Dr Bawa-Garba case: We only hope this was not a case of ethnic discrimination

Dr Hadiza Bawa-Garba, a trainee pediatrician in the NHS-UK, was convicted of manslaughter by being grossly negligent resulting in the death of Jack, aged 6 years, from sepsis in 2011 by the High Court. The jury returned the verdict 10:2 and she was sentenced to two years in prison, suspended for two years.

Dr Bawa-Garba was held responsible for a series of errors.

·     A wrong working diagnosis: Failing to recognize the early features of sepsis in the child and as such appropriate antibiotic treatment was delayed.

·     Delay in getting and reading the chest x-ray

·     Failing to recognize the implications of seriously deranged blood gas results and failing to fully communicate the implications to her consultant.

·     Mistaking normalizing pH after a fluid bolus for hypovolemic rather than septic shock

·     Failing to prevent enalapril being given, which she did not prescribe 

·     DNR mix up

Dr Bawa-Garba did not write about the system failures of that day in her e-process log up. Instead she was honest and wrote her feelings in the e-process log which was later used against her as evidence.

While taking into consideration the many system failures, the Medical Practitioners Tribunal Service (MPTS) concluded that Dr Bawa-Garba had indeed erred but was “remediable” “clinical failings, serious as they were, had been remedied, leaving a low risk of future harm” (High Court, para. 18).

Taking note of her exemplary record (before and after the death of Jack), the testimonies of her seniors supporting her as an excellent doctor, the Tribunal held that “suspending her medical license for a year, until the end of her suspended sentence, was reasonable” and that striking her name off from the medical register was “disproportionate” punishment.

However, the GMC went over and above the conclusion of its own Tribunal and successfully appealed in the High Court for “erasure from the medical register”, so that she could no longer practice medicine in the UK, ostensibly as the only way to protect public confidence in the medical profession. Observing "It necessarily follows that her failings on that day were 'truly exceptionally bad'." That reality "was not properly reflected or respected" in the tribunal's decision”, in January this year, the High Court of Justice directed that “the tribunal’s decision to impose a sanction of 12 months’ suspension be quashed and substituted with a sanction of erasure” as the Tribunal had undermined the verdict of the jury.

The counsel on behalf of the GMC: “… your performance on 18 February 2011 was so poor that, regrettably, regardless of the remediation that you have undertaken, there remains a risk that there would be a further collapse of standards in the future with an inevitable risk to patient safety. He acknowledged, however, that you had done all you could to remediate the specific failings identified. He further submitted that, given the fact that you have been convicted of manslaughter and received a custodial sentence, a finding of impairment is also required in the public interest.”

Was this a case of medical negligence or gross medical negligence? Where was the “criminal intent (mens rea)”? Was it a case of obvious careless act or res ipsa loquitur?  

Enalapril was given by the mother and the allegation was that Dr Bawa-Garba did not tell the family to not give any drug outside the hospital practice. This is the law, which presumes that a patient admitted in a hospital is under the care of that hospital and no medicine outside of hospital practice should be given.

When asked why he did not see Jack, Dr O'Riordan, her senior said that Dr Bawa-Garba had not asked him to; she had not impressed upon him Jack's clinical urgency. Was the onus not on the consultant to review the patient himself and detect the sepsis?

An open letter from the British Association of Physicians of Indian Origin (BAPIO) in January has accused the GMC of treating black and minority ethnic doctors ‘differently and harshly’.

In this case, the accused, a Black, Nigerian doctor practicing medicine in the UK…the victim, a 6-year-old white English boy who died a preventable death…

Would the verdict have been different if Dr Bawa-Garba had been a white doctor? Would the GMC have pursued the matter so vigorously, had she been a white doctor?

“In 2004, a consultant pediatrician who failed to diagnose sores and scars on the severely abused Victoria Climbié's 8-year-old body as intentional injuries had charges of serious professional misconduct against her dropped by the GMC. She also failed to alert social services to signs of abuse led to the child's return to the abusers who killed her. (BMJ. 2004 Sep 18;329(7467):643). The girl died in February 2002 eight months later after suffering 128 injuries at the couple's hands. Dr Ruby Schwartz, a white female pediatrician, wrongly concluded that bruises on the eight-year-old girl caused by torture were the result of scratching because of scabies (http://www.telegraph.co.uk/news/uknews/1471297/Doctor-in-Climbie-tragedy-escapes-censure-by-GMC.html).

Her diagnosis of scabies was decisive in discouraging police and social workers from further investigating the possibility of child abuse. Dr Schwartz had thought that some lesions were the result of scratching caused by scabies and attributed older scars to insect bites or playtime incidents. The Medical Defence Union, which represented Dr Schwartz, said the decision to drop the charges followed an expert report commissioned by the GMC.” (BMJ. 2004 Sep 18;329(7467):643).

The official inquiry report into the eight-year-old's death highlighted the failure of key social welfare agencies … “as Lord Laming shone a light on a "gross failure" of the social services system, he said Victoria's killers were not the only ones responsible. He said he was determined the horror of the child's "lamentable" treatment by those in authority should become a "beacon pointing the way to securing the safety and well-being of all children in our society” (http://www.independent.co.uk/news/uk/crime/how-a-happy-little-girl-was-turned-into-a-broken-wreck-130297.html)

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA