To feel sorry for this doctor?

[HarryStylesismycrack]

I am not in any way downplaying the death of that beautiful little boy and it is clearly acknowledged there were some failures by the doctor in question however AIBU to feel as though this intervention by the GMC into the independent decision making by the MPTS is concerning? It appears to me that the MPTS took into account many things, not just the outcome (which I completely acknowledge is heartbreaking), the fact that this doctor was working the job of several other medical staff in an unfamiliar environment with significant IT issues with no senior input. It feels like this doctor has been made a bit of a scapegoat for huge systemic failures.

www.independent.co.uk/news/uk/crime/jack-adcock-latest-downs-syndrome-death-doctor-hadiza-babwa-garba-struck-off-general-medical-council-a8177721.html

A different link to a blog by other medical practitioners 54000doctors.org/blogs/an-account-by-concerned-uk-paediatric-consultants-of-the-tragic-events-surrounding-the-gmc-action-against-dr-bawa-garba.html

Well I’m a doctor so I’m biased and I have worked in the LRI so I’m even more biased but some points

1. Sepsis training to my memory came in after this case in Lri. Children are not mini adults. They can be very sick with dehydration. They don’t all get abx.

2.cau takes all comers. You can’t close it because it’s full. You can’t say it’s unsafe. The children would then just be on the street. The next nearest general children’s hospital is Nottingham and they are always full. You have beds for about 20 but may have 60 in the department.

1. There is a picu called cicu. It sometimes has a separate registrar but sometimes the cau registrar is also the picu one as well.l if picu reg is off picking up sick patients from smaller hospitals in an ambulance. is not clear if this was the case or not during this shift. Picu beds are also like gold dust. Sometimes there are not ANY free in the whole country. It is not clear if there were any in Leicester to send him too. Often children who would be too sick for the ward in general adults are in children’s wards because there is nowhere else for them
2. It took her two hours to see the xray. It appears that in these two hours she was looking after probably near 200 other patients including one who needed a lumbar puncture for suspected meningitis that she performed. Was she supposed to stop doing this LP to look at the xray?
3. This is a big regional children’s hospital. It has around 200 child patients and it was being staffed by three maybe four doctors (if there was a picu dr). Out of the three doctors we know about Hadiza was the only one who had ever worked with children before. This would mean she was the only person who could take bloods, put in cannulas, Make any decisions about treatment,prescribe fluids and drugs, decide to order X-rays, look at X-rays etc. This is clearly impossible.
4. She was a traniee. She had had only four years training in Paediatrics. She as far as I can read had never been the senior trainee in a big hospital before.
5. This is how it still is up and down the county. Paediatric trainees are terrfied. All people can talk about is how to get out. What should they do when they get to work tonight and face a situation like this. Do they do there best and hope and pray or do they walk out. If she had said this is unsafe and walked, there would have been no one to care for these patients - the consultant wasn’t there as there would have been literally no other paediatric trained dr in the hospital.

Oh and yes sadly for all the people who asked if it is common for children to have DNACPRs. Yes many with chronic conditions do, but we don’t call them that.

Dr Bawa Garba didn't prescribe the Enalapril and blaming her for this is completely unjust

This.

I’ve luckily not been admitted to A&E many times but when you’re checked in (I had cancer but as a teenager so hazy memory) isn’t there there a ‘are you taking any medications?’ Handover type thing? Would this not have been done and meds handed over to medical team to handle prescriptions?

I feel for everyone involved but particularly for the Dr who is being so unfairly treated.

"He was also reportedly much perkier, drinking from a cup, more chatty etc and seemed to be improving. The numbers always need to be put in context of the patient in front of you"

You can say that, but the context, to put it in real life terms, is that a pH of 7.08 is equivalent to 83 nM of Hydrogen Ion Concentration [H+], a pH of 7.24 is 57 nM [H+] and a normal pH of 7.35 is 44 [H+]. So on admission, his body was almost twice as acidic as it should be. After his pH dropped to 7.24, it was still 30% more acidic than it should be.

I feel very sorry for her too but I'm a mother too objectively I can see it from both sides but as a parent it would be very hard

But - a general question of principle here - does being a mother exempt you from acting ethically and honourably towards other people?

I would hope not ...

The doctor had only given birth two weeks earlier when she was arrested and separated from her breast fed baby for hours on end.

