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Report of the Royal Commission of Inquiry Into Certain Deaths at the Hospital for Sick Children and Related Matters

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Report of the Royal Commission of Inquiry Into Certain Deaths at the Hospital for Sick Children and Related Matters Digitized by the Internet Archive in 2010 with funding from The Law Foundation of Ontario & the Ontario Council of University Libraries http://www.archive.org/details/reportofsickkidsOOonta Publication* -^3^ Hon Report of the Royal Commission of Inquiry into Certain Deaths at the Hospital for Sick Children and Related Matters The Honourable Mr. Justice Samuel G. M. Grange Supreme Court of Ontario Commissioner Ontario Published by the Ontario Ministry of the Attorney General Printed in Canada - 1984 ISBN 0-7743-9968-6 Copies are available in person from: Ontario Government Bookstore, 880 Bay Street Toronto, Ontario Or by mail through: Publication Services 5th Floor 880 Bay Street Toronto, Ontario M7A 1N8 For information call 965-6015; toll-free 1-800-268-7540; from area code 807, ask operator for Zenith 67200. MARI8IW \ The Honourable Mr. Royal Commission of Inquiry into 416/963-2778 180 DundasSt. W. 22nd Floor Justice Samuel Grange Certain Deaths at the Hospital Commissioner Toronto, Ontario Related Matters for Sick Children and M5G 1Z8 P.S.A. Lamek, Q.C. Counsel E.A. Cronk Assistant Counsel Thomas Millar Administrator December 28, 1984 The Honourable R. Roy McMurtry, Q.C, Attorney General for Ontario 18 King Street East Toronto, Ontario M5C 1C5 Dear Mr. Attorney: Pursuant to the Orders-in-Council of April 21, 1983 and May 24, 1984, setting up this Royal Commission under the Public Inquiries Act, I have completed my Report and now submit it. Yours truly. S. G. M. Grafnge Commissionej TABLE OF CONTENTS COMMISSION STAFF ix LIST OF COUNSEL x LIST OF WITNESSES xii (a) PHASE I xii (b) PHASE II xvii THE REPORT A. INTRODUCTION i 1. THE STORY IN OUTLINE 1 2. THE COMMISSION 2 B. THE CAUSE OF DEATH - PHASE I 7 3. STATISTICS 7 (a) The Wards 7 (b) The Times 8 (c) Personnel 8 (d) Conclusions 8 4. THE DEATHS, THE HOSPITAL, ITS STAFF AND THEIR CONCERNS 10 5. DIGOXIN, ITS PROPERTIES 15 (a) History 15 (b) Function 15 (c) Pathology 15 (d) Methods of Administration 16 (e) Its Operation 17 (f) Its Distribution, the Alpha Phase. 17 (g) Its Excretion, the Beta Phase. ... 18 (h) Symptoms of Toxicity and Use of Digoxin for Therapeutic Purposes. 18 6. DIGOXIN, ITS TESTING 20 (a) History and Acceptable Levels. ... 20 (b) The Taking of Tests or Levels. ... 20 (c) The Methods of Testing 21 i) RIA 21 ii) FPIA 22 iii) HPLC 22 iv) GC/MS 22 (d) Testing by the Hospital for Sick Children and the Centre of Forensic Sciences 23 (e) Tissue Samples 24 (f) Substance X 25 Other Interpretation Problems. ... 27 (h) Post-Mortem Factor 27 (i) Recent Developments and Conclusions. 29 7. THE EXPERTS . 32 Cardiology 32 it] Pathology 33 (c) Pharmacology -'^ (d) Biochemistry 34 (e) Toxicology 34 (f) Epidemiology and the Atlanta Report. 