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

That article seems very biased though @TheFairyCaravan that's what papers do they pick out the bits that are very emotive and twist it they don't give a true account of what happened i think Jack died because of a catalogue of errors because the unit was dangerously understaffed and the trust are hiding behind that so they don't have to accept their own failings .

That report made my hairs stand on end.

Any loss of life is a tragedy.

However the loss of life being blamed on someone who was doing the job of 4 people is horrendous.

It’s a nurse’s evidence from the inquest x2boys. I would say that’s a pretty fair account of what happened when Jack got to the ward.

Yes but they have only printed the nurses account what about all the other evidence about the unit being dangerously understaffed etc I'm not saying they are not printing a true account of what the nurse said just that they are choosing what bits to print that's what papers do .

Thanks for the crowd funding link. I will donate. More as a show of support, I imagine in her position it's a small comfort to see how many other people, patients and medics, are behind her.

The GMC must be regretting their decision right now, in a cack handed attempt to restore patient confidence in the profession and appease jack's parents they've nose dived the public confidence in them as a body and made medics afraid of them.

My OH was saying last night (he has had two days off before a seven day stretch of 7am-8pm, he's a junior doc) how much he doesn't want to go to work today. Not just to do with this case of course, more because he is struggling with the immense pressure of having to look after so many sick people largely alone in an environment that's fairly new to him (he's two months into this rotation), but this case has highlighted to him and his colleagues that if push comes to shove the GMC will absolutely throw them under a bus. He and his colleagues are no longer willing to use reflective practice, they may do so on paper at home and shred it straight away, but that's it. He and every doctor I've spoken to about this case agree this could have happened to anybody and no doubt will again. It infuriates me that a woman doing the job of four medics, while in training, on her first day back from mat leave, has been put through this. She should never have been in that situation and by all accounts her record before and after was exemplary. We've lost a good doctor. There are no winners in this case, even though it seems like jack's parents feel they've won a small victory with her being struck off.

x2boys they printed that article because the nurse happened to be the witness on that day. I posted it in response to the poster upthread who said that the nurses should have realised that Jack didn’t have a DNAR and as you can see they did.

To clarify my earlier query, the PM was where the diagnosis of Group A Strep pneumonia and sepsis was clarified.

court-appeal.vlex.co.uk/vid/201505475b1-654950101

The role of the enalapril dose given in the last few hours pre-arrest seems to have been ignored or downplayed by the prosecution in the manslaughter case. I cannot fathom why.

I really feel for the doctor in this case. Hindsight is a fabulous place where we all get everything right. Last time I was on shift I was responsible for 14 ‘ward based’ cardiology patients / mixed outliers, 4 CCU level cardiology patients and 8 telemetry channels. I was also the ward sister and therefore co-ordinating. All these people were already on the ward when I arrived so couldn’t refuse to accept them. Of the 14 ward based 10 were called ‘Mabel’ (name change). Several Mabel’s had DNACPRs, other Mabel’s were on hourly obs / IVs. Yet further Mabel’s and family’s all wanted to meet with the ‘nurse in charge’ for 5 minutes (reasonable).

At the end of my shift I didn’t know my own name never mind one Mabel from another. Children and cardiology patients are very similar in the fact that they can be seriously unstable but present as ‘well’ which is why they require close monitoring which the doc in this case (with the best will in the world) was incapable of doing due to other demands of her due to low staffing and lack of senior support.

This case WILL NOT improve care for people with learning difficulties as it does not address the reasons the errors occurred. As for the X-ray, ours are uploaded to the IT system for review ( was the scan available in a timely manner due to the Trusts IT problems that happened that day)?

All this has done has let the trust and its abysmal staffing off the hook. I guarantee you that clinicians have found themselves in this poor woman’s exact position and children have been in danger.

Well I don't suppose anyone is going to want to say to Jack's mother that giving the enalapril may have been a contributing factor and if this was the case why was she ever prosecuted?

My heart goes out to this doctor. I'm sure medicine will be the backbone of her life, having spent the majority of it studying towards it. To have it snatched away like this, I can't imagine how she must be feeling.

I hope she has a great support network around her.

I've been involved in countless claims against the NHS where I've encountered unbelievable failings, much more severe than this in terms of blameworthiness (not outcome, I'm not comparing that at all), where no staff have been punished. This is unfair.

You know what this looks like? The "Doctor's Plot" show trials under Stalin. The thrust of those was anti-Semitism. Now, it smells to me very much of racism and sexism. I don't think a rugger bugger with the right tie would have been treated the same. There's also the deliberate demoralising of the profession. Russian medicine took decades to recover, and even today it carries much lower status than in Europe or America.

Now, it smells to me very much of racism and sexism.

Yup.

Russian medicine took decades to recover, and even today it carries much lower status than in Europe or America

And you know why? Because in the former USSR, as far as I know, the majority of doctors were women.

TheFairyCaravan thanks for posting that link.

What I find particularly chilling here is the behaviour of the consultant, who seems to have managed to slide out of this mess unscathed.

If it was Group A Strep pneumonia, sounds like streptococcal toxic shock syndrome probably contributed significantly to the rapid decline. This would have been a much less common "zebra"* diagnosis for a patient presenting with D&V. Viral gastroenteritis much more common and would not have needed antibiotics. Not straightforward to distinguish between metabolic acidosis arising from dehydration/peripheral shutdown and metabolic acidosis arising from sepsis.

I suspect that the apparent clarity in what "should have been done" has arisen largely from the power of hindsight combined with a post-mortem result and the lawyers' filter turning everything into black and white. Real-life medicine is more like doing a jigsaw puzzle with half the pieces missing whilst wearing rain-splattered glasses.