This whole thing is like smoke and mirrors, but ultimately she was damned whatever she did.She did what she had to do as a Dr, but it was owing to the circumstances in conflict with what she had to do as a clinician with a patient who presented as very ill.
From reading a lot of the evidence it seems almost inevitable a child was going to die that day or that something was going to go horribly wrong.
It was Jack, it could have been the child with the lumbar puncture, it could have been the child who was DNACPR and if it had been him would we still be discussing this case?

A little boy died, but for her actions would he have died? It would seem not.
But could she have acted any other way? Looking at what has been presented it is hard to say yes

I’ve no idea when children’s ph values become more in line with adults but a fetal capillary sample in labour is considered normal at 7.25 and the borderline range is 7.20-7.25.

At delivery we’d really only get twitched about a ph of less than 7.10. And I’ve seen babies with a ph of less than 7.10 who have been totall fine.

But if you had read my second post Hedgerow I said I think his mum's looking for someone to blame and anyone would do and btw I'm the mother of a disabled child (similar disabillities to Jack ) and an ex registered nurse .

But isn’t that sort of the point lougle? He presented critically ill, was given appropriate treatment, was getting better and his gases were improving but he was still very sick. The expectation though, was that with continued rehydration, oxygen and antibiotics he would continue to improve.

And then he was given enalapril which would have fatally dropped the BP in a child whose cardiac function was already compromised by dehydration/sepsis. Also not great for the kidneys which were already impaired (likely reversibly) at admission and which were working overtime to correct the acidosis.

Sure the treatment wasn’t perfect but the fundamentals were solid and he was beginning to improve.

Two things would have saved his life in this stitiation IMO -

1. Leadership from the consultant paediatrician who should have appreciated that the boy was sick and either come in to supervise care himself or come in himself to organise a transfer to a PICU (adult ICU is not, IMO, a better place for a non-ventilated sick child than a paeds ward with paeds nurses). I agree an intensive care setting was appropriate 2). No enalapril. 1) would have prevented 2) as he would have been able to be more closely supervised.

How do you know the treatment was appropriate if the X-ray hadn’t been reviewed? And didn’t I read somewhere that antibiotics weren’t started either despite him having loads of red flags for sepsis?

He’d been given fluid bolus, IV ab and had improved clinically. His bloods showed an improvement. Then he was given enalapril and within an hour he had arrested.

ABC - Fruitcider.

A - intact
B - breathing, but compromised (the acidosis wouldn’t have helped) and given oxygen.
C - poor so given fluid boluses and maintenance fluid.

Pretty sure the antibiotics were given after the X-ray was reviewed. Definitely later than if he’d been in an ICU/HDU setting where there are infinitely better staff to patient ratios but reusitative treatment for septic/hypovolaemic shock (if that’s what it was - I don’t recall reading that he was blood culture positive) is still fluid boluses which he got. Intravenous antibiotics only work if the circulatory system works. In an ideal scenario the antibiotics come minutes after but he was thought to have presented as a D and V which in retrospect wasn’t correct, but wasn’t unreasonable.

Then the enalapril would have fucked up C.
He would have been trying to increase his cardiac output (helped by fluids) by a raised BP and heart rate but the BP would have been dropped by the enalapril.

He may have been sicker than the registrar realised but she appropriately informed her consultant of the boy’s presentation and gas results who did nothing - didn’t come in, didn’t suggest a nursing special, didn’t start organising a PICU transfer.

Looks like there is a lot of support out there www.crowdjustice.com/case/help-dr-bawa-garba/?utm_campaign=help-dr-bawa-garba&utm_content=post_pledge_page_flat_v1&utm_medium=Facebook&utm_reference=11c227c3897889c0291df23ac4e53630&utm_source=backer_social

Just discovered crowdjustice are funding an appeal for DR Bawa- Garba. If everyone who can makes a small donation maybe we can show her how much we value her.

and here we go again. lets forget a child with lds died

Without the original court transcript, it's wrong to go much further in to the details. The bottom line is that he was treated for gastroenteritis when, sadly, he had severe sepsis from pneumonia, which wasn't diagnosed for several hours due to a combination of systems failures, inexperienced staff, unfamiliar staff, over worked staff, and a short-staffed, under-supported, overwhelmed team, with poor supervision.

