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Health secretary orders review into use of medical manslaughter

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k592 (Published 06 February 2018) Cite this as: BMJ 2018;360:k592
  1. Gareth Iacobucci
  1. The BMJ

England’s health secretary, Jeremy Hunt, has announced a review of the application of gross negligence manslaughter in the NHS in the wake of the Hadiza Bawa-Garba case.

The High Court ruling to strike off the trainee paediatrician from the UK medical register has prompted widespread concern among doctors, who claim that Bawa-Garba was scapegoated, given the multiple system failures that led to the death of 6 year old Jack Adcock.1 Bawa-Garba was convicted for manslaughter in 2015,2 and the High Court verdict came after the General Medical Council (GMC) appealed against a medical practitioners tribunal decision to suspend her for 12 months rather than erase her.3

Norman Williams, former president of the Royal College of Surgeons, will lead the review, with support from senior lawyers.

Announcing the review in the House of Commons on 6 February, Hunt said it would examine “how we ensure there is clarity about where the line is drawn between gross negligence manslaughter and ordinary human error in medical practice, so that doctors and other health professionals know where they stand with respect to clinical liability or professional misconduct.”

Williams will also focus on the need to protect reflective learning, openness, and transparency in medicine, to ensure that “mistakes are learnt from and not covered up,” Hunt said. The review will also look at lessons for the GMC and other professional regulators in light of the case.

Hunt said that the UK’s devolved administrations, the justice secretary for England and Wales, and the Professional Standards Authority would be consulted in the review, which is expected to report by the end of April.

The announcement came as the GMC continued to be criticised by doctors for its conduct in the case. In a show of solidarity, some doctors reported themselves to the GMC on the basis that they had made similar mistakes that might have led to the deaths of patients,4 while others tore up their registration documents in protest. A campaign to crowdfund advice on appeals against both the High Court ruling and Bawa-Garba’s original conviction had raised more than £320 000 (€360 000; $450 000) by 6 February.5

The GMC’s chief executive, Charlie Massey, welcomed Hunt’s announcement. “We know that we cannot immediately resolve all of the profession’s concerns, but we are determined to do everything possible to bring positive improvements out of this issue,” he said.

Chaand Nagpaul, chair of BMA council, also welcomed the review. He said, “It’s vitally important that doctors’ personal reflections—which encourage openness and improvement through reflection and learning—are protected. While the BMA has received important assurances from the GMC in relation to the use of reflective learning, further clarity around how reflections can be protected will be welcomed by doctors. We also need greater clarity on the line between gross negligence manslaughter and human error in medicine. There is concern that a growing number of prosecutions of doctors for gross negligence manslaughter results in doctors becoming more cautious. This makes it more likely that they will practise defensive medicine, which is not in the interests of patients.”

Jeeves Wijesuriya, chair of the BMA’s Junior Doctors Committee, said that a meeting with GMC officials last week had yielded a series of fresh commitments from the regulator, including never asking a doctor to provide their reflective statements if it was investigating a concern about them, and standardising the implementation of exception reporting across England.6

Rob Hendry, medical director at the Medical Protection Society, added his voice to those welcoming the review, saying, “Gross negligence manslaughter cases are usually complex, involve systems failures, and are devastating for all concerned. A conviction should not automatically mean that a doctor who has fully remediated and demonstrated insight into their clinical failings is erased.”

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