Death of British boy has worried junior doctors all over the world - the Hadiza Bawa-Garba case


Most members are aware of the case of Dr. Hadiza Bawa-Garba, a trainee paediatrician in the NHS, who on 4 November 2015 was convicted of gross negligence manslaughter for the death of a child from sepsis, and was sentenced to a suspended sentence of imprisonment, having been initially informed in 2012 that she would not be prosecuted at all.

Her fitness to practise was found to be impaired by the Medical Practitioners Tribunal in June 2017, and she was suspended for a period of 12 months. Last week, the High Court ruled, following an appeal by the General Medical Council, that this sanction was insufficient, and substituted the sanction of erasure from the medical register – effectively ending Dr Bawa-Garba’s career.

You can read the judgment here (and in the judgment from the Court of Appeal dismissing her application for leave to appeal against conviction, here)

We have reproduced below the excellent opinion piece on this issue written by of Andrew McDonald, who is paediatrician and associate professor at University of Western Sydney and who is also an ASMOF State Councillor.

Death of British boy has worried junior doctors all over the world - with good reason

Jack Adcock was six years old in February 2011. Much loved, he had Down syndrome, had successfully been through heart surgery in the past - and had a chest infection.

Dr Hadiza Bawa-Garba, a graduate of Leicester University in 2003, was a paediatric registrar with a previous exemplary record. She had only recently returned to work after maternity leave.

By the end of that tragic day, Jack was dead and a promising career lay in ruins. It is a case that has rung alarm bells for junior doctors around the world - including in NSW.

After an initial improvement with treatment, Jack arrested a few hours after arriving at hospital. Though he was clearly unwell at presentation, he was appropriately treated by Bawa-Garba with IV fluids and antibiotics and initially improved. Why he had a cardiac arrest when he did, no one knows.

It was Bawa-Garba's first day in an acute setting since her return to work. The computers were down, meaning that vital blood results were not available for hours and only then by phone call. Another staff member was sick, meaning she was doing the work of three people. Her supervising consultant was teaching 30 minutes away and chose not to come to see Jack, despite being told of the troubling blood results.

After Jack died, Bawa-Garba wrote a "personal reflection" - a vital part of modern medical training. But when Bawa-Garba was charged in December 2014 with "negligence manslaughter" over Jack's death, this reflection was used against her in court, in a move that could adversely affect medical teaching worldwide.

Bawa-Garba was convicted in 2016 and given a two-year suspended jail sentence. She was then suspended for 12 months by the medical practitioners tribunal (who felt that erasure from the register would be "disproportionate"). The General Medical Council (the British version of Australian health practitioners' agency) appealed to the High Court, the result being that Bawa-Garba has now been struck off. Her life, and that of her family, is ruined.

Though NSW has one of the world's better health systems, Bawa-Garba could easily have been any doctor in NSW. I am a consultant who regularly sees and assesses sick children, and trying to predict deterioration is sometimes impossible. I have been personally involved in a number of cases where things went suddenly, disastrously, tragically wrong.

Tragedies like the death of Jack Adcock are more likely to occur when junior doctors are poorly supervised or supported by the system, or have unacceptable workloads. This can and does happen in NSW to most junior doctors at some stage in their first years of training. The various medical forums on the internet for junior doctors are all discussing this case. Bawa-Garba could be any of those doctors.

The scapegoating of a junior clinician (doctor or nurse) by the regulatory authorities also happens in NSW. I have seen a number of careers and lives of otherwise competent clinicians ruined for no purpose whatsoever by NSW regulatory authorities.

In NSW, Jack's blood results alone would result in nearly every case in a call to NETS (newborn and paediatric emergency transport service), whose services and support save lives every day. Bawa-Garba did not have this service available, nor did she have the available on-site consultant support she should have had.

The benchmark for quality care should be that a consultant clinician whose skills include assessment of unwell children should be available to come and see any child within 30 minutes from the call, 24 hours a day, seven days a week. Only about half of children presenting to emergency departments in NSW would qualify for that. This ensures junior doctors are adequately supervised and supported in their work.

The other benchmark is that every child in a NSW hospital is seen by the consultant in charge of care, or another consultant, on every day of admission. The better units do this, but not all. About 10 per cent of diagnoses for sick children from any emergency department will not be fully correct, even if the initial assessment is by someone senior.

We must meet these benchmarks if we are to ensure tragic deaths like those of Jack Adcock are less likely to happen.

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