Scape-goating Dr Hadiza Bawa-Garba

I referred to the NHS Newsday post on the left in a comment on my post of Carillion. It should give us all pause for thought and check any enthusiasm for contracting out even minor services. Here it is.

It’s not often I find myself agreeing with Jeremy Hunt, whom I suspect of being the smiling face of NHS privatisation – and it appears I’m not alone (Stephen Hawking and others accuse Jeremy Hunt of backdoor NHS privatisation) -, but I agreed with him when he tweeted that he was “concerned” about the implications of the case of Dr Hadiza Bawa-Garba. The General Medical Council may have been technically correct in upholding the rulings of the court, but if the original court did not hear all the evidence surrounding the tragic death of Jack Adcock, particularly about the systemic failures in the Royal Leicester Infirmary and the health trust then the question is whether justice was done in the first place.

I understand the boy’s mother wanting someone to be held responsible, but it seems unlikely that the right person was found guilty. The fact that Dr Bawa-Garba’s fellow doctors have crowd-funded over £200,000 to remedy what they fear is a miscarriage of justice which could affect them all is telling. An orthopaedic registrar explained their feelings on their Facebook page.

“The Orthopaedic Registrar

26 January at 22:17 ·

“So yesterday, a highly regarded junior doctor was struck off the GMC register after the GMC successfully appealed against the judgement of the Medical Practitioners' Tribunal Service.

“She was struck off because a child died. And that is a terrible thing. But as a tribe, we junior doctors are horrified. Why? Because this junior registrar, just back at work after more than a year off for maternity leave, has been scapegoated for system failings.

She was doing the job of two registrars, and the consultant who was supposed to be supervising her was in another city. So she was covering six wards and dealing with medical issues on the surgical wards, plus taking referrals and calls, with one FY1 (foundation year 1 doctor) and one SHO (senior house officer), both of whom were new to paediatrics. She was moving as quickly as she could, and working as hard as she could. She was no doubt anxious to make a good impression in her new post. She had had no trust induction. The blood reporting system was broken. She had missed handover because of a cardiac arrest. She mixed up two children and confused one DNAR (do not attempt resuscitation) child with another who was not - note the nurses had swapped the two patients beds around, and not told her. Concerns about the child deteriorating were also not raised to her by the nursing team. The child was given a medication for blood pressure, the last thing you would want for an unwell, dehydrated child, which she had quite rightly not prescribed, and then they arrested. How is this manslaughter? How she was then treated by her senior colleague and by the police when they arrested her 18 months later (it's not polite or reasonable to keep a breastfeeding mother away from her two-week old baby for seven hours while questioning her and any statement she signed at that time must be considered under duress) is another, horrifying issue.

“So why are we horrified? We have all been here. We have all been that doctor who is doing the job of more than one person, where our boss is not helping, and we are hours behind in what we need to do, everyone is annoyed with us, and we are annoyed with ourselves because we know our patients are not getting the care they should have. We have all been desperate to eat, and go to the toilet, and just sit down and do nothing for five minutes. We have all mixed patients up. So all of us look at this and think: 'This could me'.”

There’s an impressive professional assessment of the affair by a number of paediatric consultants: Account of GMC action against Dr Bawa-Garba.

As a mere layman, it seems that the hospital administration which permitted such pressure to be placed on a comparatively junior doctor’s shoulders have some answering to do. It appears to me that the sad sad death of a precious boy with Down’s Syndrome was caused by something more than one doctor’s human error. It involves poor management within the hospital, the irresponsible stretching of resources and, ultimately, the restricting of those resources by central government for its own socio-political purposes. That the individual doctor at the fulcrum of the system which caused her to make a mistake which proved fatal should bear the whole blame is a reprehensible example of scape-goating – a habit which it seems is becoming increasingly popular. There was once a time when the man at the top would accept responsibility for things which went wrong on his watch.

In the words of a searing article from the right-wing Bow Group,

“The outcome is to inflict a penalty on a single individual; to destroy an otherwise flawless career on this chain of events should chill every professional and indeed any member of the public. We all have a right to know our accuser and in this case it was clearly not the GMC as a whole. It has put back accountability of healthcare at least a decade by returning to the culture of shame the system by blaming the doctor. It was this refusal to see systemic failures that led to so many deaths in Mid Staffs and Morecambe Bay among others and has led in a much less publicised manner to a cruel and needless assault on the mental health and financial viability of many doctors, for some of whom it was too much to survive.” 

Finally I recommend an excellent post by Dr Rachel Clarke, a palliative care doctor who knows the pressures of being a junior hospital doctor in the NHS. She expresses the dangers of the case far more clearly than me. The Hadija Bawa-Garba case is a watershed for patient safety.