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Bawa-Garba: this case is far from closed

Dr Pete Deveson

Dr Pete Deveson BLOG duo_3x2

‘We’re actually elated - we’re so happy to hear that… this is hopefully closure for us.’ The words of Nicky Adcock, reacting on Thursday to the news that Dr Hadiza Bawa-Garba, already convicted of gross negligence manslaughter over the death of her son Jack Adcock in 2011, was to be struck off the medical register.

But whilst the family celebrate the end of a seven-year legal struggle, the GMC’s victory in the high court has sent a shockwave through the medical profession that, far from offering closure, threatens long-lasting implications across many spheres of practice.

One immediate effect will be a depressing but unavoidable increase in defensive medicine. This tragic case has reminded us all (and educated those of us who were completely unaware) that while we go into work every day to try and make lives better, we ultimately run the risk of imprisonment with every patient interaction.

Something about this feels very close to home; we’ve all seen patients who turned out to be much sicker than they initially looked, we’ve all discovered seriously abnormal results later than we should have done, and we’ve all worked at full stretch in unsafe conditions due to colleague absence or IT failure. All it takes is a regrettable convergence of all three, and I could be Hadiza Bawa-Garba. Hell, I could be Hadiza Bawa-Garba tomorrow.

The GMC, admittedly never high on the collective Christmas card list, has divested itself of any remaining credibility with the medical profession

That awful realisation is already affecting my practice; previously simple decisions become mired in subconscious ‘what if?’s, serum rhubarbs I would never have considered ordering suddenly feel indispensable, and I find myself struggling against what Christian Harkensee on bmj.com calls an ‘an irrational moral dictum to grossly over-treat infections’.

And I have the lucky privilege to be walking this clinical tightrope with a white face and an English surname (albeit one that no-one knows how to pronounce). Repeat my new-found cautiousness across 100,000 doctors, and the ramifications for the NHS budget and the ongoing battle against microbial resistance are terrifying.

Meanwhile the GMC, admittedly never high on the collective Christmas card list, has divested itself of any remaining credibility with the medical profession that funds it. CEO Charlie Massey, already a favourite doctors’ mess dartboard adornment for his close association with Jeremy Hunt during the 2016 strikes, has done himself no favours with a woeful Today programme appearance in which he manifestly failed to give a straight answer about what a doctor should do when faced with an unsafe work environment.

An even-mealier-mouthed official GMC statement simply advised doctors to ‘consider risks to patients from any refusal to cover a shift’. I really hate that C-word. ‘DO THIS’ or ‘DON’T DO THAT’ is clear; ‘CONSIDER’ is GMC-ese for ‘damned if you do, damned if you don’t’. If Mr Massey can’t get his act together and provide proper practical guidance then he should really, as the pressure group GP Survival have demanded, be considering his position. I suppose he can take comfort in the fact that the generous private health insurance package our fees provide him with will ensure he’ll never find himself at personal risk from clinical errors made by the overtired frightened doctors he’s failing to support.

There is, however, a definite feeling that this case is not over. Jeremy Hunt, realising the damage done to his beloved patient safety crusade, has declared himself ‘deeply concerned’, and sources as diverse as BAPIO and the Bow Group have stepped up to condemn the GMC. Veteran whistleblowing campaigner Peter Wilmshurst has challenged the regulator to investigate his own 40-year career for clinical errors and hold him to the same standard as Bawa-Garba. An article from 2005 has begun circulating online, in which the then GMC President Sir Graeme Catto reflects on a patient who died from sepsis after he delayed giving antibiotics; there is no mention of a consequent manslaughter charge.

Thousands of doctors have been galvanised across social media; a crowd-funder has amassed nearly a quarter of a million pounds towards new legal advice for Dr Bawa-Garba.

If any good is to come from this tragedy, a challenge to her conviction might just help the nation to recognise that the blunt instrument of criminal prosecution is not an appropriate tool with which to engender a learning culture in the NHS.

Dr Pete Deveson is a GP in Surrey

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Readers' comments (25)

  • Excellently summarised Well done

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  • Listening to Mr Massey on Today(thanks for the link),very unimpressed,a polictian not answering the question.Bordering on a level of unbelievable imcompetence.He as the regulator and the protector of patients needs to define safe working practice.He will not just another establishment stooge.

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  • @Turn Out The Lights
    There is a fantastic 'You Tube' of Mr Massey in which his performance at a Parliament Health Select committee is mashed up with input from Malcolm Tucker and some others from The Thick Of It. Sorry I haven't got the link to hand, but easy to find on google. In it he is clueless and way out of his depth in answering questions about Jeremy's proposed 24/7 NHS of which he was supposed to be in charge of the brief.
    I would say we are lions lead by sheep

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  • Yes today my notes are growing in size as the queue expands and my admission thresholds are rock bottom. Sad.

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  • PS- Pete-good article- and well summarised as said previously.

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  • Mr Massey know the system is Sh*te and dangerous but refuses to acknowledge it to protect patients. He has not stopped the bed cutting or the poor staffing levels. Let us admit and keep them under prolonged observation least we be sued. Let us practice defensively as clearly that is what we a re expected to do. Hide any errors as the ruling dictates.Consider the risks to patients Mr Massey for you not doing your job and scapegoating us. Get the beds and staffing levels back and increase the budget to investigate and treat as this is what all doctors will do. No one wants to be in jail for errors, they are too full anyway.

