Bawa-Garba Case

Outline Of The Bawa-Garba Case

On 18th January 2011, six-year-old Jack Adcock had been feeling unwell – he was having difficulty breathing, as well as vomiting and diarrhoea. Jack had Down’s Syndrome and a known heart condition, and required long-term medication.

He was admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary following his GP’s referral. Jack’s condition deteriorated that day and he passed away.

He was seen and assessed by Junior Doctor Hadiza Bawa-Garba, a paediatric registrar in year six of her speciality training (ST6). Generally, being an ST6 junior Doctor means being one or two years from sitting the final examinations to reach the level of a consultant.

Dr Bawa-Garba was taken to High Court and on 4th November 2015 was found guilty of manslaughter on the grounds of gross negligence.

Timeline Of Events

To thoroughly understand the Bawa-Garba case, it’s helpful to be aware of the mistakes that occurred. These were:

• When Jack was admitted, Dr Bawa-Garba ordered a chest X-ray that showed an infection. The X-ray results were available from 12:30, but didn’t get seen until 3pm. Dr Bawa-Garba then prescribed antibiotics, which were administered at 4pm. It’s important to understand that 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 revealed high levels of C-Reactive Protein (CRP), which occurs due to infection and inflammation. This was reported over five 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. Jack’s mother 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 off resuscitation. Resuscitation was re-continued shortly after the mistake was identified. Jack died at 9:20pm.

Failings Within The Hospital System

It should be noted that prior to the events of 18th February, Dr Bawa-Garba had an exemplary record. She had also just come back from maternity leave. Whilst mistakes were made by Dr Bawa-Garba, there were also issues within the hospital’s system which contributed to the negligence in care provided. Notably, these were:

• Dr Bawa-Garba was carrying out the work of two Doctors and the hospital was extremely understaffed. 
• Senior consultants were not on-site and therefore Dr Bawa-Garba had no one to report to. There were not enough senior nurses on the ward, either.
• The failings of the hospital computer system prolonged blood testing results. There was also no system in place to notify Dr Bawa-Garba that the X-ray was ready for analysis.
• Nurses did not notify Dr Bawa-Garba that Jack was deteriorating.
• The administration of medication for Jack’s heart condition was not carried out by Dr Bawa-Garba.

These are important factors to consider whilst weighing up whether Dr Bawa-Garba should take sole accountability for the case. Arguably, whilst mistakes were made on her part, if the hospital had been staffed correctly and with the right administrative and technical systems in place, the situation could have been prevented.

The Legal Battle

After the sentencing in November 2014, Dr Bawa-Garba appealed her sentence. The following occurred:

• December 2016. The appeal was denied by the Court of Appeal. Several Doctors were outraged by this decision and felt the court had not taken into consideration the working conditions in the NHS and lack of support for Junior Doctors.
• 12-month suspension. This Court ruling resulted in Dr Bawa-Garba being suspended from 12 months from the GMC medical register. The GMC applied to have her permanently struck off the medical register. However, the Medical Practitioners Tribunal Services (MPTS) refused this application, stating “erasure would be disproportionate”.
• January 2018. The GMC controversially appealed against the MPTS decision in the High Court. The appeal was successful and resulted in Dr Bawa-Garba being struck off the GMC medical register, preventing her from working as a Doctor.
• Crowdfunding. Following public outrage from Doctors, a crowdfunding page secured funds for Dr Bawa-Garba to continue her fight.
• March 2018. Dr Bawa-Garba was granted leave to challenge the erasure from the medical register in the Court of Appeal. She won her appeal and the original 12-month suspension was reinstated.
• November 2018. The Doctor’s Association UK (DAUK) launched the Learn Not Blame campaign, in an attempt to create a better culture that promotes learning from adverse events and focuses on fairness and openness of both patients and  NHS healthcare professionals.
• April 2019. The MPTS deemed her to be a low risk to patients, and Dr Bawa-Garba was cleared to begin practising again. The two year practice period began in July 2019.
• February 2020. Due to lack of patient contact since 2015, Dr Bawa-Garba has returned to work with a lower grade than previously employed at and must work with close supervision and several imposed conditions.
• July 2021. The Medical Practitioners Tribunal Service ruled that Dr Bawa-Garba is now fit to practise without restrictions.

Interview Questions

Understanding the key issues of the Bawa-Garba case will provide you with an important example to refer to when answering ethics questions during your interview. Some example questions you could be asked include:

• What are some issues within the NHS that currently impact Doctor-patient relationships?
• What is an interesting medical article you’ve read recently? What did you learn from it?

Check out our Interview Question Bank which has over 100 other questions and answer guides for your practice.