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

Agree with @HicDraconis- if a junior called me with that blood gas I would be going to see that patient or at the very least asking them to arrange an ITU review. But we do manage patients with those numbers on medical wards- people with diabetic ketoacidosis, renal failure- It’s not always a case that they need to go to ITU immediately if the patient is responding and numbers improving. The problem is likely that she couldn’t follow up as often as she might have if she wasn’t covering multiple jobs.

Hic
"The thing is, high CO2 also gives low pH."

True, but, and this is just a guess...wouldn't put my hat on it, as he had severe diarrhoea, and was very breathless, I would lean towards a likely metabolic acidosis with him blowing off CO2 to compensate.

Did giving that enalapril contribute to the chain of events that led to his death? I'm not a medic so I'd like to understand.

It is our responsibility to acknowledge we cannot do the job we are tasked with
My DSIS is a paediatric staff nurse and she would absolutely agree with Lougle's point above. When it is a matter of sick children and life or death situations, someone has to take responsibility even if that means saying 'we can't do this'.
Yy the NHS has systemic failures. Yy that hospital seems to have major issues. Yy there were unexpected and unforseen problems with the IT failure. But ultimately, the doctor did confuse her patients and accepted running with a workload that was completely unmanageable.
Every day in the NHS, medical and nursing staff make the call that they can't do their job with the resources/staff available.Every day, there are medical and nursing staff arguing with their superiors about whether wards can run or more beds be filled. That's the reality.
Patients have to be able to trust that medical staff will complain and piss off their colleagues rather than try to run with an unsafe workload.

@WinnieFosterTether what was she to do? I’ve worked many many understaffed shifts. I’ve filled out safety reports, called colleagues to make them aware of the issues and made it clear it’s unsafe. But I have never refused to see a patient. You just can’t do that as a doctor. You can’t decide you won’t cover a ward if there is nobody available to do so.

That poor doctor. It will be no comfort to her, but I can't help thinking that she's better off out of there.

Not to mention the family of the young boy, who have been horrendously let down by systematic failures.

@lougle

That is absolutely terrifying about the policy of being able to give regular medications even if they are not prescribed!!

I have good friends who are hospital doctors- one complained after a night shift that she couldn't convince the nurse on the phone to give paracetamol without physically coming to the ward and writing it in the drug chart.

It sounds like an absolutely insane system, no doubt leaving many patients at serious risk of coming to harm.

I just don't understand how any competent nurse could give a medication to lower the blood pressure of an already very sick patient.

The baying for blood and general behaviour of the family is....distasteful and graceless.

I thought the same as @Lougle re. blood gas result and it seeming obvious that sepsis treatment was indicated on admission re. obs and condition - antibiotics were only prescribed after the chest xray was reviewed. But I work with an adult population who get septic quite often but tend not to have complicating conditions or meds I'm not familiar with. The consultant's comments seem unforgivable - if it was so obvious that a senior review was warranted on the basis f that info, why didn't he do on?! As a nurse, I like to think I would have escalated and bleeped the consultant if I was concerned re. untreated sepsis and not getting anywhere with the junior doctor or they were unable to attend due to workload. I have had to do this in the past but, again, I work with a high stakes, generally well, population and in a culture where this acceptable and expected.

lougle I agree. But we don’t know exactly what those other, highly relevant numbers were. In a normal child I’d expect a low CO2, but he had had corrective cardiac surgery and I have no idea what his cardiac physiology was like, if he had a shunt (more than likely) for example.

LemonShark he was seriously dehydrated from his gastro. Plus possibly other infections, as according to the report antibiotics were started after seeing a chest X-ray. Enalapril is part of a class of drugs that are used to lower blood pressure by regulating the system responsible for water and salt excretion - if you’re already volume depleted, a dose of enalapril could catastrophically drop your blood pressure. We usually withhold it on the day of surgery as it has a similar effect with anaesthetic drugs.

Apparently, one of the systematic failings that was discovered at the hospital, was that there was a cultural norm, that the doctor was unaware of, that medications that were normally prescribed for the patient, but had not been prescribed by the admitting doctor, could be given without prescription. The admitting doctor had decided not to give the enalapril, because it is an antihypertensive, and he was already underfilled, but she didn't document that she had decided to omit it, because she assumed that by not prescribing it, it would be omitted. In that hospital, to ensure it wouldn't be given, it would need to be documented that his usual drugs should not be given. Absolutely barmy in any other hospital, because legally, nurses can't prescribe drugs unless they are prescribers, they can only administer drugs that are prescribed.

That sounds like the sort of system established to avoid regular meds being missed due to being consistently unable to access SHOs to add them to drug charts. I can't believe pharmacy were happy about it.

