Daniel Sokol: Reflections on Bawa-Garba—a symbol of the medical profession’s discontent

The true significance of the Bawa-Garba case lies in what it represents: a profession in crisis

daniel_sokol_2016Last Thursday, I headed to the Royal Courts of Justice to watch the final day of the Bawa-Garba appeal. Before setting off, I printed off the judgment of the lower court. Without understanding the decision under appeal, the hearing would make little sense.

And so, sitting in the public gallery of Court 4, I read the judgment.

Distilled to its essence, the case was about what the Medical Practitioners Tribunal could legitimately conclude when dealing with a doctor convicted of gross negligence manslaughter. Both parties agreed that the tribunal could not go behind the jury’s finding that Dr Bawa-Garba’s actions on that fateful day in February 2011, when a 6 year old boy died from avoidable complications of pneumonia, were “truly exceptionally bad,” but what follows from that agreed position?  In determining a sanction, how much weight, if any, could the tribunal place on the systemic failures in the hospital, even though the jury was aware of those failures when it reached its guilty verdict?

When I looked up from my reading, Dr Bawa-Garba was sitting next to me. She said hello and waited anxiously for the judges to enter the courtroom.

After hearing the submissions of Dr Bawa-Garba’s barrister, the Court of Appeal reserved its judgment, which means it will be delivered at a later date.

Later, on Twitter, I read comments about the enormous significance of the case to doctors. I considered this an exaggeration since the recent report of Sir Norman Williams on gross negligence manslaughter in healthcare revealed that the number of doctors convicted of the offence is minuscule. The Crown Prosecution Service investigates about 30 cases a year and prosecutes, on average, a single case a year. The overwhelming majority of doctors will never find themselves in Dr Bawa-Garba’s position.

Another example, I thought, of people failing to understand what a court case is really about. However, on further reflection, I came to appreciate its wider significance.

It is interesting that the anger of the medical profession does not appear to be directed at the jury, for it is they who found Dr Bawa-Garba’s failings so negligent as to be “truly exceptionally bad.” Their anger is directed at the General Medical Council, who intervened to increase the sanction given by the Medical Practitioners Tribunal from suspension to erasure. For many doctors, the GMC’s attempt to protect public confidence in doctors by seeking the ultimate sanction for Dr Bawa-Garba was misguided.

The anger is also directed at the politicians and hospital administrators who, through a series of injudicious decisions, allowed Dr Bawa-Garba to work in such unsatisfactory conditions.

The significance of Bawa-Garba does not lie in the legal consequences of the case. Its true significance lies in what it represents. It has come to symbolise a broken, underfunded health system, poor and stressful working conditions, a lack of support for doctors in training, the unforgiving consequences of errors, the ever-present threat of blame and the fear of legal sanction, a general sense of professional vulnerability, and the strained relationship between doctors and an increasingly demanding public. It is a case that reflects a profession in crisis. So low is the profession’s morale that, were it a patient, it would be diagnosed with severe depression.

The significance of Bawa-Garba thus extends beyond the law and the case of that young doctor who sat next to me in court. It has become a symbol of the medical profession’s discontent. If the appeal fails, morale will sink yet further. If it succeeds, the collective depression will lift somewhat.  

It is clear, however, that even a victory for Dr Bawa-Garba would not solve the profession’s ills. That, surely, will require radical treatment.

Daniel Sokol is a medical ethicist and barrister. Follow Daniel on Twitter: @DanielSokol9

Competing interests: None declared.