This page of NHS Hot Topics will cover the Bawa-Garba case. On the 18th February 2011, a six-year-old boy, Jack Adcock, was admitted to hospital with breathing difficulty, diarrhoea and vomiting.
Having been referred by his GP, Jack was admitted to the Children’s Assessment Unit at Leicester Royal Infirmary, where he was seen and assessed by junior doctor Hadiza Bawa-Garba, an ST6 paediatric registrar.
An ST6 junior doctor is in their sixth year of specialty training. They are generally one or two years from sitting their final examinations to reach the level of consultant. Later that day Jack’s condition rapidly deteriorated and he passed away.
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Dr Bawa-Garba was taken to the High Court, where a ruling on the 4th November 2015 deemed her guilty of manslaughter on the grounds of gross negligence.
The court ruled the mistakes Dr Bawa-Garba made on the 18th February 2011 included:
When Jack was admitted Dr Bawa-Garba ordered a chest x-ray which showed an infection. Dr Bawa-Garba prescribed antibiotics which were administered at 4pm. However, despite being available since 12:30, the x-ray had only been seen at 3pm. Prescribing antibiotics earlier could potentially have led to a different outcome, but the ward was understaffed and Dr Bawa-Garba was extremely busy. Furthermore, she had not been made aware that the x-ray was available at 12:30.
A blood test which revealed high levels of C-Reactive Protein (CRP), which occurs due to infection and inflammation, was reported over 5 hours late due to failings in the hospital computer system.
When Jack was assessed by Dr Bawa-Garba she stopped the medication for his heart condition. However, she did not document this in his notes, and subsequently this medication was administered to Jack at 7pm by his mother as she was unaware that he was not to be following his usual course of treatment for his heart condition.
Jack suffered a cardiac arrest at 8pm. Dr Bawa-Garba was one of the doctors who attended the call and arrived when resuscitation was already taking place. Dr Bawa-Garba mistook Jack for another patient whose notes were marked as DNAR (do not attempt resuscitation), and therefore Dr Bawa-Garba called of resuscitation. Resuscitation was recontinued shortly after the mistake was identified. Jack died at 9:20pm.
Bawa-Garba Case: What were the other issues?
It was noted that Dr Bawa-Garba had just returned from maternity leave, and both before and after the 18th of February had an exemplary record. Whilst mistakes were made by Dr Bawa-Garba, there were numerous failings within the hospital system which contributed to the negligence and complications of the care provided. These are notably that:
The hospital was extremely understaffed and Dr Bawa-Garba was carrying out the work of two doctors.
There were not enough senior nurses on the ward and Dr Bawa-Garba did not have a senior consultant to report to as they were not in the hospital.
The computer systems failed prolonging blood testing and results. There was also no system in place to notify Dr Bawa-Garba that the x-ray was ready for analysis.
The nurses did not notify Dr Bawa-Garba when Jack was deteriorating.
The medication for Jack’s heart condition was not administered by Dr Bawa-Garba.
Something important to consider in the Bawa-Garba case is therefore whether Dr Bawa-Garba should have to take full responsibility for the case. It could be argued that whilst mistakes were made, if the hospital had been staffed correctly and the right administrative and technical systems were in place, the awful situation would not have happened.
Bawa-Garba Case: What was the outcome?
After sentencing in November 2014, Dr Bawa-Garba appealed her sentence. However, at the Court of Appeal in December 2016, she was denied an appeal. Many doctors were outraged at this and felt that Dr Bawa-Garba had not been defended correctly, and that the working conditions in the NHS and the lack of support for junior doctors, especially Dr Bawa-Garba in this case, had not been taken into consideration by the court.
The Court ruling, and denial of appeal resulted in Dr Bawa-Garba being suspended for 12 months from the GMC medical register. The GMC had applied to have her struck off permanently from the medical register, but the Medical Practitioners Tribunal Services (MPTS) refused this application, stating “erasure would be disproportionate”.
In January 2018, the GMC controversially appealed against the MPTS decision in the High Court. They were successful, resulting in Dr Bawa-Garba being struck off from the GMC medical register, thereby preventing her from working as a doctor.
Following a massive public outcry from junior and senior doctors alike, a crowdfunding page secured sufficient funds for Dr Bawa-Garba to continue her fight. In March 2018 she was granted leave to challenge her erasure from the medical register in the Court of Appeal, and subsequently she successfully won her appeal and the original 12-month suspension was reinstated.
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