A UK doctor’s medical registration has been reinstated after it was initially withdrawn when she was found guilty by a criminal court jury of gross negligence manslaughter of a young patient.
This case raises the issue of who should decide, and in what way, doctors are sanctioned for errors in the workplace. Dr Hadiza Bawa-Garba was a competent and committed doctor who made a serious mistake on one occasion in a seriously flawed hospital environment. It’s a positive message for young doctors everywhere that a person such as Dr Bawa-Garba has a road back from a tragic mistake. None of us is immune from errors. The difference for doctors is that theirs can lead to deaths.
What happened?
In February 2011, Bawa-Garba was a junior doctor who was completing her fellowship in paediatrics. She’s of Nigerian descent and had graduated in medicine from Leicester University in 2003. She had returned to practise at the Leicester Royal Infirmary after 15 months of maternity leave.
Bawa-Garba was not familiar with the Children’s Assessment Unit of the Infirmary that received patients from the Accident and Emergency Department and direct referrals from GPs. Its role was to assess, diagnose and treat children, or admit them to the Paediatric Intensive Care Unit.
On 18 February 2011, six-year-old Jack Adcock was unwell. Jack had a complicated medical history, having been born with a hole in the heart and Down syndrome, he required long-term medication and he was susceptible to coughs, colds and breathlessness. In the past he had had pneumonia.
His mother took him to the GP as he had been vomiting during the previous night and had diarrhoea. His breathing was shallow and his lips were blue. The GP referred him to the Children’s Assessment Unit where he was seen by Dr Bawa-Garba. For both it was to be a disastrous interaction.
At about 10.45am Bawa-Garba ordered a battery of tests, including blood and blood gases and a chest x-ray, which was not undertaken until 12.01pm. She ordered Jack be given fluids (but not antibiotics) and he responded positively. She was reassured. His blood gas tests, when done a second time at 12.12pm, were better and heading back toward normal levels.
The computers at the hospital were down and the ward was busy. Bawa-Garba did not receive the chest x-ray results until 3.00pm. She had not actively chased them up. They showed it was not a case of gastro, as she had suspected, but that Jack had pneumonia. His blood test results showed he had a Group A Streptococcal infection.
She prescribed antibiotics, which were administered at 4.00pm and he was moved onto a ward. While Jack was on the ward, his mother administered his usual dose of daily medication, contrary to doctor’s orders. That probably did not help, but the die had been cast.
At 4.30pm, Bawa-Garba spoke to the senior consultant who arrived on the ward for the routine handover. She did not urge him to examine Jack himself, so he did not do so. She also did not show him the blood gas results, but she did explain her treatment plan without raising concerns about Jack. She told him Jack had improved. She spoke to him again two hours later.
But by 7.46pm the sepsis from which Jack was suffering as a result of the pneumonia resulted in organ failure, including heart failure. Efforts were made to resuscitate him. They were confused for about a minute by a mistaken belief on the part of Bawa-Garba that Jack was subject to a not for resuscitation order. While it was a concerning error, it did not make a difference to the clinical efforts. He died at 9.20pm.
The consequences for Dr Bawa-Garba
An inquest was promptly convened and expert evidence suggested the care given to Jack by both Bawa-Garba and a nurse was inadequate and complacent. But it was apparent from the outset there were many systemic issues that had contributed to what had happened.
The hospital was dependent on agency nurses, the recording of patient observations by the nurses was grossly deficient and the computer systems were not working properly on the day. Bawa-Garba was only just back from maternity leave and not familiar with the hospital’s processes, and she was tired and over-stretched, like many junior doctors. She was asked to work a lengthy, almost double shift. She was not assertive with the experienced consultant who came to the ward at handover, and he did not examine Jack himself.