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

Bloody hell, even Jeremy Hunt is incensed on the doctor’s behalf

Draylon - presumably his DS had something to do with her mistaken belief that he was under a DNR. There’s much less fuss about Richard Handley’s inquest - also happening this week - when really I think both should be given the same airspace and the same amount of public discussion.

Yes x2boys I have a severely autistic son who is currrently sectioned in an ATU. I do trust them actually - the medical and psychiatric care has been good (luckily as the ATU is 8 hours drive from home). But obviously every horror story (& there are a lot) send shudders down my spine. And so many people know nothing about them. And in many of those cases the people who should have been held accountable (management) were not. I don’t see this case as very different tbh.

@ALLISON has a point
HCPs warned that the Health & Social Care Act would be very damaging. However, although there were plenty of HCPs warning the public about how detrimental it would be, I saw very little interest from the public at the time.
Relatives and friends of mine who complain about lack of resources in the NHS went to the ballot box and voted for a party who have systematically underfunded the NHS. I say this not to blame anyone but to get across how important it is for the public to take an interest in safeguarding the NHS.

The reason that I think that we ALL (HCPs and the public) have to speak up for the NHS is because, in my experience, HCPs are the last people Trust Boards, the GMC, media organisations and the Government listen to - if a HCP brings up concerns, the media organisations and the government in particular tend to spin it and accuse the HCPs of self interest.

Junior doctors and nurses (and other HCPs) are damned if they do and damned if they don't. If they turn up to work and the unit are very short staffed/ dangerous, they don't have the option of refusing to work until conditions are made safer - they'd be reported to the GMC/their professional body if they did that. So they have no option but to work in a dangerous situation. They just have to get on with it and hope and pray that they will get through the day without a clinical incident or worse.

I am a senior member of staff working in the NHS. There have been a couple of potentially dangerous situations in the area I work in. I booked an appointment with the Medical and Nursing Directors of the Trust I work in to talk to them about it, express my concern and come up with ways of tacking the issues. I got the definite impression that they didn't want to hear about things that could potentially be a problem and only wanted to hear good news. Several other colleagues have made efforts to bring issues up and have been labelled as trouble makers! However, they do take complaints by the public seriously because they have to.

This is very sad, but does anyone here know anything about blood gases and sepsis? I'm presuming the doctors might.

This boy was breathless, with cold peripheries (fingers & toes, or even hands and feet), bluish lips, and unresponsive when he was seen. I got that from the court appeal papers linked upthread, but wasn't willing to pay for them.

His initial blood gas showed a Ph, 7.0, - that is classed as extreme acidosis. A pH below 6.8 is generally considered incompatible with human life. base excess -14, and lactate 11 mmols - a lactate of 2 mmols should raise suspicions of sepsis if any other markers are present. A lactate of 11 mmols is horrendous and would be seen in our sickest ITU patients.

"He was prescribed a fluid bolus and maintenance fluids. Blood tests including CRP were undertaken and a chest x –ray ordered."

This child was known to be dehydrated (another sign of sepsis - your body releases cytokinesis and they make your blood vessels leaky, so all the fluid that should keep your veins nice and full, maintaining your blood pressure, leaks into your interstitial space (tissues), so you get dehydrated, but your skin gets boggy), and he was given a big push of fluid in one go, followed by maintenance fluids.

But he wasn't given antibiotics. Despite having hallmarks of sepsis.

People are saying 'he improved' because the second blood gas showed a pH 7.24 - our very sick patients in intensive care have that sort of pH. A normal pH is 7.35-7.45. To be clear, the pH scale isn't linear, it's logarithmic - a step of 1 on the pH scale is a 10x increase in acidity.

I do feel sorry for her. Nobody goes to work wanting to make that mistake, and she was under terrible pressure. She shouldn't have been. But she really should have seen that he was way, way too ill to be on a ward with some fluids, waiting for an x-ray.

I got the definite impression that they didn't want to hear about things that could potentially be a problem and only wanted to hear good news. Several other colleagues have made efforts to bring issues up and have been labelled as trouble makers

The NHS has a huge problem with whistleblowers. I know several (all nurses) and all have been treated appallingly for raising concerns.

Draylon have you ever watched Hitler gets a visit from the CQC? If not I recommend you do its really funny I think it's on you tube?

I thank my lucky stars every day that I managed to retire after 36 years as a nhs nurse/midwife and something like this didn’t happen to me.

Both those professionals have been scapegoated. I pity anyone working in the nhs now.

lougle I read that antibiotics were prescribed by her. But I agree he was too sick to be on an ordinary ward.

But any mistakes are more understandable when you consider the fact the IT was down and there were delays in results. I’ve seen research that says a HCP is more likely to recognise an abnormal result which they see on a screen in front of them rather than if the results are read out to them over the phone. Human factors again.

Then the added problem of the pressure of the abnormal and unsafe workload. She would have been fire fighting, running from one crisis to another which again means that you don’t consider what’s in front of you as carefully as you normally would.

Yes I read that antibiotics were prescribed but not administered for reasons unknown. If it’s anything like Our hospital it’ll be because everything relies on IT!

The whole thing is awful it was a tragedy waiting to happen wether she made mistakes or not who can blame her she should never have been put in that position I bet she hadent had a break for hours ,rip Jack he was let down by. The sorry state of the health service not individuals

YADNBU OP. It is terrifying out there, defensive medicine is now the norm, and patients will suffer as a result.

For everyone discussing the blood gas the letter in the OP also points out that the (white male) on call consultant was aware of them. Yet he wasn't in front of the GMC. It is known that doctors from ethnic minorities fare worse in GMC investigations.