Much is being made of the possibility that the mother gave the child the enalipril, but frankly, that is the job of the admitting nurse and doctor to weed out that sort of information. "Is Jack on any medications normally?" "Oh yes, he takes x,y,z each day...." "Great, thanks for that." "We definitely wouldn't want him to have the enalipril when his blood pressure is so very low, so we won't be giving that one. Is it ok if we take his medicines while he's in, so that we don't get confused between who's giving what, or would you like to take them home? It's ok either way, but we'll need to make sure he's only given the medicines when they're prescribed on his medicine chart while he's in hospital ."

Samcro I think everyone on this thread has been at pains to point out that we know a blameless little boy died because of multiple failings. All we’re saying is this doctor has been made a scapegoat for failings that were widespread and systemic and in actual fact meant that at some point someone was going to die.

I'm reserving judgement on it. There's lots of factors at play - the parents giving a shocked child enalapril, the history of d+v for 12 hours leading to dehydration suggests gastro rather than pneumonia, the shitty staffing, using her own reflections against her, the consultant hopping off to Ireland shortly after, but at the same time the judgement says there were critical things she missed...

However, it's meaning I'm not going into paeds, and that my reflections will be verbal rather than typed from now on. Fuck that for a game of soldiers.

I'm a doctor.

1. I would never specifically think to tell parents in hospital what of the regular medications to withhold. Only medications I prescribe should be given, and in the acute phase this will be by the nursing staff. THE END.

The local culture of giving regular medication without a prescription was dangerous.

2. we don't know if the gases were venous or capillary. Capillary gases in a cold/shut down patient can be crap. A free flowing sample taken virtually simultaneously can often be much better - the numbers might have been interpreted with that in mind.

3. supervision
   I do not understand why the consultant didn't respond to the gases. I took a patient over the other day with a poor gas and I was there.
   If we are short staffed we rejig the consultant rota to provide cover. We wouldn't leave one trainee to provide this amount of cover. Especially someone Day 1 back in practice after a long break.

4)first day back after 13monthsoff. So realistically attitude/ knowledge dated at late 2009 levels. Sepsis education really wasn't big then

5. the DNAR confusion - Jack was in the same bed a DNAR kid had been in earlier her shift. Bedside nurses should have known she was wrong and corrected.

6. reflective practice
   Fuck that. I've gone through my portfolio and deleted all of mine. It will no longer be commited to paper.
   In general, the higher performing the doc the harsher they are on their own performance.
   
   At a recent M&M (morbidity & mortality) meeting one of my amazing colleagues self flagellated herself over her own perceived delayed decision making. To an outsider she had done an amazing job. If she commited those thought to writing they could be used terribly against her but as a body of her peers there were no criticisms.

7. there is something in the NHS now called Dury of Candour - it came in in 2014. Prior to that apologising for error was felt to be admitting fault and was discouraged by hospitals.

Samcro yes a child died. Because of systemic failings that are not being addressed because of the focus on one person's role in that death. It's not as if people don't care or are forgetting. It just makes more sense to support this doctor, because to do otherwise is to neglect the errors in the system that led to his death.

The GMC would have you believe that the children of Leicester are now safer because of this doctor's striking off. That's bullshit. They're worse off. They've lost a good trainee, the (ir)responsible consultant still practises there, the ward structure and staffing issues likely haven't changed and removing one doctor from those circumstances just means an equally vulnerable doctor has replaced her.

I have followed this thread from the start and the circumstances have horrified me, but I'm also heartened by the fact that most pp recognise this as the worst example of failings of a health system and that scapegoating leads to ongoing complacency. Hopefully this can spark change.

the (ir)responsible consultant still practises there,

Nope NotBadConsidering, he practices in Ireland now, that's how he's managed to escape despite teaching in Warwick for half of the shift and trying to say he needed it stressed that he should review an acidotic child with a high lactate.

I would never specifically think to tell parents in hospital what of the regular medications to withhold.

Agreed Opinionatedfreak. At the hospital I work in I don't actually think we're allowed to take patient medication into hospital stores (plus I don't have access to the drugs cupboard to stick them in there anyway!). They're locked in a cupboard next to the bed on wards, but I can imagine this hadn't happened yet on a stressed ward. Mum and dad were probably still holding the bag of medications they'd brought for the meds rec pharmacist.

Well that's one thing at least.