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27 November 2017

The case of Hadiza Bawa-Garba should worry every doctor

She was convicted of gross negligence manslaughter in 2015 over the death from sepsis of a six-year-old boy.

By Phil Whitaker

The relationship between the medical profession and its regulator, the General Medical Council (GMC), is at an all-time low, with some senior doctors contemplating referring the GMC to its own supervisory body, the Professional Standards Authority.

The issue that has provoked so much ire is the GMC’s treatment of a paediatric registrar, Dr Hadiza Bawa-Garba, who was convicted of gross negligence manslaughter (GNM) in 2015 over her involvement in the death from sepsis of a six-year-old boy, Jack Adcock.

I have written before about the inappropriateness of GNM prosecution as a tool to address health-care disasters. There are rare cases in which a doctor’s actions properly meet the legal threshold for conviction – that they were aware of the risk of death and recklessly indifferent to it – but the vast majority of cases have been brought against dedicated, caring, skilled people doing their best in highly challenging circumstances.

Dissected in a courtroom, things can be made to appear very bad by a prosecutor tasked with attributing as much blame as possible to the individual. This fails to take into account the realities of medical practice: how complex serious illnesses can unfold unpredictably within a typical day in our grossly overstretched NHS.

The court declined to take evidence on all mitigating factors at Bawa-Garba’s trial, but the Medical Practitioners Tribunal Service (MPTS) did so. The MPTS is the body that decides on a doctor’s professional future in such cases. The GMC applied to have Bawa-Garba struck off. The MPTS ruled that she should resume work once her suspended sentence expired.

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In a multifaceted judgement, the MPTS took note of Bawa-Garba’s exemplary record both before and since Jack Adcock’s death. Several highly regarded paediatricians testified to her integrity and ability. The tribunal gave due weight to the system failures that had let both doctor and patient down.

Bawa-Garba’s unit was understaffed and she was working a double shift with compromised consultant cover, looking after many more patients than usual. Because of a shortage of nurses, she was doing so without experienced ward staff to rely on. An IT failure prevented crucial test results being relayed expeditiously to her. And her hospital had no system for referring deteriorating patients to senior colleagues.

She did make mistakes, but in a properly resourced service, they should not have had fatal consequences. She had reflected at length on her errors and had undertaken additional training to address them. The MPTS found her to pose no more risk of patient harm than any other doctor.

I know of no colleague who hasn’t reacted with the thought: “There but for the grace of God go I.” We all recognise the extreme stresses that Bawa-Garba was working under in our austerity NHS. And we have troubling memories of our own cases that have gone similarly badly (I can think of three in my career). Everyone is mindful of the unimaginable devastation that Jack Adcock’s family is having to live with, but sympathy with Bawa-Garba’s plight has spawned the hashtag #ItCouldHaveBeenMeToo.

Against this backdrop, the GMC’s decision to appeal the MPTS’s judgement and to seek to have her struck off by the high court has left doctors unified in disgust. More than 100 paediatricians have written to the GMC in protest.

The former Crimewatch presenter Nick Ross, now the president of the charity HealthWatch, has entered the fray. His open letter to Terence Stephenson, the chair of the GMC, articulates what many of us feel – including the unsettling concern that the GMC has been influenced by the hostile tabloid coverage that Bawa-Garba received, and the possibility of racist or xenophobic undercurrents against the Muslim, headscarf-wearing paediatrician. It’s hard to imagine a white, middle-class colleague being pursued so vindictively.

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This article appears in the 22 Nov 2017 issue of the New Statesman, Europe: the new disorder