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

I should say that the Trust has made a number of changes, in response to the systemic problems that contributed to Jack's death, and the consultant responsible probably is (I would hope) equally remorseful about his actions and role in the case. But it's a theme that no doubt will be just waiting to happen to someone else, somewhere. And those system failures are lost in this ruling.

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.

You seem to have missed D and E off that list. Why did it take them 11 hours to do ABCDE? The bolous or fluid and 15l oxygen is to support the circulatory system - you don’t delay antibiotics for suspected sepsis! You give IV broad spectrum whilst you wait for blood cultures. The presumption of gastro was completely off the mark. The doctor failed to recognise the blood results as dangerous, failed to recognise her patient had sepsis. That’s why she has been struck off.

She was convicted by a jury.They heard all the evidence.we have only heard selected snippets put forward by people with their own agendas

Being a doctor, this case opened a cab of worms. Next week it is the change over day again. And I exactly know what I should be doing. Just manage one ward, one patient at a time. No point in being helpful or work beyond your competency.

Dr Bawa-Garba’s case has extraordinary ramifications, with large numbers of doctors and nursing leaders recognising that their conviction puts all doctors and nurses at risk in the context of a healthcare system which is clearly bearing enormous stress at a national level. The case also has implications for patient safety across the UK, because healthcare professionals will henceforth be reluctant to share knowledge openly or reflect on clinical errors for fear of criminal prosecution.

Both GMC and NMC have failed to protect its members who acted beyond their call of duty to manage the workload.

Hence an independent legal opinion has been sought on this case as to how the doctor has been convicted when clearly there were so many things went wrong in the system. Here is your chance to get involved. Please donate generously if you think they have been wrongly convicted and the justice has been denied. Please click on the link below to donate.
www.crowdjustice.com/case/help-dr-bawa-garba/

FruitCider the child came in with a 12h history of diarrhoea and vomiting. And continued to have diarrhoea during the admission. He was dehydrated (hence the metabolic acidosis and red flags) and responded appropriately to a fluid bolus.

You are banging on about suspected sepsis but with the above history and good response to fluids, a diagnosis of gastroenteritis is top of the list of differentials. The pneumonia was diagnosed and antibiotics charted after imaging was reviewed - yes, after a time delay, during which she was looking after a suspected case of meningitis, performing the LP, attending a resus, managing far too large a case load with no alternative.

Sepsis and the associated care bundles are mainstream now but weren’t in 2011 when this happened.

Her errors, as I see them, were failing to recognise how sick this child was (even after responding to fluids), failing to insist on a senior review and failing to tell the nurses not to give a medication she hadn’t prescribed. Hardly reasons to erase someone from the register.

He was responding appropriately and improving. Until he was given his ACE inhibitor, without her knowledge and without her prescribing it. She cannot he held responsible for his subsequent deterioration due to that.

Totally agree with the above assessment of the case. As a doctor the way this woman has been scapegoated is terrifying and will not lead to increased patient safety as doctors will be afraid to openly report or learn from errors. A safety culture works when it is not seen as one persons individual responsibility that matters but systems and teams. It’s terrible the poor boy died but surely the best response to his memory would be to make things better for other children not to stop someone working who by all accounts was a good and competent doctor who made a mistake.

Chilling is the word. I was a paediatric ST6 in 2011....I well remember 13 hour shifts, literally running from one emergency to another. At least my SHOs were paeds trainees. That poor woman.

Thanks to the medicos for their responses on this thread. The whole thing is scary, for everyone. I need to trust my HCPs - and they need to trust me & that I am co-operating with them.

And this has been stirred up by a vicious press campaign which the grieving parents have had little aversion to using. We can acknowledge their terrible pain, while at the same time suggesting that their behaviour has not been part of that reciprocal trust and co-operation that HCPs can expect.

I'm genuinely bemused that anyone thinks a doctor who has been convicted of gross negligence manslaughter should still be allowed to practise.

@WinnieFosterTether have you read any of this thread? The conviction should have been corporate manslaughter for the Trust, not the scapegoating of a Dr who was put in an impossible dangerous position

I’m not surprised a jury convicted- they’ll have heard the case of that 1 child only. There were many other very ill children who also needed looking after. You can’t split yourself in 4. That’s the problem.

And agree initial presentation sounds like gastroenteritis. I don’t think that was disputed by anyone in the court or at the MPTC heading. I completely agree that there was a delay in looking at the x-ray- it’s just that anyone who has ever worked in an acute service knows that this is not always avoidable.

Contrary to public opinion doctors have no interest in seeing bad doctors practice. We are generally quite critical of our own and others practice. The backlash around this case is that this little boy was harmed by a systematic failure, for which 2 individuals have shouldered the blame. We have seen reflections recorded for training purposes used as evidence. And we have seen no evidence that this will make hospitals safer.

Already my junior trainees are talking about only applying for posts which do not involve any acute medicine- as there is no control over workload or patient numbers and they don’t feel safe or protected. That is not going to help make our hospitals safer.

As regards reflections- I am extremely self critical, as are most of my colleagues. As a first year registrar I beat myself up for months about missing a rare condition and delaying treatment in a patient (who thankfully did very well). I looked back on my reflections on it this week after this case- at the time it was the FIRST time this condition had been seen in the country. It had only been described 2 years previously. It occurs at a frequency of less than 1:10million. It was in no way unreasonable of me or my colleagues to miss it- but if you read my reflections you might assume it was.

The presumption of gastro was completely off the mark. The doctor failed to recognise the blood results as dangerous, failed to recognise her patient had sepsis.

