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Expert urges doctors to report themselves to GMC

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k481 (Published 30 January 2018) Cite this as: BMJ 2018;360:k481

Second letter to the GMC regarding Dr Hadiza Bawa-Garba

5 February 2018
Prof Terence Stephenson DM FRCP FRCPCH
Chair, General Medical Council
Regent’s Place
350 Euston Road
London NW1 3JN

Dear Professor Stephenson,

My last letter to you about Dr Bawa-Garba (9 November 2017 and reprinted BMJ 2017;359:j5223) was followed by a stream of similar comments in the medical and national press and social media, mostly by doctors and the Academy of Royal Medical Colleges, but also by non-medics like me and, not least, of course, by Jeremy Hunt. I do not believe it is an exaggeration to say that in striking a physician off the medical register for making mistakes you may have called into question the future of the GMC.

In statements since, you have sought to pour oil on troubled water, and your splendid chief executive, Charlie Massey and counsel, Anthony Omo, met me with much courtesy and did their best to persuade me both that you had no choice but to seek Dr Bawa-Garba’s erasure and that you have learned important lessons from the affair.

Of course those two things are incompatible.

Indeed, many of us still find it hard to follow your logic. Your principle defence has been that to allow Dr Bawa-Garba to continue to practice would “unpick the criminal court conviction.” That is not so. Only the courts of appeal can do that, and I hope they will.

No. You opted to go further than the criminal courts, and it was not an automatic process imposed by statute.

To recap, Jack, a six-year old boy being treated by Dr Bawa-Garba, died tragically from sepsis. There were many contributory factors you knew, or should have known about: that Bawa-Garba was overstretched, covering six hospital wards across four floors including A&E and the children’s assessment unit, without a break, without a formal handover, without proper consultant cover, and with an IT system that had failed. You knew that in addition the child had been administered a drug by his mother in good faith, but without Bawa-Garba’s knowledge, that may have contributed to his death. You were well aware that sepsis has a high mortality rate in any case. And as Charlie Massey conceded, as does almost everyone else, Bawa-Garba is an otherwise reliable and competent doctor. Yet, in addition to the guilt this poor woman will suffer for the rest of her life for the mistakes she made in trying to save a patient’s life, and on top of the terrible criminal conviction she must bear, you sought to make her a scapegoat for the profession.

So I, policymakers, public and professionals find it hard to accept that you had no choice.

Indeed, your position would be insupportable even if we gave you the benefit of any remaining doubt. Suppose there really had been a clear-cut requirement that the GMC should disbar any doctor with a criminal conviction such as Bawa-Garba’s. After all, it is intrinsic to democracy that parliament enacts bad law from time to time before changing its mind - permitting slavery, transporting people for life, forbidding women’s emancipation, outlawing homosexuals - or criminalising decent people who make honest mistakes. What then should you have done?

You now concede the matter requires more reflection. It is a shame you did not reflect more wisely before. And if you concluded, as you seem to do now, that this pursuit of honest and competent doctors is wrong, then you should have refused to go along with it. If necessary you could have resigned. After all, only in totalitarian societies do citizens have to prosecute bad laws officiously.

The inescapable truth is that you chose to make matters worse.

Like Dr Bawa-Garba you erred. In your case no-one died, though a doctor lost dignity, respectability and career, buried for good measure in an outpouring of hostility and racial bigotry; and no one else was seriously harmed, although you inflicted further damage on a profession’s already battered sense of self-worth. How should we, the public, respond?

Understandably, the bereaved mother has been angry and unforgiving, perceiving that ‘Justice for Jack’ is achieved at the expense of the doctor and nurse who tried to do most for him. But resentment, and certainly vengeance, do not make for good public policy, let alone safe clinical practice. For the same reason, we should not be unduly harsh on you and Council members who yielded to such pressures, even though, unlike the clinicians, you did so with ample time at your disposal and without distraction. I do not hope for your resignation. I am sure you are a competent and caring doctor, a wise chairman and a decent human being with a strong social conscience who is trying to do your best in difficult circumstances. But I, and others, do expect that you acknowledge your mistakes, apologise, and learn. If there are systemic failures in the GMC let us learn about those too and put them right.

You cannot have it both ways: claiming what you did was justified while conceding it might not have been.

I am a layman, much more closely on the side of patients and generally scornful of professional self-interests, but your behaviour has shaken my confidence in the medical profession. You cannot expect doctors to be candid about errors, you cannot expect them to complain about systemic failures, and you cannot expect them to stay in the profession in sufficient numbers, if you set lawyers on them and throw them to the wolves when they make rare clinical mistakes.

You have created a head of steam and we must not let it dissipate. Accordingly, I propose that if by 1 March 2019 the GMC has not produced a clear statement which puts patient safety first, medical candour second, adversarial procedures last and retribution nowhere, all doctors should give notice that they will refuse to comply with the GMC, prompting the government to put in place a new organisation fit for purpose.

That may sound over the top to you, an empty threat. Perhaps. But as you know the government is considering your future anyway, along with that of the other eight bodies that regulate healthcare across the UK (Promoting professionalism, reforming regulation). I am not convinced that, on careful consideration, patient groups, politicians and the public will be so dismissive of starting with a clean slate. They realise that to err is to be human. They understand that medical error is an ever-present danger. They have seen how the commercial air industry has so successfully put safety ahead of blame and the government has wisely brought in the air accident investigator Keith Conradi to advise the NHS. Acting disproportionately is the sort of response we must all now try to find a way to avoid; but boycotting the GMC will not be disproportionate if the GMC cannot admit its error and then quickly and substantially reform.

Please may we have clarity from you and Council, that you are proud of the decision you took on Bawa-Garba and would take it again; or that, with hindsight, it was a mistake you will not repeat.

Yours sincerely.

Competing interests: No competing interests

08 February 2018
Nick Ross
broadcaster and journalist
PO Box 999, London W2 4XT, UK