Bawa-Garba and beyond: hope or despair?
In 2015 Dr Hadiza Bawa-Garba was found guilty of gross negligence manslaughter after mistakenly misdiagnosing sepsis as gastroenteritis in 6-year-old Jack Adcock, who subsequently died in 2011 at Leicester Royal Infirmary.
In light of the evidence against her, Dr Hadiza Bawa-Garba initially received a 24-month suspended sentence for gross negligence manslaughter.1 Imposing a one-year sanction, the Medical Practitioners Tribunal (MPT) argued that erasure from the register would have been ‘disproportionate‘.2 However, the GMC later appealed against the MPT’s decision stating that in order to protect ‘public confidence in the [medical] profession’, Dr Bawa-Garba should be erased from the medical register. The high court initially ruled in favour of the GMC3 but on 13th August 2018 the Appeal Court concluded that the High Court had been wrong to interfere with the original decision of suspension by the MPT.4 This verdict was unprecedented in many ways; notably due to the fact that Dr Bawa-Garba’s case was put before the Appeal court as a result of a massive crowd-funding initiative – with over £360,000 raised by over 11,000 supporters.5 In addition, both the British Medical Association (BMA) and the British Association of Physicians of Indian Origin (BAPIO) applied to intervene in the appeal in order to reflect the impact of her case on the medical profession.6,7
Timeline of the case:
• February 2011 – Jack Adcock, aged 6, a patient with Down’s Syndrome, died from sepsis at Leicester Royal Infirmary
• December 2014 – Dr Bawa-Garba and two nurses (Theresa Taylor and Isabel Amaro) were charged with gross negligence manslaughter
• November 2015 – Dr Bawa-Garba was found guilty of gross negligence manslaughter and given a two-year suspended sentence. The nurse Theresa Taylor was cleared of any wrongdoing
• August 2016 – Nurse Isabel Amaro is struck off the medical register
• December 2016 – Dr Bawa-Garba was denied permission to appeal against her conviction for gross negligence manslaughter
• June 2017 – The MPT suspends Dr Bawa-Garba for 12 months with the comment that erasure from the medical register would be ‘disproportionate’. In evidence, the MPT cited the plethora of hospital systemic failures that Dr Bawa-Garba was working in that day.
• January 2018 – The High Court ruled that Dr Bawa-Garba should be struck off the medical register to maintain public confidence in the profession
• March 2018 – Dr Bawa-Garba was granted leave to challenge her erasure from the medical register in the Court of Appeal
• August 2018 – The Court of Appeal ruled in favour of Dr Bawa-Garba after concurring that the original decision by the MPT of a one-year suspension from the register should stand
Since the details of Dr Bawa-Garba’s case became public there has been a global outpouring of support for her.8 Thousands of doctors across the UK have flocked to her side as they recognised the extremely challenging working conditions of that day.9 For example, Dr Bawa-Garba had worked long hours under extreme pressure, was stretched between caring for too many patients on too many wards, was only partially supervised, had only just returned from maternity leave, and (they feel) was also punished for being too honest about her failings through her reflective practice notes. These notes appear to have been taken down by the duty consultant as her Eportfolio was not admitted to trial in formal evidence.10
On the day that Jack was admitted to hospital, Dr Bawa-Garba made the duty consultant aware that Jack had been admitted with a PH of 7.084 and a high lactate during a handover meeting at 16.30. However, the duty consultant did not immediately review the patient as he told the court that Dr Bawa-Garba had failed to adequately ‘stress’ the abnormality of these results to him. He subsequently brought phone records to her trial to draw attention to the fact that Dr Bawa-Garba had not otherwise called him.11,12
In giving its judgment on the case the appeal court accepted that ‘no concerns have ever been raised about the clinical competency of Dr Bawa-Garba, other than in relation to Jack’s death’, and that ‘the risk of her clinical practice suddenly and without explanation falling below the standards expected on any given day is no higher than for any other reasonably competent doctor’.13,14
As a result of its appeal on the initial verdict, the GMC experienced intense and unprecedented criticism from the medical profession in the aftermath of this case, which highlighted issues that some say have gone unaddressed for far too long. The GMC pointed out that it has since commissioned an independent review into gross negligence manslaughter issues: ‘Doctors have rightly challenged us to speak out more forcefully to support those practicing in pressured environments, and that is what we are increasing our efforts to do’.15
However, pressure has been building from all sides of this tragedy. The case was recently explored in forensic but sensitive detail by Deborah Cohen on BBC Panorama, including interviews with Jack’s family and Dr Hadiza Bawa-Garba.16 The GMC have also attracted censure for their decision. Since the judgment various petitions have garnered huge support,17-20 with over 1500 healthcare professionals rejecting the idea that the GMC should use money from doctors’ fees to pay the legal bill for its failed bid to erase Dr Bawa-Garba from the medical register.18,19 The petition is still open for signature. A similar number have backed an initiative by The Doctors’ Association UK (DAUK) that calls for the GMC to reflect openly on its actions and refer itself to parliament via the Health Select Committee over its handling of the case.20 The Hospitals Consultants and Specialists Association (HCSA) have gone further and demanded the resignation of the CEO Charlie Massey as he has always made it clear that it was his personal decision to escalate the case to appeal the MPT verdict. The GMC have responded by stating that they accept the decision of the appeal court and as the regulator they have to make difficult decisions and that the case was ‘complex and unusual.’21
What do you think? Was Dr Hadiza Baba-Garba scapegoated because of the deficiencies of the system? What action with respect to conduct should be taken here by the GMC and/or parliament who they remain answerable to? On a daily basis should the GMC make it easier to report rota gaps and other deficiencies in the system without fear of recrimination? Is the UK law currently fit for purpose in complex medical tragedies? How can trust be rebuilt between all sides so a patient safety culture can flourish in future?
