Doctors are encouraged to acknowledge and reflect on mistakes that they have made to improve patient care and safety, yet Dr Bawa-Garba’s reflective E-portfolio was used as evidence against her in court. In February 2011 she had recently returned to practice as a Registrar at the Leicester Royal Infirmary Hospital (“the Hospital”) after 14 months of maternity leave. The recent Court of Appeal decision in Dr Bawa-Garba’s favour is a welcome victory, and should provide reassurance for the many healthcare professionals worldwide who were dismayed at the previous decision to erase Dr Bawa-Garba from the register. The captain of the ship and Dr Bawa-Garba's supervisor, Dr O'Riordan, was not in the hospital but teaching in a nearby city. An informed personal enquiry. Jack Adcock’s death was an industrial accident. They argued that she was personally responsible for many failings that resulted in Jack’s death and was therefore a threat to the public if she continued practicing. So the question that came to me was whether or not that criminal conviction itself should lead to suspension or erasure. Jack died of cardiac arrest as a result of sepsis and a full investigation was conducted. 2006: Hadiza Bawa-Garba qualifies as a paediatrician. Dr Bawa-Garba was then struck off the medical register after the High Court ruled in favour of the GMC in early 2018. On 30 July, Clare … 1. Dr Bawa-Garba also worked her 13 hour shift without a break and had just returned from maternity leave to a new hospital and had received no induction. Additionally, Jack was on medication for a previous heart condition, which Dr Bawa-Garba discontinued on his drug chart whilst he was being treated for a chest infection. When Dr Hadiza Bawa-Garba started treating Jack, she ordered blood tests and chest X-Rays, however, due to an electronic system failure, these results were not seen by Dr Bawa-Garba until 6 hours later. As horrendous as "attending not being in the hospital" sounds, this, too, is not atypical in the NHS. Mr Massey also recognised the increasing pressures doctors are faced with and said the GMC is now trying to help address these issues. Four years after Jack’s death, Dr Bawa-Garba, Ms Amaro and ward sister Theresa Taylor were charged with gross negligence manslaughter. Both were subsequently struck off their respective professional registers, although Bawa-Garba had that decision overturned at appeal. Dr Hadiza Bawa Garba, the Court of Appeal decision Dr Bob Gill SPeaks To Dr Chris Day - Duration: 6:43. I hope this signals change in tone from the GMC and we look forward to working with them in moving from a culture of blame, to one of learning.’. She also requested a chest X ray, which was performed promptly but was not reported on by a radiologist. Initial investigations into the case found that her mistake may not have influenced the end result of the resuscitation effort – the outcome may well have been the same. ‘I said at the time that I felt I had no option but to appeal that decision. Dr Bawa-Garba was working a typically standard paediatric shift except that her team was incomplete. The headline follows the high profile case of Dr Bawa-Garba, who was found guilty of gross negligence manslaughter over the death of Jack Adcock, a six-year-old-boy. She unfortunately did not make this clear to Jack’s mother who gave him his regular medication that evening, resulting in Jack going into cardiac arrest. The GMC is informed of the incident, which resulted in Dr Bawa-Garba being made the subject of 3 months supervised training and taken off the on-call rota. Criminal convictions and professional sanctions. Dr Bawa-Garba was a doctor in training at Leicester when she was involved in the treatment of Jack Adcock, a six-year old child who tragically died whilst in our care in February 2011. The hospital consultants should have ensured a proper re-induction occurred, over several days at least. She was the on-call pediatric registrar – the second in command for the care of sick children at Leicester Royal Infirmary. Bawa-Garba had just returned from 14 months of maternity leave, consultants claim she had not had the induction at the trust that ran the hospital, and … In June 2017, the Medical Practitioners Tribunal suspended Dr Bawa-Garba for 12 months saying that “erasure would be disproportionate”. In December 2014, almost four years after the events in question, Dr Bawa-Garba was charged with gross negligence manslaughter. ‘But I do recognise completely that question about system context, pressure and that’s why the GMC has stepped much more into this territory about thinking “how do we influence