Intended for healthcare professionals

News

GMC to push for erasure of paediatrician convicted of manslaughter

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5223 (Published 09 November 2017) Cite this as: BMJ 2017;359:j5223

Re: GMC to push for erasure of paediatrician convicted of manslaughter

The following is a letter to the GMC chair.

Dear Professor Stephenson,

I write to you about what seems to be a serious misjudgement by the GMC regarding Dr Hadiza Bawa-Garba.

To set the context for my concerns, I am, among other things, a non-executive director of a major acute hospital trust, President of the charity Healthwatch which promotes evidence-based medicine, and the longest-serving member of the RCP’s committee on ethics in medicine.

On all three criteria, management, evidence and ethics, I fear the GMC has misjudged this case. Additionally, as a journalist and broadcaster I suspect that one of the factors might have been pressure from the media, and I should remind you that newspaper reporters are out to make a story, not nuanced judgements, and whose printed morals tend to be of the finger-wagging variety.

As a director of a hospital trust I worry that the GMC has undermined patient care by endorsing and promoting a blame ethos which is inimical to safety. I am responsible for a speak-up culture in the NHS (and an adviser to the National Speak-Up Guardian) and this case is chilling. It suggests we can blame trainees for lack of training and supervision, whether they are senior or junior, whether their units are under pressure or understaffed and whether there are contributory failings by nursing or other colleagues. Had this happens in our trust I hope the Board would have accepted much of the responsibility. Dr Bawa-Garba’s treatment sends a strong message to cover up mistakes. It runs counter to lessons from elsewhere and notably the airline industry where the UN treaty which protects airline passengers around the world (Annex 13 to the ICAO convention) explicitly guards against co-mingling safety investigations with criminal prosecutions.

As a champion of EBM, and evidence-based public policy, I am not aware of any evidence of outcomes, in terms of patient safety or medical behaviours, on which this GMC ruling might be based. If there is no such compelling evidence then the GMC is working contrary to one of the greatest and most revolutionary benefits to patient safety since the development of hygiene and antiseptics. Robust evidence of outcomes is slowly replacing anecdote, received wisdoms and authority (and fear) with huge benefits to patients. Where is the evidence that extinguishing Dr Bawa-Garba’s medical career will make any patient safer? I suggest that having been involved in the heartrending death of a child Mrs Bawa-Garba is likely to be one of the safest – and perhaps most overcautious – paediatricians in the country. You had evidence from ‘reliable’ witnesses that were no other concerns about her before or since this tragedy, that she had addressed the deficiencies in her practice, and they described her as ‘an excellent doctor’. Do you have any evidence to reach any other conclusion about Dr Bawa-Garba, or any reliable evidence on its effects on any other clinician who may learn about the case?

As an ethicist who has sat on several national inquiries, including long-term membership of the Nuffield Council on Bioethics, I find this ruling equally chilling. The GMC does not exist to dispense justice. That was the task of the crown court. The GMC’s role is to protect, promote, and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. I believe in this case it overstepped its responsibilities. I worry it may have been influenced by vocal and angry coverage, added to which there are unfortunate and unmeasurable risks that vengefulness, racism and xenophobia might have played a part. The initial tribunal was satisfied that the risk of Dr Bawa-Garba, ‘putting a patient at unwarranted risk of harm in the future is low.’

Perhaps you have evidence which has not been made clear to the public, but unless I hear some reassurance against each of these concerns I fear the time has come to hold the GMC itself to account. Can it demonstrate how this case has improved patient safety and standards in medicine, or – surely the only alternative - has it acted as an erudite and urbane kangaroo court?

Yours sincerely.

Competing interests: No competing interests

13 November 2017
Nick Ross
Broadcaster, journalist
PO Box 999, London W2 4XT