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GPs go forth

Hunt orders 'rapid review' into use of manslaughter charges against doctors

The health secretary has announced a review into the application of gross negligence manslaughter charges in medicine following the Dr Hadiza Bawa-Garba case.

Jeremy Hunt told the House of Commons today that the review will be led by former Royal College of Surgeons president Professor Sir Norman Williams, and will report back by April 2018.

Professor Williams will attempt to ensure medical professionals know where they stand with respect to criminal liability, and the review will look into what lessons the GMC can learn.

Dr Bawa-Garba was convicted on gross negligence manslaughter charges in 2015 following the death of 6-year-old Jack Adcock in 2011.

This year, the GMC won a High Court appeal against its own tribunal service to strike Dr Bawa-Garba off the GMC register permanently.

However, the medical profession has vocally protested the decision, pointing out that there were major systemic problems in the Leicester hospital where she was working, and that the tribunal service said she was fit to practise.

Mr Hunt himself tweeted his concerns around the verdict, and what it would mean for openness and transparency in the NHS, after Dr Bawa-Garba’s own reflections to her senior consultant were used in court.

Speaking in the Commons today, he reiterated that he couldn’t comment on the case itself, only to say that it had ‘caused huge concern’.

He told MPs: ‘So today I can announce that I have asked Professor Sir Norman Williams, the former president of the Royal College of Surgeons and my senior clinical adviser, to conduct a rapid review into the application of gross negligence manslaughter in healthcare.

‘Working with senior lawyers, Sir Norman will review how we can ensure the vital role of reflective learning, openness and transparency is protected so that mistakes are learned from and not covered up; how we ensure there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice so that doctors and other health professionals know where they stand with respect to criminal liability or professional misconduct; and any lessons that need to be learned by the GMC and other professional regulators.

‘I will engage the devolved administrations, the justice secretary and the Professional Standards Authority for health and social care in this vital review that will report to me before the end of April 2018.’

The GMC has already said it would look into the application of medical manslaughter charges against doctors.

Dr Chaand Nagpaul, BMA council chair, said: ’We welcome this review which must provide greater clarity on the role of reflective learning and the application of gross negligence manslaughter in healthcare.

“’t’s vitally important that doctors’ personal reflections – which encourage openness and improvement through reflection and learning – are protected. While the BMA has received important assurances from the GMC in relation to the use of reflective learning, further clarity around how reflections can be protected will be welcomed by doctors. We also need greater clarity on the line between gross negligence manslaughter and human error in medicine. There is concern that a growing number of prosecutions of doctors for gross negligence manslaughter results in doctors becoming more cautious. This makes it more likely that they will practise defensive medicine, which is not in the interests of patients.’

Charlie Massey, chief executive of the GMC said in response to Mr Hunt’s announcement: ‘We welcome the announcement today from the Secretary of State to conduct a rapid review into whether gross negligence manslaughter laws are fit for purpose in healthcare in England. The issues around GNM within healthcare have been present for a number of years, and we have been engaged in constructive discussions with medical leaders on this issue.

‘As an independent UK-wide medical regulator we have committed to bringing together health professional leaders, defence bodies, patient, legal and criminal justice experts from all four countries to explore how gross negligence manslaughter or its equivalent in the devolved nations is applied to medical practice, in situations where the risk of death is a constant and in the context of systemic pressure. That work will include a renewed focus on reflection and provision of support for doctors in raising concerns.’




Readers' comments (28)

