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GPs buried under trusts' workload dump

GMC successful in High Court bid to strike off junior doctor

The GMC has won a High Court bid to have a junior doctor struck off the medical register, against the decision of its own tribunal.

The Medical Practitioner Tribunal Service decided in June last year that erasing trainee paediatrician Dr Hadiza Bawa-Garba from the register would be ‘disproportionate’ and recommended a 12-month suspension instead.

But the GMC disagreed and told the High Court in December that she should be struck off 'to protect the public' after her actions resulted in the death of a six-year-old boy.

The case sparked anger within the medical community, with hundreds of doctors writing to the GMC to voice their concerns that its actions would lead to ‘criminalisation of clinical error’ and worsen patient safety

In the judgment handed down this morning, the court ruled that Dr Bawa-Garba’s original sanction of suspension should be replaced with a decision to remove the doctor’s name from the medical register.

Lord Justice Ouseley said: 'I come firmly to the conclusion that the decision of the Tribunal on sanction was wrong, that the GMC appeal must be allowed, and that this Court must substitute the sanction of erasure for the sanction of suspension.

'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.

'It did so as a result of considering the systemic failings and failings of other, and then came to tis own, albeit unstated, view that she was less culpable than the verdict of the jury established.'

The Medical Protection Society, which represented Dr Bawa-Garba, warned that the case would have worrying implications for doctors.

MPS medical director Rob Hendry said: 'The outcome of the GMC’s appeal against the Tribunal decision on this case is disappointing and its implications will understandably be of concern to the healthcare community.

'This challenge was brought by the GMC following their recently acquired right to appeal - a power which we opposed on the basis that it creates an unnecessary and unjust duplication of the Professional Standards Authority’s function.'

The MPS argued that 'while the criminal courts dispense justice - including punishment - the regulator’s role is to protect patients'.

Mr Hendry said: 'When considering whether a doctor is fit and safe to practise every case must be assessed on its own merits and should not be solely determined by the criminal sanction handed down by the court. Gross Negligence Manslaughter cases are usually complex, involve systems failures, and are devastating for all concerned. A conviction should not automatically mean that a doctor who has fully remediated and demonstrated insight into their clinical failings is erased.

'This appeal decision may jeopardise an open, learning culture in healthcare at a time when the profession is already marred by low morale and fear. We are considering all options in the interests of our member and the wider profession.'

GMC chief executive Charlie Massey said: 'This has been a tragic case; a family has lost their son in terrible circumstances and a doctor has lost her career.

‘In today’s ruling the court has confirmed that the Tribunal was simply wrong to conclude that public confidence in the profession could be maintained without removing the doctor from the medical register.'

Dr Bawa-Garba was a registrar at the Children’s Assessment Unit at Leicester Royal Infirmary on 18 February 2011, and the most senior doctor on the shift, when a six-year-old child with sepsis died. Dr Bawa-Garba continued to work at the hospital trust up until she was convicted of manslaughter by a Crown Court Jury in November 2015.

The MPTS said in a June 2017 hearing however, that erasing Dr Bawa-Garba from the GMC register would be ‘disproportionate’, that her actions were neither ‘deliberate or reckless’ and that she did not ’pose a continuing risk to patients.’

Mr Massey said: ‘The ruling clarifies that tribunals cannot go behind the jury’s verdict when a doctor is convicted in a criminal court.

'As the ruling makes clear, the Tribunal were wrong when they decided to suspend the doctor’s registration because in doing so they "reached their own less severe view of the degree of Dr Bawa-Garba’s personal culpability" than was established in the criminal court; which found that Dr Bawa-Garba’s failures that day were not simply honest errors or mere negligence, but were truly exceptionally bad.

'The judgment also found that the Tribunal did not give the weight required when considering the need to maintain public confidence in the profession.

‘We know the strength of feeling expressed by many doctors working in a system under sustained pressure, and we are totally committed to engendering a speak-up culture in the NHS. Doctors should never hesitate to act openly and honestly if something has gone wrong.’

