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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)

  • Really worth a read... http://54000doctors.org/blogs/an-account-by-concerned-uk-paediatric-consultants-of-the-tragic-events-surrounding-the-gmc-action-against-dr-bawa-garba.html

    Maybe we can crowd fund an appeal or raise funds to support Dr Bawa-Garba

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  • Prof Stephenson did say doctors work like soldiers at war, except we never ever get a break [ unlike soldiers] from this war. It is imperative for the BMA to define what safe working is for every specialty.
    They have NOT done this PRIMARY duty to ensure doctor/ patient safety.
    Career officers in schools should point out to aspiring doctors this HORROR of manslaughter due to the multiple jeopardy of excessive workloads.

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  • case:

    On 18th February 2011 Jack Adcock was admitted to Leicester Royal Infirmary with a history of severe gastro enteritis. He had previously had an AVSD repair, doing well, on enalapril. He had a temperature of 37.7 degrees centigrade, dehydration and shock. A Blood gas showed a Ph, 7.0, base deficit, -14, lactate 11 mmols. He was prescribed a fluid bolus and maintenance fluids. Blood tests including CRP were undertaken and a chest x –ray ordered. There was a delay of two and a half hours in review of chest x-ray during which time Jack showed some recovery, playing with the radiographer, drinking juice from his beaker, improvement in blood gas, to ph 7.24. Jack was moved off the Children’s Assessment Unit (CAU) to the wards, where an unprescribed dose of enalapril was administered. Approximately one hour later he suffered a collapse from which he was very sadly unable to be resuscitated.

    The registrar that day was Dr Hadiza Bawa-Garba, a high flying doctor, with an unblemished record who had done considerable work for charitable causes just returned from 13 months maternity leave. Her last general paediatric post, ST4 commenced four years earlier in a DGH, outside Leicester. She had received no Trust induction. When she came to work that day she found that the registrar covering CAU was on training, away from the wards. Dr Bawa-Garba was requested to cover CAU as well as her own ward duties. Working under her were a foundation doctor and SHO. Both had only rotated to paediatrics that month. The consultant covering CAU was teaching outside the city

    Provision of care was dogged by the break down in IT facilities for the whole hospital, meaning that the team were constantly phoning to try to get results. Even when back on line, the flag system for abnormal results was down. The nursing staff were hard pressed, with staffing and equipment shortages logged. Jack was looked after by an agency nurse with a certificate in adult nursing.

    It is not clear what debrief for the staff involved was undertaken after the tragic events of that day, but Dr Bawa-Garba met with her consultant in the hospital canteen, where she felt under pressure to fill in areas of a trainee encounter form. She continued to work without problem and indeed with plaudits. A serious untoward incident inquiry was undertaken following the patient’s death, which was completed on 24th August 2012. A 14-person investigation team concluded that a single root cause for the death was unable to be identified. Numerous parts of the clinical process were identified as needing change. The report highlighted 23 recommendations and 79 actions that were undertaken by Leicester Royal Infirmary as a result of the organisational learning.

    At the beginning of 2012 Dr Bawa-Garba was arrested and questioned two weeks after her next baby was born. She was detained by police for 7 hours away from her baby who was fully breast fed, refusing bottles and at risk of hypoglycaemia. Dr Bawa-Garba was in no state to face sustained police questioning and sign documents.

    On 17th December 2014 Dr Bawa-Garba was charged with manslaughter on the grounds of gross negligence and found guilty on 4th November 2015, after 25 hours deliberation, on a majority verdict of 10 to 2. On 8th December 2016 she was denied leave to appeal. On 13th June 2017 she was suspended for a year by the Medical Practitioners Tribunal service. The GMC applied to over turn the MPTS suspension and instead to erase Dr Bawa-Garba from the medical register. Health Education England (HEE) withdrew Dr Bawa-Garba’s training number.

    On 7th December 2017, considering the arguments surrounding the GMC case for erasure, the judge asked to know what was different about 18th February 2011, the day of the tragic events surrounding Jack’s death Jack’s admission. This may pre-suppose that all works smoothly on other days although we do not know the level of incidents, recorded or unrecorded error, near miss, death or disability from care on other days.

    What we do know is as follows:

    On this day: The team were relatively new due to the February change over and Dr Bawa-Garba had not received Trust induction.

    On this day: The registrar covering CAU did not attend. Dr Bawa-Garba was doing their job.

    On this day: The consultant covering CAU was in Warwick. Dr Bawa Garba was doing their job.

    On this day: Due to hospital IT failure the Senior House Officer was delegated to phone for results from noon until 4pm. For this period Dr Bawa-Garba was doing their job.

    Therefore on this day Dr Bawa-Garba did the work or three doctors including her own duties all day and in the afternoon the work of four doctors.

    On this day: Neither Dr Bawa-Garba (due to crash bleep) nor the consultant (due to rosta) were able to attend morning handover, familiarise themselves with departmental patient load and plan the day’s work.

