Introduction
The UK case involving Dr Hadiza Bawa-Garba, a junior doctor convicted of manslaughter and subsequently struck off the UK medical register, is raising alarm in the international medical community.
The case has sparked discussion among doctors around the world about the role of self-appraisals and highlighted the difficulties faced by junior clinicians working in the healthcare system.
Background
At around 10.15 am on 18 February 2011, Jack Adcock, a six year old boy with Downs Syndrome presented to the Children’s Assessment Unit (the Unit) at Leicester Royal Infirmary Hospital (the Hospital) with dehydration, caused by vomiting and diarrhoea, and shallow breathing.[1] As a baby, Jack had undergone surgery for a hole in his heart, a result of which he required long term medication and he was more prone to coughs, colds and breathing difficulties.[2]
Jack was initially seen by Sister Taylor.[3] She immediately requested assessment by Dr Bawa-Garba, a specialist registrar in her sixth year of postgraduate training in paediatrics.[4] On that day:
- Dr Bawa-Garba’s consultant, Dr Stephen O’Riordan, was teaching in another town and she was covering for at least one other paediatric registrar, who was on leave;
- it was Dr Bawa-Garba’s first day on duty for emergencies involving sick children, in an unfamiliar hospital, having recently returned from maternity leave;
- Dr Bawa-Garba was nearing the end of a double shift that day (12/13 hours straight), with no breaks; and
- there was an IT failure, which led to delays in obtaining blood results.[5]
Over the next 8-9 hours, Jack was in the Unit under the care of Dr Bawa-Garba and two other members of staff, before being transferred to the ward of the Hospital around 7.00 pm.[6] During Jack’s time in the Unit, he was initially treated for acute gastro-enteritis and dehydration until a chest x-ray revealed he had pneumonia.[7] The delay in treating pneumonia (a Group A Streptoccal infection) caused Jack’s body to go into septic shock.[8]
At around 7.45 pm, Jack’s sepsis caused his heart to fail.[9] Despite resuscitation attempts, Jack died at 9.20 pm.[10]
A post-mortem revealed Jack’s cause of death was systemic sepsis complicating his pneumonia infection combined with Downs Syndrome and the repaired hole in his heart.[11]
Conviction and ban from practice
On 4 November 2015, in the Crown Court at Nottingham (the Crown Court) before Nicol J and a jury, Dr Bawa-Garba was convicted of manslaughter by gross negligence.[12] She was sentenced to two years imprisonment, suspended for two years.[13] The failings of Dr Bawa-Garba, cited by the Crown Court, included, among other things, the fact that she ignored key warning signs that Jack was in septic shock, she didn’t properly reassess Jack’s condition and she didn’t raise concerns with the consultant, when he arrived at the Hospital at 4.30 pm.[14]
On 29 November 2016, the Court of Appeal Criminal Division, refused Dr Bawa-Garba’s leave to appeal her conviction.[15]
On 13 June 2017, the Medical Practitioners Tribunal (the Tribunal) found that Dr Bawa Garba’s fitness to practise had been impaired and suspended her from practice for one year.[16]
On 7 December 2017, the General Medical Council appealed the Tribunal’s ruling at the England and Wales High Court (the High Court).[17]
On 25 January 2018, the High Court allowed the appeal of the General Medical Council and overturned the Tribunal’s decision.[18] The High Court concluded that the Tribunal had failed to adequately sanction Dr Bawa-Garba and give appropriate weight to the finding of the jury that her conduct was truly exceptionally bad.[19] The High Court determined that the appropriate sanction was erasure, not suspension, resulting in Dr Bawa-Garba’s lifelong ban from the medical profession.[20]
Reflections
This case has promoted debate and discussion in the medical community for two main reasons.
Firstly, it has called into question the culture of transparency in which medical practitioners share experiences through honest self-appraisals and reflections, so that others can learn from their mistakes. The reason for concern is that it was reported that Dr Bawa-Garba’s own reflections in her e-portfolio, and admission of culpability, were used in the case against her.[21] Despite the widespread reports, Dr Bawa-Garba’s e-portfolio reflections were never submitted to the Court.[22] However, parts of her e-portfolio (i.e. her trainer assessments) were included in the material considered by the expert witnesses and Dr O’Riordan, the consultant on-call the day Jack died, gave evidence in relation to Dr Bawa-Garba’s verbal reflections.[23]
Open disclosure and self-reflection is encouraged in Australia in order to promote learning and improve patient care. The work product related to this process needs to be kept confidential and privileged in order to prevent this information from being used in civil, disciplinary or criminal proceedings. If this doesn’t occur and medical practitioners stop being honest about mistakes, there are wide reaching implications for managing safety in the healthcare sector. Insight should be encouraged, not scorned.
This case also provides a good example of scapegoating of a junior clinician. It highlights the vulnerability of junior medical practitioners and difficulties they face working in over-stretched, under resourced public hospitals with little to no supervision. It emphasises the importance of ensuring that junior staff are adequately supervised and properly supported.
Meridian Lawyers provide advice and assistance to practitioners facing civil proceedings or disciplinary action. This article was written by Principal Andrew Saxton and Senior Associate Phoebe Callander. Please contact us with any questions.
Disclaimer: This information is current as of March 2018. These articles do not constitute legal advice and do not give rise to any solicitor/client relationship between Meridian Lawyers and the reader. Professional legal advice should be sought before acting or relying upon the content of these articles.
[1] Hadiza Bawa-Gaba v The Queen [2016] EWCA Crim 1841 at [3]-[6]
[2] Above, n 1, at [4]
[3] Above, n 1, at [6]
[4] Above, n 1, at [6]
[5] McDonald, Andrew. “Death of British boy has worried junior doctors all over the world – with good reason.” Brisbane Times, 2 February 2018
[6] Above, n 1 at [6]
[7] Above, n 1 at [6]
[8] Above, n 1, at [7]
[9] Above, n 1, at [7]
[10] Above, n 1 at [7]
[11] Above, n 1 at [9]
[12] Above, n 1, at [1]
[13] Above, n 1, at [1]
[14] Above, n 1, at [12]-[14]
[15] Above, n 1, at [,37]
[16] General Medical Council v Dr Bawa-Garba [2018] EWHC 76 (Admin) at [1]
[17] Above, n 16, at [1]
[18] Above, n 16, at [55]
[19] Above, n 16, at [55]
[20] Above, n 16, at [55]
[21] Gregory, Julia and Kaffash, Jaimie. “Revealed: how reflections were used in the Bawa-Garba case”, Pulse, 31 January 2018
[22] Above, n 21
[23] Above, n 21
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