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Independents' Day

Bawa-Garba: timeline of a case that has rocked medicine

What happened and when

18 February 2011

A six year old boy is admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following a referral from his GP. Jack Adcock, who had Down's Syndrome and a known heart condition, had been suffering from diarrhoea, vomiting and had difficulty breathing.

Dr Hadiza Bawa-Garba was a specialist registrar in year six of her postgraduate training (ST6) with an 'impeccable' record. She had recently returned from maternity leave and this was her first shift in an acute setting. She was the most senior doctor covering the CAU, the emergency department and the ward CAU that day. She saw Jack at about 10.30am.

Jack was receiving supplementary oxygen and Dr Bawa-Garba prescribed a fluid bolus and arranged for blood tests and a chest x-ray. At 10.44am the first blood gas test was available and showed a worryingly high lactate reading. The x-ray became available from around 12.30pm and showed evidence of a chest infection.

Dr Bawa-Garba was heavily involved in treating other children between 12-3pm, including a baby that needed a lumbar puncture. At 3pm Dr Bawa-Garba reviewed Jack's X-ray (she was not informed before then that it was available) and prescribed a dose of antibiotics immediately, which Jack received an hour later from the nurses.

A failure in the hospital's electronic computer system that day meant that although she had ordered blood tests at about 10.45am, Dr Bawa-Garba did not receive them until about 4.15pm. It also meant her senior house office was unavailable.

During a handover meeting with a consultant which took place about 4.30pm, Dr Bawa-Garba raised the high level of CRP in Jack's blood test results and a diagnosis of pneumonia, but she did not ask the consultant to review the patient. She said Jack had been much improved and was bouncing about. At 6.30 pm, she spoke to the consultant a second time, but again did not raise any concerns.

When she wrote up the initial notes, she did not specify that Jack’s enalapril (for his heart condition) should be discontinued. Jack was subsequently given his evening dose of enalapril by his mother after he was transferred to the ward around 7pm.

At 8pm a ‘crash call’ went out and Dr Bawa-Garba was one of the doctors who responded to it. On entering the room she mistakenly confused Jack with another patient and called off the resuscitation. Her mistake was identified within 30 seconds to two minutes and resuscitation continued.

This hiatus did not contribute to Jack’s death, as his condition was already too far advanced. At 9.20pm, Jack died.

2 November 2015

Portuguese agency nurse, 47-year-old Isabel Amaro, of Manchester is given a two-year suspended jail sentence for manslaughter on the grounds of gross negligence.

4 November 2015

At Nottingham Crown Court Dr Bawa-Garba is convicted of manslaughter on the grounds of gross negligence.

14 December 2015

Dr Bawa-Garba is given a 24 month suspended sentence.

8 December 2016

Dr Bawa-Garba's appeal against her sentence is quashed at the Court of Appeal.

13 June 2017

The Medical Practitioners Tribunal service says Dr Bawa-Garba should be suspended for 12 months and rejects an application from the GMC to strike her off the register. It says: ‘In the circumstances of this case, balancing the mitigating and aggravating factors, the tribunal concluded that erasure would be disproportionate.’

8 December 2017

GMC takes the MPTS to the High Court and argues its own tribunal was 'wrong' to allow Dr Bawa-Garba to continue to practise.

25 January 2018

The GMC successfully appeals at the High Court bid to have the MPTS decision overruled, leading to Dr Bawa-Garba being struck off the medical register. Lord Justice Ouseley says: 'The Tribunal did not respect the verdict of the jury as it should have. In fact, it reached its own and less severe view of the degree of Dr Bawa-Garba’s personal culpability.’ Health secretary Jeremy Hunt says that he is 'deeply concerned' about its implications.

26 January 2018

Prominent GPs tell Pulse that the ruling raises serious questions about how doctor's reflections are used and recorded, and that new guidance is now needed urgently.

30 January 2018

An influential international doctors group accuses the GMC of treating black and minority ethnic doctors ‘differently and harshly’, following the High Court case.

