what should consultants and trainees learn from the Bawa-Garba case?

Dr Hadiza Bawa-Garba. was a junior paediatrician working at the Leicester Royal Infirmary.

On the death of a child in 2011, Dr Bawa-Garba was investigated by the police and told in 2012 that no charges would be brought against her. She continued to be employed by the Trust up until 2015. A subsequent decision was taken to prosecute Dr Bawa-Garba.

On 4 November 2015, the Nottingham Crown Court convicted Dr Bawa-Garba of manslaughter by gross negligence and she was given a two-year suspended sentence following the death of a six-year-old boy.  The child had T21 Down’s syndrome and sadly died. Dr Bawa-Garba had stood down the resuscitation efforts because she mistakenly thought a ‘do not resuscitate’ order in relation to the child. Dr Bawa-Garba had an unblemished record and her failings occurred over a period of 12 hours

On 13 June 2017, the doctor faced a GMC hearing following the conviction. The case was heard before the Medical Tribunal Practitioner Service ("MPTS") which included a medically qualified member. At the hearing, MPTS found held that erasure would be disproportionate and found that her failings should result in suspension for one year. It was found that erasing her from the medical record would be disproportionate.

The panel listening to the evidence found that there had been systematic failings by the NHS Trust. The panel stated that these failings included “failings on the part of the nurses and consultants, medical and nursing staff shortages, IT system failures which led to abnormal laboratory test results not being highlighted, the deficiencies in handover, accessibility of the data at the bedside, and the absence of a mechanism for an automatic consultant review” The Tribunal therefore determined that whilst the doctor’s actions fell far short of the standards expected and were a causative factor in the early death of the patient, they took place in the context of wider failings.

It was found that the primary responsibility for monitoring the patient and maintaining his records fell upon the nurses working in the Children’s Assessment Unit that day but as the doctor in charge of the unit, secondary responsibility fell on Dr Bawa-Garba to ensure that this was being properly carried out. The panel found that on the day in question, the doctor was covering the unit, the emergency department and the ward. The errors were made over a period of 12 hours and she had just returned from maternity leave.

Evidence was given from Dr Bawa-Garba’s colleagues that she was a good doctor. The panel accepted that the doctor’s initial diagnosis of gastro-enteritis of the child was appropriate, but she should have had sepsis in mind as a possible diagnosis. The panel also found “It was satisfied that you had remediated the deficiencies in your clinical skills and had practised safely for a period of almost 4 years; both Dr D and Dr A described you as an excellent doctor. It was satisfied that the risk of you putting a patient at unwarranted risk of harm in the future was low”

Notwithstanding the panel’s findings the GMC appealed the judgement to the High Court who on 25 January 2018, imposed a sanction of erasure meaning that Dr Bawa-Garba could longer practise as a doctor.

In February 2018, health secretary Jeremy Hunt ordered an urgent review of medical malpractice cases following concerns over Dr Bawa-Garba's manslaughter case. Dr Bawa-Garba received wide support from doctors in the UK and abroad. She has been hailed a scapegoat with many doctors stating that against the background “this could have been me”

Following the case the GMC has issued guidance for doctors who find themselves in similar positions to Dr Bawa-Garba at https://gmcuk.wordpress.com/2018/02/02/faqs-outcome-of-high-court-appeal-dr-bawa-garba-case/

​Our advice to doctors working with a lack of resources and in situations where safety is at risk is that you must complete your shift rather than increasing the risk by walking out. You must however raise concerns immediately with the Medical Director. Those concerns should be followed up in writing once the shift has ended. You will be protected under the Public Interest Disclosure Act 1998 (whistleblowing act) if you are disciplined or dismissed for raising concerns that you consider to be true which affect or have the potential to affect patient safety.