The Pediatric Cardiac Surgery Inquest Report



Chapter 8 - Events Leading to the Suspension of the Program September 7, 1994 to December 23, 1994



On September 7, 1994, the Wiseman Committee determined that it was appropriate for the Pediatric Cardiac Surgery Program to resume full service, which it did for the next three and a half months. Following the deaths of five more children, however, the program was stopped, pending the institution of an external review. The program has not reopened since the suspension.

The events of that three-and-a-half-month period are described and discussed in this chapter. It should be noted that, during this period, Dr. Brian Postl assumed the position of head of pediatric services. While Postl was originally under the impression that the problems of the PCS program had been resolved, he became increasingly concerned about the program. As problems mounted, he sought more information and took steps that he had reason to believe would address problems in the program.

As opposed to the first half of 1994, many of the difficult operations that were carried out and deaths that occurred during this period involved newborns. As a result, the neonatal intensive care unit became increasingly involved in the care of children from the Pediatric Cardiac Surgery Program. Representatives of that unit played a key role in the decision to suspend the program in December 1994. At the same time, as the following text indicates, the program continued to be plagued with problems in communication and with concerns about the surgeon's technical abilities.



Current Home - Table of Contents - Chapter 8 - Preamble
Next September 7 - the return to full program
Previous Chapter 7
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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