http://bmj.com/cgi/content/full/323/7322/1148/c

BMJ 2001;323:1148 ( 17 November )

News roundup

Parents object to watering down of recommendations in infant death case

David Spurgeon Quebec

Three families whose children died seven years ago in Winnipeg’s paediatric cardiac surgery unit, in a situation reminiscent of that at the cardiac surgery department of the Bristol Royal Infirmary in England, fear that recommendations from the inquest have been watered down

The findings of the inquest were not published until last December, six years after the deaths of the children (BMJ 2000;321:1433). Paul Thomas, professor of political science at the University of Manitoba, was then given four months to devise a plan to implement the inquest’s 36 recommendations. He produced a report last spring.

Saul Simmonds, lawyer for the three families who are protesting about the report, said that the 51 recommendations in Professor Thomas’s report "could have been written by the doctors. They’ve all circled their wagons" (Canadian Medical Association Journal 2001;165:1242).

The inquest and Professor Thomas’s report relate to the deaths of 12 infants who died after paediatric cardiac surgery in 1994 at the Winnipeg Health Sciences Centre. Mortality was 29% among high risk cases compared with a norm of 11%.

The parents endured 30 months of testimony and then waited three months for the inquest report. The cardiac programme has since been shut down. There are similarities to the inquiry into the deaths of babies from cardiac surgery at the Bristol Royal Infirmary, which was published last summer, six years after the last baby died, and 13 years after high mortality was first noted (28 July, p 181). Both showed a flawed system that included mismanagement and surgical inadequacies.

In the Winnipeg case, because parents were not given enough information—particularly about the surgeon’s relative inexperience—the judge who presided over the inquest, Justice Murray Sinclair, recommended that all hospitals provide patients with information about physicians’ education, experience, complaints lodged, and disciplinary action taken against them. Professor Thomas’s report supports the creation of physician profiles, but he said the programme would be expensive and might deter physicians from moving to Manitoba.

Professor Thomas said that many of Justice Sinclair’s recommendations are idealistic and that he didn’t test their feasibility. He called Manitoba "a have-less province," where health costs consume 40% of the provincial budget. "I know it sounds crass, but we have to be politically and economically realistic," Professor Thomas is quoted as saying.

Mr Simmonds and the families are angry about this. Mr Simmonds criticised, for example, Professor Thomas’s advocacy of inhospital disclosure-protection policies, rather than legislation on whistleblowing suggested by the inquest report. In response, Professor Thomas said that new evidence from the Bristol case shows that whistleblowing legislation does not work. "We don’t want symbolic gestures," Professor Thomas told the Canadian Medical Association Journal. "We want to implement things that work."

Professor Thomas said that he appreciated the parents’ frustration because they believe no one has been held accountable for their children’s deaths. He has demanded that all the people affected by his recommendations—government departments, the regional health authority, the hospital, the nurses’ association, the College of Physicians and Surgeons, and the medical examiner—must implement them as soon as possible, and report their progress by next spring.
 

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