 

Readers' comments (78)

  • To summarise for my hospital colleagues - being given an outrageous workload and lack of support isn't an excuse to the GMC. So next time you're asked to accept extra duties, remember this case and say No!The hospital and GMC won't support you when things go wrong.

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  • This is politically helpful for the government as it postpones the date when the communist NHS needs to be thrown out.

    If death due to a failing system can be blamed on an individual named doctor, it ensures those doctors keep working at a paranoid intensity despite the failing system as they know their backs are not covered when the system fails.

    What's needed is some manslaughter charges that involve named commissioners, managers and eventually government ministers when system failures causes death.

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  • Well Charlie is happy and one of his minions penned a joyous response for when the judgment was to be announced and then promptly posted it. Nothing to do with the publics confidence in the medical profession, no matter what it says.

    On a related matter. The public have a right to accurate counselling. Should the deans of medical schools now explicitly state to potential medical students, that along with the many years of educational burden, student debt, unholy workload and hours etc, that they will also be liable to being struck off for systems failures outwith their control, ten or twenty years into their career?

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  • It seems the Trust board / managers / politicians have thrown this poor Dr under the bus & trying to slip quietly into the background. How about the vexatious GMC have a look in their direction. This is not down to one Dr alone.
    I agree with above comments. Any remaining semblance of good will to support services has now been firmly trodden on. I certainly don’t want a trip to the High Court if the GMC throws its toys out the pram to penalise a Dr.

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  • Scumbag racist/sexist establishment.Time for the medical profession to withdraw all good will.Bring the system down.They will have your head on the chopping block next.This can happen to any of us.Action is needed BMA.

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  • Such a deeply sad situation for ALL involved and concerned... feel saddened end to end...
    Surely...
    Prevention better than incident:
    Partial extract from Duty of Candour (GMC guidance) - excuse the context but

    "The guidance also builds on advice in Raising and acting on concerns about patient safety which clearly sets out managers’ responsibility to ensure there are systems in place to allow concerns to be raised and incidents investigated, and that staff who raise a concern are protected from unfair criticism or action.

    There is a list of all the paragraphs in GMP and explanatory guidance which are related to this guidance in Appendix 1.

    The guidance says that doctors, nurses and midwives should:

    speak to a patient, or those close to them, as soon as possible after they realise something has gone wrong with their care
    apologise to the patient, explaining what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future
    report errors at an early stage so that lessons can be learned quickly, and patients are protected from harm in the future."

    All really important... though
    It seems that the way forward is for every clinician and manager in ALL situations to be able to freely and openly report ALL failings in systems and workplace environment that MAY contribnute to increased patient risk rapidly and PRIOR to any incident.
    TO;
    Consultant
    Line Management
    Senior management
    Trust CEO
    CCG
    Central NHS
    DoH
    GMC
    CQC
    Defence organisation

    Maybe a dedicated email address and hotline direct to all these vital organsiations and people which is activated simultaenesouly... Let's see feet on the ground doing their bit to prevent

    Then everyone can arrive and roll their sleeves up together in an effort to prevent an incident.

    How else to more completely ensure that everyone is protected BEFORE an incident might occur..?

    TimeToWakeUp

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  • The Agenda in the UK is to find a professional to hang from the nearest lamppost when something goes wrong.That will not change the establishment cant be wrong.

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  • She did a DOUBLE shift after maternity probably due to a lack of staff and now she has paid for it. There is no criticism on the lack of beds, the high patient numbers the pressures not to prescribe or investigate or the DNAR sign not being changed. We all learn from our mistakes and become safer. This I would argue makes it more dangerous for patients. Time to quit the UK.I will not do anymore extra shifts. Too dangerous.

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  • This verdict means leave NHS and think working somewhere else.
    Poor Dr.Garba which was the culprit and victim of the chaos NHS system.
    By striking her off the register, how many more patients would not be seen and would put them in danger rather registering her off.

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  • Can anybody clarify for me the GMC hierarchy? Which person or persons suddenly, decided they were "not happy with due process and tribunal system with this one" then duly overrode it's own decision? Where is/what is the hierarchical process that allowed this? Does Stephenson just chime in with the power to overrule? This is an appalling precident.I must be missing something...

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