High Court rules Dr Hadiza Bawa-Garba’s name be erased from medical register

In a highly unusual decision, the General Medical Council (GMC) has brought a ruling from its own tribunal to the High Court to appeal its decision not to strike off a trainee doctor from its register.

In June 2017, the GMC’s Medical Practitioner Tribunal Service ruled that removing trainee paediatrician Dr Hadiza Bawa-Garba from the medical register would be a ‘disproportionate’ sentence as she did not ‘pose a continuing risk to patients’; recommending a maximum 12-month suspension instead.

However, in a controversial move the GMC has disagreed with the ruling on the grounds that it was ‘insufficient to protect the public’ and, on appeal, the case has now been escalated to the High Court. In reaction a group of 50 doctors have written to Professor Sir Terence Stevenson, the head of the GMC, with ‘grave concerns’ that the case could result in the further ‘criminalisation of clinical error’. A further petition has called for the GMC to drop its appeal and has already been signed by 10 300 people, while a crowd funding intitiative has raised more than £160 000 in support of Dr Hadiza Bawa-Garba.

On Friday 26th January the High Court backed the GMC and ruled that Dr Hadiza Bawa-Garba’s name should be erased from the medical register.

What are your thoughts on this case and its implications not only for the medical profession but also for the safety of the patients that clinicians care for? Please do post your comments on this blog.

Click here to view the BBC interview of Dr Jenny Vaughan on BBC Breakfast regarding the case of Dr Hadiza Bawa-Garba. 

Comments (24) Add yours ↓
  1. Eric Webb Retired GP

    For an outline of the case see Pulse:

    http://www.pulsetoday.co.uk/your-practice/regulation/gmc/bawa-garba-timeline-of-a-case-that-has-rocked-medicine/20036044.article

    The whole story screams: ‘System Failure’! An appalling miscarriage of justice in the first instance, now compounded by the GMC. In the current climate, it is increasingly difficult to imagine why anyone would wish to risk a medical career in the UK. So glad I am now ‘safely’ retired; but when are ‘they’ going to come knocking at my door about some alleged error committed 40+ years ago?

    January 30, 2018 Reply
  2. Roger Kirby Professor of Urology

    Terence Stephenson, Chair of the General Medical Council, said:

    ‘We recognise the strength of feeling expressed by many doctors, and we are listening to those concerns.

    ‘In recent months I have been engaged in workshops and constructive discussions with medical leaders on the issue of medical manslaughter. That is urgent work because, although in this case the court has ruled that the Medical Practitioners Tribunal had no powers to unpick the criminal court conviction, it is clear that there is a critical need to examine the wider issues around how gross negligent manslaughter cases are initiated and investigated, the expertise and consistency applied to those investigations, and the role of reflection in such matters.

    ‘As part of our commitment to learn and improve matters we will bring together health professional leaders, defence bodies, patient, legal and criminal justice experts from across the UK to explore how gross negligence manslaughter is applied to medical practise, in situations where the risk of death is a constant and in the context of systemic pressure. That work will include a renewed focus on reflection and provision of support for doctors in raising concerns.

    ‘We are not blind to the challenging conditions in which doctors have to work. We recognise that any doctor, no matter how experienced, can make a mistake, particularly when working under pressure. We know that we cannot immediately resolve all of the profession’s concerns, but we are determined to do everything possible to bring positive improvements out of this issue.’

    January 30, 2018 Reply
    • Eric Webb Retired GP

      And yet Stephenson – a paediatrician himself – permits (encourages?) the GMC to go after Dr. Bawa-Garba contrary to the recommendation of its own MPTS! In that light, his statement above is so much eyewash.

      February 2, 2018 Reply
  3. Roger Kirby Professor of Urology

    Doctors have raised £200,000 to help pay the legal fees of a trainee paediatrician who was stripped of her licence to practise medicine following the death of a young patient.

    The target has been hit with 27 days remaining and will be used to fund an independent legal team to review the case of Dr Hadiza Bawa-Garba and potentially challenge the original ruling of causing manslaughter by gross negligence. Funds raised can only be spent on legal fees, and the doctors behind the campaign warn that taking the case forward has to consider the “enormous cost liabilities” that she could incur if the subsequent appeal is lost.

