On this day, Jack Adcock, a six year old boy with Down’s Syndrome and a heart condition, was admitted to the Children’s Assessment Unit at Leicester Royal Infirmary, suffering from diarrhoea, vomiting and difficulty breathing.
This was Dr Bawa-Garba, was an ST6 doctor (a senior trainee paediatrician), recently returned to work from maternity leave and has been described as having an ‘impeccable’ record.
Dr Bawa Garba first saw Jack at 10.30 a.m. that day. Dr Bawa Garba arranged appropriate tests and prescribed appropriate treatment for him.
At 10.44 a.m. the first blood gas test was available and showed a high lactate reading which was a very real cause for concern. X-ray results ordered by Dr Bawa Garba became available around 12.30 p.m. and showed that Jack was suffering from a chest infection.
At the time at which the x-ray results became available Dr Bawa Garba was busy treating other children but was available to review Jack’s x-ray at 3 p.m. In any event, Dr Bawa Garba had not been informed that the results of the x-ray were available until then. As soon as Dr Bawa Garba saw the results of the x-ray, she prescribed antibiotics.
In addition, despite Dr Bawa Garba ordering blood tests shortly after she first saw Jack, there were failings in the hospital’s computer system that meant that Dr Bawa Garba did not receive the results until later that afternoon.
Dr Bawa Garba, during handover, provided all relevant information relating to Jack but did not ask the Consultant to review him. This discussion with the consultant took place at around 4.30 p.m. and later that evening, Dr Bawa Garba spoke to the same consultant but again did not raise any further concerns.
Another concern raised throughout this case is that Dr Bawa Garba did not discontinue medication for Jack’s heart condition and as a result, Jack was given his evening dose by his mother at around 7 p.m.
At around 8 p.m. Dr Bawa Garba was one of the doctors who responded to an emergency crash call which related to Jack but she called off the resuscitation after confusing Jack with a different patient. Resuscitation re-commenced once the mistake had been realised, after a period of between 30 seconds and two minutes.
Opinion is that his mistake did not, however, contribute to Jack’s death as his condition had already deteriorated by the time resuscitation commenced and he died of sepsis at 9.20 p.m.
On 4 November 2015 Dr Bawa Garba’s trial took place at Nottingham Crown Court and she was convicted of gross negligence manslaughter. She received a 24 month suspended sentence on 14 December 2015.
In the meantime, Dr Bawa Garba had also been referred to the General Medical Council (“GMC”) who conducted an investigation and referred Dr Bawa Garba to a Medical Practitioners Tribunal Service (“MPTS”) Fitness to Practise Panel hearing.
In June 2017, the MPTS suspended Dr Bawa Garba’s registration for 12 months despite the GMC asking for her name to be erased from the medical register, stating that erasure or a “striking off” would be “disproportionate”.
Under new powers available to the GMC since 2015, in December 2017, the GMC decided to appeal this decision to the High Court and argued that the MPTS Fitness to Practise Panel had been “wrong” when it decided to suspend Dr Bawa Garba as they submitted that her name ought to have been erased from the medical register.
On 25 January 2018, the High Court decided that the GMC appeal should be allowed and her name was then erased from the medical register.
Mr Justice Ouseley, hearing the High Court appeal, brought by the GMC stated, “The Tribunal did not give the weight required to the verdict of the jury, and was simply wrong to conclude that, in all the circumstances, public confidence in the profession and in its professional standards could be maintained by any sanction short of the erasure indicated by the Sanction Guidance…”
In the light of this case, a group of international doctors began to accuse the GMC of treating doctors from ethnic minorities differently to their white colleagues. A funding campaign then began because Dr Bawa Garba was a junior doctor, working under extreme pressure to keep children under her care safe, without the input or assistance from a supervising consultant. As a result of this campaign which had raised £366,289 by 26 January 2018, Dr Bawa Garba decided to seek permission from the Court of Appeal to appeal the decision of the High Court.
Her application was dated 28 March 2018.
The Rt Hon Lord Justice Simon gave Dr Bawa Garba permission to appeal to the Court of Appeal stating that the second appeal test was met “in all respects”.
In order for this test to be met, a case must have a “real prospect of success” and “raise an important point of principle or practice” or “require some other compelling reason for the Court of Appeal to hear it”.
The Rt Hon Justice Simon stated, “having rejected the GMC’s argument that a gross negligent manslaughter conviction should lead to erasure in the absence of (truly) exceptional circumstances, it is properly arguable that the Divisional Court applied an equivalent test in allowing the respondent’s appeal.”
It remains to be seen what the Court of Appeal will decide in this landmark and interesting case.
This case shows illustrates the difficulties faced by junior doctors working under extreme pressure in the NHS with no or little of the required support.
Granted, mistakes were made in this tragic case but system failings also played a substantial part in relation to Jack’s care and treatment.
The complexities of both criminal cases, cases at the Medical Practitioners Tribunal Service and the appeals process for cases of this nature are highlighted. Any investigation can be a daunting prospect for doctors with little or no knowledge of the legalities of this often complex area of the law.
If you are a doctor facing a criminal investigation, a GMC investigation, an MPTS Fitness to Practise Panel hearing or if you a doctor wishing to appeal a decision made by the MPTS, please do not hesitate to contact our specialist team on 0161 827 9500.