Bawa-Garba: timeline of a case that has rocked medicine
What happened and when
18 February 2011
A six year old boy is admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following a referral from his GP. Jack Adcock, who had Down's Syndrome and a known heart condition, had been suffering from diarrhoea, vomiting and had difficulty breathing.
Dr Hadiza Bawa-Garba was a specialist registrar in year six of her postgraduate training (ST6) with an 'impeccable' record. She had recently returned from maternity leave and this was her first shift in an acute setting. She was the most senior doctor covering the CAU, the emergency department and the ward CAU that day. She saw Jack at about 10.30am.
Jack was receiving supplementary oxygen and Dr Bawa-Garba prescribed a fluid bolus and arranged for blood tests and a chest x-ray. At 10.44am the first blood gas test was available and showed a worryingly high lactate reading. The x-ray became available from around 12.30pm and showed evidence of a chest infection.
Dr Bawa-Garba was heavily involved in treating other children between 12-3pm, including a baby that needed a lumbar puncture. At 3pm Dr Bawa-Garba reviewed Jack's X-ray (she was not informed before then that it was available) and prescribed a dose of antibiotics immediately, which Jack received an hour later from the nurses.
A failure in the hospital's electronic computer system that day meant that although she had ordered blood tests at about 10.45am, Dr Bawa-Garba did not receive them until about 4.15pm. It also meant her senior house office was unavailable.
During a handover meeting with a consultant which took place about 4.30pm, Dr Bawa-Garba raised the high level of CRP in Jack's blood test results and a diagnosis of pneumonia, but she did not ask the consultant to review the patient. She said Jack had been much improved and was bouncing about. At 6.30 pm, she spoke to the consultant a second time, but again did not raise any concerns.
When she wrote up the initial notes, she did not specify that Jack’s enalapril (for his heart condition) should be discontinued. Jack was subsequently given his evening dose of enalapril by his mother after he was transferred to the ward around 7pm.
At 8pm a ‘crash call’ went out and Dr Bawa-Garba was one of the doctors who responded to it. On entering the room she mistakenly confused Jack with another patient and called off the resuscitation. Her mistake was identified within 30 seconds to two minutes and resuscitation continued.
This hiatus did not contribute to Jack’s death, as his condition was already too far advanced. At 9.20pm, Jack died.
2 November 2015
Portuguese agency nurse, 47-year-old Isabel Amaro, of Manchester is given a two-year suspended jail sentence for manslaughter on the grounds of gross negligence.
4 November 2015
At Nottingham Crown Court Dr Bawa-Garba is convicted of manslaughter on the grounds of gross negligence.
14 December 2015
Dr Bawa-Garba is given a 24 month suspended sentence.
8 December 2016
Dr Bawa-Garba's appeal against her sentence is quashed at the Court of Appeal.
13 June 2017
The Medical Practitioners Tribunal service says Dr Bawa-Garba should be suspended for 12 months and rejects an application from the GMC to strike her off the register. It says: ‘In the circumstances of this case, balancing the mitigating and aggravating factors, the tribunal concluded that erasure would be disproportionate.’
8 December 2017
GMC takes the MPTS to the High Court and argues its own tribunal was 'wrong' to allow Dr Bawa-Garba to continue to practise.
25 January 2018
The GMC successfully appeals at the High Court bid to have the MPTS decision overruled, leading to Dr Bawa-Garba being struck off the medical register. Lord Justice Ouseley says: '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.’ Health secretary Jeremy Hunt says that he is 'deeply concerned' about its implications.
26 January 2018
Prominent GPs tell Pulse that the ruling raises serious questions about how doctor's reflections are used and recorded, and that new guidance is now needed urgently.
30 January 2018
An influential international doctors group accuses the GMC of treating black and minority ethnic doctors ‘differently and harshly’, following the High Court case.
In light of the Dr Bawa-Garba case, the GMC announces a review of how gross negligence manslaughter is applied to medical practice, which was initially led by Dame Clare Marx and later taken over by Leslie Hamilton after Dame Clare was appointed the next GMC chair. Meanwhile, an influential international doctors group accuses the GMC of treating black and minority ethnic doctors ‘differently and harshly’, following the High Court case.