    Thousands of doctors have also signed a letter warning there will be wide-ranging consequences from the ruling which they say will make doctors working in the overstretched NHS more risk-averse and less likely to admit mistakes.

    January 30, 2018 Reply
  4. DR JT GP

    https://www.crowdjustice.com/case/help-dr-bawa-garba/

    Crowd funding page to fund an independent expert legal advice in respect to challenging the decision that she be permanently erased from the medical register. Please donate and spread the word!

    January 30, 2018 Reply
  5. Anjay Consultant Paediatrician

    This case sounds like a miscarriage of justice.. An independent legal challenge is in the offing https://www.crowdjustice.com/case/help-dr-bawa-garba/

    January 30, 2018 Reply
  6. Dr Szatmary GP

    She was a paediatric trainee ( paediatric registrar was the old term), on her first day back from extended leave. It was her first time at the hospital and she had no refresher course or hospital induction given by the hospital trust. This should never have been allowed to happen, staff need to know how the hospital is run, the hospital layout, it’s policies and protocols before they start work!!! The system errors then just continue one after another….

    A child died as a result of multiple system errors. This cannot be allowed to be left as the “fault of one doctor” when it isn’t. The original conviction needs of be overturned and a proper “ no blame” investigation done into the multiple systems errors to allow information to be gathered and all the facts to be known and improvements to the system to be made to prevent this happening again.

    The fundraising link for Dr H Bawa Garba is:

    https://www.crowdjustice.com/case/help-dr-bawa-garba/

    January 30, 2018 Reply
  7. Huma Afzal GP

    This is a triple tragedy involving the child , Dr Bawa-Garba and Nurse Amaro . None of these Individuals deserved the treatment they received.
    The use of reflective learning from the doctors e-portfolio to prosecute her is totally beyond me!
    I am very upset and disappointed by the actions of GMC.
    The junior doctor and a nurse were convicted of Manslaughter for something which clearly was due to combination of system and human errors.
    The fear set in by this judgement will stop doctors and nurses to share honest reflections of clinical errors which have been an important part of training and improving care .
    This judgement is unfair and definitely should be challenged.
    I am pleased that there are many like me who feel the sense of urgency to get this right!

    January 30, 2018 Reply
  8. Mary O'Gorman Dr

    The GMC are not to be trusted on this. The whole thing has been a travesty of justice for doctor and nurse and leaves juniors exposed more than ever before. Proud to support the legal effort for the sake of young doctors.

    January 30, 2018 Reply
    • Patrick O Neill GP

      Fully agree. I’m gutted with the actions of the GMC. Those involved need sacked and exposed for a media driven witch hunt backed by the GMC.

      February 2, 2018 Reply
  9. Roger Kirby Professor of Urology

    Here is the link to a recent piece that Professor Sir Simon Wessely and myself wrote about the issue of Gross Negligence Manslaughter prosecutions of clinicians: https://www.rsm.ac.uk/about-us/latest-news/president-updates/january-2018.aspx
    It makes the point that while no doctor should be above the law, prosecution of clinicians who make mistakes is only likely in the end to be detrimental to patient safety.

    January 31, 2018 Reply
  10. John Dr

    The patient had a life-threatening blood gas disorder. He was administered treatment and improved. His mother gave Enalapril that was not prescribed. The patient then died. Why was the mother not placed on trial for manslaughter? Sounds cruel, but this question needs to be asked. This question also needs to be answered. In court.

    February 2, 2018 Reply
  11. Patrick O Neill GP

    It could have been me! Totally gutted for the treatment of this paediatric doctor and nurse. I’m a GP of 20 years experience and this case just destroys my faith in the GMC and the legal system. Make a mistake and you will not be defended. In fact you may wind up in jail. Let’s put a big signpost up to defensive medicine. We should be dealing with only one patient in a fixed period of time with no interruptions or distractions. Hospital beds should be freely available for admissions and nobody should be under pressure to see another patient until they are satisfied their current patient has been fully looked after. We should work to this standard. We should never be understaffed or hurried. The hospital concerned needs to be prosecuted for corporate man slaughter. The doctor and nurse involved need their criminal prosecutions overturned and financially compensated! It could have been me ???

