Support mounts for paediatrician whom GMC wants struck off
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5384 (Published 21 November 2017) Cite this as: BMJ 2017;359:j5384
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editors
I share similar concerns with other respondents in which a doctor is held responsible for a death of a child in 2011 resulting from multiple failures of a system under pressure; I am surprised the 2015 conviction had not been followed by any successful appeal.
My attempts at finding 2013 coroner's proceedings and 2015 court proceedings have been unsuccessful; I would appreciate it if fellow readers can offer suggestions and point me in the right direction.
However in response to Dr Ashworth's post (ref 1), I like to also share my concerns about the nature of how the legal proceedings have occurred and the resulting public perception of the case.
These concerns are precipitated by inadvertent discovery of a webpage (Ref 2) which described the FOI request on 5 November 2015 of a person named 'Chris' seeking to find out about Bawa-Garba's medical qualification.
"Where did Dr Hadiza Bawa-Garba (Leicester Royal Infirmary) qualify and what medical qualifications does she hold"
The result of the FOI provided on 24 Nov 2015 (prior to conviction of Bawa-Garba in Dec 2015) clearly shows that Dr Bawa-Garba is a graduate of University of Leicester in 2003.
Without over-speculating "Chris" original purpose seeking the FOI, or the intent on how this information was going to be used, I simply wonder what would have occurred if Bawa-Garba was instead a foreign graduate?
Furthermore I have found that the webpage displaying the FOI is invariably found within the top 20 Google listing when searching with keywords involving "Bawa-Garba" and "GMC".
I have personal concerns from this discovery about the nature of public perception of Dr Bawa-Garba and whether it would have any effect on the court proceedings and subsequent management of processed by the GMC as a result.
Would this revelation reflect on the prejudices of certain parts of the wider community, I wonder.
References:
1. http://www.bmj.com/content/359/bmj.j5384/rr-2
2. https://www.whatdotheyknow.com/request/where_did_dr_hadiza_bawa_garba_q
Competing interests: No competing interests
Another ethnic minority doctor is being aggressively pursued through
the High Court by the GMC.
Following similar aggressive pursuit of Dr Nwachuku (1) (who is Black)
I sought data from the GMC using a freedom of Information request (2)
The data provided showed that, in 2016:
0.53% of white doctors holding a licence to practice were referred by
their Responsible Officers to the GMC, with 0.74% of Asian Doctors and
1.03% of black doctors being referred.
The GMC has written to me opining that these figures do not imply
Institutional Racism by the GMC. Their position is accurate since the
figures demonstrate the Institutional Racism of Responsible Officers.
For those doctors referred to it the GMC published warnings (that
generally include details of the unproven allegations) to 2.3% of
white doctors, 4.8% of Asian Doctors and 6.8% of Black Doctors.
All of these doctors were publicly humiliated on the basis of
allegations that there was, according to its own guidance, "no
reasonable prospect" of proving, thus undermining the confidence of
their patients in them. Shouldn't the GMC be concerned at this data?
MPTS outcomes did not show differences based on ethnicity.
On the basis of evidence, Responsible Officers and the GMC
discriminate on grounds of race, the MPTS is colour blind,
The GMC and the High Court should be careful of the GMC's true
motivation further to punish Dr Hadiz Bawa-Garba. In being over
aggressive to vulnerable colleagues, apparently on the basis of their
ethnicity, does the GMC not put at risk its traditional role of
consensual professional policing?
For the avoidance of doubt and the benefit of justice for a colleague
being pursued by an increasingly autocratic and unaccountable
regulatory authority, I am prepared to give quantitive and qualitative
evidence of regulatory racism to the High Court, citing paired
examples of pro-white racism together with data showing that the GMC
acts beyond its legal authority defined by the Medical Act 1983 in 53%
of the warnings that it imposes.
1. BMJ 2017;358:j3864
2. GMC information request F17/9081/SW
Competing interests: I am White, Middle Aged and Conservative. I have been in dispute with the GMC
This was Dr Bawa-Garba’s first on call shift in this setting, commencing her Level 3 training , after return to work from 13 months maternity leave. There appears to have been limited, if any Trust Induction to help her re-skill. This was her first registrar placement in General Paediatrics at this hospital, with the majority of her registrar training having been completed in neonatal and community medicine. Four years previously she had undertaken a year’s Level 2 General Paediatrics training at a smaller hospital.
On the day in question she was doing the work of 2 doctors due to unexpected absence of a fellow registrar, including cover for two ward areas, four floors apart. Under such circumstances senior cover should have been increased. The usual direct consultant cover was absent due to problems within the rostering system. On top of this crucial morning handover was interrupted by a ‘crash call’.
It appears that a team of inexperienced medical and nursing staff were thrown together, reliant upon each other through the exhausting 13 hour shift, but who had not worked together in some cases, without any simulation training , team introductions, adequate handover or consistent IT support. This team was led at registrar level by a committed and dedicated but new doctor, four years away from her general paediatric experience , who may not have been able to access Trust induction. How did this even happen?
