Basically Dr Bawa-Garba was convicted of manslaughter of a child and then struck off the medical board (against the wishes of the Medical Practitioners Tribunal Service). Doctors are not happy given the circumstances,ie she was doing the jobs of several doctors at the time and there are problems to say the least with the system.
http://www.independent.co.uk/news/healt ... 84966.html
opinion piece here
http://www.pulsetoday.co.uk/your-practi ... 44.article
Firstly lets go through some of the problems raisedDr Hadiza Bawa-Garba: What led to six-year-old Jack Adcock's death?
Junior doctor's conviction sparks outrage from medical community who raised concerns over apparent failure to consider exceptional pressures faced by NHS staff
Lucy Pasha-Robinson @lucypasha a day ago
The case of Dr Hadiza Bawa-Garba rocked medical circles after she was stripped of her medical licence following the death of a six-year-old boy with Down’s Syndrome.
The junior paediatrician was convicted of manslaughter by gross negligence and given a two-year suspended sentence for mistakes which led to Jack Adcock’s “needless death” in 2011.
But the decision has sparked anger from the medical community, with many raising concerns the High Court case failed to look at medical realities, including exceptional pressures faced by NHS staff and system-wide failings.
Here’s a timeline of the key events surrounding Jack’s death and Bawa-Garba‘s conviction:
18 February 2011
Jack is admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following a referral from his GP.
He has Down’s Syndrome, a known heart condition and has been suffering from diarrhoea, vomiting and difficulty breathing.
He is treated by Bawa-Garba, a specialist registrar in year six of her postgraduate training (ST6).
The trainee had recently returned from maternity leave and was solely in charge of the emergency department and acute Children’s Assessment Unit that day as there was no senior consultant available.
There was also an IT failure which led to delays in obtaining test results.
Bawa-Garba did make mistakes, including failing to ask a consultant to review Jack’s condition during the afternoon handover meeting and confusing him with another patient causing her to briefly put a stop to CPR – though this was not deemed to have contributed to his death.
She also failed to specify that the Enalapril medicine Jack took for his heart condition should be discontinued, and his mother gave him his evening dose at 7pm.
At 8pm, Jack “crashed” and Bawa-Garba responded.
At 9.20pm, Jack died of a cardiac arrest as a result of sepsis.
2 November 2015
Nurse Isabel Amaro, 47, of Manchester, is given a two-year suspended jail sentence for manslaughter on the grounds of gross negligence.
Prosecutor Andrew Thomas QC said her record-keeping was “woefully incomplete” and failed to monitor Jack’s vital signs.
He said: “The prosecution say that these were major failings which contributed significantly to the overall deficiencies in Jack’s care.
“If nurse Amaro had brought any of these to the attention of her senior nursing and medical colleagues, this should have led to urgent reassessment and initiation of further treatment to improve Jack’s condition.
“It was a needless death.”
She has since been struck off the register and is no longer able to work as a nurse or a midwife in the UK.
4 November 2015
At Nottingham Crown Court, Bawa-Garba is convicted of manslaughter on the grounds of gross negligence.
Mr Thomas said she has “failed to discharge her duty” as the responsible doctor.
“In short, she neglected her duty to care for Jack,” he said.
“It was not just a momentary lapse. The prosecution say that Jack’s care was neglected over a protracted period of time: her failings were compounded by a failure to go back and reassess Jack despite clear indications that his underlying condition was continuing.
“These were not just simple breaches of duty, but really serious breaches amounting to gross negligence.”
14 December 2015
Bawa-Garba is handed a two-year suspended sentence.
8 December 2016
Bawa-Garba’s appeal against her sentence is denied at the Court of Appeal.
13 June 2017
Bawa-Garba is suspended from working for 12 months by the Medical Practitioners Tribunal Service (MPTS). It rejects an application from the General Medical Council to strike her off the register, saying: “In the circumstances of this case, balancing the mitigating and aggravating factors, the tribunal concluded that erasure would be disproportionate.”
8 December 2017
The GMC appeals the MPTS ruling at the High Court. It argues it was “wrong” to allow Bawa-Garba to continue to practice medicine.
12:35 AM - Jan 26, 2018Jeremy Hunt
✔
@Jeremy_Hunt
Wouldn’t be appropriate for me as Govt Minister to criticise a court ruling, but deeply concerned about possibly unintended implications here for learning & reflective practice in e-journals. Am also totally perplexed that GMC acted as they did: patient safety must be paramount https://twitter.com/shaunlintern/status ... 6854221825 …
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25 January 2018
Bawa-Garba is struck off the medical register after a successful appeal by the GMC. Lord Justice Ouseley said: “The Tribunal did not respect the verdict of the jury as it should have. In fact, it reached its own and less severe view of the degree of Dr Bawa-Garba’s personal culpability.”
But Health Secretary Jeremy Hunt warns he is “deeply concerned” about the implications of the decision.