In light of the Dr Bawa-Garba case, the GMC announces a review of how gross negligence manslaughter is applied to medical practice, which was initially led by Dame Clare Marx and later taken over by Leslie Hamilton after Dame Clare was appointed the next GMC chair. Meanwhile, an influential international doctors group accuses the GMC of treating black and minority ethnic doctors ‘differently and harshly’, following the High Court case.

31 January 2018

Dr Bawa-Garba’s defence body releases a statement saying e-portfolio reflections were not used against her in court, despite ‘wide misreporting’ that they were. But Pulse uncovers that her reflections were used in court, from a document submitted as evidence by the on-call consultant on the day.

6 February 2018

Former health secretary Jeremy Hunt announces a review into the application of gross negligence manslaughter charges in medicine in light of the Dr Bawa-Garba case.

7 February 2018

Following a crowd funding campaign, which raised over £335,000, Dr Bawa-Garba decides to appeal the ruling, and considers appealing the manslaughter conviction from 2015.

12 February 2018

The GMC refutes claims that there was discrimination in its decision to launch a High Court bid. In response to an open letter from the British Association of Physicians of Indian Origin (BAPIO), the GMC said the accusations were ‘troubling and without merit’.

19 February 2018

The GMC is criticised by their regulator, the Professional Standards Authority (PSA), for striking off Dr Bawa-Garba from the medical register. The PSA said the bid was ‘without merit’, according to an unpublished review of the case.

13 March 2018

GMC chair Professor Terence Stephenson says he is ‘extremely sorry’for the distress caused to the medical profession by the Dr Bawa-Garba case.

19 March 2018

University Hospitals of Leicester NHS Trust releases its serious incident report in to the death of Jack Adcock, which was completed six months after his death. The report says that there was no ‘single root cause’ behind the six-year-old's death.

29 March 2018

Dr Bawa-Garba is granted permission to appeal the High Court’s decision to allow the GMC to strike of the junior doctor. Meanwhile, the BMA applies and is later permitted to advise the Court of Appeal in the case.

23 April 2018

The GMC announces the launch of its review into why black and minority ethnic doctors are more likely to face complaints from employers than their white colleagues, which is to be co-led by researcher Roger Kline and Dr Doyin Atewologun.

11 June 2018

Department of Health and Social Care’s ‘rapid review’ into medical gross negligence manslaughter concludes that the GMC should longer be able to appeal decisions made by its own tribunal regarding fitness-to-practise decisions.

27 June 2018

The BMA supports a vote of no confidence in the GMC in light of the Bawa-Garba case at its Annual Representative Meeting.

3 July 2018

Despite the conclusions of the DHSC's 'rapid review' in gross negligence manslaughter, the GMC tells Pulse it is not intending to halt appeals against its own fitness-to-practise tribunal until the law is changed.

25-26 July 2018

Dr Bawa-Garba’s appeal of the High Court decision that saw her struck off the medical register is heard in the High Court over one and a half days. Dr Bawa-Garba said after the hearing that she is ‘whole-heartedly sorry’ for her mistakes, while Jack’s mother Nicola Adcock says she ‘will cause a public uproar’ if Dr Bawa-Garba is reinstated.

13 August 2018

The Court of Appeal judges rule in favour of Dr Bawa-Garba, restoring the MPTS decision that she should be suspended from the medical register rather than erased. The judges said the matter has been passed to the MPTS 'for review of Dr Bawa-Garba's suspension'. 

20 December 2018

The Medical Practitioner Tribunal Service (MPTS) decides to extend the suspension of Dr Hadiza Bawa-Garba by a further six months, saying the measure is 'appropriate' to 'protect the public'.

13 March 2019

The MPTS announces a two-day review hearing for Dr Bawa-Garba set for 8 and 9 April 2019. The hearing will decide whether her fitness to practise remains impaired and whether she is deemed fit to return to work. 

