The Pediatric Cardiac Surgery Inquest Report



The decision to operate

By the spring of 1994, Giddins was giving active consideration to scheduling Ashton's heart repair. A March 30 echocardiogram showed increased right ventricular outflow tract obstruction. While the muscular right ventricular outflow tract obstruction had been giving Ashton a measure of relief from increased pulmonary blood flow, over time the obstruction itself was increasing and coming to represent a threat to adequate blood flow. Ashton continued to be given a diuretic to treat his pulmonary congestion. Giddins wrote to Hawkins that while Ashton was old enough and large enough to undergo a repair, he had no short-term concerns about his health.

On April 11, Ashton's case was presented at the CVT conference. Following this meeting, Odim arranged to discuss surgery with Ashton's parents. The Feakes testified that, based on that conversation, they expected surgery to take place in the spring of 1994.

On May 2, Ashton was admitted to the Children's Hospital with a cough, an elevated temperature and decreased oxygen saturation. After a chest X-ray showed that he had bronchopneumonia, he was given intravenous antibiotics. Ashton also had a rash on his buttocks, trunk, arms, and back. He was discharged in stable condition, still taking the diuretic, on May 17.

Odim met with Ashton's parents on May 30, 1994. In testimony, Odim was unable to explain why there had been a seven-week delay between the CVT of April 11 and the meeting with the Feakes. By the date of this meeting, the PCS program was in hiatus, as a result of the action taken by the anaesthetists. The very serious lesion that had put Ashton in the high-risk category was one that could not be repaired in Winnipeg during this period. Odim testified that he did not inform the parents of the slowdown in the Winnipeg program; nor did he suggest that they consider having the operation performed out of province.

I guess it did not cross my mind. My sense was that was really the territory of the cardiologist and it didn't really cross my mind. They were having discussions with cardiology, cardiology refers me a patient, I see the patient in clinic. (Evidence, page 25,731)

In a letter to Ashton's doctor, Odim wrote:

The planned definitive repair and attendant risks were discussed with the parents in detail. The natural history of medical therapy versus operative intervention was explained to the family. The higher risk in this particular subset of patients with Tetralogy of Fallot and AV canal lesions was explained to the family in detail. In view of his torrential pulmonary blood flow despite his right ventricular outflow tract obstruction and his pulmonary hypertension, which responds to oxygen therapy, I think Ashton is a candidate for definitive repair. (Exhibit 6, page FEA 5)

He also wrote, "In the interest of improving his quality of life and extending his longevity the parents are willing to take the substantial operative risk and consent to surgery." (Exhibit 6, page FEA 5)



Current Home - Table of Contents - Chapter 8 - The decision to operate
Next Consent
Previous Background and diagnosis
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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