Between a GMC-shaped rock and lots of hard places: medical errors in the era of Dr Bawa-Garba

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Malevolent, lazy, or incompetent?

 

It must be one of those things.

 

Did Dr Hadiza Bawa-Garba, a specialist registrar in paediatrics with 6 years of post-graduate training and a previously immaculate record, regarded as an excellent doctor by her colleagues, wake up on the 18th of February, 2011 and decide that she wanted to harm one of her patients? If the evidence presented at court is anything to go by, then no. If she’s anything like all the paediatricians that I’ve met, who, even under the most overwhelmingly pressured circumstances, continually do the absolute best that they can for their young patients, then certainly not.

 

So, not malevolent. Was she lazy? It depends how you define it. On that Friday, Dr Bawa-Garba was on a thirteen hour shift, doing the work of three absent registrars, acting as the most senior doctor in the team, looking after paediatric patients in the Children’s Assessment Unit, the paedatric ward and in an Emergency Department you’ve never worked in before whilst taking referrals from GPs, surgeons and midwives with a broken IT system. You could call that lazy, but most would say not.

 

Finally, and if the verdict of ‘manslaughter by gross negligence’ is to hold true then this must have been her crime, was she incompetent? Failing to recognise the signs of septic shock, failing to specify to the parents not to give the enalapril that dropped Jack’s blood pressure, confusing Jack with another child. Yes, there it is. A catalogue of errors resulting in the tragic death of a six-year old child that can only be explained by your sheer incompetence. Nobody else is at fault. Just you. Two years behind bars and two for your nurse chum, too. Forget your ‘immaculate’ records and ‘excellent’ medical practice. You told us you were guilty in that reflective journal of yours (the one we said was confidential). Done. Incompetent. A danger to the public. We don’t care how tricky the diagnosis or the treatment was. Stay away from our profession, please.

 

The fact is, she was none of these things.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Of course, Dr Bawa-Garba made these mistakes, and she will have been inconsolably devastated because of it. Jack’s death was not inevitable and, instead of looking for excuses, in those reflections she will have completely castrated herself, reliving every conceivable error she made over and over again. From that point on, she will have seen Jack in every patient she treated. It’s the kind of case that keeps you up night. The kind of case that follows you around the hospital, breaking free from the dungeons of your memory using any and every tenuous reminder as the lock pick, crawling out as a cruel, haunting example of your own fallibility. The kind of case that changes the way you practice forever. In such circumstances, it is hard to blame the Adcock family for pursuing legal action. The death of any child is an unimaginible trauma that is impossible to understand unless you have been through it. Explanation is no replacement for experience. However, in very different terms, this same logic applies to the experience of working in a chronically understaffed system where compromised care is almost always the best that can be offered. This was a key element that had not been understood by the twelve jurors who found Dr Bawa-Garba guilty of manslaughter. To make that decision, you need to understand that to work in the NHS today is to play a game of Russian roulette. That every time you step into that hospital, you enter a real-life Swiss cheese model, an arena filled with errors of all sizes, filled with holes that you do your best to tip-toe around. Eventually, those holes will line up, and you can only hope that it isn’t you that falls through them. That scenario has become the primal fear of the NHS doctor. Unfortunately, for Dr Bawa-Garba and Jack, the holes lined up with them at the end. The truth is, though, it could have been any one of us.

 

In a way, those jurors have an excuse. They’ve not experienced first-hand the dire conditions and cataclismic chaos that doctors fight to the best of their ability every day. However, given that their job is to regulate the practice of doctors, you’d think that the GMC would. It seemed not.

 

Like vultures circling a mauled body, the GMC weren’t happy with just a two year prison sentence, a one year suspension and a retracted training number. They wanted her off the medical register for good. They wanted the whole carcass. In their pursuit, they highlighted that the ‘wholesale collapse of the standard of care’ that Dr Bawa-Garba provided ‘came out of the blue’, and ‘it was therefore impossible to have any confidence that this would not happen again’. In other words, Dr Bawa-Garba’s mistake proved that she was fallible. Cold, hard evidence that she could make mistakes and was therefore prone to making them again, unlike all those other good doctors who’ve never made a mistake that has, in some way, compromised patient care. She must have missed that part of medical school where Agent K and Agent J perform some Men In Black style obliteration of the ability to make human error.

