What Lessons Should Be Learned From Bawa-Garba?

Peter Russell

August 14, 2018

"A lightning rod for the dissatisfaction of doctors and medical staff" was how the Bawa-Garba case was described in court, ahead of the junior doctor's successful appeal against being permanently struck off the medical register.

On Monday, three senior judges at the Court of Appeal quashed an earlier decision by the High Court, supported by the General Medical Council (GMC), that Dr Bawa-Garba should be permanently struck off the medical register. They agreed instead with the Medical Practitioners Tribunal Service (MPTS) that a 1-year suspension was more appropriate.

Dr Bawa-Garba said she was sorry for her role in the death of 6-year-old Jack Adcock. She added: "I hope that lessons learnt from this case will translate into better working conditions for junior doctors."

Medscape UK received numerous comments added to our coverage of the court case. Most members of the medical profession were highly critical of the GMC and supportive of a doctor in the early stages of her career who they felt had been unfairly targeted by the regulatory body and the courts.

Some commentators also expressed the view that what had happened to Dr Bawa-Garba, a black woman with Nigerian ancestry, would probably not have happened if she had been white.

We asked two members of the medical profession about their view on the case and what they hoped would happen now.

Dr Ramesh Mehta is the president of the British Association of Physicians of Indian Origin. He was in court alongside Dr Bawa-Garba and believes the case has exposed issues of diversity within medical malpractice claims.

Dr Adrian Harrop is an ST3 registrar in general practice in Newcastle-upon-Tyne and a spokesperson for The Doctors' Association UK, which has campaigned for a culture of 'learn not blame' for health professionals.

Q&A

Medscape UK: What is your reaction to the judgement made by the Court of Appeal?

Dr Ramesh Mehta: I was in the court, and we were absolutely delighted that justice has been done and Bawa-Garba can go back to work. It would have been a major loss to the NHS to have a very competent doctor erased from the register.

Medscape UK: What lessons should be learned from this case?

Dr Adrian Harrop: We're not arguing that Bawa-Garba is not responsible. Bawa-Garba herself has accepted that she is – at least – partly responsible for the outcome of this case.

But there are systemic factors at play here. And I think that's a major point that we need to get out of this case: how much are we going to place the responsibility on the shoulders of the corporate leaders of these organisations? Who ultimately are the ones who take responsibility for the rota gaps, for wards being understaffed, for the use of locums, for the use of agency nurses, and for checking peoples' suitability for being in that workplace?

I think a duty falls on the GMC to conduct an inquiry into how this case ever came to this point and what decision-making processes were underway that resulted in them raising this legal case in the first place.

Clearly, the outcome of this case proves, in legal terms, that they made a wrong call. And what we don't yet know is how many other Bawa-Garbas exist out there – other doctors who have not gained the same type of media representation and coverage.

How many other examples are there out there of doctors who have been wrongly erased from the medical register – because you've only got to look at the Medical Practitioners Tribunal Service (MPTS) website to see that it happens with relative frequency, that doctors are erased from the medical register and their careers are effectively destroyed.

How strong are those decision-making processes? Are there weaknesses within those decision-making processes? Are they racist? Are they sexist? Are they making class distinctions? And we need to ensure that when these decisions are happening, they are made in a fair way, [and] they're being made with the appropriate checks and balances.

Medscape UK: A number of people commented before and after the Bawa-Garba appeal case that if the doctor had been white, this would never have happened. Do you think there was a racial element to the Bawa-Garba case?

Dr Mehta: There is no doubt about it. I think discrimination and racism is the big elephant in the room. I have raised this issue on all the platforms and I'm happy to raise it again. You see, it doesn't make sense that there is a differential treatment for ethnic minority doctors and white doctors.

The majority of the complaints to the GMC are from the administration and management. And I think it's very unfortunate that instead of appreciating the diversity, and instead of trying to be inclusive, the management are bent upon blaming or scapegoating the BAME [black, Asian and minority ethnic] doctors.

If BAME doctors are not happy to work in the NHS, and if they feel discriminated at all times, they can't provide the best quality of care that they could. They can't utilise their full potential for the benefit of patients.

Medscape UK: Given the very high profile that Dr Bawa-Garba has received during this case, do you think continuing with her medical career after suspension will represent an insurmountable problem to her?

Dr Mehta: I don't think it will be insurmountable. I think she has been very dignified in her approach to what disastrous thing has happened to her. She's a very modest doctor.

There have been examples all over the country where white patients have said 'I don't like BAME doctors, I want a white doctor'. But this is very, very rare.

My feeling is that the majority of the patients who come to the NHS do appreciate the good work done by BAME [doctors]. I feel quite confident that patients would appreciate her as well.

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