    February 2, 2018 Reply
  12. Roger Kirby Professor of Urology

    This is indeed a very hot topic! For those interested in the issues that surround it here are some links to the current media coverage:

    https://www.thetimes.co.uk/article/jack-adcock-case-are-hospitals-doomed-to-repeat-their-mistakes-dxxtb7qhm

    http://medicalrepublic.com.au/doctors-rally-behind-struck-off-registrar/12801/amp

    http://www.bbc.co.uk/news/uk-england-leicestershire-42892862

    https://apple.news/AQ4SrlPtgTFKmZwxhqMgVbg

    February 3, 2018 Reply
  13. Roger Kirby Professor of Urology

    One of the most contentious areas surrounding the Baba-Garba case is the disclosure of her reflections which were part of her annual assessment.

    Although the prosecution at Dr Bawa-Garba’s trial said her reflection did not form part of the evidence against her, elements of her assessment were reportedly seen by expert witnesses.

    Dr Jonathan Cusack, Dr Bawa-Garba’s supervisor at Leicester Royal Infirmary said that he had “full sight and helped her write her reflections”.

    Mr Woodall has written to the BMJ as follows: “The use of information disclosed during appraisal and case reviews to prosecute individuals for gross negligence manslaughter has, at a stroke, ended the confidence of the entire medical profession in the learning culture that is supposed to exist to enable professionals to better prevent errors and avoidable harm to patients.”

    He added: “Hundreds of my colleagues have now stated they will no longer engage in meaningful written appraisal, and many of us who have voluntarily worked in overburdened areas of care such as out-of-hours urgent care are withdrawing their services due to the professional risk that clearly is being devolved down to the front-line clinician.”

    On the day of the six-year-old’s death, Dr Bawa-Garba was completing duties on behalf of of three or four doctors, he said, and she had no support from a consultant. “Under those circumstances anybody can make errors,” he added.

    Dr Woodall said no one at the hospital trust was held to account, pointing out that no corporate manslaughter charges were pursued. “People are going to act defensively” if the GMC continues to hold individuals accountable for systemic failings, he said, adding: “More people will suffer harm and die if the GMC pushes doctors to defensive practice.”

    His comments come after the BMA GP sessional subcommittee chair Dr Zoe Norris, who works as an appraiser, said she would advise all doctors to amend their appraisal reflections to read: “I am happy to reflect on this case one-to-one with my appraiser. However, following the unjust treatment of a UK doctor by the GMC on 25 January 2018 I am not prepared to reflect in writing.”

    Dr Peter T Wilmshurst, a consultant cardiologist at Royal Stoke University Hospital last week wrote an open letter to the British Medical Journal in which he asked the GMC to investigate his clinical practice over the last 40 years to see whether he was fit for practice.

    “During four decades of practice, I have made clinical errors including delayed diagnosis and errors in treatment,” he said. “Some sick patients died. I am sure that many would have died anyway, but in some cases my errors are likely to have contributed to poor outcomes and some patient deaths. It is clear that the High Court agreed with the GMC that honest errors should be career ending mistakes.”

    In a statement, the GMC said Dr Bawa-Garba’s reflective statements on her assessment did not contribute to the decision to strike her off the medical register.

    A spokesman said: “We recognise the strength of feeling expressed by many doctors, and we are listening to those concerns. Reflective notes are an important part of learning for doctors, and show insight on a doctor’s part if they are ever questioned about their actions. That’s why we welcome the Medical Protection Society – who represented Dr Bawa-Garba – making clear this week that her reflective notes were not used against her in court, and were introduced into her tribunal by her defence team. The GMC does not ask doctors to provide their notes.”

    February 3, 2018 Reply
  14. Oleg Tatarov Consultant

    Doctors and nurses should be given the same protection as the police and armed forces. There are similarities in a way we encounter critical situations and make decisions under pressure with resulting adverse outcomes

    February 3, 2018 Reply
  15. Mark Hickey Consultant Cardiac Surgeon

    This is the current guideline for University Hospitals of Leicester (UHL) employees

    “Raising Concerns

    Dear colleagues

    I know that last week’s decision by the High Court to uphold an application by the General Medical Council (GMC)to strike off Dr Bawa-Garba has caused a great deal of disquiet and concern, particularly amongst medical staff and at a national level amongst the Royal Colleges in terms of the negative impact that the ruling may have on clinicians feeling able to reflect honestly, openly and safely without fear of sanction in order that we learn from mistakes. As a clinician I share those concerns and therefore welcome the Royal College of Paediatrics and Child Health’s dialogue with the GMC to discuss these issues in more detail.

