The recent case of Dr Bawa-Garba and the tragic death of Jack Adcock have received much media coverage in the last few days. We wholeheartedly sympathise and regret the tragic death of Jack Adcock and recognise the paramount need for justice and prevention of further such tragedies. As an organisation with over 6,000 members, we are deeply concerned about the way this case has been handled by the General Medical Council (GMC), in particular the decision to challenge the ruling by the Medical Practitioners Tribunal Service.
Medical staff who have worked with Dr Bawa-Garba have testified to her integrity and compassion, commitment to charitable activities and public service, unblemished record and four years of work at the hospital after Jack’s death with much praise and no concerns with regard to competency. Erasure from the medical register is a huge loss not only for the profession, but also to the public she has tirelessly served. As medical practitioners we are becoming all too familiar with the disjointed, understaffed, chronically underfunded and sometimes dangerous conditions that NHS staff are forced to work under every day. The report published by the Leicester Royal Infirmary, where Dr Bawa-Garba worked, highlighted 23 recommendations and 79 actions that were instituted by the Trust following this tragic episode. While errors were made by Dr Bawa-Garba, it seems disproportionate for her to be held responsible for complex systemic failures including, but not limited to, the lack of induction and being rostered on call on her first day back from maternity leave without a handover; covering the workload of 3 doctors due to the failure of the Trust to provide adequate cover; the lack of consultant supervision who was away teaching in another city while his team was short staffed and his own CAU registrar was absent; administration of unauthorised medication that Dr Bawa-Garba was not aware of; IT failures and severe nursing shortages leaving adult-trained nurses appointed by the Trust’s management to work in paediatrics.
We are concerned by the lack of support that Dr Bawa-Garba has received since this tragic incident occurred. We are concerned that she may have been pressurised into filling a trainee encounter form without being properly advised. We are concerned by the Trust’s processes of handling significant incidents, lack of formal support and advice offered to Dr Bawa-Garba, and by the failure to protect her against the onslaught of the media’s vitriolic campaign against her by the Trust, HEE and GMC. We question whether she was offered support in line with the GMC’s own recommendations on supporting vulnerable doctors under investigation.
We furthermore wish to echo concerns regarding the use of Dr Bawa-Garba’s personal reflective entries in her e-portfolio as evidence against her. These entries were always intended for personal reflection, to learn from mistakes and should be seen as a demonstration of her honesty and integrity. There have been huge concerns raised across the board, including by the Secretary of State for Health & Social Care himself, about the implications this case would have on an open and blame-free culture of learning from mistakes to protect the public. There have been calls to boycott reflective entries for appraisals across medical specialities, which would be detrimental to patient safety.
Furthermore, this tragic case highlights the important issue for debate concerning the treatment and fate of BME doctors working in the NHS as illustrated by published data. This data demonstrates that BME doctors are more likely to receive GMC sanctions and public warnings compared to Caucasian colleagues. We are concerned by the influence of public perceptions on the GMC’s decision in this case, largely fuelled by the media’s racial hatred campaign against which she was offered no protection. We are concerned about the role played by the on-call consultant for CAU who continues to practice freely, while Dr Bawa-Garba has a criminal conviction and erasure from the medical register. A single untoward incident inquiry completed in 2012 concluded that a single root cause for the death was unable to be identified. The MPTS had ruled in 2017 that erasure from the register would be disproportionate in view of multiple systemic failures and mitigating factors. We would like to have an open and honest opportunity for debate to discuss if race and background – whether intentional or unintentional – played any part, however great or small, in the GMC’s decision to challenge the MPTS decision. 19 years on from the Macpherson report outlining institutional racism in a major public sector body, we have a collective duty to ensure that we are not complacent in ensuring that such issues continue to be tackled with utmost vigour in all organisations. We know from recent reports on the proportions of BME professionals in senior management positions in the NHS that we have a collective duty to better serve this community.
Scapegoating and criminalising an individual for medical errors made in a multi-factorial, complex and failing system is wrong. The end to the career of a doctor in training who deserved far greater support in the environment than the denigration she has been subjected to and who presents no further risk to the public is also wrong. Finally, the use of reflective entries being used as evidence against doctors and lack of formal support and advice offered is wrong and may have huge implications for patient safety, as well as healthcare professionals’ morale, confidence and willingness to work in the NHS in already challenging times.
Our position, in line with other representative bodies:
- We offer our utmost sympathy to the bereaved parents and stand with doctors and healthcare professionals who have been affected by this tragic case.
- We urge the GMC to reflect on the position they have taken on this case, in particular if their actions and stance are objective, fair, proportionate and consistent in each and every case regarding fitness-to-practice.
- We request reassurances on the steps taken by the GMC to investigate the role of racial factors in the decision-making processes of this case and its public stand to protect doctors subject to vitriolic media campaigns.
- We urge the Department of Health and NHS Trusts to ensure safe working conditions for all healthcare professionals to ensure and maintain patient safety.
- We urge the GMC, the Secretary of State of Health & Social Care and Health Education England to urgently review the use of personal reflection and processes around investigation, suspension and removal from the register and around advice and support offered to vulnerable doctors and healthcare professionals subject to significant untoward incident inquiries and investigations.
- We call for an urgent review of the law relating to criminalising medical practitioners where patients suffer harm as a result of multiple systemic factors.
- We fully support opportunities and actions to appeal Dr Bawa-Garba’s original conviction and subsequent erasure from the GMC register.
Dr Hina J Shahid
Dr Suhail Hussain
Ms Salam Youssef
Dr Omar Hussain
For all enquiries related to this statement please email [email protected]
- An account by concerned UK Paediatric Consultants of the tragic events surrounding the GMC action against Dr Bawa-Garba http://www.54000doctors.org/blogs/an-account-by-concerned-uk-paediatric-consultants-of-the-tragic-events-surrounding-the-gmc-actionagainst-dr-bawa-garba.html 2. GMC Press release July 2015 “Key principles for supporting vulnerable doctors”. https://www.gmc-uk.org/news/26552.asp
- Back to blame: the Bawa-Garba case and the patient safety agenda http://www.bmj.com/content/359/bmj.j5534
- Doctors who commit suicide while under fitness to practise investigation: an internal review https://www.gmc-uk.org/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf
- Action not words- making NHS boards more representative https://www.theguardian.com/society/2016/aug/21/under-representation-of-bme-community-in-nhs-disgraceful