{"id":40869,"date":"2017-12-13T17:53:25","date_gmt":"2017-12-13T16:53:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=40869"},"modified":"2017-12-15T17:57:03","modified_gmt":"2017-12-15T16:57:03","slug":"deborah-cohen-the-bawa-garba-case-the-gmc-and-a-tragic-circle","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/12\/13\/deborah-cohen-the-bawa-garba-case-the-gmc-and-a-tragic-circle\/","title":{"rendered":"Deborah Cohen: The Bawa-Garba case, the GMC, and a \u201ctragic circle\u201d"},"content":{"rendered":"

When eminent senior doctors\u2014who have a keen and known interest in medical ethics\u2014leave a courtroom threatening to quit the General Medical Council (GMC) so that their money can\u2019t be used to scapegoat trainees, it leaves a sense of how little confidence the profession has in their regulator.<\/p>\n

The Royal College of Paediatrics and Child Health<\/a> has put out a statement: \u201cLoss of confidence in the General Medical Council would diminish their authority as a regulator, the respect in which they are held, and ultimately their ability to protect patients,\u201d it said. <\/span><\/p>\n

But that seems to matter little. It\u2019s the public whose confidence in the profession the GMC has a duty to uphold, its QC opined at the High Court in London on 7<\/span>th<\/span> December\u2014a point recognised by the RCPCH.<\/span><\/p>\n

But in the fight to maintain \u201cpublic confidence\u201d\u2014which is hard to define and even harder to measure\u2014the GMC is fast losing respect in the profession it seeks to regulate. They are seen as out of touch about the challenges of working on the frontline and worse still, their actions are viewed as jeopardising patient safety\u2014one of the principal reasons they exist. This all comes at a time when the roles of the professional regulators are up for consultation.<\/span><\/p>\n

Courtroom 3 saw the latest in the high profile case of Hadiza Bawa-Garba, a trainee paediatrician convicted of gross negligence manslaughter in 2015 after the death of six year old Jack Adcock from sepsis at Leicester Royal Infirmary<\/a>.<\/span><\/p>\n

The GMC is attempting to overturn a decision<\/a> by the Medical Practitioners Tribunal Service to keep her on the medical register.<\/span><\/p>\n

In the words of one of the two presiding judges, it is a tragic case all round and one that has garnered huge public interest. Indeed, the press gallery was full and doctors were wearing badges saying \u201clearn not blame\u201d.<\/span><\/p>\n

Alongside the doctors, Jack\u2019s parents were in attendance understandably visibly angry and upset.<\/span><\/p>\n

\"\"Outside a cardboard placard was painted with a \u201ctragic circle.\u201d The trainee paediatrician who had made the sign explained that it represented the idea that the first victim of medical error was Jack; the system failures surrounding Bawa-Garba\u2019s mistakes made her a second victim; which, if not handled properly, would make the NHS a third victim. This would only further perpetuate the \u201ctragic circle\u201d creating yet more victims.<\/span><\/p>\n

On social media Bawa Garba is not seen by many outside the profession as a victim. The Adcock\u2019s anger has been shared by others, who see a privileged, patronising medical \u201cclub\u201d\u2014a word used in court\u2014defending their own. There\u2019s a pervasive view that doctors seem unperturbed by the death of a child and fail to understand that they\u2019re not the only ones working in high risk environments.<\/span><\/p>\n

Nigerian born, she has\u2014perhaps predictably given previous experiences of overseas black and ethnic minority doctors working in the UK\u2014endured an ongoing barrage of racially motivated abuse that\u2019s now been reported to the police. She\u2019s also been hit with allegations that she gave substandard care because she was prejudiced against Jack because he had a disability. Bawa-Garba\u2019s own child has autism and she is a trained child behaviour therapist with expertise in working with children with special needs. <\/span><\/p>\n

Bawa-Garba does seem to have the \u201cclub\u201d on her side, however. But these aren\u2019t just medical professionals who throw their weight behind any doctor. Indeed, they\u2019re outspoken and proactive critics of perceived unethical behaviour by other doctors.<\/span><\/p>\n

There\u2019s just no consistency, one doctor commented outside the courtroom. Why do some serious mistakes resulting in tragic harm or death end up in the Crown or civil courts, a tribunal, a suspension, or erasure, and others don\u2019t? And why are some doctors with criminal convictions pursued by the GMC as particularly damaging and others are not?<\/span><\/p>\n

There\u2019s a concern that the full situation hasn\u2019t been properly understood. Statements made were met by disbelief by doctors in the galleries\u2014the complexities of day to day working in a stretched NHS distilled in courtroom exchanges between the QCs and judges. Systems failures dismissed as passing the blame onto others\u2014what was so different about this day, the judges asked. Many doctors work a \u201cdouble shift,\u201d one judge added.<\/span><\/p>\n

Doctors who had worked with Bawa-Garba were aghast at this description. Seventy three system failures had been identified. She was working on 4 different floors covering multiple wards including respiratory HDU and admissions.<\/span><\/p>\n

\u201cShe was doing the work of three doctors\u2014the consultant, absent registrar who should have been covering the children\u2019s assessment unit,\u201d one said. She\u2019d also appointed an SHO to chase up results because of the IT failure and so was doing their job too.<\/span><\/p>\n

According to Jonathan Cusack<\/a>, a neonatologist at the infirmary who became Bawa-Garba\u2019s supervisor as part of her re-training following Jack\u2019s death, a computer failure meant she was told Jack\u2019s results over the phone rather than reading them on screen, making her more susceptible to \u201ccognitive error.\u201d<\/span>
\n<\/span><\/p>\n

This is well described in the literature as increasing the risk for error and patient harm. \u00a0<\/span><\/p>\n

Perhaps the GMC\u2019s own report<\/a>\u2014published a mere ten days before\u2014warning that trainees were being forced to work beyond their capabilities and to run busy departments unsupervised putting patients at risk had got lost in the post, another doctor remarked. <\/span><\/p>\n

Bawa-Garba has undoubtedly made mistakes. <\/span>But she had been blamed for the fact that the consultant, when he arrived for evening handover, did not act on the blood gas results he was given by her. She has also been held responsible for not checking nurses were making the correct observations; for someone else giving blood pressure lowering drug enalapril\u2014which she didn\u2019t prescribe\u2014when Jack already had sepsis. This was felt to be a significant contributory factor in his death by one expert\u2014yet Bawa-Garba had no knowledge of the fact that it had been given.<\/span><\/p>\n

The GMC\u2019s Charlie Massey was quoted in the Daily Mail as saying<\/a>: \u201cAt the heart of this tragic case was the sad death of a six-year-old boy, Jack Adcock, who did not receive the care he should have. We acknowledge the strength of feeling expressed by many doctors,\u201d adding that \u201cthe decision to appeal the suspension was not taken lightly\u201d.
\n<\/span>
\n<\/span>But the concern amongst doctors is that this move will only perpetuate further the \u201ctragic circle.\u201d<\/span><\/p>\n

Deborah Cohen<\/strong> is a freelance journalist.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

When eminent senior doctors\u2014who have a keen and known interest in medical ethics\u2014leave a courtroom threatening to quit the General Medical Council (GMC) so that their money can\u2019t be used […]<\/p>\n

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