Second letter to the GMC chair regarding Hadiza Bawa-GarbaBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k667 (Published 13 February 2018) Cite this as: BMJ 2018;360:k667
The following is a letter of 5 February 2018 to the chair of the General Medical Council.
Dear Professor Stephenson,
My last letter to you about Hadiza Bawa-Garba (9 November 2017)1 was followed by a stream of similar comments in the medical and national presses and on social media, mostly from doctors and the Academy of Royal Medical Colleges but also from non-medics like me and, not least, of course, from Jeremy Hunt. I do not think 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 that you had no choice but to seek Bawa-Garba’s erasure and that you have learned important lessons from the affair.
Of course those two things are incompatible.
Many of us still find it hard to follow your logic. Your principal defence has been that to allow Bawa-Garba to continue to practise would “unpick the criminal court conviction.” That is not so. Only the courts of appeal can do that, and I hope they will.
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 Bawa-Garba, died tragically from sepsis. There were many contributory factors that you knew, or should have known, about: that Bawa-Garba was overstretched, covering six hospital wards across four floors including the emergency department 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 the child had been given 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. 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 feel 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, policy makers, the public, and professionals find it hard to accept that you had no choice.
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 occasionally enacts bad law before changing its mind—permitting slavery, transporting people for life, forbidding women’s emancipation, outlawing homosexuals—or criminalising decent people who make honest mistakes.
You now concede that 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. Only in totalitarian societies do citizens have to prosecute bad laws officiously.
The inescapable truth is that you chose to make matters worse.
Like Bawa-Garba, you erred. In your case no one died, but a doctor lost dignity, respectability, and career, buried for good measure in an outpouring of hostility and racial bigotry. Although no one else was seriously harmed, you inflicted further damage on a profession’s already battered sense of self worth.2 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 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 aligned with 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. I propose that if by 1 March 2019 the GMC has not produced a clear statement that 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. 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.3 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 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 that the government has wisely brought in the air accident investigator Keith Conradi to advise the NHS. We must all try to avoid acting disproportionately; but boycotting the GMC will not be disproportionate if the GMC cannot admit its error and then quickly and substantially reform.
Please can you and the council clarify 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.
Competing interests: None declared.