Official gagging? “…a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.”

This case has been festering, and playing in the minds of many reflective doctors. The principal that we should be completely open in our reflection will not hold water for those doctors who have made mistakes – Is this a form of official gagging? Dr Vaughan’s comment at the end of this report reads: “You can’t learn from errors in  a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.” The Official BMA response (30th Jan 2018) is here.

Chris Smyth reports for the Times, 26th Jan 2018: GMC wins appeal to bar Hadiza Bawa-Garba after boy’s death

A doctor whose career was spared despite being convicted of the manslaughter of a six-year-old boy has been struck off after the General Medical Council won a High Court appeal.

Jeremy Hunt, the health secretary, joined doctors in arguing that the ruling could harm patient safety by making staff scared to admit mistakes.

Doctors accused the regulator of a vindictive campaign to use Hadiza Bawa-Garba as a scapegoat for systemic failings in the NHS. The GMC, however, insisted that patients would lose confidence in doctors if they could be convicted of criminally negligent treatment yet continue to work.

Bawa-Garba, who was 35 and a paediatric registrar, was on duty at the Leicester Royal Infirmary in 2011 when Jack Adcock arrived with diarrhoea and vomiting. She did not follow up on abnormal tests quickly, did not call in a consultant and missed what an expert described as a “barn-door obvious” case of sepsis.

She then told a crash team to stop resuscitation without looking at Jack’s notes because she had mistaken him for another patient after confusing their mothers. Although this did not contribute to Jack’s death, the trial judge said that the “extraordinary” error illustrated how bad her care was. She received a two-year suspended sentence in 2015.

Last year, an independent Medical Practitioners Tribunal Service panel decided not to end her career, citing “the context of wider failures”, such as short-staffing and IT glitches that delayed test results. It suspended her for at least a year, but told her the mistakes were not irredeemable and would not preclude a return to work. The GMC, which won the power to challenge such rulings last year, made an appeal.

Yesterday Mr Justice Ouseley overturned the panel’s verdict, citing a ruling by Lord Bingham that “the reputation of the profession is more important than the fortunes of any individual member”. He ruled that the tribunal had not respected the “true force of the jury’s verdict” that Bawa-Garba’s failings were “truly, exceptionally bad”. He said that a panel had no right to judge her culpability less severely after considering the same issues. “The holes in the patient’s safety net cannot reduce her personal culpability,” the judge wrote, arguing that systemic problems did not cause Bawa-Garba’s errors.

The health secretary said he was “deeply concerned about possibly unintended implications” of the ruling for the process of learning from mistakes. He said he was “totally perplexed” by the GMC decision to pursue the case.

Charlie Massey, chief executive of the GMC, said “doctors should have nothing to fear” from the case as he would not hold an admission of error against them. “People are confusing normal, everyday error with things that are ‘truly, exceptionally bad’.”

Jenny Vaughan, a consultant who has supported Bawa-Garba, said: “You can’t learn from errors in a climate that threatens individuals with criminal sanctions and lets the system off. The hospital hasn’t been held to account.”

Rob Hendry of the Medical Protection Society, which defended Bawa-Garba, said: “This decision may jeopardise an open, learning culture at a time when the profession is already marred by low morale and fear.”

Bawa-Garba may appeal to the Supreme Court.

Back to blame: the Bawa-Garba case and the patient safety agenda. Is there any Dr who will not stop putting any form of patient identifiers in their portfolio now? Medical errors may now be hidden for fear of litigation.

Update 1st Feb 2018: “Junior doctors fear reporting errors” by Kat Lay

Doctors have been warned that they risk disciplinary action if they carry out threats to stop recording mistakes in writing.

They fear that any admissions could be used against them, after a junior doctor was struck off last week for errors that led to the death of a six-year-old boy. Hadiza Bawa-Garba was convicted of manslaughter by gross negligence in 2015 over the death of Jack Adcock from sepsis in 2011.

Her case has provoked anger among thousands of doctors, who believe that she was a scapegoat for systemic failings and may have been the victim of racism. Jack was admitted to Leicester Royal Infirmary in 2011 with diarrhoea and vomiting. Bawa-Garba failed to follow up tests quickly, did not call in a consultant and told a crash team to stop resuscitation after mistaking him for a patient with a “do not resuscitate” order. She was covering the work of two doctors after return from maternity leave, with no induction into the role.

Last year the Medical Practitioners Tribunal Service decided not to strike her off but the General Medical Council appealed and won last week.

Kaanthan Jawahar, a junior doctor specialising in geriatric psychiatry in Nottingham, wrote on Twitter: “Your employer will scapegoat you for systemic failures . . . Your seniors will throw you under the bus.”

Doctors must keep an eportfolio as part of their annual appraisal process, in which they should reflect on how they could improve their practice.

Rob Hendry, medical director at the Medical Protection Society, which represents doctors in legal cases, said: “One particular area of concern has stemmed from reports that Dr Bawa-Garba’s eportfolio reflections were used against her at the criminal trial. In fact, her eportfolio did not form part of the evidence before the court and jury.

“We also advise doctors to bear in mind that not disclosing an incident or reflection during appraisal may lead to a greater risk of allegations of probity and referral to the GMC.”

Terence Stephenson, chairman of the GMC, said that although the court had ruled that the tribunal “had no powers to unpick the criminal conviction”, there was a “critical need” to examine how gross negligence manslaughter cases were initiated and carried out.

This entry was posted in A Personal View, Gagging, Junior Doctors, Professionals, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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