that context more effectively”? Bawa-Garba had recently returned from 13 months’ maternity leave when she made the errors that ended her career. Bawa-Garba granted Court of Appeal challenge against erasure ruling; Race played no part in Bawa-Garba decision, says GMC; New guidance on reflective practice to be published in wake of Bawa-Garba case “We would employ Hadiza Bawa-Garba,” say 159 paediatricians; BMJ Opinion by Nick Ross: GMC, heal thyself ; News timeline. ... ensuring better systems for induction and re-orientation of staff returning to work The role of criminal law and medical manslaughter in cases where doctors make mistakes must be rethought, a leading professor of health law and ethics has said. Dr Bawa-Garba appealed the decision of the High Court and was successful. Lawrence Weed proposed we develop computerised, problem-oriented medical records that guide and teach. Bawa Garba was just back from maternity leave, without an induction, working a very busy shift with a computer failure meaning that lab results weren’t available when … During … The results indicated that Jack had a chest infection so Dr Bawa-Garba immediately prescribed a course of antibiotics, but it was not administered until an hour later by the nurses. Dr Bawa-Garba is a junior doctor specialising in paediatrics. The appeal will now be listed for a full hearing by three Court of Appeal judges later this year. Lana Spawls writes about the case of Dr Hadiza Bawa-Garba, who was convicted of manslaughter by gross negligence over the death of Jack Adcock, a six-year-old boy who was under her care at Leicester Royal Infirmary in 2011 (LRB, 21 June).Bawa-Garba was struck off the medical register in January 2018, though the Court of Appeal very recently overturned that decision. It clarified that that legal advice I had was, with hindsight, not correct and I completely accept that. Why did Ms Cohen not question Dr Bawa Garba’s being allowed to be the ‘bleep holder’ on her first day back after 14 months on maternity leave (in the ‘Long Read’ but not mentioned in the programme)? NoticeWe collect personal information on this site, to improve our website. We were pleased that DAUK was found to be correct in the Court of Appeal in August 2018 and that Dr Bawa-Garba was rightly restored to the medical register, something we have long fought for during our Learn Not Blame campaign.‘. bawa-garba. Dr Bawa-Garba attended the arrest call and, due to the moving of beds, confused Jack with another patient and briefly ordered a stop to CPR (though this was not deemed to have contributed to his death). After an appeal to the GMC from Jack’s parents, Dr Bawa-Garba was convicted of gross negligence and given a 2 day suspended sentence. This site is intended for health professionals only. Lana Spawls writes about the case of Dr Hadiza Bawa-Garba, who was convicted of manslaughter by gross negligence over the death of Jack Adcock, a six-year-old boy who was under her care at Leicester Royal Infirmary in 2011 (LRB, 21 June).Bawa-Garba was struck off the medical register in January 2018, though the Court of Appeal very recently overturned that decision. Furthermore, before this incident there were no concerns about Dr Bawa-Garbas fitness to practice. Dr Bawa-Garba was six years into the speciality training, so Jack’s condition was something that she should have been trained for. We recognise that it has been very difficult for everyone involved. They argued that she was, The Dr Bawa-Garba case has made many doctors question their practice and working environments, with doctors acknowledging that they could have made the same mistakes working in the same circumstances (. Dr Bawa-Garba’s is appealing the Divisional Court’s judgment (25 January 2018) that she should be removed from the register. Dr Hadiza Bawa-Garba was struck off the medical register and given a suspended sentence after Jack Adcock, six, died of sepsis at Leicester Royal Infirmary - but others are equally to blame. Posted by Nate in Medical Leadership in the Foundations on November 16, 2018. a specialist registrar in year six of her postgraduate training (ST6) with an ‘impeccable’ record. Bawa-Garba is struck off the medical register after a successful appeal by the GMC. He was seen by Dr. Hadiza Bawa-Garba, a trainee paediatrician in her sixth year of speciality training. What will the GMC’s role in the appeal be? No. Dr Hannah Laidley, AFY2, University of Leicester Quality improvement work can feel inescapable. Dr Bawa-Garba prescribed Jack antibiotics for his pneumonia, but he didn't get them for another hour. The case has resonated with many female