22 Update Bawa-Garba: the legacy of a truly tragic case A GMC review has cleared Dr Hadiza Bawa-Garba to return to practice. Léa Legraien looks at the repercussions of the case The name Bawa-Garba will long be remembered. From the day in 2011 when six-year-old Jack Adcock died, to Dr Hadiza Bawa-Garba’s conviction for gross negligence manslaughter and subsequent fight against the decision to strike her off, her case has shaken medicine. After eight years a GMC review hearing last month finally closed the case: Dr Bawa-Garba has been deemed fit to return to practice from July – although she will resume work in February 2020, when her maternity leave finishes. The hearing saw the GMC’s Medical Practitioners Tribunal Service (MPTS) decide the paediatrician’s suspension since June 2017 has served the public interest and that she can return to practice, subject to supervision for 24 months. The long-running case may have reached its final chapter (see timeline) but its repercussions continue to be felt. When the GMC chose to oppose its own tribunal’s decision – and have Dr Bawa-Garba struck off – doctors made a stand and rallied behind her. Shocked Pulse readers wrote in with their own ‘near-misses’ – occasions when they were lucky that comparable errors had not had the same tragic consequences. Even former health secretary Jeremy Hunt said he was ‘totally perplexed’ the GMC acted as it did. Faced with the profession’s reaction, the Government carried out a review of how gross negligence manslaughter charges are handled in medicine. It went on to announce the GMC should no longer be able to appeal decisions of its own tribunal regarding fitness to practise. However, this has yet be enforced and the GMC has said it will continue to contest MPTS decisions until legislation is enacted. The regulator itself is not standing still. It is conducting its own work into how cases of gross negligence manslaughter involving doctors are initiated and investigated, and will report later this year. Pulse May 2019 And following accusations of racial discrimination in the treatment of Nigerian-born Dr Bawa-Garba, it last year launched a review into why black and minority ethnic doctors are more likely to face complaints from employers than their white colleagues. It extended this work to looking at why BME doctors are also less likely to progress through postgraduate medical education. This will ‘not report before summer’, the GMC says. And in a move that could be viewed as acknowledgement that it needs to do better, the regulator last month announced changes to the way it handles one-off complaints about doctors. Despite these steps, the GMC still needs to repair its relationship with the profession. BMA chair Dr Chaand Nagpaul says: ‘The GMC’s decision to appeal against its own tribunal meant it lost the trust and confidence of many doctors. A lot of work is needed to rebuild it.’ Tim Johnson, the law firm that represented Dr Bawa-Garba, says the case has ‘caused enormous controversy’, with doctors across the world concerned they could face a similar fate if they ‘make a mistake in diagnosis’. But the focus is now squarely on the environment that allowed Jack’s death to happen in the first place. The Doctors’ Association UK is calling for ‘a just culture so the system is made safer’. Its law and policy officer Dr Jenny Vaughan says: ‘Dr Bawa-Garba was working in appalling conditions that day. The evidence of what the hospital needed to put right was not heard by the jury. ‘There is a culture of blame in the NHS which, if left unchecked, will mean patient safety is not what it should be as staff will be too scared to admit mistakes.’ The GMC’s recent statements stress ‘how difficult this process has been for the Adcock family’ and that it is ‘important the doctor’s return to practice is safely managed’. A lot of work will be needed before clinicians can feel protected from a trial for making an error at work. How the Bawa-Garba case unfolded • February 2011 Six-year-old Jack Adcock, a patient with Down’s Syndrome and a known heart condition, is admitted to Leicester Royal Infi rmary after suff ering from diarrhoea, vomiting and breathing diffi culties. Dr Bawa-Garba, a junior paediatrician who had recently returned from maternity leave, is on shift at the hospital, which is experiencing several systemic problems, including an IT failure leading to delayed blood test results. She originally diagnoses Jack with gastroenteritis and fails to spot sepsis. Jack later dies. • July 2013 Despite the hospital fi nding that Jack’s death was the result of systemic errors, the coroner calls for the Crown Prosecution Service to review the case, following expert testimony. • December 2015 Dr Bawa-Garba is convicted of manslaughter on the grounds of gross negligence for ‘truly exceptionally bad errors’ and is given a 24-month suspended sentence • December 2016 Dr Bawa-Garba’s appeal against her sentence is quashed at the Court of Appeal. There is a culture of blame in the NHS. If left unchecked, it will mean patient safety is not what it should be Dr Jenny Vaughan • June 2017 The GMC Medical Practitioners Tribunal Service says Dr Bawa- Garba should be suspended for 12 months and rejects an application from the GMC to strike her off . • January 2018 The GMC successfully appeals at the High Court to have the MPTS decision overruled, leading to Dr Bawa-Garba being struck off . • August 2018 The Court of Appeal judges rule in favour of Dr Bawa-Garba, restoring the MPTS decision that she should be suspended from the medical register rather than erased. • April 2019 The MPTS decides Dr Bawa-Garba will be able to return to practice from July 2019 – under certain conditions, including supervision.