MANCHESTER—A doctor who received a suspended jail sentence over the death of a 6-year-old boy can return to unrestricted practice, a medical tribunal has ruled.

Dr Hadiza Bawa-Garba returned to work last November for the first time in 5 years after a raft of conditions were imposed on her registration.

In November 2015 a jury convicted her of gross negligence manslaughter in her treatment of Jack Adcock, who developed sepsis and died of cardiac arrest at Leicester Royal Infirmary in February 2011.

A month later she was sentenced to 2 years in jail, suspended for the same period.

Conditions ‘Not in the Public Interest’

On Friday, she was informed at a Medical Practitioners Tribunal Service (MPTS) hearing there were no longer any outstanding concerns over her clinical practice, and it was not in the public interest to maintain the conditions.

Among her failures in Jack’s treatment were making an incorrect diagnosis of gastroenteritis on initial examination of the youngster – who had Down’s syndrome and a heart condition – and not acting on a clinical reading which “ought to have been a clear indicator”.

The doctor was “on the cusp” of becoming a consultant before the incident, as a specialist registrar.

Dr Bawa-Garba was barred from practice for 12 months before the General Medical Council (GMC) took the case to the High Court to appeal against the sanction, saying it was “not sufficient”, and Dr Bawa-Garba was struck off in January 2018.

Later, the Court of Appeal ruled her name should be restored to the medical register and her case sent back to the MPTS.

Read the full article here.

Dr Hadiza Bawa-Garba is free to practise without conditions again after the Medical Practitioners Tribunal Service delivered its verdict today.

The MPTS said that it was ‘in the public interest’ for the current order on her registration to be revoked with immediate effect.

The GMC, which had previously ruled that Dr Bawa-Garba should be struck off the medical register permanently, remained ‘neutral’ in the most recent hearing.

This marks the end of the case for Dr Bawa-Garba, after the death of 6-year-old Jack Adcock, who tragically died after Dr Bawa-Garba made an incorrect diagnosis of gastroenteritis with moderate dehydration when in fact he had sepsis.

Dr Bawa-Garba was found guilty of manslaughter and the GMC later struck her off the register permanently.

The case caused a huge backlash from the medical profession, including GPs, who pointed out that there were severe systemic failings that contributed to Jack’s death.

In 2017, an MPTS ruling found that Dr Bawa-Garba’s actions had fallen ‘far short of the standards expected’ and did contribute to Jack’s death. It imposed a 12-month suspension on her.

However, the GMC appealed the decision, calling for a complete erasure from the medical register, which a court upheld. But following an appeal by Dr Bawa-Garba, this was later overturned by the Court of Appeal.

In 2019, an MPTS tribunal allowed her back on the medical register with conditions, finding that her fitness to practise had been impaired by account of her extended absence from medicine.

Dr Bawa-Garba, who was a paediatrician in training at the time of Jack’s death, has been practising since November 2020 with conditions.

Today, the MPTS removed these conditions. It ruled: ‘Dr Bawa-Garba has already demonstrated sufficient insight, fully remediated following her conviction.

‘While Dr Bawa-Garba had only resumed clinical practice in November 2020, the Tribunal was struck by the volume of evidence she has been able to produce detailing all aspects of her clinical practice and the steps she has taken to ensure her skills and knowledge are now fully up to date.

‘The Tribunal took account of the multi-sourced and multi-angled feedback before it, all of which set out the view that Dr Bawa-Garba is a competent, safe and reliable clinician about whom no further concerns had been raised. Further, the Tribunal gave careful consideration to all of the testimonials provided on Dr Bawa-Garba’s behalf, all of which were positive.’

Dr Jenny Vaughan, chair of The Doctors’ Association UK and Learn Not Blame Campaign Lead, who has been supporting Dr Bawa-Garba throughout the case, said: ‘We welcome the news that Dr Hadiza Bawa-Garba had her licence to practise medicine fully restored today to allow her to work independently. We are also pleased that the GMC opted for a neutral stance.’

‘Healthcare desperately needs an open, transparent, learning culture, where harm is minimised by learning from error and failings. Scandals such as Mid-Staffs, Gosport and Morecambe Bay repeatedly demonstrate how a culture of defensiveness and denial can escalate into widespread cover-up leaving families fighting for answers. The climate of fear amongst the medical profession created by the GMC’s actions over Dr Bawa-Garba only makes it more likely that this will happen again. Jack Adcock should have received better care and his death was a tragedy. Our thoughts are also with his family.’

Read the full article here.

The Doctors’ Association UK is pleased that the report agrees with our written submission that the provision for the HSSIB to accredit NHS trusts to do their own ‘safe space’ investigations is an enormous conflict of interest. We are therefore delighted that the report has recommended that the entirety of part 3 of the draft Bill, relating to Trust accreditation, be dropped.