trainees. In December 2016, Dr Bawa-Garba was denied permission to appeal against her manslaughter conviction. Bawa-Garba and nurse Amaro were convicted. There is therefore worry that doctors cannot reflect openly and honestly in fear of repercussions. CMR systems can reduce prescribing errors and could be developed to flag gaps in supervision. The High Court decision have upheld that view and then the Court of Appeal overturned that view. After receiving a 24-month suspended sentence for the conviction, the GMC’s Medical Practitioner Tribunal Service (MPTS) suspended her for one year. Dr Bawa-Garba clearly wasn’t wilfully or recklessly negligent; she was overloaded. Introduction to the ST3 year. Criminal convictions and professional sanctions. ‘DAUK wrote to the GMC as far back as February 2018 in a letter signed by over 4,500 doctors in protest of the GMC’s appeal against Dr Bawa-Garba. The Great NHS Heist 1,576 views. ‘DAUK also pointed out that the Supreme Court established that professional tribunals were better placed than courts to determine professional competence in 2016. Its true significance lies in what it represents. They wanted to override The Medical Tribunal Service (a body that decides if doctors can continue to work or not), who deemed that Dr Bawa-Garba should be suspended from work for 12 months. Criminalising doctors BMJ 2018: 360:k479. Check out our FREE Medicine 2020 Interview Guide, In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance. She added: ‘To my knowledge this was the first occasion that Charlie Massey accepted publicly that this decision was wrong. Leaders In Healthcare 2018: Rt Hon Matt Hancock. In February 2011 she had recently returned to practice as a Registrar at the Leicester Royal Infirmary Hospital (“the Hospital”) after 14 months of maternity leave. Dr Bawa-Garba was convicted of manslaughter by gross negligence in 2015 following the death of six-year-old Jack Adcock at Leicester Royal Infirmary in 2011. The tribunal decided to suspend Dr Bawa-Garba. She had worked a double shift that day (12/13 hours straight) without any breaks and had been doing her clinical best, despite the demands placed upon her. … Bawa-Garba was an accomplished trainee. The Doctors’ Association UK (DAUK) said Mr Massey’s admission that his attempt to strike off Dr Bawa-Garba was wrong was ‘long overdue’. On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning 4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls. In March 2018, Dr Bawa-Garba was granted leave to appeal this decision and the High Court rejected the GMC’s argument that a manslaughter conviction should result in automatic erasure from the register. The high profile case involving Dr Hadiza Bawa-Garba raised questions about how the context in which doctors work should be considered when evaluating their fitness to practise and performance. The accident’s victims included Dr Bawa-Garba and Isabel Amaro. An unpublished review – conducted by the Professional Standards Authority in July 2018 – criticised the GMC for its handling of the case, saying the reason for overruling the MPTS decision to suspend, rather than strike off, Dr Bawa-Garba ‘appeared without merit given the established case law’. Subscribe to Pulse’s newsletters to ensure you receive the news as it happens. The Bawa-Garba case. Dr Bawa-Garba ordered blood tests, but due to an IT failure there was a delay in obtaining results. Dr Bawa-Garba, a senior paediatric trainee who had been involved in the care of a child who died shortly after admission to hospital, was convicted of gross negligence manslaughter and subsequently erased from the medical register. In a recent BBC Radio 4 interview with DAUK chair Dr Samantha Batt-Rawden, Mr Massey said: ‘The GMC wasn’t involved in the criminal process whatsoever. On the day of the incident, Dr Bawa-Garba was solely in charge of the emergency department and acute Children’s Assessment Unit due to staff shortages and the fact that her consultant was off-site. Dr Bawa Garba was doing the work of 2 registrars, covering several wards, so was looking after many more patients that usual, She did not have adequate supervision from her consultant, This was her first shift in a high-intensity setting after maternity leave, She was working 12-hours continuously without a break, IT failures meant that she could not review results in a timely manner, Jack’s mother gave medication that she did not prescribe. When she acted on the test results a few hours later she immediately prescribed a course of antibiotics, but these were not administered by the nursing staff until an hour