I'm a Dr and I have to say I am dismayed by the GMC's action in this case. I cannot fathom why they have taken this action.

There were so many systemic failures that I feel the Dr (and nurse who has also been involved) has been used as a scapegoat. I know many colleagues feel this could be any one of us with the way things are at the moment. Mistakes were made, and I'm not saying that these need to be ignored- but the action taken has been disproportionate.

In addition, the use of reflective practice from the Dr's portfolio is a huge concern- we are encouraged to reflect on mistakes made to try and prevent them happening again, to be open and honest in a space that is meant to be "blame free". But if the GMC can then use this against you, who is going to use reflective practice in the way it is intended? The answer: it won't. I hear that many supervisors are actively advising against the recording of reflective practice over errors/near misses etc as it may then be used against you.

And to Vivalabeaver. Enalapril is a fairly commonly used ACE-inhibitor. Not unusual, rare and specialised medicine. Many wards would stock it. And drug errors can and do happen in wards, that's a fact. I don't think it is impossible this happened- I don't know what the evidence is that it happened, but it seems to be a widely accepted fact. So I think it more likely than not that it did happen in this particular instance.

YANBU OP - that poor woman

the Tory's have been in power for almost 8 years - when will they stop blaming everything on a party last in power in 2010?

Badly I saw that, and it's awful. But that was in the evening. The time that sepsis should have been identified and antibiotics should have been given was as soon as he came in with altered consciousness, cold extremities, blue lips, breathlessness, and that first blood gas showed a pH of 7.08 and lactate of 11.0. He had all the markers of sepsis, and once his blood was drawn, he should have been given antibiotics as per their hospital protocol (each hospital Trust will have an agreed broad spectrum antibiotic that they give when someone has screened positive for sepsis but the cause isn't yet identified).

Bless him, he needed a team of people working to stabilise him.

I do feel sorry for his Doctor. She had a dreadful day. I feel sorry for his nurse, too, but actually a bit less so (I'm a nurse). As his Doctor, she had little choice, it seems - she was taking on 4 people's jobs. I think she should have had a bit of a backbone by ST6, and called Paeds ITU for advice, but you don't know what you don't know.

But the nurse, she was agency. She was adult trained, working on a Child Assessment Unit. It was her 12th shift there, not her 1st (her NMC tribunal transcript is available online). So she knew what it was like, and she chose to work there. She didn't do obs, she didn't do fluid balance, she didn't escalate, and she didn't go above 'nurse 2' when 'nurse 2' 'wouldn't listen' that he had sepsis (apparently). It is our responsibility to acknowledge we cannot do the job we are tasked with. She declared herself competent to monitor and treat sick children, with an adult nursing qualification. Perhaps she considered herself so. But that day she didn't even carry out basic monitoring of him.

Missed tge timings there lougle
Yes, he should have been treated, very easy to imagine that being lost in the amount of work/unfamiliarity/newly back.
They always teach us when looking at human factors about 'the Swiss cheese effect ' when all the holes line up, the disaster happens. The short staff, the IT, the inexperienced nurse, the doctor Judy back from mat leave. Sadly she's been made the scapegoat

*the
*just

James Reason is awesome Badly Have you read anything by Atwul Gwande? His book 'The Checklist Manifesto' is a great read. Human Factors is fascinating.

The fact that she was doing 4 doctors' jobs is dreadful but sadly not unusual.

The fact that handover could not happen is dreadful but not unusual.

The sort of situation where a junior doctor is arriving at work to be presented with a situation outside of their remit of responsibility and physical capability is not unusual and it is a bloody disgrace. Patients are dying are doctors and not coping.

Doctors (and probably nurses but I don't know enough and haven't chatted about this with them) are routinely scraping though shifts with more acutely sick patients that they have hands to deal with, combined with multiple permanent rota gaps that mean they don't have any colleagues!

What are the options? Turn around and say this is unsafe, I refuse to treat these patients? Well, you'll get in BIG trouble for that, obviously. Jim over there needs resuscitating. If you walk away you'll be struck off. Do your best in an untenable situation? ANY slips up and you'll be pushed under the bus.

It's like removing the pilots and air traffic and control, and then bollocking the co-pilot for not managing to successfully land 5 planes alone.

But it's not the current governments fault, or the previous one, or the one before that. It's ALL of them. It's been a long time coming and it's a systematic and deliberate dismantling of the current healthcare model that spans all the major parties and governments (imo ).

There does come a point where we have to say no. I think that is done at a nursing level, often. We say 'No, we cannot admit another patient unless we have more staff. I know there is a physical bed, but we will not use it unless you allow us to staff up the shift.' Or in the case of Critical Care it would be 'we can take a level x patient but not a level y patient, unless you can find a ward bed for the patient who has been waiting for the last 3 days for one to become available....' The pressure will always be there to go beyond what is safe, but when you say yes, you become responsible and accountable. So you have to be clear that you can safely operate your area with the patients you're saying yes to.

It's no good saying yes and then not looking after the patients. And if you're short staffed, prioritise. What's life-saving, what's essential, what's important, what's ideal, what's nice to do?

-So who needs 1/2 hourly observations/fluid balance/visual check for improvement/deterioration/meds?
That's life-saving

-Ditto hourly, 2 hourly, 4 hourly, 6 hourly
-Who needs operations, investigations, etc?
-who needs positioning assistance?
-Who is nil by mouth or on a special diet/needs assistance with eating/swallow difficulties?
Who needs wound dressings?
Those are your essentials

• Who needs help with washes,?

Important

Anything else.... Can probably wait.