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Bawa-Garba to appeal High Court ruling and may challenge manslaughter conviction

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k655 (Published 09 February 2018) Cite this as: BMJ 2018;360:k655

Re: Bawa-Garba to appeal High Court ruling and may challenge manslaughter conviction

Dear Sirs,

Many will have heard of this terrible, tragic case. The doctor involved was tried for manslaughter and convicted despite serious Trust flaws which led to the tragedy.

My feeling here is rather different to the majority. I do agree that a junior doctor, left unsupervised with two juniors below her, each of whom had only a month's experience of paediatrics, and had herself just returned from 13 months' maternity leave was particularly vulnerable to a mistake being made. Where I depart from many people’s stated views is that I do not think the registrar is culpable.

After 32 years as a consultant, I know that my duty working with junior doctors is to ensure they manage every case with knowledge and insight. This is done by closely supervising the least experienced ones and checking that all the right things have been done with every case admitted under my care. Those patients admitted when I am on call are my responsibility. The buck stops with the consultant. It has always been so.

If the registrar makes a mistake then it seems clear to me that I am the one who should be held accountable, not the junior who is following my instructions. I am the consultant and the patient is my patient. If I leave a junior in charge, it remains my responsibility and I have a duty of care.

In this case, the clinical biochemistry details were given to the consultant in charge of the case, by Dr Bawa-Garba before she went off shift. The matter is then his responsibility. Even had she not imparted the correct information, it remains the responsibility of the consultant to ensure the patient is safe and being treated properly.

If I have a failing registrar one must ask oneself who’s responsibility is that? Junior doctors are not a few months out of the pram, they are qualified, responsible medical practitioners, with medical and often postgraduate degrees. They are all capable of learning. Those that do not learn, remain the consultant’s responsibility, and the failure is his and his alone with only rare exceptions.

Consultants are at the top of the clinical salary scale in the NHS for only one reason - because they take responsibility in the end. The registrar in this case was scapegoated and was not adequately backed up by her consultant who it seems, was elsewhere, teaching at the time. I find this below a reasonable standard, in my opinion. A consultant who knows the inexperience and limitations of the junior doctors under him, and who is absent in any case, is not doing right by the patients or staff. He should not have been allowed to be away from the hospital if he was not immediately available for the patients being admitted under his care. He must have planned the teaching, accepting that it was a commitment which once begun could not be easily left. Did he arrange for another consultant to cover in his absence? Apparently not.
Accepting commitments away from work when you are on call has always been regarded as wrong. This is especially true if the consultant is engaging in private practice or other fee earning work. How is it different to arrange a teaching session elsewhere? He was on call and therefore responsible.

If the registrar in the hospital needs supervision, then that is the responsibility of the consultant. When I am on call with any new registrar, I always check with them what experience they have and what operations they have already done with and without supervision. When I am called by them I always take their experience and ability into account.

Dr Bawa-Garba, in my opinion is the victim of scapegoating to protect others who should stand up and accept the responsibilities which they assume on appointment as a British consultant.

I really hope the case is appealed once more, and others are prepared to speak out in support of this victimised and wrongly punished doctor.

Fred Nath, Consultant Neurosurgeon

Competing interests: No competing interests

09 February 2018
Fredrik P Nath
Neurosurgeon
NHS
Department of Neurosurgery, James Cook University Hopsital, Marton Road, Middlesbrough, TS4 3BW