34 (g) Other Experts 37 8. MEDICATION ERROR AND THE THEORY OF ACCIDENT 38 9. THE HEART AND ITS FUNCTION 42 10. THE CHILDREN 44 (A) General 44 (B) Specifics 49 (1 Laura Woodcock 49 (2 Alan Perreault 52 (3 Andrew Bilodeau 54 (4 David Taylor 56 (5 Amber Dawson 59 (6 Lillian Hoos 63 (7 Philip Turner 65 (8 Dion Shrum 67 (9 Kelly Ann Monteith 70 (10 Paul Murphy 72 11 Antonio Velasquez 74 12 Lauretta Heyworth 77 13 Brian Gage 79 14 Richard McKeil 81 15 Antonio Adamo 84 16 Francis Volk 86 17 Matthew Lutes 88 18 John Onofre 90 19 Darcy MacDonald 93 20 Real Gosselin 95 VI (21 Stephanie Lorabardo 98 (22 Jesse Belanger 102 (23 Janice Estrella 105 (24 Frank Fazio Ill (25 Bruce Floryn 113 (26 Jennifer Thomas 115 (27 David Leith 117 (28 Colleen Warner 119 (29 Jordan Mines . 121 (30 Barbara Gionas 127 (31 Michelle Manojlovich 130 (32 Kevin Pacsai 133 (33 Kristin Inwood 141 (34 Charlon Gardner 145 (35 Allana Miller 147 (36 Justin Cook 152 11. THE CONSIDERATIONS LEADING TO THE CONCLUSIONS 157 (a) The Categories 157 (b) Onus 158 (c) Meaning of Categories 159 (d) Credibility of Witnesses 160 (e) Severity of Illness and Autopsy Findings 160 (f) Recommendations 161 12. THE CONCLUSIONS ON PHASE I 162 (a) Deaths by Digoxin Toxicity 162 (b) Natural Deaths 165 (c) Highly Suspicious Deaths 166 (d) Suspicious Deaths 167 (e) Undesignated Deaths 169 (f) Summary 170 C THE INVESTIGATION AND PROSECUTION - PHASE II 173 13. THE FACTS UP TO THE ARREST 173 (a) The Coroners 173 (b) The Police 175 (c) The Nurses 182 14. THE ARREST 185 15. THE EVENTS IMMEDIATELY SUBSEQUENT TO THE ARREST 189 Vll 16. THE INVESTIGATION TO THE COMMENCEMENT OF THE PRELIMINARY INQUIRY 195 4r 17. THE PRELIMINARY INQUIRY 201 -klS, THE JURISDICTIONAL QUESTIONS 208 19. THE CONCLUSIONS ON PHASE II 214 (a) The Standards 214 (b) The Hospital and the Doctors .... 214 (c) The Nurses 215 (d) The Coroners 215 (e) Susan Nelles 216 (f) The Police 217 (g) The Crown 219 (h) Compensation 220 ^ EPILOGUE 223 APPENDICES 1. ORDER-IN-COUNCIL 227 2. AMENDING ORDER-IN-COUNCIL 231 3. REASONS FOR JUDGMENT OF THE COURT OF APPEAL 233 4. STATEMENT OF CLAIM - Nelles V. The Queen et al 254 5. CHART OF CARDIOLOGY WARD DEATHS OCCURRING ANYWHERE IN THE HOSPITAL 263 6. CHART OF DEATHS OCCURRING ON WARDS 4A AND 4B 265 7. CHART OF DEATHS BY TIME FROM 2400 TO 0600. 267 8. CHART OF DEATHS BY TIME FROM 0100 to 0500. 269 9. SUMMARY OF ATLANTA REPORT FINDINGS .... 271 10. LIST OF EXPERT WITNESSES IN PHASE I. 273 11. DIAGRAM OF THE NORMAL HEART 277 12. DIAGRAM OF THE CIRCULATION OF THE HEART. 279 13. GLOSSARY OF MEDICAL TERMS 280 INDEX 289 Vlll COMMISSION STAFF Commissioner The Honourable Mr. Justice Samuel G.M. Grange Counsel P.S.A, Lamek, Q.C. Associate Counsel E.A. Cronk Administrator Thomas B. Millar Computer Consultant Anne Gilraour-Bryson Ph.D. Research Counsel Anita Fineberg Registrar Murray Elliott Police Advisors Superintendent Murray McMaster Det./Insp. Charles Judson Computer Operator Eric Stine Secretarial Staff Helen Warburton Dorothy Kosonic Brenda Boyd Phyllis Traversy Office Manager Robert Kosonic Security Officers Constable Ken McLeod Constable John McMullen Research Assistants Mark Hayes James Marsland Assistants to Mark Davidson Office Manager Michael Madarang IX LIST OF COUNSEL WHO APPEARED BEFORE THE INQUIRY P. S. A. Lamek, Q, C. For the Commission E. A. Cronk Anita D. Fineberg Thomas C. Marshall, Q.C. For the Attorney General for Douglas C. Hunt Ontario, the Solicitor General Lucy A. Cecchetto for Ontario, Crown Attorneys and Coroners