later. https://www.theguardian.com/.../hadiza-bawa-garba-doctor-make-same-mistake © 2020 The Aspiring Medics. On 13th June 2017 she was suspended for a year by … The significance of Bawa-Garba does not lie in the legal consequences of the case. There was a patient overload that day, with three medical colleagues away for most of Bawa-Garba's shift-duration. She had just returned from 13 months’ maternity leave but had no induction. All rights reserved. The medical practitioners tribunal heard evidence about the context in which Bawa-Garba was working before it decided that erasure would be disproportionate. Dr Bawa-Garba was in no state to face sustained police questioning and sign documents. Dr Bawa-Garba raised Jack’s diagnosis with her consultant, but he did not review Jack in person. Over £350,000 was raised by protesting doctors to fund Dr Bawa-Garbas legal fees for an independent appeal. They wanted to override The Medical Tribunal Service (a body that decides if doctors can continue to work or not), who deemed that Dr Bawa-Garba should be suspended from work for 12 months. Dr Bawa-Garba’s appeal. She should have spotted the abnormal test results earlier, She should have asked her consultant to review Jack, She should have told Jack’s mother to stop his heart medication. There were multiple people involved including the responsible consultant, nursing staff, Bawa-Garba and the trust. It would be interesting to hear from the Secretary of State for Health and Social Care any day. On 22 February the GMC announced that it had commissioned Clare Marx, past President owf the Royal College of Surgeons, to lead a UK-wide independent review into how gross negligence manslaughter and culpable homicide (in Scotland) in healthcare are initiated and investigated in the UK. She had recently returned from maternity leave to a new hospital where no induction had been provided. Don't forget to share our website with friends and family. Posted by Nate in Medical Leadership in the Foundations on August 23, 2018. Are skin colour, facial appearance and gender the elephant in the room? The Bawa-Garba case outcomes might have been different if care had been supported by computerised medical record (CMR) systems. Dr Bawa-Garba was convicted of manslaughter by gross negligence in 2015 following the death of six-year-old Jack Adcock at Leicester Royal Infirmary in 2011. 6:43. Dr Bawa-Garba won her case and is allowed to practice again. She made a mistake, on the back of incredibly hard working conditions over the course of a 13 hour shift, and a 6 year old boy died. Last month, Mr Massey said the GMC would shift how it spends the bulk of its resources, from investigating doctors to supporting them. Dr Bawa-Garba gave evidence in her own defence and relied on her previous good character including positive character evidence. The GMC did not want the public to lose confidence in the medical profession. Accordingly, the sanction of erasure has been set aside and the original order of 12 months … The GMC appealed to the high court to get Dr Bawa-Garba struck off the medical register. The case is centered around the tragic preventable death of 6 year old Jack Adcock, a young boy with Down’s Syndrome. We must work to get the law changed. This represents a crucial first step in repairing the damage done to the medical profession by the Bawa-Garba case. Although she was two years from becoming a consultant, there were occasions when she was responsible for looking after very sick children, and saved many lives. The Bawa-Garba case was different with the public details of the case suggesting an over-worked, understaffed NHS with deficiencies in induction, IT and support for doctors. Bawa-Garba was suspended from the medical register for 12 months last June but the General Medical Council (GMC) appealed, saying this was "not sufficient to protect the public". In response, Dr Batt-Rawden said: ‘The acknowledgment that his decision to appeal the MPTS verdict in Dr Bawa-Garba’s case was incorrect was long overdue and will be welcomed by doctors and the public. Dr Hadiza Bawa-Garba, the junior doctor who treated him (under the supervision of duty consultant Dr Stephen O' Riordan) and a nurse, Isabel Amaro, were subsequently found guilty of manslaughter on the grounds of gross negligence. Lord Justice Ouseley said: “The Tribunal did not respect the verdict of the jury as it should have. It is not acceptable for a doctor to be left alone covering a huge busy ward at night.’