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

Viva Enalapril is a pretty commonly used anti-hypertensive, I have administered it a fair few times on the maternity ward

That is a shocking chaotic environment description of what happened on the day in question - no one should be asked to work in that kind of pressure, those were management and organizational failures, and horrendous treatment of the Dr and Nursing staff in the investigation.

How can we complain/make it known how utterly unacceptable that working environment was, and their subsequent scapegoating??

If I get a patient winding up into a rant, almost always in the waiting room, 5 years ago I might've deflected, calmed, apologised. I don't any more. I remain professional, and polite, but I will say words to the effect of 'Unfortunately, sir, the crisis in the NHS that you hear about- well, here it is in action. We hate the pressure of being 2 hours behind by 11am as well, It writes off any chance of any breaks for any of us today. Now, would you like to come with me?'

Brilliant post. I work in a GPs surgery, so a much less pressured environment (though I have worked in a psychiatric ward previously, so am aware of the stresses hospitals face). In the psych ward though, abuse was easier to deal with, as there was a medical reason for it. In my job now, there are people who could be mates with your mum, lovely well people, screaming personal abuse in your face. The pressure is a lot more in a hospital though of course.

Nevertheless, when I'm screamed at for patients not being able to get non emergency appointments for two days (which is actually very good comparatively), or patients waiting for 1 hour+ for our same day emergency clinic, this is what I say too. Have you heard what's happening to the NHS? This is it.

I'm not comparing as I know GPS are in better nick than hospitals by a long stretch, but still, we get paid much less and for many less types of appointments than previously. We've just reached 40k patients. We're actually brilliant compared to other practices, but patients used to a same day service twenty years ago are convinced we're all disgraceful. I take complaints that will be escalated to the GMC every day (mainly in relation to reluctance to prescribe benzo's early, funnily enough).

We try our absolute best to accommodate patients to keep them out of A&E. But when they are absolutely furious to wait two days for a sore ankle that they've had 3 weeks etc. Or can't believe their non repeat prescription can't be done for them on the spot. Hello?! Do you read the news. Vote for a party that gives a shit, and hopefully me and my colleagues can provide the top notch primary care that we want to.

I feel the pain. I've had excruciating sinusitis for 2 weeks now; I desperately need antibiotics. I'm having to take cocodamol well over the 3 day limit as my Doctors can't find me an appointment for 10 days. It's shit.

Anyway, expecting to get flamed as I know my job is much less stressful than in a hospital (one of the main reasons I changed jobs). But just wanted to say that we all are feeling these cuts.

And god bless that little boy. And that poor doctor. I'm going to be writing a letter to the GMC. And may raise it for discussion at our staff day next week, to get some more Doctors on her side, if they've not read about it already.

Lougle

I agree, there were definitely mistakes made, for which she is answerable. I am not suggesting that she did not make clinical errors- clearly she did.

But, I think being struck off, given the context of extreme workload and the many systemic failures also at play, is not the right course of action for the GMC to take. I find their use of the Dr's reflective practice from her portfolio particularly concerning.

Why are not the trust responsible for putting her in that whole situation .? They bid for the contract , they are the employer .

I feel for the parents of this child, but unfortunately with the way money is trying to be saved by the NHS, year on year Health Bodies have to make cutbacks - this will happen again and again - no way am I saying that this is the fault of health professionals, they are pushed to their limit, I'm not one but I've seen the burn out of them, people can't sustain this work environment

I feel desperately sorry for the poor parents of that poor wee lad. But it looks to me as though Dr Bawa-Garba has been scapegoated.

What were her options, when she arrived for her first acute shift after maternity leave, and discovered that she was doing the work of several doctors, with IT systems down, her consultant teaching off site in a different town, and multiple incoming poorly patients?

If she had refused to work, she would have been struck off.
If she had whistleblown, she would have been suspended, lost her training, and probably struck off (based on what happened to Dr Chris Day, who tried to raise concerns about being forced to work in a similar situation)
So she tried to do her best in an impossible situation. And it wasn't good enough. But if she'd spent all the time with poor Jack that he needed, then perhaps it would have been the baby she was screening for meningitis that died (mention of her doing an LP in a baby).

