he declined to do this. Wiseman testified that he could not recall this conversation.

After Borton spoke to Boyle about her concerns with the Goyal case, Boyle also made an appointment to speak with Wiseman about concerns that Hinam, Borton and Youngson had raised. She said that she went to Wiseman because Wiseman was in charge of pediatric surgery. Wiseman could not recall the specific meeting with Boyle, but agreed that it had probably taken place.

McNeill testified that she also had several discussions with Wiseman about the Pediatric Cardiac Surgery Program. She said these were informal discussions, often in the hallways, that in many ways constituted venting on her part. At the same time, McNeill hoped that Wiseman would become involved in the program in some manner.

Well, I think in some ways, he was another surgeon, I knew he had had experience with cardiac surgery during his own training, and he did do ductus ligations and he does do a lot of intrathoracic work. So he has ability to, you know, he has some familiarity with what we were doing I guess.

Again, at that point I get back to what I was saying before, about being really in some ways unsure whether these were valid concerns. And so he was somebody I saw who might be able to sort of reassure me, if you will, or perhaps agree that we should be looking at things more closely.

Oftentimes our operating rooms or the operating setup is very small, like there is only five rooms that run, and it's not uncommon for surgeons to go in each other's rooms and stop in for a chat or things like that, and for an anaesthetist to go back and forth and that sort of thing.

I thought that atmosphere of people, you know, the sort of going back and forth at times, and the fact that he was this titular head of pediatric surgery, I guess in the back of my mind-I shouldn't say I guess-in the back of my mind I was hoping perhaps he might help to come in, into the room and see how things were going, to see whether some of the interaction and/or procedure was going. (Evidence, pages 13,224-13,225)

Swartz also spoke, informally, with Wiseman about her concerns with Odim. Specifically, she recounted what, in her view, had happened in the Ulimaumi case. She stated she spoke to Wiseman because he was both a respected colleague and the head of pediatric surgery. She said Wiseman told her that he had been speaking to Hancock, who provided him with a very different account of the operation.

Wiseman testified that he never thought that he was being approached as Odim's supervisor, a position that he did not believe he occupied. From the evidence it appears that Wiseman was correct, he was not Odim's supervisor and Odim did not report to him. However, it should be noted that Wiseman had a responsibility as the head of pediatric surgery to ensure that the quality of surgery offered at Children's Hospital was of the highest degree. He was also a member of the panel of three pediatric surgeons charged with investigating pediatric surgical deaths, a member of the Children's Hospital Standards Committee and a member of the College of Physicians and Surgeons of Manitoba's Paediatric Death Review Committee. He was more than a disinterested colleague.

Swartz testified that, aside from her concerns about specific operations such as the Ulimaumi case, she was starting to have concerns about case selection. She realized that Giddins was under tremendous strain.

And I found him tired, testy at times, and sometimes just run off his feet.

And then you begin to wonder, is this guy making-where does he come from when he is making his decisions? Is he able actually to have time to sit down and think and make decisions? Is he able to also be, say the administrator of Variety Heart Centre and deal with all of those issues also? So-and I don't know who-see this, he didn't ever confide in me, for example, but I had to wonder how he was managing to do all of this. (Evidence, pages 15,731-15,732)

Swartz said that by the time Vinay Goyal underwent surgery, she was becoming concerned that the program had been restarted without sufficient preparation. She said that she had discussed her concerns with other anaesthetists.

We had experience with these types of surgeries as anaesthetists, perfusionists and nurses. And I guess we assumed that Dr. Odim had experienced these procedures himself. Although I was-I had reservations, we went ahead with the procedure thinking that it wasn't-I mean, it is complex but it wasn't that complex. (Evidence, pages 15,390-15,391)

McNeill said that by the time of Vinay Goyal's death there were informal discussions among various HSC staff in which people asked why the program had not confined itself to low-risk cases. However there were no formal objections. She believed that everyone was still committed to the program.



Current Home - Table of Contents - Chapter 6 - Approaches to Wiseman
Next Anaesthetic meetings
Previous Perfusionists
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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