. It is agreed that Dr Bawa-Garba made some mistakes, but healthcare professionals work as a team, so there are many factors to consider when investigating what happened to Jack. Following on from the equally welcome announcement that the Government intends to remove the GMC’s right to appeal decisions made by … Dr Bawa-Garba was a doctor in training at Leicester when she was involved in the treatment of Jack Adcock, a six-year old child who tragically died whilst in our care in February 2011. However, CMR systems are not a panacea and need to be fit for … •Bawa-Garba was supposed to have an induction •This would cover the wards, the patients and how to manage workflow, and to integrate all of Jack’s information into her decision-making •For staffing reasons the induction didn’t happen. August 21st ST3 - Induction. Reg. This is what happened to Dr Bawa-Garba. We were therefore astonished by the GMC’s actions in this case. The case of paediatric registrar, Dr Bawa-Garba has rocked the medical and nursing professions, both in the UK and in Ireland. 2147432, At the heart of general practice since 1960, GMC chief executive admits Bawa-Garba legal advice was wrong, Bawa-Garba: timeline of a case that has rocked medicine, the High Court ruled in favour of the GMC, ruled in her favour – restoring the MPTS decision that she should be suspended from the medical register rather than erased, reason for overruling the MPTS decision to suspend, rather than strike off, Dr Bawa-Garba, GMC would shift how it spends the bulk of its resources, from investigating doctors to supporting them, GMC fees to rise with inflation from April, CQC: No evidence that remote GP consultations increase A&E attendance, CQC review finds evidence of ‘inappropriate’ DNR decisions during pandemic, GPs to receive referrals from A&E under new NHSE proposals, Tributes to leading GP who has died aged 40, Number of GP sites delivering Covid vaccine plummets to around 100, Asymptomatic GP Covid testing to launch from this week, NI GPs to lose income protection if they don’t staff Covid centres, GPs to be paid £12.58 per jab as details set out for Covid vaccination campaign, CQC to restart in-person GP practice inspections from next month, High-profile GPs warn Government against second Covid lockdown. Dr Bawa-Garba’s case has raised a number of important issues for us and the medical profession. Bawa-Garba just returned from a circa year-long maternity leave and did not undergo an induction that she ought to have been provided. Dr Bawa-Garba was to be erased from the medical register (although an appeal is under way). She was asked to cover the children’s assessment unit along with her own ward duties. There are two further considerations that are important to me and relevant to Dr. Bawa-Garba’s particular situation that are not being discussed in the BMA report or in this week’s BMJ magazine, regarding gender and colour. A medical tribunal has ruled Dr Hadiza Bawa-Garba can return to work. Pulse is owned by Cogora. •A “crash bleep” as a child went into cardiac arrest meant that she missed the morning handover Her consultant was out of town, the senior house officer was unavailable. Charlie Massey said he ‘completely accepts’ the legal advice he was given to pursue the striking off of Dr Bawa-Garba – who was convicted of manslaughter by gross negligence following the death of a six-year-old patient – was ‘not correct’. Sign up for news alerts and don't miss out. Later that day, Jack’s condition deteriora It is one that has, Dr Bawa-Garba was six years into the speciality training, so Jack’s condition was something that she should have been trained for. ‘The GMC still has a long way to go in regaining the trust of doctors, but for the first time in this interview I saw that some genuine reflection and learning had taken place. It is one that has highlighted the pressures on junior doctors and the detrimental impact that this can have on their patients. This was a case of the tragic death of a child and the consequent criminal conviction of a doctor for gross negligence manslaughter. It has also provoked fear within the profession of legal sanctions. The advice that I had at the time was that the tribunal had acted unlawfully and went behind the criminal judgement in terms of her responsibility for Jack Adcock’s death. If that case came up now, that Court of Appeal judgement would mean that I wouldn’t have appealed that case.’