Apparently, one of the systematic failings that was discovered at the hospital, was that there was a cultural norm, that the doctor was unaware of, that medications that were normally prescribed for the patient, but had not been prescribed by the admitting doctor, could be given without prescription. The admitting doctor had decided not to give the enalapril, because it is an antihypertensive, and he was already underfilled, but she didn't document that she had decided to omit it, because she assumed that by not prescribing it, it would be omitted. In that hospital, to ensure it wouldn't be given, it would need to be documented that his usual drugs should not be given. Absolutely barmy in any other hospital, because legally, nurses can't prescribe drugs unless they are prescribers, they can only administer drugs that are prescribed

This sounds like the perfect system where the swiss cheese model is demonstrated, an utter shit storm is going on and this is the straw that breaks the camel's back, so to speak.

SHOs do not purposely avoid coming to the ward to prescribe meds, they are often dealing with other urgent things elsewhere in the hospital (my limited experience, hearing this from junior doctors I know).

Plus, it's a very dangerous culture where ward staff robotically give regular meds...the clinical picture can obviously change, patients get sick and certain meds are stopped.

I guess that is the nature of medicine and working as a doctor- you don't just give regular meds because they are on the patient's list of meds- you make decisions based on the current picture, as Dr Bawa-Garba did in this scenario.

BadlyParkedRangeRover Sadly that's my take on this too. While she undoubtedly meant well, her actions in giving a hospitalised child medication without the knowledge or permission of the clinicians taking care of him, were dangerous and naive. Surely anyone knows that you don't give a patient under medical care medication of your own volition?

I doubt it's being reported as it doesn't fit with the 'scapegoat the doctor' narrative, and it looks heartless to acknowledge a grieving parent's role in the boy's death. But if true, it is a factor that contributed and I believe she should be publicly baying for blood and celebrating a woman's career being in tatters if she's aware she played a part.

It's all very 'deflect the attention onto others so nobody sees my role' sadly, whether she's doing it consciously or subconsciously. Either way it's tasteless. I guess if she did give the elanapril she'll know deep down for the rest of her life and have to live with that.

Thanks RangeRover. What a bloody mess for all concerned, but it’s a terrible situation to start throwing decent nhs staff under the bus. What’s this meant to achieve? I suppose it draws attention away from the awful working conditions.

www.google.co.uk/amp/www.leicestermercury.co.uk/news/local-news/parents-jack-adcock-celebrate-champagne-1116426.amp

Speechless

While I am sorry they lost their child, they're not covering themselves in glory behaving like this and going out of their way to publicise it. How that poor doctor must feel losing her career, her livelihood, and knowing that the press are painting her as some kind of demon while a family are squarely blaming her for their child's death is hard to imagine.

I'm so glad once you dig a little deeper than the shock headlines that the doctor has so much public support. I hope she's aware of that.

What I've just learned on this thread makes me even more outraged and angry at the way this doctor has been treated!

I took a quick google at the local papers in Leicester and I feel that the coverage is rather distasteful, given all this things that have come to light about the case & that this doctor has been truly hunted down by many parties and now her career is in ruins.

I wonder how she is coping? she has a young family apparently. I suppose for all the tabloids out there, portraying her as a monster who made error after error makes much more salacious reading.

A total and utter travesty.

*SHOs do not purposely avoid coming to the ward to prescribe meds, they are often dealing with other urgent things elsewhere in the hospital (my limited experience, hearing this from junior doctors I know).

Plus, it's a very dangerous culture where ward staff robotically give regular meds...the clinical picture can obviously change, patients get sick and certain meds are stopped.*

Exactly, the obvious solution is more doctors (or adequate doctors plus a system designed to ensure regular meds are incorporated appropriately at the point of prescribing/ admission), not to allow a slide into dangerous complacency. I completely agree that this was an incident waiting to happen as a result of this policy.

I don’t think it’s fair to judge a bereaved family. Presumably they see this as justice. They aren’t in a position at this time (for many reasons) to be objective about the situation. I’m sure the past few years have been hell for them.

We should however expect hospital management, the CPS, courts and GMC to be objective and see the bigger picture.

I'm a peadiatric nurse in a large teaching hospital. The way this Dr has been treated is appalling. Enalapril isn't kept on most wards as stock and would be orders on a named patient basis. It is very unlikely that the nurse gave it, if it wasn't prescribed on the drug chart. I don't see how the doctor can be blamed for giving it, if she didn't prescribe it.

@lougle I’m sure she reflected in her mistake to not involve icu. But it wasn’t just her mistake was it. Why did the a&E dr not involve icu. Why did the a&E nurse feel happy to send to general ward. Why was paeds ward happy to accept. Why didn’t consultant review when knew of gas. It is never just one mistake it is systems failure as in this case

i am still concerned at the mix up over 2 patients.
and I think making nasty comments about the parents is sick. they are the parents of the child who died. they will know a lot more about this than people on here.