Criminal Law : Doctor struck off and convicted of manslaughter – professional errors made under pressure.
In December 2015, Dr Hadiza Bawa-Garba, an Accident & Emergency doctor, was found guilty at Nottingham Crown Court of gross negligence manslaughter of six-year-old Jack Adcock, who had been admitted to the Leicester Royal Infirmary in February 2011. Jack had a known heart condition and had been admitted with vomiting and diarrheaoa. During his admission Jack developed sepsis and then died after suffering a cardiac arrest. The Prosecution case was that Dr Bawa-Garba had failed to properly discharge her duty as the doctor in charge, including temporarily confusing him with another patient and wrongly believing (again temporarily) that Jack was under a ‘Do Not Resuscitate’ Order.
The sentencing judge, addressing both Dr Bawa-Garba and her co-defendant nurse said “There was no evidence either of you neglected Jack because you were lazy or behaved for other selfish reasons. You both had other patients to attend to. The problem was neither of you gave Jack the priority which this very sick boy deserved”. Dr Bawa-Garba received a two-year suspended prison sentence.
Following this, the Medical Practitioners’ Tribunal imposed a suspension of 12 months. In January 2018, the General Medical Council (GMC) asked Lord Justice Gross and Mr Justice Ouseley to quash that decision and direct Dr Bawa-Garba’s erasure from the medical register. The GMC argued that anything short of erasure was "not sufficient" to protect the public or maintain public confidence in the medical profession. Allowing the GMC's appeal, Lord Justice Gross said: "Notwithstanding the system failures and the failures of others, the jury convicted Dr Bawa-Garba of manslaughter by gross negligence." It necessarily follows that her failings on that day were 'truly exceptionally bad', which was "was not properly reflected or respected" in the tribunal's decision. Clearly, the decision to erase closely followed the result of the criminal trial.
In Dr Bawa-Garba’s defence, medical commentators point out that she had just returned from 13 months on maternity leave and had little experience of working on a child assessment unit. She was meant to have had an induction to get up to speed and boost her understanding of managing patient workflow across various wards, but for staffing reasons the induction did not happen. In fact, due to a diary mix-up, the consultant who was due to be in charge was in fact lecturing at a university. Also, the registrar covering the children's assessment unit was not working during the shift either. And due to an IT failure, the senior house officer was delegated to phoning for test results over a four hour period, during which Dr Bawa-Garba also had to cover his role. This meant Dr Bawa-Garba was covering six hospital wards over four floors, in which dozens of sick children were all directly under her supervision. For the most part during her 13 hour shift, her work was exemplary. Her first act on arrival was to respond to a ‘crash beep’ as one child went into cardiac arrest. That emergency caused her to miss a morning crucial handover, but it also enabled her to save that child’s life. Later, she performed a lumbar puncture on one child, and stabilised another during an epileptic fit. However, it was accepted that Dr Bawa-Garba made errors in the diagnosis of Jack Adcock, errors which contributed to his tragic death.
Aside from the very challenging working environment that day, another troubling aspect of the case was the Prosecution’s reliance on Dr Bawa-Garba’s own learning reflection that she expressed afterwards to her consultant, in which she was recorded saying that she "could have done better". This level of honest reflection was seized upon by the Prosecution as an admission of negligence, an admission which ultimately led to her conviction for gross negligence manslaughter and being struck off as a doctor. Many doctors are concerned that patient safety is not enhanced if a culture of fear permeates their confidential reflections, where utterances such Dr Bawa-Garba's are used to incriminate them. If healthcare professionals cannot have a space in which to honestly assess their own conduct and learn from mistakes, they will know that simply expressing a willingness to improve may be construed as an admission of negligence. For Dr Bawa-Garba, this led directly to a suspended sentence of two years imprisonment and being struck off by the General Medical Council.
As a result of the GMC's appeal, more than 8,000 doctors have signed a petition stating that this case will only “lessen our chances of preventing a similar death”. The case brings into sharp focus the pressures facing the medical professionals who have to make numerous life-saving decisions every day. Whilst there ought to be transparency and accountability for life-changing mistakes, the uncomfortable truth is that, in such an environment, a degree of human error is simply inevitable. A regulatory regime, however well-meaning, must allow the space for honest reflection, candour and improving from mistakes.
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Articles are intended as an introduction to the topic and do not constitute legal advice.