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The Bawa-Garba Case

In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance

The monumental Dr Bawa-Garba case has sparked huge media attention and outrage from the medical profession in recent years. It is one that has highlighted the pressures on junior doctors and the detrimental impact that this can have on their patients. The case is centered around the tragic preventable death of 6 year old Jack Adcock, a young boy with Down’s Syndrome.

Timeline of Events

February 2011

Jack Adcock was urgently referred by his GP to Leicester Royal Infirmary and admitted to the Children’s Assessment Unit (CAU) with symptoms of nausea, diarrhoea and breathing problems. Dr Bawa-Garba ordered blood tests, but due to an IT failure there was a delay in obtaining results. She also requested a chest X ray, which was performed promptly but was not reported on by a radiologist. When she acted on the test results a few hours later she immediately prescribed a course of antibiotics, but these were not administered by the nursing staff until an hour later. Dr Bawa-Garba raised Jack’s diagnosis with her consultant, but he did not review Jack in person. Additionally, Jack was on medication for a previous heart condition, which Dr Bawa-Garba discontinued on his drug chart whilst he was being treated for a chest infection. She unfortunately did not make this clear to Jack’s mother who gave him his regular medication that evening, resulting in Jack going into cardiac arrest. Dr Bawa-Garba attended the arrest call and, due to the moving of beds, confused Jack with another patient and briefly ordered a stop to CPR (though this was not deemed to have contributed to his death). Jack died of cardiac arrest as a result of sepsis and a full investigation was conducted.

April 2012

The GMC is informed of the incident, which resulted in Dr Bawa-Garba being made the subject of 3 months supervised training and taken off the on-call rota.

November 2015

After an appeal to the GMC from Jack’s parents, Dr Bawa-Garba was convicted of gross negligence and given a 2 day suspended sentence.

June 2017

The GMC appealed to the high court to get Dr Bawa-Garba struck off the medical register. They wanted to override The Medical Tribunal Service (a body that decides if doctors can continue to work or not), who deemed that Dr Bawa-Garba should be suspended from work for 12 months.

January 2018

The Court of appeal erased Dr Bawa-Garba from the medical register.

January - August 2018

Over £350,000 was raised by protesting doctors to fund Dr Bawa-Garbas legal fees for an independent appeal. Dr Bawa-Garba won her case and is allowed to practice again.

The GMC’s Perspective

Dr Bawa-Garba was six years into the speciality training, so Jack’s condition was something that she should have been trained for. They argued that she was personally responsible for many failings that resulted in Jack’s death and was therefore a threat to the public if she continued practicing. The GMC did not want the public to lose confidence in the medical profession.

On that day:

She should have spotted the abnormal test results earlier
She should have asked her consultant to review Jack
She should have told Jack’s mother to stop his heart medication

The Medical Profession’s Perspective

It is agreed that Dr Bawa-Garba made some mistakes, but healthcare professionals work as a team, so there are many factors to consider when investigating what happened to Jack. Furthermore, before this incident there were no concerns about Dr Bawa-Garbas fitness to practice. The medical profession wanted the learning from this case to be based around what we can learn from the environment that Dr Bawa-Garba was working in on that day.

On that day:

Dr Bawa Garba was doing the work of 2 registrars, covering several wards, so was looking after many more patients that usual
She did not have adequate supervision from her consultant
This was her first shift in a high-intensity setting after maternity leave
She was working 12-hours continuously without a break
IT failures meant that she could not review results in a timely manner
Jack’s mother gave medication that she did not prescribe

The Impact of Dr Bawa-Garba’s Case

The Dr Bawa-Garba case has made many doctors question their practice and working environments, with doctors acknowledging that they could have made the same mistakes working in the same circumstances (#IamHadiza on twitter). It has also provoked fear within the profession of legal sanctions. Doctors are encouraged to acknowledge and reflect on mistakes that they have made to improve patient care and safety, yet Dr Bawa-Garba’s reflective E-portfolio was used as evidence against her in court. There is therefore worry that doctors cannot reflect openly and honestly in fear of repercussions.

Lily

Liverpool Medical Student