  • I am a GP myself, with a background in junior (non-consultant) hospital posts prior to qualifying as a GP. This case is truly tragic for all concerned and it is understandable that the family feel very aggrieved and look to apportion blame as a way to help them feel just a tiny bit better about all they have been through. That is often a natural human instinct and reaction.
    However, the blame is being directed at two individuals (I believe a nurse was struck off as well and there should be a similar campaign for a thorough review of the nurse's case as well) for what are not only a number of systemic problems and issues, but also the realities of working in that environment-where junior doctors are frequently pressured into working long shifts, providing far more cover and responsibility to far more patients than they ought to be, with little or no protections and safeguards in place.
    I've experience of this-working as a newly qualified SHO in general medicine, in my first medical post after gaining my full GMC registration, being the most senior medical person in the hospital, with responsibility for patients over several wards, supervising a JHO and with a consultant at home who 'will come in if necessary' (and we all know how much inferred or actual pressure juniors can be placed under to avoid disturbing the consultant, who is either at home or attending to alternative duties elsewhere)
    At least my medical SHO post involved working no more than fifteen hours without any sort of a break.
    In other SHO posts it was common to start work at 9am on a Saturday morning and work through to 5pm (theoretically, but often later) on a Monday evening, with perhaps no more than three hours sleep per night possible, if that (due to being in theatre in the middle of the night doing caesarean sections, attending to sick babies in the SCBU etc)
    Cognitively you feel absolutely knocked for six and close to collapse with sleep deprivation and stress often putting junior doctors in a situation where they are as cognitively impaired as if they were well above the drink driving limit-so it's okay for senior doctors, management, the government to put a doctor in that position, but if they turned up for work drunk then that wouldn't be okay?!
    Most doctors have been placed in that situation and there has been the potential for significant patient harms as a result and we think ‘there but for the grace of god’ that this tragic event that has happened could have happened to any of us.
    It's also (naturally) the case that non-medical people do not have an appreciation for the difficulties of decision making within medicine, how situations often change and how doctors (and nurses) often do the best they can in extraordinary circumstances, within the confines and limits of what they have at their disposal-then risk getting hung out to dry when something goes wrong.
    Sometimes there are situations (not in this case) where all the assessment/clinical care has all been beyond reproach, but then a patient still deteriorates quickly with devastating consequences eg the child who has early meningitis who presents with non-specific features. If all patients were sent into hospital in that situation or if every patient with a headache had a brain scan in case it was a tumour or if every patient with heartburn had an endoscopy to rule out stomach cancer as a cause then there would be less ‘missed cases’, but there would also be a two year waiting time even for urgent scans/endoscopies, huge additional cost and the potential for significant harms to healthy patients.
    Patients also sometimes give widely different accounts of what are objectively the same presenting features and that can make decision making difficult, when there is naturally a large degree of subjectivity in the way that patients often present.
    It is also the case that we all make mistakes, sometimes with tragic and awful consequences, because we are not infallible and cannot be held to be infallible anymore than any other profession. Some serious mistakes thankfully do not result in serious harm and some much less serious mistakes unfortunately do result in serious harm.
    If it is truly the case that Dr Bawa-Garba has truly reflected on what she has personally got wrong here (eg failure to spot the early signs of sepsis or act on the patient’s blood test results, even though in fact she does seem to have acted on them, in one sense, by discussing the patient’s results with her supervising consultant), rather than what has gone wrong in this case as a result of system problems or factors outside of her control, such as the giving of the enalapril and if it is also the case that she has an otherwise 'unblemished record' and was deemed to be very competent, safe, trustworthy and a credit to her profession over a number of years, then she is actually one the 'good doctors' and not the 'bad doctors' who fail to reflect, cover mistakes and have an arrogance about them that is often misguided.
    It is also the case that there are other doctors/nurses/professionals who have been found guilty of dubious, untoward, dishonest practices etc where the resulting punishment has been far less than complete erasure from their professional register, whereas in this case the punishment seems to be for clinical error only, with no suggestion that Dr Bawa-Garba is guilty of anything other than working extremely hard, trying to do the best she can and being upfront and honest about her failings.
    I obviously do not know all the details of this case, just what I have read-but what I am certain of is that she deserves a lot of support in order for her to receive a fair and objective assessment of the situation and what happened and that given what I have read and what seem to be the facts about this case, rather than opinions, then this doesn’t seem to have happened thus far.

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  • There has been a lot of money raised for legal reviews etc.

    I would like to see that money (some of that money) used to see if HBG can litigate against the hospital for a careers worth of earnings? It is plain for everyone to see that she has been let down by being forced to work in conditions that were sub-optimal. As a result a child died and her career has ended.

    I think a large payout would set a precedent that means that placing doctors in this terrible position is unacceptable. Every hospital does it and that puts us all at risk.

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  • Jeremy
    1. It had better be rapid
    2. It had better reverse previous injustices
    3. Until then stick your reflection where the sun don't shine

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  • We welcome this order by the Health Secretary! Please consider attending a March in Support of Dr Hadiza on the 22nd March. Details on our website. Badges and Tshirts are onsale to show your support and all proceeds are towards her crowdfunding page which is already over £300,000.
    Follow us on facebook

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  • 'Beware the Ides of March '. Tell me it's Hunt!

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  • Can somebody please explain to me why it took the government 7 years to intervene this case? How many other poor doctors and nurses have not been treated fairly in that time?!

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  • Well done Jeremy and Charlie in recognising that the law is a mess. Just need to hang someone out to dry first to have a test case.
    So in view of his comment why did Charlie so assiduously want to use the potentially flawed GMN law here?

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  • This surgeon was censored by the DOH whilst being interviewed on Sky TV. You really couldn't make it up!

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  • medicine tastes awful

    Is this surgeon on the payroll from Mr Hunt!

    A full independent inquiry with appropriate legal parameters etc etc is what the profession needs and what the junior doctors need working in Mr Hunt's toxic NHS.

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