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  • It does appear that under English law once a Doctor is convicted of manslaughter the GMC has to strike the Doctor off. The problem lies with English law and how a result of negligent manslaughter is made I.e the process.

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  • A miss-trial then I suspect.

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  • Very good article in Times today giving the correct facts of the case from the author of black box.

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  • Maverick

    https://www.youtube.com/watch?list=RDLnH-Pc6MicM&v=lMlA4gPtrBk
    Here's the link.... Real NHS leaders in the thick of it...
    Go Charlie

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  • Thank you for saying what needs to be said. I doubt if there is a practicing doctor who hasn’t experience that ‘Hadiza moment’ of sympathy/guilt/despair for not having had a crystal ball and magic wand when needed

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  • Here is the Times article Mark Howson mentions. It is very good. https://www.thetimes.co.uk/article/jack-adcock-case-are-hospitals-doomed-to-repeat-their-mistakes-dxxtb7qhm

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  • Deeply worrying. I gather from a Times article today that contributing factors (there were many) were not fully aired in court.
    Also, what about the issue of supervision in that a consultant or GP trainer would generally be aware of the situation on the ground. Why did this poor doctor carry the can alone? Why was appeal not allowed ? Who in GMC pushed for this decision and what are the checks and balances there? Did no one speak up for this unfortunate doctor?
    Considering the pressure doctors are under these days we are all at risk for becoming scapegoats for systemic failures.

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  • Collectively as a profession, we are under attack. All of us are Hawa-Garbas. All of us at some point have been in her shoes; but have luckily escaped the horror of being hung out to dry because we failed to be super-human. But here we are; exposed, vulnerable. We need to rise up as a profession and defend our core principles and practices. This case is a IMG_0929.JPGdangerous precedent; which if ultimately successful will drive another nail in our profession’s coffin.
    I have fled the UK as I fear for my career. Now I seek refuge in another country which gives medicine the respect it deserves.

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  • medicine tastes awful

    Working in the NHS is toxic. The doctor gets the stick.

    Ah- it is not our concern says Mr JH, the GMC or the CQC. - these guys don't care and the blame culture is on the poor Doc.

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  • Cases like this make me so glad that I have retired.
    Whilst always having been aware of "damned if you do and damned if you don't" scenario, this is just awful beyond words.
    As Dr Deveson remarks "but for the grace of God there go I"
    As a junior doctor in the 1970s... Being on call for 2 weeks at a go whilst your opposite number was on vacation, was the norm ! Thank God for supportive and experienced nursing staff then !

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  • There is something missing. The poor child seemed to be getting better, the pH and lactate levels had improved.
    There could be an opinion that Jack suddenly collapsed because of the administration of ACEI and might well have survived without the catastrophic hypotension of that drug.

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  • I used to teach trainees that they would be likely to make at least one, if not two serious mistakes every year. I did. There are multiple explanations; fatigue, inadequate information, test results not back or misinterpreted, ignorance (particularly for rare-as-hen's-teeth conditions), failure to seek advice because you didn't realise you were out of your depth, delay are but some. I would challenge any doctor in practice to deny that they ever made, or make mistakes. Unfortunately the law is now clear that there is no mitigation.

    I was personally sued once in my career (by a private patient whose claim was spurious, but nonetheless dragged on for over a year) and another patient brought an action for serious harm due to a series of mistakes, some mine and some not. Had that patient died I suspect I could have been prosecuted for manslaughter by a vindictive relative; as it happened, the patient and I had a full discussion about what had happened and I suggested she brought a compensation case, which she won, but she continued to see me as a patient. This points up the inconsistency which may result from patients being greedy and vindictive on the one had, and fair and forgiving on the other. But who is to know which is which? It's a no-win situation for which the only defence is not to work.

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  • I recommend this article to those interested in the legal aspects.

    https://thesecretbarrister.com/2018/01/31/some-thoughts-on-dr-bawa-garba-and-our-faith-in-the-jury-system/

    I draw the conclusion that on this occasion at least, the GMC is the wrong target.The greater problem is the injustice of Dr B-G's criminal conviction.

    The jury were asked whether her care was "truly exceptionally bad” and they concluded that it was, the overwork and other systemic failures notwithstanding. It concluded that it was. After that, and losing he appeal too the GMC asked the High Court whether the MPTS were right in law to treat her more leniently. The answer apparently was No.

    "...the High Court concluded, the Tribunal fell into legal error in effectively disregarding the verdict of the jury and reaching its own views as to the level of culpability. If a jury has found Dr Bawa-Garba’s actions to be truly exceptionally bad notwithstanding the systemic conditions, it’s not for a professional disciplinary tribunal to try to form its own opinion based on the systemic failings and downgrade the doctor’s actions to only ‘really quite bad’, in other words.

    We may well disagree, but that's the law.

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  • GPs need to be reassured that doing significant events or reflective learning will not be used in court against them or this will affect honest learning.We all need to do honest learning.

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