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

Those donating to the doctor's legal fund, do you think a case arguing for the reinstatement of the doctor will address the systemic problems that are leaving patients at risk?

I would hope so. But cannot guarantee it.

There were multiple areas (70 plus) flagged in the trusts report.

Some of them should have been addressed by now.

Nargle how can you say in one breath that you don't think that a pH of 7.24 is life-threatening (I agree with you, btw, if you are defining 'life-threatening, as opposed to critically ill), especially if his condition is improving, but then at the same time, say the Consultant should have attended, having been told the initial blood gas?

The Consultant was told about the child at 16.30, 6 hours after he had been admitted, so would have been told something along the lines of 'Child brought in, pH 7.08, ordered bloods and chest x-ray, gave fluids, thought gastroenteritis, very busy everywhere, was sitting up drinking after fluids while chest xray done, got results of xray and bloods much later, showed pneumonia, so gave him abx, blood gas was 7.24.'

So, either, his blood gas of 7.24 was serious enough that the Cons should have been worried, in which case your statement that people are going on about a 7.24 unnecessarily is a bit off, or he shouldn't have been, in which case, he didn't act inappropriately. Either way, the hand over didn't happen until 6 hours after he arrived.

@Lougle I think @Nargle was saying that the pH alone isn’t a reason for ITU, especially if getting better. It depends on circumstances- pH 7.24 in child with asthma- definitely ITU case, pH 7.08 in dehydrated patient with DKA which after some treatment is 7.24, not necessarily panic stations. It depends on the situation and the clinical picture.

KateAdiesEarrings- I am a doctor who has contributed to the fund. My feeling is that as long as Hadiza is scapegoated the real issues underpinning this horrible tragedy will not be addressed. The first step as I see it is to get her wrongful conviction overturned which is why I have contributed to the legal fund. Once we recognise that removing her from practice has made it more likely, not less, that avoidable deaths will continue to occur, hopefully the real causes of this tragedy will be recognised. It is a very sad and worrying time for all us in the frontline of medical care in this country.

Another good comment on this case: blogs.bmj.com/bmj/2017/12/08/rachel-clarke-hadiza-bawa-garba-could-have-been-any-member-of-frontline-staff-working-in-todays-overstretched-nhs/

"how can you say in one breath that you don't think that a pH of 7.24 is life-threatening (I agree with you, btw, if you are defining 'life-threatening, as opposed to critically ill), especially if his condition is improving, but then at the same time, say the Consultant should have attended, having been told the initial blood gas?"

In this case, I think the Consultant should have been attending, not because the situation was potentially life threatening but, because the situation was serious.

For what it's worth, I actually think the Consultant should have been in attendance even if there weren't at least two serious cases (Jack and the baby with suspected meningitis) in the wards that day because of the workforce issues.

I am a Consultant. If the same workforce situation had occurred, I would be manning the wards and admitting patients just like the junior doctors. Ultimately they are my patients and I would consider sitting in my ivory tower getting on with paperwork or training would be a very poor use of my time when juniors are firefighting in the clinical areas and patients are waiting hours to be seen.
In fact, I know several months in advance when my new trainees are going to join my team and I clear my diary so that I am relatively free that day as it is likely that they will need a bit of extra support on their first day in an unfamiliar environment however "good at coping" they are. Clinics and ward rounds would obviously go ahead but any external meetings and training sessions are cancelled or postponed.

I am not alone in doing this. Most of the Consultants I know are extremely supportive of their juniors and ALL of the Consultants I know would prioritise the clinical area over "management" work (training, audit, non-clinical meetings etc).....

@KateAdiesEarrings

I agree with @cremeeggsandspam

SadabouttheNHS that's an interesting viewpoint, thank you for sharing.

Can you help me to understand why the equivalent in this case wasn't held to account?
That's what i'm struggling to understand when reading about the facts and accountabilities here (as a non-medical professional).

@agbnb

If by "equivalent" you mean the Consultant in question, I'm struggling to understand too.......as the duty Consultant, he had ultimate responsibility for the patients admitted that day.......I find it staggering and incomprehensible that a) he wasn't held responsible and b) he ran away and left his junior to face the music by herself

Thank you for that Draylon. It says it all.

Poor Dr Bawa-Garba. Poor Nurse Isabel Amaro too. She had also had an excellent record prior to this, and afterwards. Until the court case, when she was also found guilty of manslaughter and subsequently been removed from the Nursing Register.

It could have been any of us.

Excellent and illuminating post @Draylon

I have to say that I'm reconsidering my view. I still maintain that the oxygen requirement, lactate, general presentation and temperature should have been screaming Sepsis to her, but I think I have viewed it through the relative luxury of the ICU environment, where patients stay in their bad spaces, nurses are assigned to one or two patients and know about them intimately, their observation charts are pinned up beside their beds, etc.

I've also studied human factors, and haven't given that enough regard. The doctor was set to fail when she woke up that day. Perhaps she should have called her Gold Commander, but who would, on their first day at a new Hospital, on their first day back from maternity leave?

Frankly, I now think if it hadn't been Jack, it would have been someone else, simply because she couldn't be everywhere at the same time, and he died because she was busy treating other critically ill children. If she'd been treating Jack in the way he needed, those children would not have been treated.

@Draylon

Thank you for posting that, I think it really sums everything up about this sad case.

Excellent post, @Draylon.

The Mail has run a story on this today that covers the issues quite well and ends

Yet while [the parents] grief must be respected, the wider issue should not be neglected: a dedicated paediatrician who made mistakes has been branded a criminal, and both doctors and patients might well end up the worse off for it.

www.dailymail.co.uk/news/article-5402367/Doctor-six-year-old-boy-death-hung-dry.html

I am a GP and I have donated to the Bawa Garba crowd justice fund. As medics we need to all stand together on this. This could have been any one of us. We have all been in scary understaffed situations. It is flabbergasting that this consultant could throw his junior under the bus like this. Absolutely awful.

I cannot quite believed that I agree with a daily mail article!

But it has been fairly well written & balanced...very unlike the DM

Thank you, Draylon, that's very kind of you. I have done quite a lot of reading around Human Factors, and it fascinates and terrifies me in equal measure. How we are all just one dysfunctional step away from the nightmare that we see colleagues in, yet by employing systems of protection, we can build a moat between disaster and success. The trouble is, we're human, and the systems rely on human function. I love Atwul Gwande. His books are inspirational.

I think Draylon's post makes so many good points. Yes, Dr Bawa-Garba made mistakes. But the system set her up to fail, the system didn't provide the support to allow her to provide the best care and the system let that little boy down.

It's easy to say "she should have seen x" and in all likelihood she would have- if she hadn't been trying to juggle so many balls, trying to manage the roles of a number of different people. As a Dr, and many other HCPs I know in all sorts of roles in the health service, I recognise on any given day it could have been any one of us. There but for the grace of god...

Dr Bawa-Garba has been used as a scape-goat here. "We have acted" is what the GMC can say, rather than looking at the deeper underlying issues. There are many who have done things more concerning than this Dr, yet are still practicing (some under supervision, some after retraining and so on)- but these cases haven't been in the media spotlight, so the GMC hasn't felt the need to be so draconian. This was nothing to do with patient safety or justice, this was about the GMC wanting to be seen as "being tough".

Perhaps most importantly, the way the GMC have acted has meant that patients are less safe in the future. True reflection and reporting are less likely, because it can be used to throw you under the proverbial bus. So those "lessons" that politicians are so keen on telling us "will be learnt" to prevent problems in the future may well never be learnt.