31 January 2018
Dr Bawa-Garba’s defence body releases a statement saying e-portfolio reflections were not used against her in court, despite ‘wide misreporting’ that they were. But Pulse uncovers that her reflections were used in court, from a document submitted as evidence by the on-call consultant on the day.
6 February 2018
Former health secretary Jeremy Hunt announces a review into the application of gross negligence manslaughter charges in medicine in light of the Dr Bawa-Garba case.
7 February 2018
Following a crowd funding campaign, which raised over £335,000, Dr Bawa-Garba decides to appeal the ruling, and considers appealing the manslaughter conviction from 2015.
12 February 2018
The GMC refutes claims that there was discrimination in its decision to launch a High Court bid. In response to an open letter from the British Association of Physicians of Indian Origin (BAPIO), the GMC said the accusations were ‘troubling and without merit’.
19 February 2018
The GMC is criticised by their regulator, the Professional Standards Authority (PSA), for striking off Dr Bawa-Garba from the medical register. The PSA said the bid was ‘without merit’, according to an unpublished review of the case.
13 March 2018
GMC chair Professor Terence Stephenson says he is ‘extremely sorry’for the distress caused to the medical profession by the Dr Bawa-Garba case.
19 March 2018
University Hospitals of Leicester NHS Trust releases its serious incident report in to the death of Jack Adcock, which was completed six months after his death. The report says that there was no ‘single root cause’ behind the six-year-old's death.
29 March 2018
Dr Bawa-Garba is granted permission to appeal the High Court’s decision to allow the GMC to strike of the junior doctor. Meanwhile, the BMA applies and is later permitted to advise the Court of Appeal in the case.
23 April 2018
The GMC announces the launch of its review into why black and minority ethnic doctors are more likely to face complaints from employers than their white colleagues, which is to be co-led by researcher Roger Kline and Dr Doyin Atewologun.
11 June 2018
Department of Health and Social Care’s ‘rapid review’ into medical gross negligence manslaughter concludes that the GMC should longer be able to appeal decisions made by its own tribunal regarding fitness-to-practise decisions.
27 June 2018
The BMA supports a vote of no confidence in the GMC in light of the Bawa-Garba case at its Annual Representative Meeting.
3 July 2018
Despite the conclusions of the DHSC's 'rapid review' in gross negligence manslaughter, the GMC tells Pulse it is not intending to halt appeals against its own fitness-to-practise tribunal until the law is changed.
25-26 July 2018
Dr Bawa-Garba’s appeal of the High Court decision that saw her struck off the medical register is heard in the High Court over one and a half days. Dr Bawa-Garba said after the hearing that she is ‘whole-heartedly sorry’ for her mistakes, while Jack’s mother Nicola Adcock says she ‘will cause a public uproar’ if Dr Bawa-Garba is reinstated.
13 August 2018
The Court of Appeal judges rule in favour of Dr Bawa-Garba, restoring the MPTS decision that she should be suspended from the medical register rather than erased. The judges said the matter has been passed to the MPTS 'for review of Dr Bawa-Garba's suspension'.
20 December 2018
The Medical Practitioner Tribunal Service (MPTS) decides to extend the suspension of Dr Hadiza Bawa-Garba by a further six months, saying the measure is 'appropriate' to 'protect the public'.
13 March 2019
The MPTS announces a two-day review hearing for Dr Bawa-Garba set for 8 and 9 April 2019. The hearing will decide whether her fitness to practise remains impaired and whether she is deemed fit to return to work.
8 April 2019
The MPTS rules that Dr Bawa-Garba' the fitness to practise remains impaired, due to her lack of face-to-face patient contact while she was under suspension, agreeing that the risk of her putting another patient at an unwarranted risk of harm is low.
9 April 2019
The MPTS decides that Dr Bawa-Garba will be able to return to practice from July 2019 - under certain conditions - but she does not intend to return to work until February 2020, when her maternity leave finishes. The MPTS argues that the public interest has been served already by her cumulative suspension and that any higher sanction would be 'disproportionate and punitive'.
High Court, December 2017 - reports from court reporter
MPTS press releases, 8-9 April 2019