We are all Hadiza

In the days following the successful appeal by the General Medical Council (GMC) to have Dr Hadiza Bawa-Garba struck off the medical register, meaning she is not able to return to practice for at least five years, a crowd-funding campaign has raised over £200, 000 to fund further legal counsel for the paediatrician. The money will be used to pay for independent legal review of the ruling and potentially a legal challenge to the High Court decision, as well as the original ruling of manslaughter by gross negligence.

The swell of support from doctors across the UK was triggered by concerns over patient safety following the ruling and perceived scapegoating by Dr Bawa-Garba’s trust and the GMC to cover up systemic failings in the run up to the tragic death of six-year-old Jack Adcock in February 2011. These concerns were shared by health secretary Jeremy Hunt, who tweeted that he was “deeply concerned” by the potential implications of the ruling. Worries were voiced by Hunt and doctors over the damage done to transparency in medical education following the use of Dr Bawa-Garba’s portfolio reflections in the trial, which were submitted by her defence. Thousands of doctors have penned a letter warning of the potential consequences, such as more defensive medicine and less expressive reflection, which could contribute to similar mistakes in the future and subsequent harm to patients.

Jack Adcock was admitted to the Leicester Royal Infirmary Hospital at around 10:30am after being sent there by his GP. He presented with dehydration secondary to vomiting and diarrhoea, shallow breathing, and blue lips. When admitted he was unresponsive and limp. Initially treated with fluids and oxygen, after a chest x-ray revealed pneumonia, he was prescribed antibiotics. Jack seemed to recover initially, but at 7.45pm he went into cardiac arrest as a complication of sepsis, which had been missed by the medical team. Around an hour previously, he had been given an unprescribed dose of enalapril, a regular medication he was prescribed following heart surgery in early life. Jack died 90 minutes later, after resuscitation failed to revive him.

The original ruling of gross negligence manslaughter is grounded on the failings of Dr Bawa-Garba having hastened the death of Jack. Several mistakes were made, which were given in the evidence of Professor Nadel, expert witness of the prosecution and were admitted by Dr Bawa-Garba herself. These included missing signs of sepsis on admission, failing to ask for consultant review by phone or in handover at 4.30pm, and a three hour delay in reading the chest radiograph.

Several key mitigating factors were found to have contributed to the day’s events by an internal trust report, yet were not included in the original trial. The extent of their contribution was such that the report concluded that no single cause for the death was able to be identified. These were outlined in an account written by several consultant paediatricians in support of Dr Bawa-Garba. They included the fact that she was doing the work of three doctors that day, as her consultant and the other registrar were away on leave. Due to IT failure, her House Officer was having to phone for results in the afternoon, making them unable to assist in care. In addition, the agency nurse caring for Jack was not trained in paediatrics.

Despite all of this, Justice Ouseley, of the GMC appeal, ruled that these conditions were not “something she had not been trained to cope with or was something wholly out of the ordinary for a year 6 trainee”. This speaks volumes about the current state of the NHS, that a trainee working without supervision is expected to do the job of three doctors without making any mistakes.

Hence, empathy for Dr Bawa-Garba is strong, with the hashtag #weareallhadiza cropping up on Twitter. Many doctors have experienced similar working conditions in their careers, especially in recent years within a buckling, chronically underfunded NHS. Dr Wilmshurst, Consultant Cardiologist at Royal Stoke University Hospital has asked the GMC to investigate his 40 years of clinical practice, admitting to clinical errors leading to delayed diagnosis and treatment. Writing to the BMJ, he stated “it is clear that the High Court agreed with the GMC that honest errors should be career ending mistakes”.

The tremors from the case have reached medical students here at Imperial, who fear what the decision of the GMC means for their training. One student commented that they are “terrified” that doctors are expected to cope without adequate resources and not only do one job, but that of two other doctors. Another said that they are “hesitant” to engage with the reflective process for learning purposes if it can be used as evidence against them. Perhaps most worrying is the GMC’s move to strike Dr Bawa-Garba off, despite the previous ruling of the Medical Practitioners Tribunal to suspend her for 12 months. Supposedly this was done in the public interest, to restore confidence in the profession. To many, however, the decision seems to be an act of political and public appeasement, and will do nothing to prevent similar deaths in the future.