    On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning 4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls.

    On this day: Even when the computer system was back on line, the results alerting system did not flag up abnormal results.

    On this day: A patient who had shown a degree of clinical and metabolic recovery due to Dr Bawa-Garba’s entirely appropriate treatment of oxygen, fluids and antibiotics was given a dangerous blood pressure lowering medication (enalapril) which may have precipitated an arrest.

    So what did Dr Bawa-Garba personally miss? Her initial treatment was felt to be good. She was not informed of Jack’s further diarrhoeal fluid losses by the nursing team. In terms of laboratory results she missed raised creatinine which arguably may have not affected the ongoing treatment in and of itself. She was unaware of the time of the chest x-ray, that she had correctly ordered, upload to the system, but as she had been personally undertaking procedures such as lumbar puncture and covering six ward areas, this must be understandable. No–one is all seeing. She correctly prescribed antibiotics as soon as she reviewed the x-ray.

    Dr Bawa-Garba has inexplicably been held responsible for

    -The fact that more senior staff did not apparently realise the implications of a blood gas result. Seniors supervise juniors, not vice versa.

    -The fact that the nursing staff were not adequately supervised and supported to do their job. This is the role of nursing management.

    -The fact unprescribed medication (enalapril) was given, not checked with the medical team. Dr Bawa-Garba could not take measures to counteract the effect of this medication, before patient deterioration into an arrest situation, as she was not informed enalapril had given.

    -The fact that she did not personally apologise. Dr Bawa-Garba would have needed to obey all Trust and Medical Protection Society directives and the advice of her legal team with respect to communication with the patient’s tragically bereaved family.

    Dr Bawa-Garba did mistakenly stop resuscitative efforts, confusing Jack with another patient, although this was not seen as contributory to the final tragic outcome. There had been confusing movement of patients of which Dr Bawa-Garba was not informed, so that when she was crash bleeped 13 hours after attending one arrest situation, having had no time for food, drink or a break, she raced to the area and wrongly assumed that she was going to the same patient. There were a minimum of 7 professionals in the cubicle, including Jack’s named professionals and equally senior, less exhausted paediatric and intensive care doctors leading or assisting the resuscitation. No–one queried Dr Bawa-Garba or double checked the name but rather they stopped resuscitative efforts on her word.

    After these events, Nurse Amaro, an agency nursed trained in adult medicine, who had worked for 17 years with feedback attesting to a high level of performance, who was helping out CAU in a crisis, was struck off for 5 years. In her statement to the nursing and midwifery council she said nursing was her life and she had always wanted to be a nurse, because she wanted to help people. Some staff from the Trust who were working on the day have left voluntarily, with some moving abroad. Public statements from the Trust medical director say that improvements have been put in place to prevent similar tragedies. Dr Bawa-Garba awaits the decision of the Court of Appeal.



    Signed:

    Dr Lyvia Dabydeen, Consultant Paediatric Neurologist

    Dr Hilary Klonin, Consultant Paediatric Intensivist

    Dr Sethu Wariyar, Consultant in Paediatric Neurodisability

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  • Would you want to be a doctor? This is beyond gruesome.

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  • This is such a travesty of justice. Why on earth should one person be held accountable for the catalogue of errors that all played their part in Jack’s death?

    The open letter from Dr Bawa - Garba’s consultants posted above clearly details the host of systemic failures. Why was this not taken into account, either by the jury who found her guilty of manslaughter or the GMC who asked for her to be struck off?

    Reading comments on social media from those who knew her, she is a caring and hardworking doctor. My thoughts are with her and her family. Is there anything we can do as a profession to stand behind her and help?

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  • Lost for words!

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  • Reading the letter from the consultants above is distressing. This situation could happen to any dr no matter how capable given the ridiculous pressure she would have been under with that degree of understaffing and IT failure.

    It's incredulous that this was not taken into account and in fact this is a reflection of the state of the pressure within the NHS so good luck to the profession and the patients. Seems luck is what we are counting on if this is something to go by as No one outside of the people on the frontline is listening.

    Are we living in a parallel universe to the powers that be? Either that or we are missing something massive that the GMC was party to about this case???????

    How depressing says it all!

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  • Vinci Ho

    Please keep sending your comments.

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  • My My My, What a sad state of affairs.
    DEAR ALL. Please do not try to be a martyr and save failing NHS. Please look after yourself first , then patients and finally NHS. Do not take any calculated risks (that we all do day in and out).
    Give the most appropriate drug, expensive as it may be, Investigate to the nth degree and take your time. Important decisions should take time. Take a break after few hours, you are not a machine and not paid for all your extra time and please complain to your line manager everything you think is wrong and keep a log. DONT put yourself in these situation as NO one will be looking after you. Work your shift and leave, do not stay behind. If you get a chance, please leave this failing ship and live your life. Sad as it may be, NHS is not worth saving. I feel sick........

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  • Is it worth practicing medicine in this country.Very sad, very tragic situation.

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