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Bawa-Garba: What happens next

The aftermath of the GMC’s actions will go on, finds Carolyn Wickware

The case that rocked medicine has finally been resolved. Dr Hadiza Bawa-Garba has been reinstated onto the medical register with a successful verdict handed down in the Court of Appeal.

It has been a long road for all concerned, that has encompassed a manslaughter conviction, the GMC successfully taking its own tribunal to court to erase her from the medical register and now a crowdfunded appeal that has found against the GMC.

But the Court of Appeal has had the final say. In one succinct phrase on 13 August, it brought the matter to a close: ‘Undoubtedly, there are some cases where the facts are such that the most severe sanction, erasure from the medical register, is the only proper and reasonable sanction. This is not one of them.’ 

It restored the MPTS judgement – that Dr Bawa-Garba be suspended from practice for 12 months. In real terms, she will be able to work again once the MPTS reviews her case – which could be soon, as the GMC has said it is happy to bring her review forward. 

But beyond the practicalities, there is still a lot on anger from the medical profession, and it may have implications on future regulation. 

Most obvious is the role of the GMC in pursuing erasure. The regulator had always argued that it had no choice but to pursue Dr Bawa-Garba. It said its duty to the public meant it had to seek erasure from the medical register for doctors convicted of a ‘serious criminal offence’. Indeed, it had argued as recently as March that this should be an automatic process.

But it looks like this will be a forlorn hope, which will allow doctors to breathe a sigh of relief. The GMC’s position has little support. BMA chair Dr Chaand Nagpaul has criticised the regulator for its ‘ill-judged handling of the case’, and has asked the GMC to research whether the public actually expect them to pursue doctors in cases of clinical error following the GMC justification that it needs to maintain public confidence.

More surprisingly, even former health secretary Jeremy Hunt questioned its handling in a tweet where he said he was ‘totally perplexed that GMC acted as they did’.

And the most recent decision from the Court of Appeal suggests that the judiciary doesn’t agree with the GMC either. Sir Terence Etherton, a judge at the Court of Appeal, explained in a statement read out in court: ‘The appropriate sanction will always depend upon the precise circumstances of the particular case.’

Indeed, the implications of the case are likely to remove powers from the GMC. As part of Mr Hunt’s ‘rapid review’ of gross negligence manslaughter in medicine launched in February, he announced proposals to stop the GMC appealing decisions made by the MPTS regarding fitness-to-practise cases – which is currently going through the legislative process.

But the issue of doctors facing gross negligence manslaughter charges in the first place is one where there is greater agreement between the GMC and the wider profession.

The regulator has suggested that there are problems with the way manslaughter charges are applied in medicine, and has commissioned out an independent review of gross negligence manslaughter separate to the one announced by Hunt as a way of looking ‘at how [the charge] is applied in situations where the risk of death is a constant’.

In its response to the GMC’s review, the BMA has called for all gross negligence manslaughter cases in healthcare to be referred to the police ‘only after consultation with the chief coroner (in England and Wales)’ as this would ‘ensure that only the cases that warrant further investigation are referred’.

However, the most significant point of the whole case is the medical profession’s confidence in the GMC. The BMA says a motion of no confidence in the GMC that was passed at its Annual Representative Meeting still stands, while also calling for an apology from the GMC and a public enquiry ‘to review the GMC’s conduct in the Bawa-Garba case’.

Meanwhile, in an open letter to outgoing GMC chair Professor Sir Terrance Stephenson, GPSurvival has called for the resignation of his chief executive Charlie Massey, saying their actions have ‘caused doctors throughout the U.K. to suffer considerable fear and anxiety working in a highly pressured system that they will be held as scapegoats for systematic failures’.

They add that without an inquiry into the GMC’s handling of the case and resignations from its executive board, as GPSurvival demands, ‘it is difficult to see how the GMC can recover to become a respected regulator of the medical profession’.

The regulator has a lot of work still to do.