The Doctors’ Association UK is also pleased that the report agrees the value of the HSIB as an independent body, bringing medicine in line with the rail and aviation industries. ‘Safe space’ investigations will allow staff to speak freely and determine what went wrong to prevent similar mistakes happening again. If ‘safe space’ investigations are to carry the confidence of the public, the independence of the HSIB must be assured.

The Doctors’ Association UK’s central campaign is entitled “Learn Not Blame”, and seeks to engender a national conversation about the need for a just culture in the NHS. We are campaigning for a step change in the NHS so that honest error is used to drive learning and change for a safer, better NHS, rather than being a focus for individual blame. The creation of a truly independent body is a welcome step towards this.

‘For those of us observing it’s still hard to believe that we have got to the stage where an otherwise dedicated and hard working doctor has been criminally prosecuted and taken to court by the GMC for what were essentially honest mistakes [made when] working under pressure,’ she said.

Dr Bawa-Garba is appealing a decision made in January by two High Court judges that she should be erased from the medical register rather than receive the year’s suspension that had previously been imposed by the Medical Practitioners Tribunal Service (MPTS).

‘Systemic failings’

Their ruling followed a successful appeal by the GMC, which argued that suspension was ‘not sufficient’ to protect the public or maintain public confidence in the medical profession.

On Wednesday, the opening day of the appeal, Dr Bawa-Garba’s counsel James Laddie QC said there was particular concern in the medical profession over the court’s decision to disregard ‘systemic failings’ which contributed to the environment in which Dr Bawa-Garba came to make the mistakes leading to the death of six-year-old Jack Adcock in 2011.

Dr Batt-Rawden, who sat in court during the appeal’s opening yesterday, said: ‘Particularly concerning to all of us has been the GMC’s line of argument. To an observer, it seems the crux of their argument is that system failures were not relevant in Hadiza’s case, and should not have been taken into account by the MPTS when determining her level of culpability and her sanction.

‘This has huge ramifications for the medical profession and for patient safety. We are all working in an immensely pressured system, with widespread staffing issues and rota gaps. Hadiza’s story of doing the jobs of several doctors at once, across multiple wards and multiple floors, with a failing IT system, in the absence of senior colleagues or indeed a consultant is sadly increasingly common.

‘Before this case I don’t think any doctors thought that mistakes made whilst simply trying their best under such pressured circumstances would ever lead to a criminal conviction, or erasure from the register. Now, all of us are feeling vulnerable.’

In written argument before the court, Ivan Hare QC for the GMC said the appeal should be dismissed because the High Court was correct to decide that the MPTS failed to apply the relevant rule of the GMC (Fitness to Practise) Rules Order of Council 2004 and undermined the rationale for making criminal convictions conclusive evidence of the offence committed in disciplinary cases.

In response to Dr Bawa-Garba’s case, The Doctors’ Association UK has launched a new campaign ‘Learn not Blame’.

‘We must move away from a culture of blame and fear, to one of learning,’ Dr Batt-Rawden said. ‘We repeatedly fail to learn from scandals such as Mid-Staffs and Gosport and the NHS urgently needs a safe space to enable staff to speak up about patient safety issues.’

She added that there are ‘no winners’ in a culture which seeks to blame one individual for medical error whilst failing to address wider system failures.

‘Our ongoing campaign seeks to empower doctors to be part of a transformational change process working towards a shift from a culture of blame, to one of learning.’

She concluded: ‘An unsuccessful appeal today would do further damage to a profession whose morale is already at rock bottom, and signals a further move away from the open, transparent NHS that we all want to see.’

We need a culture of learning, not of blame and persecution. We need a culture of compassion and care for all who are served by it and all who work in it. A culture where mistakes and harm are prevented by openness, listening and learning. And where mistakes and harm do happen, change, not blame, is the outcome. A just culture. This is the only way we will see a real improvement in patient safety.

This campaign has been born out of a growing awareness amongst clinicians of how a toxic mix of defensiveness and concern for reputation management above all else can lead to blame-seeking culture. This is bad for doctors and worse still for patient safety.

Most patients and families, when things go wrong in healthcare, just want to know honestly what happened and make sure that the same thing never happens to anyone else. But many people face a brick wall when seeking answers from NHS organisations, and get pushed into an adversarial complaints procedure, or even litigation.

Equally, staff who raise concerns often find themselves the subject of counter-accusations, victimisation and blame, instead of having their concerns acted upon. Staff are forced into a formal whistleblowing procedure, where the ensuing legal action may bankrupt them and ruin their careers.

This campaign aims to bring doctors together to say – enough. This has to stop.

The campaign will encourage individuals to commit to action within their own sphere of influence, and join together as a movement to put pressure on NHS leadership to mirror that change and commit at a Trust or Health Board level to an open, learning and just culture.

Look out for more details coming soon, and how YOU can be the change.

#LearnNotBlame