*zebra reference:
There's a medical saying - if you hear hooves, think horses not zebras.
In this case, gastroenteritis would be the horse, Group A Strep sepsis would be a zebra.

Great article to challenge those who think the GMC "had no choice":

www.54000doctors.org/blogs/whos-interests-are-the-gmc-really-trying-to-serve-in-the-bawa-garba-case.html

I don't know why the parents are happy with this verdict. If I was them I would want some kind of action taken against the staff - a temporary suspension like the original tribunal ruled seems proportionate - but the main fault clearly lies with managers and the government's underfunding of the health service. Until they are held to account this little boy has not got justice. Hard to imagine them pursuing a white man in the same way - the consultant also looked at the blood results, but said Garba did not "stress" the abnormal results enough - what?!

It looks like what might have contributed to the boy's death is that he was given his regular medication by no one knows who - and Garba had nothing to do with that.

I do two 10-hour night shifts on a laptop from the comfort of my own home with lots of breaks, and its still exhausting, juggling that with looking after a young child - I almost passed out the other morning. So I have no idea how medical staff can be expected to work 24 hours in a physically and mentally demanding job safely!!!

So is that the end of the case then? No more appeals? Is there anything we can do for this Doctor?

If you want doctors with convictions for gross negligence manslaughter to treat your children, crack right on.

You seem to want the regulators to be able to overturn the verdict of the courts (and remember that the original verdict went to appeal and was upheld).

It cuts both ways. Do you want the GMC to have the power to re-examine all the evidence in the cases of doctors who are found innocent? Decide that actually, they were guilty after all and strike them off?

And, in spite of the parents' celebrations, I don't think they've got justice for Jack at all.

This judgement has made paediatric care in Leicester and elsewhere less safe, as talented junior doctors turn away from medicine (especially acute specialties) having weighed up the chances of being awarded a custodial prison sentence for an honest error made in a fucked-up underfunded understaffed dangerous system.

Justice for Jack would have included full courtroom exposure of the working pressures, the impossibility of doing a safe job to an acceptable standard for every patient in every ward on every day. Understaffing and unsafe working is rife, and certainly not just in Leicester.

Justice for Jack would flag up consultants being so overloaded that they are expected to be in two places at once; that training and improvement cannot occur unless there is time set aside for it away from the ward.

Justice for Jack would encourage a reflective learning culture; this judgement has done exactly the opposite.

Dame Janet Smith in the Shipman report heavily criticised regulatory bodies having control over their own disciplinary proceedings which is why independent panels now oversee fitness to practise and are the decision makers. So do I think the GMC should have the power to overrule that of an independent body? No not really. There are bodies such as the PSA whose job it is to do that.

Hear hear Splitterbug.

The NMC hearing determination is here. www.nmc.org.uk/globalassets/sitedocuments/ftpoutcomes/2016/august/reasons-amaro-cccsh-36269-20160804.pdf

The key issues are -

1. the child presented with d+v - a reasonable assumption to make was that the metabolic acidosis and high lactate were directly caused by fluid loss and a gastroenteritis

2. she corrected these with the fluid bolus and maintenance fluids, and the blood gas numbers back her up by showing improvement in response

3. we can debate whether she should've given antibiotics from the off instead of waiting for the chest X-ray - it seems both her consultant and the three independent paediatricians who've reviewed the notes and written the letter cited above agreed it was reasonable to wait

4. there was a 2.5hr delay in her chasing the X-ray result - it seems she was spending this period of time doing her job, her consultant's job and a second registrar's job looking after 6 wards, doing lumbar punctures, seeing lots of other sick patients and simultaneously dealing with at least one other critically ill child

5. her consultant was absent throughout this entire shift, teaching in another city - so she had no-one supervising her

6. the child was clinically improving until the parents administered enalapril precipitating a cardiac arrest an hour later. In a child with borderline systemic blood pressure and ongoing kidney impairment giving a nephrotoxic antihypertensive will contribute considerably to that kind of end result. One can speculate on how this might be impacting on how the parents feel and their subsequent behaviour.

7. following the cardiac arrest call, she confused the child for the previous child that had been in that bed hence her error regarding the dnar. Either way, the 1-2 minute stoppage of CPR would have held zero effect on the eventual outcome.

Yes, she made mistakes. She could've:

1. administered broad spectrum antibiotics early
2. involved her intensive care colleagues on the basis this child was too ill to be managed on a general ward
3. insisted on earlier senior review of the child from her consultant who was in a different city
4. warned the parents not to administer the child's usual meds
5. not confused the dnar status of the child
6. apologised appropriately to the parents afterwards

Do the mistakes add up to a manslaughter conviction and GMC erasure? I agree with those who call this out as a classic case of scapegoating for systemic failures with a side of racial discrimination thrown in for good measure.

JargArmani

Do you want the GMC to have the power to re-examine all the evidence in the cases of doctors who are found innocent? Decide that actually, they were guilty after all and strike them off?

That's the job of the Tribunal, to examine all the circumstances once any legal proceedings have concluded. They did that in this case and examined all the factors and decided a suspension was adequate. They would do the same the court had found her innocent. For some reason known only to themselves and also discussed in the article I linked above, the GMC appealed it. Wrongly in most people's opinion.

to all who say the GMC 'overthrew' the independent mpts decision - they didnt , they can't , they do not have the legal powers.

what the gmc does have is the right to appeal an mpts decision.

This is what they did and the case is then heard in a high court by an independent judge...he did not have to agree with the gmc's request for a harsher sanction, he could have agreed with the mpts's decision.

it is this high court judge who decided that the mpts had been incorrect.