Intended for healthcare professionals

Rapid response to:


Paediatrician convicted of manslaughter must be erased from register, rules High Court

BMJ 2018; 360 doi: (Published 26 January 2018) Cite this as: BMJ 2018;360:k417

Rapid Response:

Error on managing childhood sepsis is now a criminal offence, punishable by excommunication from the medical profession

The developments in the case of Hadiza Bawa-Garba are extremely worrisome for the entire medical profession. As human professionals deal with human patients, human error is inevitable and will never be completely erased; although I fully agree everything should be done to genuinely and effectively reduce errors from occurring.

It has long been understood that it is not the blaming and punishing of individuals that increases patient safety, but the learning about why a system did not stop an individual from making an error. This is not meant to be exonerating individuals from their personal responsibility for patient care, but to prevent individual blame where system failures enabled or even created individual erroneous decisions, as I believe is the case in the case of Dr Bawa-Garba. The NHS has signed up to promoting a Human Factors Approach which just tries to do that, somewhat replicating what made the airline industry safe to a degree that over the last year there was no major aircraft disaster.

It is my profound concern that the judgements against Dr Bawa-Garba, both her criminal prosecution as well as the GMC appeal, will signify the end of Human Factors Approach in the NHS. What I hear from my colleagues, with its actions the GMC has lost a huge amount of credibility and Trust as a regulator among doctors. Does it really have the safety of the patient in mind if its decision undermine learning from error?

Furthermore, as a specialist in the management of paediatric infectious diseases I am very troubled about the impact that these judgements are likely to have on the management of paediatric sepsis in clinical practice. Early sepsis in a child may be difficult to diagnose as it may initially present indistinguishable from a viral illness. Over the last couple of years, in the wake of the "Sepsis 6" campaign we have seen an attempt to improve the management of sepsis, which is an important, necessary and justifiable goal; albeit evidence for this approach is weak and over-diagnosis and over-treatment is a likely result. If doctors now have to fear criminal prosecution and erasure from their career, there will be an irrational moral dictum to grossly over-treat infections, resulting in unnecessary hospitalization and antibiotic treatment, rising antimicrobial resistance and escalating pressure on services, provoking further errors to happen.

This is a wake-up call for all involved parties to re-think how the NHS wants to deal with medical error, beyond the case of Dr Bawa-Garba. This can only happen with the involvement of all stakeholders.

Competing interests: No competing interests

26 January 2018
Christian Harkensee
consultant paediatrician
Newcastle upon Tyne