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Independents' Day

Bawa-Garba: this case is far from closed

Dr Pete Deveson

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‘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 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
    Here's the link.... Real NHS leaders in the thick of it...
    Go Charlie

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