The pH and lactate numbers, although improving, were worrying. But there is documentary evidence that she told the consultant, because the consultant wrote them down in their notebook, then complained the trainee should have stressed them to him. Who the fuck is meant to be the trainee, and who the consultant in that situation?

The GMC said, basically, that she had to be struck off because the courts had found her guilty. But the prosecution managed to stop most of the systems failure evidence being presented to the jury. And the previous fitness to practice team, who had considered all the evidence, had considered that it was so mitigating that suspension was appropriate, not striking her off.

There is more than one victim in this case. And the victims will include the patients that die because of how far back this has set the cause of patient safety reporting systems.

(I am a doctor. I have never worked in that hospital. I do not know any of the doctors involved. I have spent most of the evening reading up on the case)

It is utterly horrifying. Someone very close to me is a junior doctor and this case has shocked them all to the core, they will no longer commit any reflection to writing for fear of it being used against them if something goes wrong. As juniors they rotate onto a new department every four months, the one I know extremely well rotated onto a new ward two months ago and was given zero training, was in charge of 30 new patients, consultant was elsewhere and he had to spent a fifteen hour workday simultaneously trying to figure out how to run the ward and also doing everything with little support. Then go home and spend hours revising the health conditions he came across that day to try be better prepared the following day. Two months in he's managed to cut his average workday from 16 hours down to 11. He's contracted for 8. These are brand new doctors btw, yes they're smart and qualified but medicine is so vast and they have so little proper workplace experience carrying all of the responsibilities they do now, that it's massively negligent not to provide any guidance or training or time to acclimatise to the systems and how they work. It's just show up on the first day of rotation and fingers crossed. Many of his workmates are trying to find a way out of medicine, less than a year after qualifying and leaving uni.

That poor woman. Completely scapegoated. I understand the deceased's parents are and will forever be distraught, but his mother's quote on the BBC article about being glad she was struck off was disgusting. Has she read the same info as the rest of us? A skilled empathetic hard working woman's career is over, that isn't going to bring their son back, yet it will surely affect sick kids in the future with one less paediatrician to care for them. And the kicker is there's no evidence it was her fault. She did the best she could with the knowledge she had in incredibly difficult circumstances. She was clearly suffering from extreme exhaustion trying to do the job of multiple doctors. I agree with PP saying it's a travesty she's been struck off. Conveniently blame the doctor instead of placing blame on the system being stretched and underfunded and understaffed, as if the blame was placed there there'd be some difficult questions about what to do to prevent it happening again. Fire the doctor and the ignorant think the problem is solved. Shocking.

Brilliant post, snow. I wouldn't do my OH's job for £1m per year. Every day is fear. As PP have mentioned, in this scenario of spinning plates, if she'd somehow been able to take more time with the deceased boy it could easily have been another child who died. It's almost inevitable, sadly.

To those talking about not admitting liability through apologising, familiarise yourself with the uk compensation act 2006. Which states that an apology is not an admission of guilt admissible in court. Ironically, an apology often reduces the chance of a court case or being sued, yet there's such a widespread belief that doing so will mean you're admitting mistakes people don't.

lougle I know more about blood gases and sepsis than I care to. I certainly know enough not to judge someone's management of a blood gas based purely on the pH and lactate - I'd have to know whether it was arterial or venous, what the O2 and CO2 levels were, what the bicarb was, whether the patient was on oxygen or not - before I'd venture an opinion on someone else's management.

I will say that if someone has a pH of 7 which improves to 7.24 with one bolus of fluid to the extent that they are "playing, drinking juice from a beaker" they may well be better off on a paediatric ward (which should have staff used to looking after sick children) than on an adult ICU. Does this hospital even have a PICU? Many don't, mine included. We would manage the patient on the children's ward here (or fly them elsewhere, and he doesn't sound sick enough to warrant flying out).

