Dr Hadiza Bawa-Gaba - Medical liability in team-based, underesourced health care settings:
Much of the reaction by medical professionals towards the Dr Bawa-Garba case has been of fear, concern and sympathy towards this junior doctor’s circumstances. A crowdfund to support Dr Bawa-Garba appeal against the GMC’s decision to strike her off the medical register reached over an astonishing £360,000; a small testament of the support for Dr Bawa-Garba.
Since the Court of Appeal’s decision to reinstate Dr Bawa-Garba, the government ordered a review of protection offered to doctors and nurses when mistakes are made. New measures are thus being introduced, including, perhaps the most controversially, the General Medical Council (the initial regulator for practising doctors) to no longer be able to appeal against the findings of doctors’ disciplinary hearings.
Professor Sir Norman Williams, a consultant colorectal surgeon, led the policy review after being appointed by Jeremy Hunt, the Secretary of State for Health and Social Care. In a statement published by Mr Hunt prior to its commencement, the Health Secretary stated that the review was prompted by concerns among healthcare professionals that errors could result in prosecution for gross negligence manslaughter, even in the face of broader organisation and system failings. This was a clear response to the numerous articles by medical professionals on the Dr Bawa-Garba’s case. We have discussed some below.
Dr Moosa Qureshi, Dr James Haddock and Dr Chris Day, the doctors behind the crowdfunding campaign, expressed deep concerns about this case and highlighted the ramifications for NHS professionals. It was interesting to note that there has not only been concerns for doctors, but also the implications for patient safety, in that a reluctance by healthcare professionals to discuss their concerns or errors openly will invariably affect patients and their healthcare.
Dr Jonathan Cusack, Mr Bawa-Garba’s former Educational Supervisor and the individual said to be the reason behind Dr Bawa-Garba not being struck off the medical register permanently, has stated that the junior doctor’s competence as a clinical pediatrician is irrefutable. Rather, he describes Dr Bawa-Garba working in a ‘perfect storm’ as he states that ‘errors rarely occur in isolation’ whilst listing off issues like staffing concerns and computer problems contributing to the unfortunate situation that the doctor faced on the 18th of February, 2011.
Conversely, there are others that emphasise that though Dr Bawa-Garba was under pressure with multiple factors seemingly working against her, she had made numerous mistakes independent of her surroundings. Dr Amar Alwitry, in his blog titled ‘The Case of Dr Bawa-Garba - Where does the buck stop?’, notes that the judgment of GMC vs. Bawa-Garba highlighted two of such instances. Firstly, it was felt that Dr Bawa-Garba had ignored obvious clinical findings and symptoms that indicated that Jack was not an ordinary case and rather he was a particularly vulnerable patient due to a unstable history of health. This included symptoms of diarrhea and vomiting for about 12 hours, extreme lethargy and significantly high lactate reading. Secondly, there was held to be failings in Jack’s subsequent consultations and inadequacies in properly reassessing Jack’s condition. In this respect, it was alleged that Dr Bawa-Garba failed to properly act on the obvious clinical findings and alarming test results indicating both an infection and organ failure from septic shock. In this way, Dr Amar Alwitry expresses an understanding with GMC’s approach of acting within the framework of the law.
The GMC, the public body that successfully appealed for Dr Bawa-Garba to be struck off in January 2018, provided a response to the case. Alongside an apology for triggering concern amongst many medical professionals, expressed that the body has taken steps to ensure doctors feel supported under the pressure of the current healthcare system.
From the outside-looking-in, Dr Bawa-Garba was working within unfortunate circumstances. Add to this that she had been absent on maternity leave and had returned without formal induction, had not had much experience relative to the responsibilities that had been conferred upon her, and there were IT failings beyond her control. The overall context in which she was operating was one where there were at least arguably many systemic failures. In those circumstances, is a system of medical negligence liability which focuses only on the doctor appropriate?
However, it is also important to note that a doctors’ role has never been seamless, and we have always known this. The numerous years of studying and practice, going through the competitive process of being assessed for your competency and credibility to gain a place at a medical school, is evidence that a doctor’s position is both distinctive and onerous. In this way, it is easy to see why the GMC took the approach of ensuring that a doctor remains capable of doing their job (both within society and within the medical community), and for necessary punishments being conferred where a doctor falls short.