NHS Hot Topics for Interview: Dr Bawa Garba Case

The Dr Bawa Garba case was a monumental case. It highlighted the pressure upon junior doctors and the detrimental impact it can have on patients. Due to the controversial decision made by the High Court, the case sparked a huge amount of media attention and outrage from the medical community, with many doctors arguing that the High court failed to look at the case in detail. 

The divisive nature of the case means that universities could ask for your understanding in a medical school interview or MMI circuit. So, what do you need to know? Here to give you expert interview preparation, this is your NHS hot topics post to the Dr Hadiza Bawa Garba case.

BACKGROUND

Hadiza Bawa Garba was a paediatric doctor, who was stripped of her medical licence after the death of Jack Adcock, a 6-year-old child who suffered from Downs Syndrome. This case started in February 2011 and has only recently come to its conclusion in August 2018. There are many factors to this case and it is important to understand the details of the trail. 

TIMELINE OF EVENTS:

• February 2011: Jack Adcock urgently presented to the Leicester Royal Infirmary A&E department with symptoms of nausea, diarrhoea and breathing problems. He was admitted to the children’s ward. 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. 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. During the handover with the consultant, Jack’s diagnosis was raised but no one decided to review Jack in person again. Additionally, Jack had previous underlying heart conditions which required certain medication. This medication should have been discontinued whilst Jack was being treated for his chest infection. However, this information was not specifically written down on the patient notes, and later that evening Jack’s mother gave him a dose of his previous medicine. An hour later Jack began to become severely unwell and required CPR. Due to the mismanagement of information, Dr Bawa-Garba delayed CPR for one minute, because she confused Jack with another patient, who had a signed Do Not Resuscitate form. Unfortunately, at 9:20 pm Jack had passed away because his heart would not restart with CPR. Following his death, a full investigation was conducted. 
• November 2015: the nurse-in-charge, Isabel Amaro was given a two-year suspended jail sentence on the grounds of gross negligence. Dr Bawa-Garba was also convicted of gross negligence and was given a 24-month suspended sentence. 
• June 2017: The Medical Practitioners Tribunal Service (MPTS), which is a body that decides if doctors can continue to work or not, deemed that Dr Bawa-Garba should be suspended for 12 months from work. Dissatisfied with the MPTS’s decision, the general medical council GMC appealed to the High Court. The chief executive of the GMC claimed that MPTS was wrong to allow Dr Bawa-Garba to practise and wanted her to be struck off the register 
• January 2018: The Court of appeal overruled the tribunal’s decision and Dr Bawa-Garba was erased off the medical register. 
• January – August 2018: The decision of the Court of appeal provoked a storm of protest from doctors and a crowdfunding campaign was started, which raised over £350,000. Consequently, an independent appeal was created. Finally, in August 2018, Dr Bawa-Garba won her case and will be allowed to practice again. 

THE GMC’S PERSPECTIVE

Hadiza Bawa-Garba was 6 years into her speciality training, a very senior doctor, and Jack’s situation was not something she was untrained for. Dr Bawa-Garba herself admitted making a series of errors in relation to Jack's care and said she had underestimated the severity of his illness.

• She should have checked the observation charts and should have spotted abnormal blood test results earlier
• She did not ask the consultant to review Jack during the handover
• She did not specifically inform Jack’s mother about stopping Jack’s heart medication
• At the time of the cardiac arrest, she paused CPR because she confused Jack with another patient who signed a Do Not Resuscitate form. However, doctors claim this did not impact Jack’s condition because he was already beyond the point of no return. 

The GMC claimed that her personal culpability carried so much bearing in causing the death of the patient, that she would be a harm to the public if she was allowed to carry on practising. Therefore, Dr Bawa-Garba had to be struck off the UK medical register to maintain public confidence in the profession.

THE MEDICAL COMMUNITY AND MPTS PERSPECTIVE

Medical professionals agree that Dr Bawa-Garba did make some mistakes. Health care professionals work in a team to provide the best quality of care. Consequently, when something doesn’t work out, multiple factors need to be considered.

• Dr Bawa-Garba was doing the work of 2-registrars on that day, covering several wards without adequate supervision from a consultant 
• She had recently returned from maternity leave and this was her first shift in a high-intensity setting 
• She was working 12-hours continuously without a break. 
• Systemic failures and inefficiencies from the hospital system meant that Dr Bawa-Garba was waiting for almost 2½ hours before she could review them. 
• There was a significant interval in getting blood test results, which led to a 6-hour delay in administering vital antibiotics. 

The pressure of understaffing and gaps in rotas resonates with most junior doctors. They claimed that it is unstainable to maintain the high quality of care required by patients amidst the extreme levels of pressure and stress. The MPTS stated that, before this case, no concerns were raised about Dr Bawa-Garba’s ability to work as a doctor safely. 

The evidence highlighted that she was in the top third of her specialist trainee cohort. Dr Bawa-Garba also remedied the deficiencies in her clinical skills and did not present a continuing risk to patients. Therefore, the tribunal found the erasure of her medical licence to be “disproportionate” taking into consideration of the failings at the hospital trust, including a lack of senior consultant cover, IT problems and staff shortages.

IMPACT

JUNIOR DOCTORS

This case has affected the confidence of the medical profession, and as a result, many doctors are feeling upset and unsure about their practice and their working environments. Doctors have a duty, to be honest, and open with their patient when things go wrong. It is vital to acknowledge an error and reflect on it so that measures can be put in place to rectify mistakes to improve patient care and safety. 

However, currently there is a “blame and shame” culture in the NHS and the fear of legal sanctions reinforces this culture. Dr Bawa-Garba was encouraged to record her mistakes in her e-portfolio and to reflect on them. However, elements of her e-portfolio were included in materials seen by expert witnesses. Therefore, there is worry that doctors can no longer reflect openly and honestly and cannot learn from their mistakes.

FUTURE MEDICAL COURT CASES

The former health secretary, Jeremy Hunt, highlighted the need to change the perception of medical errors. Therefore, following the Bawa-Garba case, Hunt ordered a review of criminal cases against doctors. He implemented new measures, which are designed to improve patient safety and protect healthcare professionals when mistakes are made. These new measures include:

The former health secretary, Jeremy Hunt, highlighted the need to change the perception of medical errors. Therefore, following the Bawa-Garba case, Hunt ordered a review of criminal cases against doctors. He implemented new measures, which are designed to improve patient safety and protect healthcare professionals when mistakes are made. These new measures include:

• The investigation of every hospital death by a medical examiner or coroner
• Having data on doctors' performance to allow them to see how they compare to others and help them improve
• The GMC will no longer be able to appeal against the findings of doctors' disciplinary hearings

Having a clearer understanding of when manslaughter charges should be brought in healthcare should lead to fewer criminal investigations. Furthermore, criminal investigations should be confined "to just those rare cases where an individual's performance is so 'truly exceptionally bad' that it requires a criminal sanction".

There is no doubt that the death of Jack Adcock could have been prevented, and there were grave mistakes which contributed to this his death. However, when asked about this incident within interviews, it is important to see both sides of the story.

We hope that this was a helpful overview of the NHS winter pressures issue and you feel more confident tackling it if it comes up as a question. Don't hesitate to send us any questions or comments by email at hello@theMSAG.com. Good luck in your interview!