Barry A. Percival, Q.C, For the Metropolitan Toronto David Young Police Force Ian G. Scott, Q.C. For the Hospital for Sick Ian J. Roland Children Mary M. Thomson G. Richard Batty Stephen M. Grant Ross Wells Reva E. Devins W. Niels Ortved For Various Doctors at the Kirby Chown Hospital for Sick Children Frances Kiteley For the Registered Nurses' Elizabeth Symes Association of Ontario and Elizabeth Mclntyre 39 Individual Nurses Holly Solomon For the Ontario Association Marion L. Cohen of Registered Nursing Assistants and Various Ward Clerks at the Hospital for Sick Children John Sopinka, Q.C. For Susan Nelles David Brown William A. Bogart Kathryn I. Chalmers Claude R. Thomson, Q.C, For Phyllis Trayner George R. Strathy Elizabeth J. Forster Patricia Rae , Marc Rosenberg For Sui Scott Christopher N. Buhr Brent S. Knazan For Marianna Christie Barbara L. Jackman Nancy S, Goodman John A. Olah For Janet Brownless Morris Manning, Q.C. For the Parents of Children Stephen M. Labow Justin Cook, Barbara Gionas, Real Gosselin, Kristin Inwood Matthew Lutes, Paul Murphy, and Philip Turner Frederick J. P. Shanahan For the Parents of Babies Amber Dawson and Stephanie Lombardo Jack S. Shinehoft For the Parents of Baby Kevin Pacsai Warren W. Tobias For the Parents of Baby Peter Krawec Jordan Mines Glen R, Solomon SPECIAL APPEARANCES Mary Eberts For Elizabeth Symes Alan A. Borovoy For the Canadian Civil Liberties Association Daniel J. Henry For the Canadian Broadcasting Corporation Clayton Ruby For The Globe and Mail Alex K, Paterson, Q.C, For Dr. Peter Macklem (of the Quebec Bar) Peter Y. Atkinson Vera Neslund For Dr. James Buehler (Attorney at Law State of Georgia) XI 1 LIST OF WITNESSES APPEARING BEFORE THE INQUIRY PHASE I NAME POSITION AS AT MARCH, 1981 OR AT RELEVANT TIME BAIN, Dr. Harry Former Chief of Pediatrics Hospital for Sick Children BECKER, Dr. Laurence Senior Pathologist Hospital for Sick Children BELL, Bertha, R.N. Team Leader Ward 4B Hospital for Sick Children BROWNE, Carol, R.N. Pediatric Clinical Nurse Specialist Wards 4A/B Hospital for Sick Children BROWNLESS, Janet, R.N. A. Nursing Assistant Ward 4A Hospital for Sick Children BUCCI, Gloria, R.N. Staff Nurse Ward 4A Hospital for Sick Children BUEHLER, Dr. James Medical Epidemiologist Field Services Division Centers for Disease Control Atlanta, Georgia BUNT, Dr. Donald G. Coroner for the Province of Ontario CARVER, Dr. David ' Chief of Pediatrics Hospital for Sick Children CHRISTIE, Marianna, R.N. A. Nursing Assistant Ward 4A Hospital for Sick Children CIMBURA, George Director of the Toxicology Section Centre of Forensic Sciences Toronto XI LIST OF WITNESSES APPEARING BEFORE THE INQUIRY PHASE I NAME POSITION AS AT MARCH, 1981 OR AT RELEVANT TIME COSTELLO, Mary, R.N. Head Nurse Ward 4B Hospital for Sick Children COSTIGAN, Dr. Colm Chief Pediatric Resident Hospital for Sick Children COULSON, Mary K., R.N. Night Nursing Supervisor Hospital for Sick Children CUTZ, Dr. Ernest Senior Pathologist Hospital for Sick Children DAWSON, Heather Mother of Baby Amber Dawson ELLIS, Dr. Graham Assistant Biochemist Hospital for Sick Children FAY, Dr. John Cardiologist Department of Medicine and Department of Pediatrics Kingston General Hospital FOWLER, Dr.
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