Bawa-Garba case has left profession shaken and stirred
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k456 (Published 29 January 2018) Cite this as: BMJ 2018;360:k456
The case of Hadiza Bawa-Garba, who was struck off the UK medical register by the High Court on 25 January,1 could be a tipping point in the way the criminal justice and regulatory systems deal with doctors whose failings play a part in their patients’ deaths.
Her case has sparked a realisation in the medical profession and government that a system that heaps the blame on an individual for wider hospital failures could stop the development of a no-blame culture in its tracks, further endangering patients’ safety.
Within hours of the judgment, Jeremy Hunt, the secretary of state for health and social care for England, pronounced himself “totally perplexed” by the General Medical Council’s decision to appeal against a medical practitioners tribunal conclusion that Bawa-Garba should be suspended from the register but not struck off, despite her conviction for manslaughter by gross negligence.
By lunchtime on Monday 29 January supporters had raised more than £200 000 (€230 000; $280 000) to crowdfund advice on appeals against both the High Court ruling and her original conviction, and the needle was ticking up by the minute, with 27 more days to go (crowdjustice.com/case/help-dr-bawa-garba).
A donor who pledged £15 wrote, “Don’t relent for your cause is just. Your colleagues across the world in Australia support you too!” Another, who gave £50, added, “My own experiences have shown a system at breaking point causing suboptimal care. Those responsible need to be held to account.”
The High Court’s decision has sparked fears throughout the medical profession that moves to develop a more open culture in the NHS could be scuppered, threatening patient safety. Thousands of doctors have signed a letter warning that the case could deter doctors from admitting their mistakes, leading to further tragedies in the future.
The Royal College of Paediatrics and Child Health said that it had initiated a “high-level dialogue” with the GMC and the Crown Prosecution Service to discuss the issues in the case, which had engendered “anxiety, anger, and bewilderment.”
Hunt tweeted that he was “deeply concerned about possibly unintended implications here for learning and reflective practice in e-journals.” Later he told the BBC, “For patients to be safe, we need doctors to be able to reflect completely openly and freely about what they have done, to learn from mistakes.”
Evidence not heard
Among the evidence before the jury at Bawa-Garba’s criminal trial was a reflective document from her e-portfolio, which she filled in seven days after 6 year old Jack Adcock died from sepsis at Leicester Royal Infirmary. Yet the jury was not told of the many improvements that the hospital had brought in after the serious untoward incident report into the case, which highlighted the multiple system failures contributing to Jack’s death.
The medical practitioners tribunal heard evidence about the context in which Bawa-Garba was working before it decided that erasure would be disproportionate. She had just returned from 13 months’ maternity leave but had no induction. She was asked to cover the children’s assessment unit along with her own ward duties.
A foundation doctor and senior house officer were working under her, but both had rotated to paediatrics only that month. The consultant covering the children’s assessment unit was teaching elsewhere. IT facilities for the whole hospital had broken down, and there were shortages in the nursing staff.
The tribunal took account of the system failures in deciding to suspend Bawa-Garba for 12 months. But the High Court ruled that the tribunal had impermissibly gone behind the verdict of the jury and that Bawa-Garba had to be struck off to maintain the public’s confidence in the medical profession.
Jeremy Hyam QC, a senior barrister who acted for Bawa-Garba at an earlier stage but not at her trial or before the tribunal, described the High Court’s judgment as “surprising.”2
The Academy of Medical Royal Colleges said that the case “brings into sharp focus a number of deeply concerning issues which must be addressed with some urgency.” The Royal College of Emergency Medicine agreed, adding, “We believe that unless clear action is now taken, the consequences of this case will have a damaging effect on the morale of junior and senior staff managing risks which are often much outside of their control.”
“Truly humbled”
The CrowdJustice campaign to fund advice on possible appeals was set up by the junior doctors Moosa Qureshi, James Haddock, and Chris Day. In a statement Bawa-Garba said that she was “overwhelmed with gratitude” and “truly humbled” by the response to the campaign. She added, “This tragic case raises some important questions. I share all of your concerns about the implications of this case and the GMC’s actions on future patient safety.
“In the light of this huge outpouring of support, I plan to use your generous funds to change to a top independent legal team, to potentially challenge the GMC and to have an independent review of the original conviction.”
Rob Hendry, medical director at the Medical Protection Society, which represents Bawa-Garba, said, “The strength of feeling on the outcome of this case and its implications for the healthcare community have been clear to see. We are pleased Jeremy Hunt has acknowledged the concern. This is an important and timely gesture for the profession.”
The GMC’s chief executive, Charlie Massey, said, “We have already been speaking to the Royal College of Paediatrics and Child Health and a number of other organisations and individuals about some of the wider issues highlighted by this case. We will continue to work with royal colleges and other organisations over the coming weeks to address the concerns that we are hearing clearly from doctors.”
Footnotes
bmj.com News Analysis Back to blame: the Bawa-Garba case and the patient safety agenda doi:10.1136/bmj.j5534