Dr Bawa-Garba was held responsible for the administration of a medication (Enalapril) that she did not prescribe. The educational focus on decreasing drug error stresses that if medications are not correctly prescribed, they should not be administered. She was not informed that the drug had been given and so could not advise measures to counteract its effects.
There are further questions regarding the supervision and support of Dr Bawa-Garba after the event. There is no talk of a staff debrief for instance ,or how honest reflection in mentorship meetings or portfolios may be taken as an admission of overall guilt for the entire broken system and used in law against the trainee. It is unclear who supported her from the educational perspective through the ensuing media onslaught (‘Disgraced doctor walks free’ is one headline).
Health Education England appear to have remained silent through this case. One imagines that Sir Keith Pearson and Professor Ian Cumming , Chair and Chief Executive of HEE will wish to instruct their teams to urgently produce a statement reassuring trainees that any deficiencies in the educational support and supervision uncovered by this tragic chain of events have been addressed.
Competing interests: Dr Bawa-Garba looked after paediatric neurology patients during my time as Consultant at Leicester Royal Infirmary. I wrote a testimonial for the MPTS in her support
By now, almost every doctor engaged in acute healthcare in the UK must be aware of the gross structural deficiencies that contributed to Jack Adcock's tragic outcome. In particular, the absence of clinical leadership in the department, the lack of contingency plans in the event of IT failure, and ineffectual Human Resources policies combined to create an environment in which, sooner or later, disaster would be inevitable.
Who will gain from the GMC's intention to appeal against the MPTS decision that suspension of Dr Bawa-Garba from the register, rather than erasure, is the appropriate course of action?
Trust management will be relieved that the spotlight remains focussed on her. Racists will be delighted, and fundamentalists pleased to seize on what they will portray as evidence of a crusade against Islam. A number of lawyers will see their bank balances swelled by contributions from our annual retention fees.
But Jack will remain, tragically and irretrievably, dead, his distraught parents as bereaved as before.
The law on involuntary manslaughter, obliging jurors to make complex decisions on four separate elements, has demonstrated itself unfit for purpose, and the edifice of clinical governance, the corporate rather than individual responsibility for high quality care, has been shown to be a facade. Responsible professionals will be appalled at the vindictiveness of the establishment. If the appeal is successful, a competent and respected doctor will be lost forever to the profession. And recruitment to the embattled and understaffed speciality of acute paediatrics will be dealt another blow, possibly severe enough to compromise the future care of sick children throughout the United Kingdom.
The GMC has already argued, fatuously, that Dr Bawa-Garba was responsible for ensuring that nursing observations were performed appropriately, that she was to blame for the unofficial and, indeed, illegal administration of a drug she had suspended, and even that, since her record has otherwise been exemplary, there is every chance of a similar disaster occurring again in future "out of the blue". So will this initiative achieve its stated aim of protecting patients?
Definitively, no.
Competing interests: No competing interests
I wrote to GMC re duty of candour in light of their use of trainees reflective notes in court.
Buried in reply:
"If a concern were to be raised with us that related to a single clinical incident, where a doctor acted in good faith and didn’t try to cover it up, followed procedure and demonstrated insight, we would be unlikely to find fitness to practise impaired."
Just fancy that!
Competing interests: No competing interests
The huge interest this case just illustrates the far reaching concerns that it has stimulated. The GMC's actions, sadly, just mirror what many of us experience at the front line: That there is a deep-rooted, ingrained blame culture within the NHS that suffocates genuine learning from errors and blocks substantial progress with making health care safer. It would be a large step backwards and affect the practice of all doctors if the GMC would deem it acceptable, overriding even a Court judgement, to single out individual practitioners for system failures, The stance that the GMC is taking here may cost future lives. Dr Bawa-Garba, having learned her professional and personal lessons from this tragic case, should be treasured as a huge asset for promoting patient safety within the NHS, rather than being vilified.
Competing interests: No competing interests
Re: Support mounts for paediatrician whom GMC wants struck off
This tragic chain of events is of importance to all health care workers and it is worthwhile for us to find out as much as possible to understand how we can best prevent similar situations in future. I applaud Mr Goh in his analysis and in answer supply the following. Information regarding application for trial transcripts can be found at https://www.gov.uk/apply-transcript-court-tribunal-hearing.
The professional organisations judgement are available at https://www.mpts-uk.org/decisions/data/12693.asp and https://www.nmc.org.uk/globalassets/sitedocuments/ftpoutcomes/2016/augus...
A copy of the letter to the GMC signed by 120 doctors requesting that it does not proceed to the high court to request erasure of Dr Bawa-Garba, overturning the MPTS decision, recommending suspension is on http://www.manslaughterandhealthcare.org.uk/
Competing interests: Conflict of interest; I signed the letter to the GMC and helped check accuracy of signatures