Bawa-Garba Wins Court Appeal

Peter Russell

August 13, 2018

Dr Hadiza Bawa-Garba has won her appeal against a General Medical Council (GMC) ruling that she should be struck off the medical register over the death of a 6-year-old boy in her care.

The judgment means that the trainee registrar, described as being in the top third of her specialist trainee cohort, will be allowed to practice again.

Three senior judges at the Court of Appeal quashed the High Court's decision and decided in favour of a one-year suspension which had originally been meted out by the Medical Practitioners Tribunal (MPT), only to be overturned by the GMC.

The Bawa-Garba Case Fostered Intense Unease Among Medical Professionals

The Bawa-Garba case focused attention on pressures faced by doctors in the healthcare system, spawning a period of intense debate about healthcare funding, and public protection against negligence by healthcare professionals.

She was found guilty in 2015 of gross negligence manslaughter over the death at Leicester Royal Infirmary of 6-year-old Jack Adcock in 2011. She received a 24-month suspended sentence. 

Imposing a one-year sanction, the MPT argued that erasure from the register would have been "disproportionate". 

However, the doctors' regulatory body, the GMC, appealed against the decision and demanded that Dr Bawa-Garba should be struck off the medical register. It ruled that the MPT had overlooked the findings of a court of law and failed to take into account public confidence in the healthcare system.

The High Court later ruled in the GMC's favour.

However, the Appeal Court ruled that the High Court had been wrong to interfere with the decision of the MPT.

Today's judgment will have widespread implications for the medical profession. 

Doctors complained that Dr Bawa-Garba had worked long hours, under extreme pressure, was stretched between caring for too many patients on too many wards, was only partially supervised, had only just returned from maternity leave, and was ultimately punished for being too honest about failings through her reflective practice notes.

The British Medical Association (BMA) said the judgment also raised further questions about the GMC's handling of the case. "As a regulator it has lost the confidence of doctors and must now act to rectify their relationship with [the] profession," said Dr Chaand Nagpaul, the BMA's council chair.

On the opening day of her appeal case last month, Dr Bawa-Garba's counsel, James Laddie QC said the case was "something of a lightning rod for the dissatisfaction of doctors and medical staff in this country".
 

Timeline of Events

  • February 2011: Jack Adcock, aged 6, died from sepsis at Leicester Royal Infirmary

  • December 2014: Dr Bawa-Garba and two nurses, Theresa Taylor and Isabel Amaro charged with gross negligence manslaughter

  • November 2015: Dr Bawa-Garba was found guilty and given a 2 year suspended sentence. Nurse, Theresa Taylor was cleared

  • August 2016: Nurse Isabel Amaro is struck off the medical register

  • December 2016: Dr Bawa-Garba was denied permission to appeal against her conviction for gross negligence manslaughter

  • June 2017: Medical Practitioners Tribunal suspends Dr Bawa-Garba for 12 months and said that erasure from the register would be "disproportionate"

  • January 2018: High Court ruled that Dr Bawa-Garba must be struck off the medical register to maintain public confidence in the profession

  • March 2018: Dr Bawa-Garba was granted leave to challenge her erasure from the medical register in the Court of Appeal

  • August 2018: The Court of Appeal ruled in favour of Dr Bawa-Garba and said the original decision by the Medical Practitioners Tribunal of a 1-year suspension from the register should stand

Giving judgment on Monday, Sir Terence Etherton, Master of the Rolls, said the court accepted that "no concerns have ever been raised about the clinical competency of Dr Bawa-Garba, other than in relation to Jack's death", and that "the risk of her clinical practice suddenly and without explanation falling below the standards expected on any given day is no higher than for any other reasonably competent doctor".

Issues 'Have Gone Unaddressed for Too Long'

The GMC, which along with other medical bodies acknowledged the loss borne by the family of Jack Adcock, said it fully accepted the court's judgment. Its Chief Executive Charlie Massey, said: "It was important to clarify the different roles of criminal courts and disciplinary tribunals in cases of gross negligence manslaughter, and we will carefully examine the court's decision to see what lessons can be learnt."

The GMC, which had experienced intense criticism from the medical profession in the aftermath of the case, said it had highlighted issues "that have gone unaddressed for far too long". It pointed out that it had commissioned an independent review into gross negligence manslaughter issues.

"Doctors have rightly challenged us to speak out more forcefully to support those practising in pressured environments, and that is what we are increasing our efforts to do," said Mr Massey.

However, the Doctors' Association UK, said the GMC had shown it could not be trusted to take a balanced and non-punitive approach in situations where a healthcare professional's abilities might be compromised by shortcomings in the system.

It said the case of a "highly regarded doctor" had "united the medical profession in fear and outrage". It said the case had involved "a paediatrician in training, with a previously unblemished record, convicted of gross negligence manslaughter for judgements made whilst doing the jobs of several doctors at once, covering 6 wards across 4 floors, responding to numerous paediatric emergencies, without a functioning IT system, and in the absence of a consultant, all when just returning from 14 months of maternity leave".
 

The Future of Doctors' Reflective Notes

One issue that emerged from the Bawa-Garba case was whether doctors' reflective notes, designed to help healthcare professionals learn from their clinical experiences, could be used against them in legal or disciplinary proceedings. The GMC had argued that in the Bawa-Garba case that had not happened.

The Royal College of Paediatrics and Child Health said it had "previously flagged the importance of fostering a culture of supporting doctors to learn from their mistakes, rather than one which seeks to blame".

The BMA's Dr Chaand Nagpaul said: "Lessons must be learnt from this case which raises wider issues about the multiple factors that affect patient safety in an NHS under extreme pressure, rather than narrowly focusing only on individuals. 

"Today's judgement is a wake-up call for the Government that action is urgently needed to properly resource the NHS and address the systemic pressures and constraints that doctors are working under and which compromise the delivery of high-quality, safe patient care."

The Royal College of Physicians (RCP) said the death of Jack Adcock 7 years ago had been the result of "an overstretched system" that saw a competent trainee covering the workload of several doctors.

Professor Dame Jane Dacre, RCP president, commented: "We hope today's judgement will provide some reassurance to doctors, particularly our trainees, that they will be protected if they make a mistake."

The mother of the boy who died while in Dr Bawa-Garba's care, Nicky Adcock, described the verdict as an "absolute disgrace" that set "a precedent for doctors to do exactly what they like".

She said she would take the decision to the Supreme Court.

Dr Bawa-Garba gave an interview to the BBC's Panorama programme in which she said: "I want to let the parents know that I'm sorry for my role in what has happened to Jack.

"I also want to acknowledge and give gratitude to people around the world from the public to the medical community who have supported me."
 

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