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Dr Bawa-Garba case reverberates in Ireland

The RCPI has said it is “deeply concerned” about the outcome of the Dr Hadiza Bawa-Garba case in the UK, following the General Medical Council’s (GMC) successful court bid to ensure it can erase the junior doctor from its register.

In 2015 Dr Bawa-Garba, a specialist registrar in paediatrics, was convicted of manslaughter on grounds of gross negligence, arising from the avoidable death from sepsis of six-year-old Jack Adcock at Leicester Royal Infirmary, UK, in 2011. The jury concluded that the doctor’s failures were “truly exceptionally bad”. She was given a suspended sentence and failed at appeal.

The Medical Practitioners Tribunal Service decided that Dr Bawa-Garba should be suspended from the register for 12 months, having considered that erasure would be “disproportionate”. However, last month, the GMC was successful in its court appeal of this decision.

The outcome of the case – and the GMC’s course of action – have provoked huge reaction among the medical profession on both sides of the Irish sea.

Writing in The BMJ Opinion, Dr Rachel Clarke, a palliative care doctor in the UK, stated that superficially, the GMC’s course of action seems reasonable. “A young child had died in unforgivable circumstances, a doctor criminally convicted. So why has her treatment so convulsed the profession?

“We are angered, in part, by the absence from the GMC’s narrative of the possibility that Bawa-Garba’s negligence arose because it was the working conditions into which she was thrust that day that were ‘truly exceptionally bad’. Rota gaps forced her to cover two other doctors’ jobs as well as her own work. Her consultant was off on a teaching day. The hospital IT had broken down, causing chaos.

“So what, precisely, was Bawa-Garba meant to do? Down tools and say it was unsafe for her to work? Is that what we should all do now—simply walk out on our patients when rota gaps are dangerous?”

It has also been highlighted that Dr Bawa-Garba had recently returned from maternity leave into an unsupported and under-resourced working environment when the tragic death of Jack Adcock occurred. 

Moreover, there is major disquiet that reflective learning from Dr Bawa-Garba’s e-portfolio was used in evidence in the court case that found her guilty of manslaughter by gross negligence in 2015.

In Ireland, the Junior Obstetric and Gynaecology Society (JOGS) committee issued a statement last week outlining how the outcome of the GMC case has “resonated deeply with trainees in Ireland and has prompted calls for JOGS to make a statement on the matter”.

“JOGS would firstly like to extend our sincere sympathies to the Adcock family for their loss,” it said. “We feel it is vital that all NCHDs receive appropriate support when returning to work from extended leave periods, irrespective of reason for absence.  The opposite appears to have been the case for Dr Bawa-Garba…

“Following on from this case, JOGS members are concerned that reflective entries in their e-portfolio could be used as evidence against them in a legal case. We do not feel that this is in alignment with a ‘no blame’ culture – indeed, it may adversely affect the move towards the practice of open disclosure.

“It is rarely an individual person solely to blame for an adverse event and the treatment of Dr Bawa-Garba ignores the systemic factors at play. Learning from adverse events can only happen if a culture of openness and transparency continues to evolve. The recent action taken by the GMC will do nothing to reassure NCHDs that they can reflect and learn safely.”

It added: “Situations where healthcare professionals are overstretched in understaffed units with less than adequate support and malfunctioning reporting systems are common in this jurisdiction. Should a similar scenario happen to an Irish NCHD we need to know we have the support of our consultant colleagues, in particular the Institute of Obstetricians and Gynaecologists and the Irish Medical Council.”

IMO NCHD Committee member Dr John Duddy said doctors are fearful “that the same thing could happen here”.

“Because when you read the detail of the case, I think every doctor who has read it has gone ‘there but for the grace of God go I’…The Medical Council here doesn’t have a good track record in terms of, let us say, responding to the concerns of the profession, and you would be worried it would take this very legalistic adversarial route that the GMC has taken over there.”

According to Dr Duddy, the use of reflective learning material in legal proceedings against doctors raises questions around how honestly doctors will complete such assessments in the future.

He added: “You can see how seriously people are taking [the matter] when you hear doctors in the UK agreeing with what [Health Secretary] Jeremy Hunt says about it, that tells you how bad things are; he was very concerned about the judgement as well and the implications it has for the NHS.”

The RCPI stated to this newspaper that it and its training bodies “fully support the doctors on our specialist medical training programmes and is advocating for improved staffing levels and adequate supports for trainees”.

Its spokesperson added: “The College is aware of the Dr Bawa-Garba case and is actively addressing the issues around it as a priority. We are deeply concerned that a single trainee was held accountable when there were so many systemic errors in this case. This is unacceptable.” 

Meanwhile, GMC Chair Prof Sir Terence Stephenson has announced “a programme of work” to look at the wider issues around medical manslaughter.

“We recognise that any doctor, no matter how experienced, can make a mistake, particularly when working under pressure. 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.”

At the time of going to press, an online legal fundraising appeal for Dr Bawa-Garba had raised over £250,000 and she had issued a statement thanking her supporters, noting that “this tragic case raises some important questions”.

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