The Pediatric Cardiac Surgery Inquest Report



The Williams and Roy Report

On February 3, Williams and Roy sent their report to Blanchard. The report listed ten conclusions. Williams and Roy stated that there was evidence to question Odim's technical competence; that Odim might have been judged unfairly since he had attempted to adopt the HSC's methods rather than import his own preferences; and that the program had been poorly supported by the HSC from the outset. On this last point, Williams and Roy commented that it appeared that the program lacked protocols for effectively resolving disputes over patient care. It should be noted that Williams and Roy specifically stated that their report "neither exonerates nor condemns the present surgeon." (Exhibit 20, Document 364) They concluded that there was a crisis of confidence and identified the hostilities that have been described by this Inquest report. They also noted that their work was:

. . . hampered somewhat by the lack of relevant data. Information relating to morbidity and length of stay were unavailable. Those interviewed often referred to these issues but were unable to support their contentions with data. This program needs to establish an accessible database. (Exhibit 20, Document 364)

Other key issues that the report identified were the long periods of bypass, the large number of people involved in providing both anaesthetic and post-operative care and the lack of an identifiable budget for the program.

Their report contained two proposals for consideration. The first was that the program be consolidated with the program in Saskatoon.

An amalgamated single unit would be cost effective because of an economy of scale (which would need to be proven, although there is data to support such a conclusion) and would provide a critical mass of patients for focused expertise including two pediatric cardiac surgeons. If the program is moved to Saskatoon it solves all of the above problems in a single stroke. If the unit is located in Winnipeg, a major restructuring is required. (Exhibit 20, Document 364)

The report noted that in the United States, larger units were not only more cost effective, but had better morbidity and mortality rates than smaller units.

If the program was to remain in operation in Winnipeg, they suggested a complete restructuring. This would involve the creation of a cardiac program run by a triumvirate of a nurse administrator, a doctor and a hospital administrator.

All aspects of the cardiac service, namely surgery, cardiology, cath lab., operating room, ward, outpatient clinics, cardiac nursing, intensive care should be organized and run by the 3 program administrators. These three individuals should be directly responsible to the vice president or the CEO of the hospital and responsible for all aspects of the cardiac program including the budget. (Exhibit 20, Document 364)

They further stated that Lindsay needed to make this program his first priority. To do this, they recommended that the chief of surgery assist at all pump operations for the coming year. This was to allow an assessment of the surgeon, to provide consistency, and to resolve disputes. They also recommended that the chief of surgery be available to ensure that case selection was appropriate and that issues, such as the transfer of all patients to a single ICU, were resolved quickly. Williams and Roy believed that between two to three anaesthetists should be involved in the program, that all cases should be dealt with by a single ICU, that nurses had to be involved in program decision-making in a meaningful manner and that two more cardiologists should be hired.



Current Home - Table of Contents - Chapter 9 - The Williams and Roy Report
Next Responding to the report
Previous From Lindsay to Williams and Roy
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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