You will probably all be aware of last week’s High Court ruling regarding Dr Hadiza Bawa-Garba following the tragic death of a 6-year-old boy in 2011. As doctors we strive to provide the best possible care for our patients, and so in this instance where such a catastrophic outcome has occurred we can only express the deepest possible sympathy for the family.
Dr Bawa-Garba was involved in the child’s care at time of the incident. As the doctor held responsible for the outcome, Dr Bawa-Garba was subsequently convicted of manslaughter and suspended from the GMC register by the Medical Practitioners Tribunal Service (MPTS) in 2015 for a year. The GMC appealed the MPTS decision arguing for Dr Bawa-Garba to be erased from the medical register, and the High Court last week ruled in favour of the GMC. The relevant Trust where Dr Bawa-Garba worked has acknowledged systemic failures which contributed to the events that day.
This entire episode raises wider issues about the GMC’s approach to such cases – this includes its decision to appeal a judgement reached by the MPTS, the lack of adequate consideration of systemic failings, concerns regarding gross negligence manslaughter law as it affects doctors and the impact of using personal reflective learning material which could be used as evidence against doctors.
This ruling has also brought into sharp focus the difficult and pressurised environment in which doctors now work. A climate in which many doctors feel fearful and vulnerable, as they are forced to work without the support, colleagues or resources to provide safe, let alone high, quality care.
I understand many of you may be feeling deeply worried and uncertain following this ruling, including about recording of reflective learning or how and when to raise concerns regarding working under pressure. The profession is right to demand clarity and certainty as a matter of urgency. Without this we run the risk that doctors will practice medicine more defensively, be less open and fail to learn and improve from experiences. This would have the perverse effect of undermining patient safety and is why we are seeking direct answers from the GMC and others.
Like many of you, I believe that the greatest risk to patient safety is an under-resourced, understaffed NHS which is forcing doctors, nurses and all healthcare staff to work under the most challenging of conditions. Can it be safe to manage patients in corridors without the facilities they need in a hospital bed? Can it be safe for patients who should be admitted in an emergency to suffer ambulance delays of several hours? Can it be safe to work within an environment of perpetual rota gaps? Can it be safe for GPs to spend just 10 minutes with patients with complex co-morbidity of 4 or more problems? Sorting out such examples of serious system inadequacies is what government and regulators should prioritise in their responsibility for safe patient care.
I want you to know that the BMA is here to support you as doctors.
We are urgently seeking to address all the implications that have arisen from this case. I have set up a working group comprising of chairs of all BMA branches of practice, and BMA chairs of all nations, since this is an issue that affects all doctors, working in all environments, across all four nations. We are taking forward the following actions:
I will continue to keep you updated on this matter in the weeks ahead – and I would like to assure you that the BMA is taking the issues extremely seriously and is committed to addressing the questions and concerns this case has brought up.
Chaand Nagpaul is chair of BMA council
Read the news story on the ruling
The statement and clarification is very good, however why does it take so long for the BMA to do anything?
Independently an organisation has raised over £200k, there has been much outcry in private and it has taken the BMA approximately a week to make a response.
Where was the help prior to the court ruling?
Couldn’t agree more.
I suppose better late than never?
My opinion is divided in this case. I agree that doctors eportfolio reflections should not be open to the public.
However the fact remains that resuscitation of a 6 year old boy was not commenced on this doctors say so. As a doctor don’t we need to be 100 percent confident before we make that kind of call?
This is a very bad ruling and i do feel strongly that the decision ( judgement) is totally wrong and would make Medicine an un-attractive profession to be in UK. Why didn't BMA intervene earlier. Has Doctor harassment become the current past time. I think the decision should never be made by non-doctors as they don't understand medicine ever. When had a judge or solicitor ever charged for losing? No other profession should be allowed to judge a Doctor except by a doctor. Its like Painter judging on the quality of electrical wiring in a car.
Anonymous, it is important to be aware of the facts. She did not prevent resuscitation of a child on her say so.
When the arrest bleep went off (she was carrying the paediatric arrest bleep for the whole hospital as well as being responsible for the acute take on the admissions unit), she ran to the ward, and was directed to the room where CPR had been started. A few hours earlier she had been looking after a child in that very same room who had a DNACPR order. Unbeknown to her, that child had been discharged earlier on. CPR was stopped briefly whilst the identity was checked, then recommenced. The court accepted that the interruption of CPR had no effect on the outcome.
The mistake was that CPR should have been continued until the identity of the child and the presence or not of a valid DNACPR form was established. But this was a mistake of the whole resus team, not just Dr Bawa-Garba.
This case has certainly made medics feel very uncomfortable in stressful and stretched working conditions , especially when all most of want to do is provide best patient care. It shows how very vulnerable we are to lynching when things do not happen according to people’s expectations. We are all humans at the end of day and humans make mistakes and learn from them.
Paedophiles , murderers and rapists are being pardoned / released early from prison if they show remorse according to their human rights , but doctors who always wish and try their very best for their patients are being crucified and made jobless !!!!
Where are their human rights now ??
It is allready proving to be a very unattractive occupation and will become more so even now , if nothing substantive is done !
BMA help sooner rather than later is appreciated as long it acheives what it is striving for, to re-affirm faith in this noble occupation
BMA has been tardy to produce a public response in this unfair ruling. The GMC has made a mockery of the pressurised work environment in the NHS.
In a similar way, the GMC does take into account the views of non training grade middle grade doctors who make up 40 % of the NHS medical work force in the trainee survey. These doctors are appointed with the promise of being trained, lured from other countries and usually treated less than fairly. GMC openly discriminates. The BMA offers lip service.
Why is the BMA not the legal team rather than just a support. I am in two minds if it's worth paying in every year.
The fact that Dr Bawa-Garba's reflective learning notes have been used against her in a court of law has been known since March 2016. Within 6 months both MPS and MDU have issued guidance on how to ensure our reflective notes are correctly anomymized. While it is encouraging that the BMA is now approaching the GMC to discuss this point -among other issues- I cannot help but feel let down that it has taken so long for the BMA to take this step.
I hope the role of the media can be evaluated. Doctors are prohibited by confidentiality from defending themselves in the media - yet patients can say anything and their views can be distorted by grief/misunderstanding. Newspapers can selectively (mis)represent with a view to circulation rather than justice. So the public get a distorted view. This is the same public who the GMC cite that 'Public Confidence' trumps all. Of course the public are also propagandised by the government that the NHS is safe and adequately resourced, that sepsis can be eradicated etc. You can't constrain a free press - but one has to wonder if one can get a fair trial/hearing from a public who are fed this daily. I'd prefer medical justice to be delivered by specialist panels of predominantly peers with judicial oversight - ie mainly clinicians working at the coal-face who know the truth.
Well done BAPIO. Why is the BMA letting us down?
The entire membership of the GMC should read the book Just Culture to understand exactly how much they have increased risk to patients as a consequence of their action. Public confidence will not be increased/ restored by increasing reporting concealment. The Airline industry to which we are so often compared went over to this philosophy nearly 10 years ago. We are human, we learn best by observation, learning from other peoples error inevitably has greater impact than 'how clever am I".
Just like the GMC launching a legal campaign against Dr Bawa-Garba, does the BMA plan to challenge this hearing and action in court? I think This should be Independently of her legal team as it has wider implications for the entire medical team and also training implications.