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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 General Medical Council is perhaps between a rock and a hard place with this case as it is pressing ahead with an appeal in the High Court. One hopes the high court would do the right thing.

The profession should be more outraged at the adversarial legal system rather than at GMC as there has been more medical manslaughter cases recently.

With regards to Bawa- Grabas case, I do have some concerns.

The CPS website refers to a four stage test for gross negligence manslaughter ( also known as the Adomako Test as outlined by the House of Lords). (1). The test involves the following stages:

a) the existence of a duty of care to the deceased;
b) a breach of that duty of care which;
c) causes (or significantly contributes) to the death of the victim; and
d) the breach should be characterised as gross negligence, and therefore a crime.

Bawa-Garba’s case does fulfill the 1st and 2nd criteria.

As regards to the 4th criteria i.e "The Grossness of the Breach" , the CPS website says "It is for a jury to decide whether the defendant's conduct was so bad, in all the circumstances, as to amount to a criminal act or omission".

As regards the 3rd criteria i.e Causation , the CPS website refers to "R v HM Coroner for Inner London, ex parte Douglas-Williams [1999] 1 All ER 344" for a causation test in relation to gross negligence manslaughter. This case in turn refers to Galbraith test and the need to take into account the "strength of the evidence". (2).

Published literature indicates "Children with Down syndrome and sepsis have elevated risk of mortality." (3).
So the question is whether the Jury has been specifically aware of this increased mortality risk that is present even in promptly treated patients because of the disturbance in the adaptive immune system that is intrinsically present in Downs syndrome patients.(4).

References:

1.The Crown Prosecution Service.Homicide Murder and Manslaughter: https://www.cps.gov.uk/legal/h_to_k/homicide_murder_and_manslaughter/#gross

2. Chief Coroner. Law sheet no 2. Galbraith plus. https://www.judiciary.gov.uk/wp-content/uploads/2016/02/law-sheets-no-2-...

3. Garrison MM et al. Risk of death for children with down syndrome and sepsis. J Pediatr. 2005 Dec;147(6):748-52. https://www.ncbi.nlm.nih.gov/pubmed/16356424.

4. de Hingh YC, et al. Intrinsic abnormalities of lymphocyte counts in children with down syndrome. J Pediatr. 2005 Dec;147(6):744-7. https://www.ncbi.nlm.nih.gov/pubmed/16356423

Competing interests: No competing interests

16 November 2017
Santhanam Sundar
Consultant Oncologist
Nottingham City Hospital