 

Anyway, even if you didn’t think that this one case was compelling enough evidence of her incompetence, it doesn’t matter. At least not in GMC-land.

 

‘A finding of impairment was required in the public interest’.

 

If your ‘public’ is the editorial team of the Daily Mail, then this is true. ‘Black, hijab-wearing, muslim woman struck off for negligent care’ sounds like something that came out of their own headline generator. It’s great ammo for the far-right anti-muslim, anti-women brigade. However, I’m dubious that twisting the evidence to strike off a very capable paediatrician who would most likely have gone on to make countless lives better, alienating a whole profession and creating a nationwide culture of fear in the process is ‘in the public interest’. With regulating bodies like this making life as a doctor in the NHS even more terrifyingly difficult, it becomes an act of ignorance to even ask why applications to medical school are dropping.

 

In their defence, the GMC were corned by the High Court’s decision. However, in an alternate pre-post-truth reality, the GMC would have looked up, not down. They would have realised that mistakes are inevitable when you are working in such circumstances. They would have realised that no event occurs in a vacuum, and would have chose not to ply on with the scapegoating of Dr Bawa-Garba. Instead, if they really cared about patient safety, they would have asked how it can become the norm to have a junior doctor covering three wards without a supervising consultant present and expect no errors to occur. If they truly cared about what was ‘in the public interest’, they would have asked the more salient question of: ‘was Dr Bawa-Garba responsible for the situation she found herself in?’. They would state clearly the role of systemic failings in Jack’s death and the need to hold those responsible to account, asking how healthcare professionals can still be expected to provide first-class delivery when we’re being posted with a second-class stamp. If the GMC were to be the ambassadors of patient safety they claim to be, they would follow their own guidance, show some compassion and integrity, and own up to their mistake on this.

 

Back on Planet Earth, the GMC have instead noted that they’ve ‘listened’ to the concerns of the medical profession, which includes the BMA, a number of NHS trusts and the Royal Colleges. Their response? A flow-chart on whistleblowing. Exactly what we needed. The elixir to solve all these institutional, systemic failings. Fail to do follow that flow-chart, and you’ll get a suited man knocking at your door holding the remnants of Dr Bawa-Garba’s license number as a gentle reminder that you could be next. Follow it, and you’ll be immortalised into GMC folklore as a true hero of patient safety. That is, until Health Education England take away your training number for doing just that. Maybe it’s best just to keep your mouth shut, get on with the job and hope for the best.

 

The death of Jack Adcock was an absolute tragedy. A child died and a family were left broken. However, in an ordeal like this, it’s easy to look for an individual to blame. It provides us with the kind of certainty that us humans love. Anything more complex than a simple story like this and we lose interest. Yes, Jack’s death was a case of manslaughter, but Dr Bawa-Garba is not the criminal. Granted, there is a complex array of underlying factors that make errors like her’s more likely but, if this was any kind of manslaughter, this was institutional manslaughter. This is not just a case of medical comraderie. The High Court and the GMC’s decisions were wrong. Whether malevolent, lazy, or incompetent, the real criminals are those who, in one of the richest countries in the world, allow the conditions that led to Jack’s death to prevail.

 

At the end of it all, I hope that we still remember how much of a tragedy this was and has been for Jack, his family and all who knew him, as well as for Dr Bawa-Garba and all those involved in Jack’s care. We can only hope that, rather than being the tragedy that it was for them, the outcome of this mess is that it doesn’t become a tragedy for the medical profession. Instead, we must hope that Jack’s legacy is that the case becomes the watershed moment where the conditions that led to his death are not accepted, and the doctors who try their very best in those conditions do not have to live in fear of being branded as criminals for doing so. For the sake of patients like Jack, that has to happen.

 

#IamHadiza

 

The crowdfunding page for Dr Bawa-Garba’s legal appeal can be found at https://www.crowdjustice.com/case/help-dr-bawa-garba/

 

2 Comments

  1. Reshma Shanmugam says:

    Very important story to highlight, great job Elliot!

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