8 April 2019

The MPTS rules that Dr Bawa-Garba' the fitness to practise remains impaired, due to her lack of face-to-face patient contact while she was under suspension, agreeing that the risk of her putting another patient at an unwarranted risk of harm is low.

9 April 2019

The MPTS decides that Dr Bawa-Garba will be able to return to practice from July 2019 - under certain conditions - but she does not intend to return to work until February 2020, when her maternity leave finishes. The MPTS argues that the public interest has been served already by her cumulative suspension and that any higher sanction would be 'disproportionate and punitive'.

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Readers' comments (57)

  • I feel desperately sorry for the family but the law is meant to be fair to everyone. I have read that the blood gases and overall condition of the child were improving prior to the administering of the drug. The doctor did not prescribe it. That should have been sufficient to ensure it was not given . I agree there is nothing to be gained by trying to pin the blame on one particular action when there seem to have been many factors in the build up to the tragic conclusion but someone has been convicted of manslaughter and denied the right to appeal because the likely final causative event ( in my humble opinion ) in a run of system failures was dismissed as irrelevant. It beggars belief.

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  • Vinci Ho

    No doubt , the culture of the world is changing . The expectations on the ‘guardians’ of the world are radically altered. With the evolution of IT technology, social media and hence, globalisation, the reflection of competing notion of virtues any authority(government) should honour or reward , is subjected to even more open and liberal challenges . One can argue the word ‘transparency’ has got a new meaning . Clearly , our prosecution and judiciary system is under huge pressure to ‘get it right’ time to time. As a strong believer of the old doctrine of independent judicial system , I chose not to comment until this verdict was reached.

    One thing I am not sure is how general public understands the difference between murder and manslaughter, with motive(s) and without intention in homicide. Ian Patterson was struck off the GMC list because he harmed(no necessarily killed)so many patients with motives and clearly would be unsafe to let him practise medicine again in future.
    Gross negligence is an involuntary manslaughter(correct me if I am wrong ) carrying no intention to kill.
    It is difficult to revisit the original indictment in 2016 as her appeal to higher court was already rejected.
    But the action of GMC was extraordinary and questionable:
    (1) If the ‘rules’ stated GMC sanction was immediate erasure whether the indictment was murder , voluntary manslaughter or involuntary manslaughter, why was the doctor not erased immediately after the indictment?
    (2) The answer was perhaps because the power of doing that lied in Medical Practitioner Tribunal Service . And if you remember recent report in here about another case :

    There appears to be a ‘power’ struggle between GMC and tribunal services.
    As I wrote before , GMC has an old fashioned superhero-protector complex to fulfil that it clearly wants to ‘centralise’ all power in itself. This will serve the appetite of this ‘ Right OR Wrong ; Left OR Right; nothing in between’ climate of the world.
    (3) The conclusion of this present verdict is as long as one being found guilty when a patient died , one will be struck off GMC list PERMANENTLY , no matter what .
    (4) Whether the reflection process in appraisals(hence , revalidation)needs modification is only scratching the surface . Like many first generation appraisers(quit 5 years ago) , I lost the belief in the original telos of a genuinely reflective exercise which was replaced by a tick-boxing one anyway. If this case means anything, it simply adds more flaws into an exercise which has already lost people’s faith.
    (5) The system failure involved in this case , also well demonstrated the poor availability and distribution of resources(you should all know my definition of resources by now)in NHS. The fallacy of austerity and efficiency saving (not a lot people want to mention that openly these days) in NHS had a good translation in this case. All authorities ,including the government, ‘understandably’ wanted to distance themselves away .
    As it was written in Analects, ‘’When the higher authority had lost its way , people deserted losing their faith . After discerning all the details from the matter, we should only show sympathy rather than schadenfreude for those who committed a crime under such circumstances and climate.’’
    (上失其道 ,民散久矣。如得其情,則哀矜而勿喜。)Well , the higher authority here is ,of course , GMC .
    I am all for a legal challenge to Supreme Court if that is feasible and decided.