    As clinicians, patient safety is our abiding concern and learning from previous experience supports this. We recognise that safe and effective care is delivered as part of a system and that especially at this time of year, ‘the system’ is under great pressure, at both a local and national level, particularly in relation to urgent and emergency care.

    I therefore wanted to take this opportunity to remind everyone of the ways that concerns can be raised in relation to safety, or the way that care is being provided in the area that they work.

    For all staff:

    · By raising your concern with your immediate line manager

    · By raising your concern with your Educational Supervisor

    · By raising your concern with your CMG Clinical Director, Head of Nursing or Head of Operations

    · By raising your concern via the ‘Staff Concerns Reporting Line’ – Telephone 3636 or through the 3636 Staff Concerns Reporting Line

    · By raising your concern with the ‘Freedom to Speak Up Guardian’ via Freedom2speakup@uhl-tr.nhs.uk or directly on 07950 839 130

    · By raising your concern with the Director of Safety and Risk – moira.durbridge@uhl-tr.nhs.uk

    · Out of hours, by raising your concern with the Senior Manager or Director on Call via Switchboard

    In addition, for Doctors in Training the following routes also exist:

    · By raising your concern with your Consultant or Clinical/Educational Supervisor

    · By raising your concern through the ‘Junior Doctor’s Gripes’ reporting tool on INsite

    · By raising your concern with the Directorate of Medical Education

    · By raising your concern through the Doctors in Training Committee

    · By raising your concern with the Guardian of Safer Working (Dr Jonathan Greiff)

    Furthermore, if you feel that your concern has not been addressed through any of the above routes then myself as Medical Director and Julie Smith as Chief Nurse are happy to listen.

    With best wishes

    Andrew Furlong

    Medical Director

    University Hospitals of Leicester NHS Trust”

    Clearly, there is considerable awareness of the pressures employees are under and this notification goes some way towards acknowledging a problem that is not unique to UHL. The difficulty for all of us in healthcare is to know when to ring alarm bells and stop doing what we can within the constraints of limited resources. Most of us will continue to “make do and mend”.

    Perversely, in this Trust, there is a feeling that if a mistake is made due to ongoing recognised ‘pressures’ and the notification system referred to above has not been used, the individual “responsible” for the mistake will be told that they should have acted differently and he/she will be asked why did they not use the procedures that are in place.

    Most trainee doctors are reluctant to “whistleblow” for fear of the affect on their careers. Working in the current shift system makes them feel isolated and vulnerable. This was the reality for Dr Bawa-Garba.

    In my specialty -cardiac surgery- I am aware of the many mistakes that I have made during the course of a career that is reaching its end. I would hate to be staring out now.

    February 5, 2018 Reply
    • Richard Rawlins Consultant (retired)

      Surely, if a doctor has concerns the PATIENT MUST BE TOLD>
      They cannot give informed consent otherwise – and the GMC reqires they do so.

      Make a note in the clinical record. Invite the CEO to counter sign it. (And note if they refuse).

      Get on the front foot!

      May 29, 2018 Reply
  16. Roger Kirby Professor of Urology

    Watch Dr Jenny Vaughan’s BBC interview about Bawa Garba case and patient safety concerns

    https://youtu.be/PIRWtBVhmjA

    February 5, 2018 Reply
  17. Roger Kirby Professor of Urology

    Reflecting on the criminal conviction and now striking off of Hadiza Bawa-Garba for gross negligence manslaughter (doi:10.1136/bmj.k456; doi:10.1136/bmj.k417), the consultant cardiologist Peter Wilmshurst has gone one step further. Renowned for referring others to the GMC, he has now referred himself and encourages others to do the same (bmj.com/content/360/bmj.k417/rr-5; doi:10.1136/bmj.k481). “During four decades of practice, I have made clinical errors including delayed diagnosis and errors in treatment,” he writes. “In some cases my errors are likely to have contributed to poor outcomes and some patient deaths.”