To view the video of Dr Jenny Vaughan and Dr Hadiza Baba-Garba speaking out about the trial please click here. To view Dr Samantha Symington and Dr Cicely Cunningham of DAUK talking about the campaign of Learn not Blame please click here.
Dr Jenny Vaughan, FRCP, is a medical law campaigner and Consultant Neurologist.
Professor Roger Kirby, FRCS, Medical Director, The Prostate Centre, London.
1. BBC News. Leicester doctor guilty of manslaughter of Jack Adcock, 6 November 2015 (https://www.bbc.co.uk/news/uk-england-leicestershire-34722885; accessed 24 August 2018).
2. Medical Practitioners Tribunal. Dr Hadiza BAWA-GARBA 13 June 2017 appealed. Medical Practitioners Tribunal June 2017. (https://www.mpts-uk.org/static/documents/content/Dr_Hadiza_BAWA-GARBA_13_June_2017_appealed.pdf; accessed 24 August 2018).
3. Dyer C. Paediatrician convicted of manslaughter must be erased from register, rules High Court. BMJ January 2018 (https://www.bmj.com/content/360/bmj.k417; accessed 24 August 2018).
4. Haddock J, Qureshi M, Day C. Bawa Garba case: team Hadiza statement (http://54000doctors.org/letters/team-hadiza-statement-13aug2018.html; accessed 24 August 2018).
5. Haddock J, Qureshi M, Day C. Independent Legal Opinion on Dr Bawa-Garba Case (https://www.crowdjustice.com/case/help-dr-bawa-garba/; accessed 24 August 2018)
6. Wickware C. BMA applies to ‘intervene’ in Bawa-Garba appeal case. Pulse April 2018 (http://www.pulsetoday.co.uk/news/gp-topics/legal/bma-applies-to-intervene-in-bawa-garba-appeal-case/20036465.article; accessed 30 August 2018).
7. Cook J. Doctors’ groups throw weight behind Bawa-Garba legal appeal. GP July 2018 (https://www.gponline.com/doctors-groups-throw-weight-behind-bawa-garba-legal-appeal/article/1488150; accessed 30 August 2018).
8. Jha S. To Err is Homicide in Britain – The Case of Dr. Hadiza Bawa-Garba. The Health Care Blog January 2018 (http://thehealthcareblog.com/blog/2018/01/30/to-err-is-homicide-in-britain-the-case-of-dr-hadiza-bawa-garba/; accessed 24 August 2018).
9. Wickware C. No single root cause’ found after Bawa-Garba SUI investigation. Pulse March 2018 (http://www.pulsetoday.co.uk/your-practice/regulation/no-single-root-cause-found-after-bawa-garba-sui-investigation/20036369.article; accessed 24 August 2018).
10. Cohen D. Back to blame: the Bawa-Garba case and the patient safety agenda. BMJ November 2017 (https://www.bmj.com/content/359/bmj.j5534; accessed 24 August 2018).
11. MD. The GMC’s handy scapegoat. Private Eye August 2018 (http://www.private-eye.co.uk/columnists; accessed 24 August 2018).
12. Cohen D. Struck off for honest mistakes. BBC News August 2018 (https://www.bbc.co.uk/news/resources/idt-sh/the_struck_off_doctor; accessed 24 August 2018).
13. Vaughan J. The long road to justice for Hadiza Bawa-Garba. BMJ August 2018 (https://blogs.bmj.com/bmj/2018/08/14/jenny-vaughan-the-long-road-to-justice-for-hadiza-bawa-garba/; accessed 24 August 2018).
14. Cunningham C. The Court of Appeal was right to re-instate Dr Hadiza Bawa-Garba. The Guardian August 2018. (https://www.google.co.uk/amp/s/amp.theguardian.com/commentisfree/2018/aug/14/court-appeal-right-reinstate-dr-hadiza-bawa-garba; accessed 24 August 2018).
15. Massey C. Statement on Court of Appeal’s judgment on the Bawa-Garba case. GMC August 2018 (https://www.gmc-uk.org/news/media-centre/media-centre-archive/statement-on-bawa-garba-appeal; accessed 24 August 2018).
16. Cohen D.BBC Panorama 13 August 2018 (https://www.bbc.co.uk/news/resources/idt-sh/the_struck_off_doctor)
17. Wickware C. Appeal court rules in favour of Bawa-Garba appeal. Pulse August 2018. (http://www.pulsetoday.co.uk/news/hot-topics/bawa-garba/appeal-court-rules-in-favour-of-bawa-garba-appeal/20037269.article; accessed 24 August 2018).
18. Manslaughter and Healthcare (http://www.manslaughterandhealthcare.org.uk; accessed 24 August 2018).
19. Dyer C. Don’t use our fees to pay Bawa-Garba’s court costs, doctors tell GMC August 2018. BMJ August 2018 (https://www.bmj.com/content/362/bmj.k3612; accessed 24 August 2018)
20. Bostock N. Hundreds of doctors demand investigation into GMC’s ‘aggressive pursuit’ of Bawa-Garba. GP August 2018. (https://www.gponline.com/hundreds-doctors-demand-investigation-gmcs-aggressive-pursuit-bawa-garba/article/1491034; accessed 24 August 2018).
21. Knapton S. Doctors demand resignation of GMC head over handling of Dr Hadiza Bawa-Garba case. The Daily Telegraph August 2018 (https://www.telegraph.co.uk/news/2018/08/27/doctors-demand-resignation-gmc-head-handling-dr-hadiza-bawa/; accessed 31 August 2018).