'Lessons Must Be Learned': UK Societies on Bawa-Garba Ruling

Peter Russell and Lisa Nainggolan

August 14, 2018

As the dust settles around the latest decision in the case of UK physician Hadiza Bawa-Garba, MBChB — who yesterday won her appeal against a ruling by the physician's regulatory body, the General Medical Council (GMC), that she should lose her medical license (known in the UK as being "struck off" the medical register) over the death of a 6-year-old boy in her care 7 years ago — Medscape Medical News summarizes reaction in the UK to the judgment.

The ruling means that Bawa-Garba should soon be able to return to work.

Bawa-Garba was a trainee pediatrician in the National Health Service (NHS) who was convicted in a British court of law of "manslaughter by gross negligence" in 2015 and was ultimately prevented from practicing medicine by the subsequent GMC decision in the High Court in January of this year.  

The case centered on a catalog of errors in 2011 that led to the death of Jack Adcock, a 6-year-old boy with Down syndrome who died from sepsis at Leicester Royal Infirmary. At the time of the tragedy, Bawa-Garba had recently returned from maternity leave and was solely in charge of three separate units on an evening no senior physician was available and there was a delay in obtaining test results (see timeline of events below).

Giving judgment yesterday, Sir Terence Etherton, Master of the Rolls (of the Court of Appeal), said the court accepted that "no concerns have ever been raised about the clinical competency of 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."

A much more detailed account of the events in this tragic case was described in a commentary by Saurabh Jha, MBBS — To Err Is Homicide in Britain: The Case of Hadiza Bawa-Garba — published in Medscape Medical News in February, just after the GMC ruling meant she could no longer practice medicine.

Following that decision, physicians all over the world rallied behind Bawa-Garba, citing the undue pressures she was under, that she was only partially supervised, and that she was ultimately punished for being too honest about her own failings.

A crowd-funding initiative raised enough money for her to launch an appeal.

Bawa-Garba Pays Tribute to Jack; Relieved to Be Able to Work Again

Following yesterday's decision, Bawa-Garba gave an interview to the BBC Panorama program. "I want to let the parents know that I'm sorry for my role in what has happened to Jack. I want to pay tribute [to him]," she said.

"My hope is that the lessons learned from this case will translate into better working conditions for junior doctors, better recognition of sepsis, and [will ensure] factors [are] in place that improve patient safety."

She also said she wants to "acknowledge and give gratitude to people around the world from the public to the medical community who have supported me."

Her ultimate emotion is of relief: "I can't see myself being anybody else but a practicing doctor, so of course when I got the news that I could work again, I was very pleased."

But the mother of the boy who died while in Bawa-Garba's care, Nicky Adcock, told the BBC she was "devastated" by yesterday's verdict.

"What she did that day, I will never ever, ever, ever forgive her for. And I don't know how she can go back into this profession; she has shown no remorse, she has no guilt. I don't know how she can live with herself."

"I'm disgusted. I cannot understand how someone can be charged with gross negligence manslaughter, struck off the [medical] register by the GMC, and then be reinstated."

She is now considering whether to take the decision to the Supreme Court.

Timeline of Events

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

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

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

  • August 2016: Nurse Isabel Amaro loses her medical license (is "struck off" the medical register).

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

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

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

  • March 2018: 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 favor of Bawa-Garba and said the original decision by the Medical Practitioners Tribunal of a 1-year suspension from the register should stand.

Reaction So Far in the UK: GMC Criticized

The GMC has been greatly criticized by the medical profession for its handling of the case of Bawa-Garba, in which it was deemed to have overreacted, perhaps because of the criminal prosecution that followed the case.

It did concede yesterday that the whole saga has highlighted issues "that have gone unaddressed for far too long." It has now commissioned an independent review into gross negligence manslaughter issues.

In a statement in which it said it fully accepts the Court of Appeal's decision, the GMC noted: "We are sorry for the anguish and uncertainty these proceedings may have caused for Jack's family, Bawa-Garba, and the wider medical profession."

Charlie Massey, chief executive of the GMC, said the organization will "carefully examine" the issues surrounding the case "to see what lessons can be learned."

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

The Doctors' Association UK said the GMC had shown it could not be trusted to take a balanced and nonpunitive approach in situations in which a healthcare professional's abilities might be compromised by shortcomings of the system.

The case, it noted, has "united the medical profession in fear and outrage," whereby "a pediatrician in training...a highly regarded doctor, with a previously unblemished record, [was] convicted of [the criminal offence of] gross negligence manslaughter for judgments made whilst doing the jobs of several doctors at once, covering six wards across four floors, responding to numerous pediatric emergencies, without a functioning IT system, and in the absence of a consultant [senior physician], all when just returning from 14 months of maternity leave."

Physicians Will Rest Easier in Their Beds: Trainees Will Be Protected  

Speaking to the BBC outside the Court of Appeal, Jenny Vaughan, BMBS, a medical law campaigner, expressed her sympathy for the Adcock family.

But she stressed, "If someone is a trainee and is making honest errors in a very challenging hospital, which is what happened that day, they absolutely should not pay with their career. Many doctors and nurses will be resting easier in their beds, thinking 'I am human, I can make mistakes and I will not lose my license.' "

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."

And Chaand Nagpaul, MBBS, council chair of the British Medical Association, the UK physician's union, said: "Lessons must be learned 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 judgment 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 was the result of "an overstretched system" that saw a competent trainee covering the workload of several physicians.

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

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