    February 5, 2018 Reply
  18. Christopher Bastianpillai Academic Urology Fellow

    It is a shame that the current emerging generation of junior doctors have entered at at a time when we as a profession feel undervalued and abused by the system in which we work. It means that morale among junior doctors is at an all time low, and their attitude to their working pattern is very different to that of previous generations.

    A large part of maintaining a good standard of patient care with the resources we have available relies on the goodwill of staff, who are prepared to work outside their designated hours, cover rota gaps, and stretch themselves to compensate for underfunded services. Cases like this demonstrate that working harder to cover these deficiencies and help our patients may please the management who are struggling to fill rota gaps, but in the event that things go wrong, you will be left alone to face disciplinary action and possible criminal prosecution.

    The message it sends is loud and clear, and it will only serve to further lower morale within our health service, discourage a culture of openness and candour, and further push a generation of disillusioned doctors to change career or move country. It is important, therefore, that we do not allow the case to affect our approach to patient care. The work that has been done on cultivating an environment in which we are open with our patients and are encouraged to reflect on and learn from our mistakes must not be wasted. This is the message that we need to drive home to our governing body, to ensure that they do not have a permanent detrimental effect on our practice by making cases such as this the norm.

    February 5, 2018 Reply
  19. Roger Kirby Professor of Urology

    The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
    On the day that we mark the 100th anniversary of giving a voice to women, I want to update the House on concerns in the medical profession that we may not be giving a voice to doctors and other clinicians who want the freedom to be able to learn from mistakes. The House will know that, as a Government Minister, I cannot comment on a court ruling, but it is fair to say that the recent Dr Bawa-Garba case has caused huge concern, so today I can announce that I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons and my senior clinical adviser, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

    Working with senior lawyers, Sir Norman will review how we ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up, how we ensure that there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand in respect of criminal liability or professional misconduct, and any lessons that need to be learned by the General Medical Council and other professional regulators. I will engage the devolved Administrations, the Justice Secretary and the Professional Standards Authority for Health and Social Care in this vital review, which will report to me before the end of April 2018.

    February 6, 2018 Reply
  20. Kaji Sritharan Consultant Vascular Surgeon

    Every doctor, every day, works within the resource-stretched, understaffed environment which is the current NHS. Dr Bawa Garba was doing what every doctor does each day and therefore it is not surprising that this case has stirred up so much emotion amongst doctors, as any of one of us could have been Bawa Garba.

    Throughout my 17 year career, I have willingly stayed late, covered multiple gaps in the rota and tried to keep the service running. My colleagues and juniors have done the same. Sadly, speaking up every time there are staffing issues, as Terence Stephenson suggests we do, does not magic up more staff!

    79 actions were undertaken by Leicester Hospital as a result of their internal report and this itself points to multiple systems failures, yet the GMC could not see this, which in itself is disturbing. This case tells doctors who are already under considerable stress to practice defensive medicine, it tells us not openly reflect on mistakes for fear of reprisal and it tells us if possible, change career.

    With this one case, the GMC has not only lost the confidence of doctors but also threatened the culture of openness in medicine to the detriment of patient safety. This case however, is far from over..

    It can only be hoped that Professor Sir Norman Williams can be the voice of sense and reason in this sad chain of events, which has scapegoated a doctor and nurse, leaving their careers in tatters and demoralised an entire profession.

    February 7, 2018 Reply
  21. Aida Jawhari Consultant Gastroenterologist and training programme director

    I am appalled at this decision which criminalises medical errors occurring in the context of a complex, under-resourced and imperfect system. Everything about this decision is unwise and unjust. The legal definition of ‘gross’ negligence is vague and circular. Its application in law and prosecution by the CPS inconsistent.
    Health professionals work every day with the full intention of helping patients not harming them. Errors occur in spite of best efforts in many cases. Healthcare professionals are not in full control of the complexity of factors which contribute to errors. Their part in any event is simply one factor amongst many. Using an adversarial approach will inevitably scapegoat one individual for an error for which the overall system is ultimately responsible. This will not make patients safer……far from it. We need to invest in creating a culture which open and supportive, where human factors and system errors can be studied, identified and ameliorated. This will only happen if healthcare workers feel safe to discuss adverse events without fearing persecution.

    February 14, 2018 Reply

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