Medicine, despite all the advances made in recent centuries in this area, is never a completely exact science. Conditions can present as one thing and be treated as such but in reality be some other underlying illness. Doctors, no matter how skilled and learned they are are not gods, they are humans with human frailties. However there are doctors who are so gratuitously incompetent and so unsuited to the stressful job of practising medicine that they should not be allowed anywhere near any patient. It is for the purpose of keeping bad doctors from practising medicine that the system of registration for doctors exists.
We’ve recently seen a case where the system of registration for doctors has failed utterly and has allowed a doctor whose gross negligence caused the death of a six year old boy, back into the medical profession. This in my view should not have happened. Whilst all medical staff are prone to making honest mistakes or misdiagnoses which should always result in the loss of career, there are other doctors whose errors are so blatantly and outrageously bad that they should never be allowed to practise medicine again.
The case of Dr Hadiza Bawa-Garba is one of those where a doctor has behaved so badly that there should be no question of her ever being allowed to work as a doctor in the medical profession again. It’s rare for a doctor who makes an honest mistake to end up in court but that is what happened to this particular Muslim doctor. At a trial in 2015 Dr Hadiza Bawa-Garba was found to have caused the death of a six year old boy, Jack Adcock, who suffered from Downs Syndrome and a heart condition by virtue of her gross negligence whilst he was being treated for a gastrointestinal problem at Leicester Royal Infirmary. She was given a two year prison sentence suspended for two years after being convicted of manslaughter due to gross negligence. A nurse who worked with her on this case Isabel Amaro was given a three year sentence for the same offence. Both Amaro and Bawa-Garba were struck off their respective medical registers.
Whist under the care of Dr Hadiza Bawa-Garba and a nurse Isabel Amaro, Jack Adcock died from a cardiac arrest brought upon by sepsis. It’s worth reading the Wikipedia account of the circumstances leading up to this boy’s death as it is very comprehensive and shows that although there were systemic problems such as staffing levels an IT problems present in the hospital, Dr Bawa-Garba didn’t exactly cover herself in glory when it came to how she went about her work. The Wikipedia account of the case stated that Bawa-Garba made a number of mistakes including failing to share information about test results with an on-call consultant this meant that abnormal test results were not shared with the consultant which they should have been. She also allowed the child’s mother to administer a blood pressure / heart failure drug despite leaving this medication off of the notes and failing to tell the mother not to administer it. It was the custom in the hospital at the time to allow parents to administer medications. The administration of this medication, enalapril, at a time when it should not have been given due to the nature of Jack Adcock’s condition, caused the boy’s condition to deteriorate badly.
These errors were bad enough but Bawa-Garba’s incompetence became worse. She confused Jack Adcock with another paediatric patient, a terminally ill one with a ‘do not resuscitate notice on their file,who was in the same room. She thought that a resuscitation team that had turned up on the ward for Jack Adcock was there for the terminally ill child and because this other child had a ‘do not resuscitate’ note, ordered resuscitation procedures to be stopped. When she realised that she had made a grave error in misidentifying the patient,she ordered resuscitation to be restarted on Jack. Sadly these resuscitation efforts failed and Jack died.
Whilst I quite readily accept that the usual NHS screw ups concerning IT and staffing rotas played a part in Jack Adcock’s death, the prime cause of this death is Dr Bawa-Garba’s gross incompetence. She failed to deal with medications or tests properly, failed to communicate with consultants about Jack’s condition and the test results and even failed to properly ascertain the identity of the patient, confusing Jack with another terminally ill patient. The hospital did fail to induct her in her new job as paediatric registrar which she was starting on her first day back from maternity leave and this is something that the hospital can be blamed for. But Bawa-Garba was the doctor here it should have been Bawa-Garba’s responsibility to point out any deficiencies in her induction and ensure that she knew what she was doing and who she should contact if she needed to refer up to senior staff for any reason.
As I said earlier, it’s rare for a doctor who made a genuine and honest human error mistake to end up in court, let alone be convicted of manslaughter, a doctor has to be pretty bad for this to be the outcome. Bawa-Garba’s conviction should, as her defence counsel said at her trial during mitigation, ‘be the end of her career’ as a medic and at first it seemed that this was going to be the outcome. The initial twelve month suspension from practise was increased to permanent removal from the medical register in early 2018. The shameless incompetent medic Bawa-Garba appealed this judgement to the High Court which ordered the Medical Practitioners Tribunal Service to reconsider the case. The case was reconsidered and she was put back on the medical register in August 2018.
This is a very troubling case and one which the family of Jack Adcock are angry about as well they should be. I’m not convinced that the conditions that she will have to practise under which include increased supervision will make this doctor safe in the future. Also her apology, which I heard on BBC radio this morning seemed to me to be mealy mouthed and self serving.
There is an aspect of this case that bothers me immensely and that is the leniency with which she has been treated and I wonder whether or not the fact she is a Muslim woman has played some part in that leniency? Other doctors who have failed assessments or who have behaved incompetently have been struck off the medical register as we can see from reports here, here and here. The only comparable case I can find where a doctor who prescribed the wrong treatment to a patient and was allowed to practise again was this one but in this case he was forbidden to work with cancer patients and has to find other employment. There was certainly a massive ‘community’ campaign for her and to raise money for her appeal and other medics backed her appeal on the grounds that they felt she was carrying the can for general failures by the Leicester Royal Infirmary. I can understand the position of other medics on this as it is all too easy for hospital management to pass the buck down to doctors for management mistakes. However, this doctor has been treated with such excessive leniency bearing in mind the gravity of her errors that it will raise questions as to whether there were other factors, such as this medic being Muslim and having a large fighting fund pot, involved in this troubling leniency. With so many other instances of Muslims being treated with leniency by the courts, the police and by other agencies, the way that Bawa-Garba has been treated will raise questions about whether she has been given a bit of a free pass here because she is Muslim.
I believe that justice would have been better served by keeping Dr Bawa-Garba out of the medical profession or at least revoking her right to practise as a doctor. If she wanted to work in some other area of the medical profession say as a manager or a health advisor then fine, that could have been acceptable as she would not then be in a position to make life or death decisions, something she has shown she has had problems dealing with in the past. It is right in my view that the family of Jack Adcock are protesting Dr Bawa-Garba’s readmission to the doctors register. As the family say, this doctor has been given a second chance which is more of a second chance that Jack Adcock got because of Dr Bawa -Garba’s incompetence. I really don’t know what Dr Bawa-Garba thinks she will get out of this readmission to the medical register. After all, with her record and her conviction for manslaughter, which hospital would be willing to employ her and undertake the onerous job of supervision of her work?
If I was a patient or had a relative who was a patient and Dr Bawa-Garba was allocated to my or their care, I would vehemently object to her being involved with the treatment. Who in their right mind would want to be treated by a doctor who many would find impossible to trust? I’m all for not unjustly punishing doctors who make genuine errors or who are put in positions where they are overly stressed by workload, but Dr Bawa-Garba’s errors were so grave and had such huge repercussions that she should not practise medicine again. Her errors were not just a misdiagnosis or the prescribing of a wrong medication, they were of a level of incompetence that went far beyond that and I fail to see what good can ever come of letting her back into medical practise. There has been far too much leniency in how Dr Bawa-Garba’s case has been handled and it’s the type of leniency that should be protested.