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  • This case is a perfect example at how the facts are twisted and even the jury which consists of ordinary citizens could be easily misled when the aim is to indict someone for the failing of the system and putting the blame solely on the individual. Are the blood test and x ray results solely the responsibility of the paediatric registrar on duty covering wards A&E taking referrals and God knows what. Is the medication which is not prescribed on the chart and given by someone else when everyone who has ever worked in hospital knows this as a fact,that it should never be given unless prescribed by anyone nurses parents carers all can the blame be put on the doctor..similarly blame the doctor if someone in the hospital overdoses himself or herself with paracetamol saying it was never written in notes not take more than 8/day.
    We the doctor community should stand up and support the efforts against shaming the physicians and nurses and the profession for the few mistakes which are done in the line of duty in most adverse circumstances. We all know how tough is it on call whether for pads, gynaecology surgery or medicine with so few staff especially on weekends and also the governnent law and patients after you as well..what kind of environment are we creating. Gross negligence no one condones and should be punished but according to circumstances and situation. If one does a survey of most doctors even many of those who are asking for her throat might find themselves in same situation and simular events or near misses would have happened to most of them if they have worked long enough in a position of making decisions.

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  • Had she been a white doctor the GMC themselves would have been as lenient as possible. I speak as an ex-appointee to GMC's FTP panel where we were all given training to go easy on white doctors and try as far as possible to erase non-white doctors.I believe judges and other tribunals receive the same training. This is state sponsored racism not institutionalised racism as it is played down to be. The racists are not naïve children they are wilful.

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  • Council of Despair

    basically game over - I don't think the powers in charge realise the impact of this case on the rank and file. we've been on the edge for a while and just about coping hoping that things might get better but this case shows that it's over now. Officially there is no point being a doctor in the UK. There are too many negatives and it's sad that we are now responsible for the government, management, and public failures. In a way collpase of the NHS may be a good thing as it will force those in charge and the public to face up to the realities. Bring on total collapse!

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  • So now we are all individually responsible however messed up the system may be?!! Wonderful. "Well done" GMC !! Shame on you for pretending to represent doctors.

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  • Working as a doctor has always involved taking “calculated risks” as we only see a patient at a short moment in their illness. On top of this we all work in a broken system which is understaffed.

    This case will change my practice, I will be referring and admitting more patients.

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  • There but for the grace of God go I.

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  • Tragic ... for all
    Every time I read about this case I become enraged at the sledgehammer used against this professional.

    First headlines Nigerian female what

    Nigeria and the rest of Africa along with other internationals make up over 35% of NHS staffing.

    Nigeria has excellent Medical schools

    Women outnumber men at medical schools in many countries

    Hadiza studied for her BSc at Southhampton

    Hadiza is a British trained medical doctor .... Leicester medical school

    St6 Reg with nonexistan SHO cover for 3 wards

    The Consultant saw the blood gas results

    76 systemic lapses withheld from the jury by the cps ( oh yes remediated by the time of her trial).....disgraceful

    Just back from maternity leave...did she have an adequate phased return to work...hmmmm an umblemished record ..methinks they thought she could be relied to dump on as much work as possible

    When i worked on the wards the lab or radiology would call through critcal results.... so the computers crashed why is this her fault?

    I want to hug her and I wonder at the strength she has exhibited. This woman is an example to us.

    Finally tonight .... I read that this poor childs Mom gave him his enalapril... a child in hospital??? Given meds by his mum.

    I cant comment i dont / wont work in pediatrics...

    A critically ill child in a hospital setting? given cvs meds by his mom in a professional setting. Enalapril on top of septic shock...who authorised this action...????

    No further comment

    I said if her erasure was upheld... I would leave medicine or the country...Actively Looking to do so

    This case is a complete disgrace and she needs to get advice to sue the lot if them hunt gmc leicester trust.....etc

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  • Oh yes...cps as well

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