Kesselman, on behalf of the medical staff of the PICU, prepared a document on June 3, 1994, which identified three areas of concern: surgical equipment, areas of responsibility and communication (Exhibit 227).

Surgical equipment/materials to be available in the PICU for emergency and elective procedures in the PICU

The PICU staff were concerned about the fact that they had not been prepared for the kind of surgical procedures Odim was undertaking in the intensive care unit. The PICU nursing staff had already asked Odim to give them some direction as to what essential equipment he thought should be kept in the unit in anticipation of the procedures he felt he had to perform there. This matter had been raised with him following the Ulimaumi case in March, but had not been resolved before the establishment of the committee. It should be noted that while some of the PICU nurses questioned whether or not it was appropriate to perform certain procedures in the PICU, Kesselman was only asking for more information on the materials Odim needed to perform these procedures. The other two points were linked.

Clarification of areas of responsibility in post-operative management and communication about patient status and proposed changes in therapy, both to the surgeon and from the surgeon.

These points refer to issues that have been discussed in the previous chapter. In particular, it would appear that Odim was still persisting in bypassing intensive care unit doctors and attempting to give medication orders to the PICU nurses. He was also requesting early-morning status reports via phone calls to his residence from nurses, whose schedules of providing nursing care to patients did not allow them enough time to make those telephone calls.

Kesselman testified that he presented these concerns at the committee meeting, and that Odim acknowledged that he would speak directly to the doctors on duty.