That's bullshit. The diagnosis of gastroenteritis for a patient presenting with 12 hours of vomiting and diarrhoea was an accurate diagnosis. The doctor possibly didn't pick up on the raised creatinine but that could be quite in keeping with pre-renal impairment from someone hypovolaemic from gastro who was on an ACE inhibitor. I would personally like to know the post-mortem micro result. The reports all say sepsis, but what was the organism? He apparently had pneumonia but that doesn't mean the initial assessment was incorrect. For example adenovirus can cause awful diarrhoea and pneumonia.

What Winnie said. The courts found her guilty. And another court found the MPTS were wrong to hand down a suspension instead of erasure. Lots of confusion on this thread about the role of the regulator. The GMC had no choice but to appeal.

There aren't many professions where you can just carry on as normal when you've been convicted of manslaughter. Medicine is one of them - for obvious reasons.

JargArmani I think most medical professionals are wondering how this got as far as the criminal courts rather than a corporate manslaughter investigation. The thought that I could be arrested for doing my best in a pressured environment and making a mistake is frankly terrifying. An independent investigation, serious case review, censure from professional bodies if needed yes, but a criminal court?

HedgerowAnimal the family can deal with this any way they see fit. I don’t expect them to see the bigger picture. I would expect the GMC to be more objective.

The court found her guilty without having heard any of the evidence regarding the systems failures, the absent colleagues and increased workload, the lack of IT for much of the day, the other sick patients.

This was written on the medical registrar Facebook comments (not by me!) :

The main issue here is surely the initial prosecution and conviction for Gross Negligence Manslaughter. The legal basis for this is based on
R v Adomako [1994]:

The prosecution needs to establish 4 things - that the defendant:

1. Owed a duty of care to the victim
2. Was in breach of that duty
3. The breach of duty caused death
4. The defendant's conduct was so bad in all the circumstances as to amount in the jury's opinion to a crime.

This case was heard in 2012 and a suspended sentence given.

In my view, given the systemic failures including the absence of a consultant covering (which should not be permitted), the 4 tests are not met, particularly 3 and 4. I am surprised if this didn’t go to appeal. She could still appeal the conviction and if successful could be reinstated on the register.

The GMC had no choice but to appeal.

Their argument is they needed to restore public confidence. This appeal and its result should do the opposite. It highlights the GMC has no interest in protecting patients. By accepting the (wrongful) conviction and now striking off one doctor it places itself as a reactionary, mob-ruled police force instead of a force for change and the improvement of doctors' performance. It will result in doctors' working in fear and loathing of self-improvement. They had a choice.

Differential diagnosis is still a practiced thing though, yes?

From Medscape:

"Older children [leading on from a section about toddlers and preschoolers] and adolescents may also present with fever, cough (productive or nonproductive), congestion, chest pain, dehydration, and lethargy. In addition to the symptoms reported in younger children, adolescents may have other constitutional symptoms, such as headache, pleuritic chest pain, and vague abdominal pain. Vomiting, diarrhea, pharyngitis, and otalgia/otitis are other common symptoms.

So, whilst she got the chest x-ray ordered, surely, in such an ill child, reviewing it so late after it was done was not a good idea, because pneumonia should have been one of her prime differentials? Especially as the child was breathless, required oxygen and had 4 of the common markers for pneumonia?

Gastroenteritis was a reasonable diagnosis to be running with until the moment there was evidence to show otherwise, but the delays in treatment cost him his life, and "drinking from a breaker" is not a reliable clinical assessment of health.

However, I do think she was failed. In my hospital, if a chest x-ray is very bad, the radiographers will telephone the ward and report that the result is ready, it needs to be reviewed, and take the name of the person they have spoken to. Likewise, if a blood result is badly deranged, our labs will telephone the ward, report the result, repeat the result, ask you to confirm the result you have heard, and ask for your name. They won't just shove it on the screen and hope you see it.

Exactly Rinceoir the parents have lost their child of course they blame the Dr , but its the fact that shes been prosecuted and convicted and struck off by the agencies that should be able to see the bigger picture that is wrong

@HicDraconis I believe her applications for appeal was denied? Apologies for DM link, it’s all I could find.

Thinking more about the general principles:
I agree that a doctors cannot be convicted of manslaughter and also be on the registeR. What GMC decision has done is throw light on the original court ruling. It appears that the court were not told about the other working pressures at the time.

If she had had no other patients then her management of him could be considered to be poor. There should not have been the long delay in reviewing the chest X-ray and so prescribing antibiotics so late. However she was unavoidably delayed in looking at that xray by other very unwell patients. If the jury were not told that because for some reason the legal system rules it is inadmissible as evidence that is terrifying to doctors.

Every shift our practice is not perfect, it is the best we can do in a very stretched system. There are alayws delays in reviewing things because you see a patient t, order tests, see some other patients and then go back and look at the results from the first one. You can’t just sit at the computer hitting refresh to see if the results are back for a few hours. If something goes wrong and we are to be judged as if the system is working perfectly, as if we only had that patient to care for then I’m to scared to work.

For goodness sake, hindsight is wonderful. As I stated upthread I was a ST6 in a big hospital in 2011. I'd like to think I would have given ceftriaxone in the assessment unit and got to the ward to review the patient (or at least sent an SHO with VERY clear parameters of what to look for). But this doctor was under immense pressure, we don't know how sick the other patients were. She didn't know her juniors , she didn't know the hospital. Bottom line she shouldn't have been put in that position. The enapiril certainly shouldn't have been administered, but to face criminal charges and be struck off seems out of all proportion.

Bedside nurses should have known she was wrong and corrected.

They did. A nurse screamed out that it was not handed over to her that Jack had a DNAR on him when Dr Bawa-Garba called it off. Dr Bawa-Garba hadn’t even checked a face or name band before calling it off.

It doesn’t seem like she received a little boy who was playing and perky on to the ward either. Here

Enapiril sorry