The medical community voice fears surrounding the impact of a “blame culture” in the NHS. Thousands of doctors sign a letter warning there will be wide-ranging consequences from the ruling which they say will make doctors working in the overstretched NHS more risk-averse and less likely to admit mistakes.
26 January 2018
Medics raise over £200,000 to fund an independent legal team to review Bawa-Garba’s case and potentially challenge the original ruling of causing manslaughter by gross negligence.
“For large numbers of the medical profession who have read this account, the clinical circumstances surrounding Jack’s death sound exceptionally horrific, with Dr Bawa-Garba struggling against all odds to keep her young patients safe and undertaking the roles of 3 or 4 doctors in the absence of her supervising clinical consultant,” the medics in charge of the fundraising page wrote.
“It seems clear to us that even the most competent junior doctor would struggle to keep children safe under such conditions.”
1. The amount of duties she was saddled with.
Its said that she was doing the work of several doctors. Given she was somehow expected to run two units, ie Emergency and the Child Assessment unit, it seems quite plausible to me. In adult medicine there is emergency and medical admissions unit / acute assessment unit or whatever you want to call it. They are separate units and each are ridiculously busy, at least in my state. Its not inconceivable to me that these are ridiculously busy as well given what I hear from UK colleagues.
2. She didn't get the consultant to see the patient
This to me is disputable if this is a problem. The consultant sees everyone on a ward round, or in some cases patients who the junior staff are worried about. From other sources than the Independence, she was allegedly not worried at that time she spoke to the consultant because the child was supposedly better.
Again this is hard to prove in my mind whether this was negligence. Its quite possible the child was looking better and deteriorated suddenly or in the 1.5 hours since she spoke to the consultant (spoke at 6.30, child crashed at 8.00).
3. Doing resuscitation she got confused with another child who had a "do not resuscitation order," although this was corrected within 30 seconds to two minutes when another doctor realised it wasn't.
This could be a reflection of her or on the system with so many patients that she got confused. However ultimately the court found that this did not contribute to the death of the child as he was too far gone at that point. Of course if the child wasn't too far gone, it could have been fatal to lose that time not doing CPR. However that wasn't the case here.
4. The delay in getting antibiotics to the child
http://www.pulsetoday.co.uk/your-practi ... 44.article
Basically x-ray available at 12.30. She was unaware of it being available until 3pm. A lost of 2.5 hours. Antibiotics were prescribed but did not get administered until 1 hour later for a delay of 3.5 hours. Its questionable whether the last hour is her fault as doctors don't exactly stand over nurses waiting for them to administer antibiotics. I also don't think the initial delay is her fault either since she was missing a junior doctor who helps chase up these tests.
This delay could potentially cost the child his life since he ultimately had pneumonia which became sepsis (as the bacteria causing his chest infection spread to his blood).
5. the administration of enalapril
Now this would have definitely worsened the child's condition. Basically enalapril was given for his cardiac condition and it lowers blood pressure When a child becomes septic one of the features is a drop in blood pressure. Not a good combination when its given with a drug which lowers BP. Low blood pressure means less perfusion to vital organs, and if severe enough, you go into cardiac arrest.
Was it her fault that it was still given? Perhaps but this seems like a system fault (which the hospital has since corrected). Remember, she didn't prescribe it (which was the right decision), but she didn't tell the mother not to give it or made that known, so it was still given.
In the hospitals I worked in, all medications are recorded and administered from the hospital stores even if the patient has the drug with them when they present to hospital. The patient's own drugs are locked away until discharge. In the event the patient has some rare drug which the hospital may not necessarily have on hand, it can be given from the patient's own store, but the nurses must observe it being taken and record it being given so all staff know what has been administered. The way it worked in this UK hospital seems a bit different and sadly led to this mistake.
Consider how this would have been handled in a Western Australia hospital. If the doctor decide not to give enalapril for now, they could either
a) not write it on the medication chart, and the patient's own supply would be locked away, or
b) write it on the chart but indicate it would be withheld for a certain length of time or withheld pending a review. In the medical notes, the doctor would ideally write with hold enalapril, but if they forget to record all their thoughts, as long its withheld on the med chart, administration by the parents would be unlikely.
Apparently in this UK hospital, not writing it on the chart is not good enough, one has to actually state in the plan as well to prevent the parents giving the usual medication.
I think this system has problems.
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Based on these articles (and I concede I don't have all the information), I am going to say the only thing she did that was blatantly wrong was stopping the resus because she mistook the patient for another one who had a do not resuscitate order. However this did not lead to the death of the child, so she can certainly be disciplined over it, but its unfair to attribute the cause of death to her via manslaughter. Keep in mind she was working under very trying conditions to say the least.
My feeling is that we have a need to identify one cause, or maybe someone who is at fault, rather than the system which is a complex interaction between numerous factors.
