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Bawa-Garba: this case is far from closed

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 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