Bawa-Garba case exposes shortcomings in management of medical errors

As we await the results of an urgent review into medical malpractice, medical bodies continue to criticise the way errors are handled in the wake of Dr Bawa-Garba's conviction.

Dr Bawa-Garba

In November 2015, Dr Hadiza Bawa-Garba was convicted of the manslaughter of six-year old Jack Adcock, on the grounds of gross negligence.  Dr Bawa-Garba was a junior doctor who had recently returned from maternity leave. She was solely in charge of the Emergency Department and Children’s Assessment Unit at Leeds Royal Infirmary on the day that Jack, who had Down’s Syndrome, was brought in. Over the course of the day a series of errors (administrative, personal and systems-related) culminated in the boy’s tragic death.

Dr Bawa-Garba was convicted of manslaughter and given a 24-month suspended sentence which the Court of Appeal upheld in December 2016.

What followed was a tussle between the General Medical Council (GMC) and the Medical Practitioners Tribunal Service (MPTS) over the appropriate severity of Dr Bawa-Garba’s sanction. The GMC initially recommended that she be struck off the medical register, however the MPTS found in December 2017 that erasure was "disproportionate", and instead imposed only a 12-month suspension.

In January of this year, the GMC successfully appealed the MPTS decision and Dr Bawa-Garba was struck off the register. Ouseley LJ said that the Tribunal had not respected the verdict of the jury as it should have, instead reaching its own, less severe, view of Dr Bawa-Garba’s culpability. 

Following the successful appeal, Jeremy Hunt tweeted that he was “deeply concerned about possibly unintended implications here for learning & reflective practice”. He suggested that the decision will mean doctors are more hesitant to admit mistakes through fear of severe repercussions and said: “If we are going to keep patients safe then we have to make sure that doctors are able to learn from mistakes.”

The decision has sparked intense debate in the medical community; with many focussing on the role NHS under-resourcing has to play in the increasing frequency of medical malpractice cases. An open letter to the GMC written by medics in December 2017 read: “We now see [doctors] being held criminally responsible for mistakes made whilst working under these pressures, which, with chronic staff shortages, prolonged underfunding and low morale, now occur with worrying frequency.”

The Williams Review

The rapid policy Williams Review, announced on 6 February 2018, will be chaired by Professor Sir Norman Williams and will investigate the following issues: 

• how we ensure healthcare professionals are adequately informed about gross negligence manslaughter (GNM), and the prosecution process

• how we ensure that reflective learning and transparency are protected where a mistake has been made

• lessons the GMC needs to learn in relation to dealing with professionals following the criminal process for GNM 

The Review is expected to announce its findings by the end of April. 

Medical errors 

In the same month as the Review announcement, the Health Secretary spoke again on medical malpractice, this time highlighting on 26 February the 237 million drug errors which healthcare professionals make each year. Research has suggested these could be causing 700 deaths a year, and are a contributing factor in thousands more. 

The NHS continues to face resourcing challenges, and attributing blame in medical malpractice cases is becoming an increasingly fraught topic of debate. The Medical Protection Society this week have criticised the law on medical manslaughter as setting too low a bar for conviction. MPS medical director Dr Rob Hendry said: "The public and medical profession would expect that extreme cases where there is intent to cause harm or a high degree of recklessness result in prosecution – and we support that. Most medical manslaughter cases are however more complex, involve systems failures, and are devastating for all concerned." The MPS recommend legal reform so that 'careless' actions alone do not result in conviction.

Medical professionals and their insurance providers will be hoping that Mr Hunt’s focus on malpractice will not only bring clarity and reassurance for those who make mistakes, but also that steps are taken to address the root issues that lead to errors being made.

Look out for our comment on the Review's findings, once published.