From reading the reports linked, I think this doctor has been very unfairly scapegoated. I don't know why.

It used to be common practice to blame the doctor rather than the systems failings when things went awry. It is easier to blame the doctor than change the system, because changing the system costs money.

It's time that, rather than blaming an overworked, stressed junior - who sounds as though she had had an exemplary record prior to this - we blamed the managers. Who made the decision to allow the consultant to be out of the area during their call? Who made the decision to allow a junior to cover their job rather than requesting one of their consultant colleagues cover for them? Who allowed the CAU junior to be away without cover? All of these will be decisions made at management level, due to costs.

The most important question I would ask is - who gave him the enalapril? It's the last thing you want to give to someone who is intravascularly dry with potential sepsis. If it wasn't prescribed, why was it given? If it was prescribed, who prescribed it? If it was given then it should have been signed for somewhere, or documented somehow.

This poor doctor has been completely hung out to dry, as a cover up.

I am ever more grateful I left the NHS 9 years ago.

Great posts LemonShark - doctors are human, not God and sometimes people do die (well we all die eventually) the NHS is so stretched we cannot blame HCPs for deaths when they are run ragged and trying to do the job of several people. I could rant forever so I'll shut up now,

I worked in that hospital around that time. Thankfully as a junior (SHO), because I always thought the registrars had it really tough. There are six big wards, an assessment unit (which frequently saw 60+) patients a day and a CICU. At night there are two registrars, one covering CAU and the wards and one covering CICU. Sometimes though the CICU reg would go on transport and the paeds reg would cover it all.

I am now a registrar and this sort of thing terrifies me. I came on tonight with about eight waiting to be seen, and a septic child who needed a really close eye on the ward. My SHO is a trust grade who won't do bloods and cannulas and who I don't really trust so I have to see all the patients myself. It is very stressful. I have just sat down with a drink and a stack of paperwork, because I have just caught up.

She made mistakes...... But there but for the grace of god go I! Plus I don't worry about this because I'll get bloody struck off! I worry about this because I will have a child's death on my conscience for ever- I dread that more than anything.

I have written to complain. I do understand why Jacks mum’s reaction. It is natural to want to see someone held accountable. It gives her someone to blame and hate. She will probably want that even more if she in fact administered the elanapril herself.

The whole situation is tragic.

Put medical professionals in those circumstances and you will get preventable deaths. They are the natural consequence of our government's policies. I can't see it getting better. It's criminal.

Our government WANTS the NHS to fail, in order to bring in privatisation, and it is working to this end , So who is really responsible, Doctor, Nurse , admin or the people closing wards and cutting staff so there is no one to cover for missing staff.

This is an appalling case and the NHS deserves to lose doctors and nurses if this is the way they are treated by their governing bodies.

MissDuke. Must be our place then that doesn’t use it. I’ve worked on a labour ward for ten years and never heard of it before this case, even checked the brand name and not heard of that. I guess different hospitals must use different stuff.

I think her treatment was appalling. There was clearly a multitude of factors leading to this death, which was indeed tragic. She did make clinical errors. There isn’t a doctor or a nurse who hasn’t- usually the mistake is picked up or the mistake is of little consequence thankfully. And as a doctor every cases that I feel I’ve handled badly haunts me, even years later.

I have worked on risk registers and strongly feel that hospitals should investigate these cases on a no fault basis. We should be reporting all mistakes whether of consenquence or not and using them to develop safety net practices, offer retraining and generally making hospitals a safer place.

ST4 is relatively a junior registrar. She was just back from mat leave. She was covering the jobs of several people. She discussed the case with her consultant. She should have been supported by the hospital and the GMC.

Of course the child’s parents are devastated and want someone to blame. The blame lies with the system who allowed one junior so much responsibility.

All this case has done is erode public confidence even further and to make doctors and nurses fearful and unlikely to report errors or reflect on cases with seniors. I call that a bad result.

Hic I read elsewhere that the parents administered the drug, as they usually did at home. I don't know if that's right - I couldn't see it in the official reports.