The death of Jack Adcock at Leicester Royal Infirmary was a tragedy for all concerned; the devastating loss of a son for the Adcock family and a gruelling eight-year ordeal for Paediatric Registrar, Dr Hadiza Bawa-Garba. Last week, the GMC’s Medical Practitioners Tribunal Service (‘MPTS’) found Dr Bawa Garba’s fitness to practise (‘FTP’) remained impaired due to the length of time she had been away from medical practice, but permitted a return from July 2019, subject to conditions for 24 months.  She has indicated that she does not intend to return to work until February 2020 following maternity leave.

Timeline

The MPTS' decision is the final chapter in a series of criminal and regulatory proceedings which shook the medical profession.

18 February 2011

Against a background of returning to work after 14 months’ maternity leave, staff shortages, an off-site consultant, systemic delays in obtaining test results, Dr Bawa-Garba failed to diagnose Jack with pneumonia and sepsis from which he sadly died. She was the most senior paediatric doctor on duty covering patients on 6 wards over 4 floors. 

November 2015

A jury, having heard the facts of the case without context, found Dr Bawa-Garba guilty of gross negligence manslaughter (‘GNM’). She was given a 2-year prison sentence suspended for 2 years. The judge noted ‘yours was a responsibility shared with others’. 

June 2017

MPTS found Dr Bawa-Garba’s FTP impaired and imposed 12 months suspension, having accepted the context of her failings. The Trust’s Serious Incident Investigation made 23 recommendations and identified 79 actions to be taken, but no single root cause. January 2018 GMC appealed to the Divisional Court which substituted suspension with erasure. August 2018 Erasure overturned by Court of Appeal which referred the case back to MPTS.

Key issues from MPTS’ decision

Fitness to Practise

The MPTS determined that Dr Bawa-Garba’s FTP remained impaired due to her conviction.

  • This was solely due to the extended time (c. 4 years) during which she has not had face-to-face contact with patients.
  • The public interest had been served by her periods of suspension, to date.
Sanction

Jack Adcock’s parents had opposed Dr Bawa-Garba’s return to practice.  However, the GMC agreed that conditional registration would be an appropriate and proportionate sanction having considered the following:

  • Supervision.Dr Bawa-Garba’s prolonged absence from clinical practice meant that she would need a level of supervision about that of a ‘normal’ ST4 trainee upon her return to work
  • Mitigating factors.Dr Bawa-Garba’s  engagement with her medical supervisor, the wider support for her in the local medical profession, her remediation, insight, numerous apologies and expressions of remorse and targeted CPD study were ‘extensive and substantial’
  • Risk. Her risk of harm to another patient was low.  She had continued to work in clinical practice without concerns raised until January 2015 when she was removed from having face-to-face contact with patients pending her criminal trial
  • Public interest. It would not be in the public interest to deprive the public of an otherwise competent and dedicated practitioner who had the potential to respond positively to conditional registration
  • Conditions. During a period of 24 months’ conditional registration, Dr Bawa-Garba will be subject to ‘close supervision’ for 3 months from the commencement of a training programme or, alternatively, 6 months from the commencement of any other post. Afterwards, the level of the supervision will reduce and she must be supervised by a clinical supervisor 
  • Further review. MPTS will conduct a review hearing shortly before the end of the period of registration.

Comment

The extent of Dr Bawa-Garba’s remediation and insight clearly played a significant part in the decision to keep the period of close supervision short. The tribunal was struck by the fact that Dr Bawa-Garba frequently attends regular meetings with her supervisor with journal articles and clinical scenarios for discussion.

This case has caused great controversy as doctors feared that they could be convicted of gross negligence manslaughter and struck off if they made a mistake in diagnosis. They have emphasised that they want to be involved in engendering a ‘learn not blame’ culture in the face of human error in an overstretched NHS.  Since the Court of Appeal decision the GMC has announced the Marx/Hamilton Review into medical manslaughter and that its investigators will be given ‘human factors’ training.

In June 2018 the government announced its support for the Williams' Review into GNM which recommended that the GMC should lose its right to appeal an MPTS decision.  This recommendation is yet to be implemented.

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