Readers' comments (16)

  • If Dr BG could be accused of manslaughter, now that we understand the context of her working conditions, isn’t there a case for corporate manslaughter against her employer?

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  • Vinci Ho

    (1)It is essential to remember this appeal was technically only about reversing a GMC decision to strike off the list , despite an established recommendation of MPTS . Nothing more , nothing less in legal terms.
    (2) The two big questions are(a) how can we modify (if it was the general consent) the legislation to define gross negligence manslaughter in medical accidents so as to have a purpose to fit? Can some form immunity be granted in individual cases after taking into account of all objective evidences? (b) Is manslaugter automatically equating to removal from GMC list ? This latter question was exactly what GMC was biting on repeatedly in this case.
    (3) Without these questions answered , the ‘fight’ is never over and as I wrote before , we will be continuing to demand the heads of our regulators to resign.

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  • A debate is needed with society about what is realistic to expect from doctors. The government cannot continue to "sub-contract" system failures to individuals.

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  • Anon2016 has a good point - but there may be two ways of proceeding. I still believe, despite the Court of Appeal's judgement on the criminal case, that she should not have been found guilty, and on that basis a further appeal to the Supreme Court might be justified. However if that is turned down then I agree there is a case for a corporate manslaughter charge. Other people have raised the issue of whether it was appropriate for there to be no consultant cover because the supposed on-call person was double-booked; also whether the pathology computer system failure was acceptable. I have always said that any doctor is likely to make one mistake every year that will seriously compromise a patient, or even end their life. If that is truly the case - and from my own experience such mistakes occur through ignorance, fatigue, lack of supervision or simply having tramlined thinking to the wrong diagnosis - then almost all of us should have been, or will be charged with gross negligence manslaughter. What a prospect!

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  • IN FEB 2017, I LODGED ON THE GOVERNMENT UK PETITION WEBSITE:

    “Remove exemption for public functions from The Corporate Manslaughter Act 2007”.

    I GOT ONLY A FEW SIGNATURES-NOW 18 MONTHS LATER, MAYBE SOMEONE MIGHT LISTEN???

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  • How I agree with Last Man Standing. Government, the D.o.H and NHS England are all too happy to sub-contract any unpopular decisions to front line services. A typical recent example is the non-prescription of OTC medicines. How much better would it be if these were simply unavailable on prescription. Please don't tell me that there will be some who will suffer. The half billion + that would be saved could be put to much better use.

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  • @epicureedward
    Agreed.
    We are 'lead' by inherent cowardly bullies.
    This episode was pinned on Dr BG and now it should be their turn to pay.

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  • Doctor McDoctor Face

    Hospital trusts and Health ministers can 'learn' a 101 things from such events but absolutely nothing has changed; Still rota gaps, nurse shortages and useless IT systems in hospitals. She would walk straight back into the same minefield.

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  • Would expand Angus Podgorny's remark to:
    We are lead by INEPT cowardly bullies (or amoral gong chasers).

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  • I cannot possibly imagine that this matter has come to a close.

    We are talking about arrest incarceration,trial and conviction,as you sit in a cell with Mike the mad axe murderer the intentions of the GMC would certainly not be on my mind,

    The critical error according to the clinical supervisor was to not transfer on receiving the lactate result.

    We have taught for generations that you treat the patient not the result,it appears the judge has reversed that.From a GP point of view this impacts particularly on the high potassium phoned through at 5.30 on a Friday night,which I think now must mean automatic admission.

    The defence offered the workload as a mitigating factor,it appears the judge dismissed this,therefore it does not matter if she had to see 50 or 500 patients or whether the IT system had crashed the clinical doctor carries the full responsibility.The BMA whose behaviour defies description,are in full agreement.Those who subscribe should hang their heads in shame.

    The judge tried convicted and sentenced her in a British court,the problem is the entire medical profession disagrees with him.Unfortunately for us he is a judge and therefore one assumes he may have some understanding of the law.

    Surely our clinical practice will change in light of this,and only time will tell if the treasury can afford the consequences

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