. The Bawa-Garba Case: In February 2011, Jack Adcock, a six year old who had Down’s Syndrome and a known heart condition was admitted to hospital following referral by his GP. Sharpen your skills and further your career with Pulse. Later in 2018 Court of Appeal judges ruled in her favour – restoring the MPTS decision that she should be suspended from the medical register rather than erased – pointing out that the legal advice given to the GMC was not correct. The GMC’s chief executive has admitted the legal advice the regulator received during the Dr Hadiza Bawa-Garba case was wrong and if the same case were to take place now he would not try to have a doctor barred from practice. After receiving a 24-month suspended sentence for the conviction, the GMC’s Medical Practitioner Tribunal … The appeal is likely to be heard before the end of July 2018. There is an … She was employed in the Children's Assessment Unit of the Hospital (“the Unit”). Jack Adcock was urgently referred by his GP to Leicester Royal Infirmary and admitted to the Children’s Assessment Unit (CAU) with symptoms of nausea, diarrhoea and breathing problems. Courtroom 3 saw the latest in the high profile case of Hadiza Bawa-Garba, a trainee paediatrician convicted of gross negligence manslaughter in 2015 after the death of six year old Jack Adcock from sepsis at Leicester Royal Infirmary. Bawa-Garba had just returned from a thirteen-month maternity break. The monumental Dr Bawa-Garba case has sparked huge media attention and outrage from the medical profession in recent years. Its chair told Dr Bawa-Garba “Whilst your actions fell far short of the standards expected and were a On 17th December 2014 Dr Bawa-Garba was charged with manslaughter on the grounds of gross negligence and found guilty on 4th November 2015, after 25 hours deliberation, on a majority verdict of 10 to 2. However, the GMC appealed its tribunal’s decision and called for the doctor to be struck off. To learn more about how we use your information, see our Privacy Policy. Bawa-Garba was obviously fatigued owing to the absence of a break during her 13-h shift. Around this time, the doctor's consultant returned to the hospital. On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning 4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls. There was widespread criticism about the decision by doctors who argued systemic pressures affecting the hospital Dr Bawa-Garba had been working in at the time had not been taken into account. The medical profession wanted the learning from this case to be based around what we can learn from the environment that Dr Bawa-Garba was working in on that day. February 2011: Jack Adcock dies at Leicester Royal Infirmary after being admitted to hospital … The Implications of the Bawa-Garba Case Fiona Drysdale, Advocate Introduction At the start I would like to acknowledge that I am speaking today about a case in which a child died in tragic circumstances and that his loss was devastating to his family. 3 Lessons Learned From Failed QI Projects. As a “registrar” she was both a master and an apprentice – a juxtaposition of roles necessary for the survival of acute care in the NHS. He died from a cardiac arrest caused by sepsis just 11 hours after hospital admission. Four years after Jack’s death, Dr Bawa-Garba, Ms Amaro and ward sister Theresa Taylor were charged with gross negligence manslaughter. Reflecting on the Bawa-Garba case - Patient Safety Learning, The Bawa-Garba case: a timeline - GP Online, High Court ruling on GMC v Bawa-Garba - RCOG, Test your knowledge of our ethical guidance by utilising this free resource from the the General Medical Council entitled "Good Medical Practice in Action', Learn from the experiences of medical students from across the UK, Discover our free community articles written by medical students to further hone your insight and knowledge of medicine. Dr Bawa-Garba had also only just returned from 13 months’ maternity leave and had little experience of working on a child assessment unit. Posted in Uncategorized | Tagged bawa-garba, elearning, induction, nudge, organizational culture, QI | Leave a response. -Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards spanning 4 floors, undertaking paediatric He said: ‘For the vast majority of doctors where we end up suspending or erasing them they’re not for honest and innocent mistakes against the background of system pressure. Induction at Northampton General Hospital had three key messages a) The QI department is world-beating so get involved, b) Here’s a long list of eLearning modules, and c) Try not to worry about the Bawa-Garba thing. Little experience of working on a child and the medical and nursing professions, both in the legal of. Doctors and the consequent criminal conviction of a break during her 13-h shift fitness. The question that came to me was whether or not that criminal conviction itself should lead to suspension erasure... 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