View from the ground, by Dr Punam Krishan
Healthcare professionals in Britain could face criminal consequences every time they work now.
In 2011, a little boy lost his life at the tender age of 6; it is a doctor’s worst nightmare when any patient dies under their care but this is intensified 10-fold when it is a child.
The death of Jack Adcock, under the care of Dr Bawa-Garba, has become a game-changer for both doctors and nurses as it raises serious concerns about the safety of their working environments. It also highlights the vulnerability of healthcare workers, under continual scrutiny, as they consider their future and whether their jobs are worth risking a criminal conviction for.
A catalogue of systemic failings has been identified in this case. Dr Bawa-Garba was working a typically standard paediatric shift except that her team was incomplete. Her consultant was out of town, the senior house officer was unavailable. Dr Bawa-Garba had recently returned from maternity leave and, without any hospital induction, was working a 12-hour shift covering CAU, the emergency department, and several wards. She was doing the job of three doctors, supported inadequately by agency nursing staff.
As if this was not enough, Dr Bawa-Garba faced IT failures, resulting in a delay of at least 4 hours in the delivery of lab results. As we know, biochemical markers and radiology results are vital to monitoring response to treatment and determining further management, especially in children. Added to this chaotic scene was a rearrangement of bed spaces whereby Jack was moved without the doctor in charge being informed, a very common occurrence in hospitals due to endless bed crises. Last but not least, an unprescribed antihypertensive was given to Jack, who already had sepsis. All without informing the doctor in charge.
Jack later arrested. A crash team responded but resuscitation was unsuccessful. Dr Bawa-Garba was convicted. The end.
Or is it?
We have all been in situations similar to that of Dr Bawa-Garba. Even as I write, there are several Dr Bawa-Garbas working right now in ridiculously high-pressured circumstances.
We go into work switching off our personal lives and trying to forget how tired we are from the shift the day before. We face rota shortages, staff sickness, and exceptionally demanding patients and managers. As a GP, I have to review up to 40 patients face-to-face every day, no matter how I feel. This is on top of mountains of urgent admin work, telephone consultations, and home visits.
We have all experienced the nightmare when systems crash, needing test results but being unable to access them. How often does the whiteboard of patient names correlate with the bed numbers on the ward? We have all chased a patient around the hospital, sometimes discovering they have been discharged without physician consent due to bed shortages. We have all been there, we have all been Dr Bawa-Garba.
How then can convicting a doctor of manslaughter and permanent exclusion from the medical register be in any way appropriate? Doctors intuitively believe in doing no harm. Years of training mean that a desire to help people get better is central to their practice.
The doctor in question had a previously unblemished career. Her level of seniority meant that she had passed appraisals and was considered fit to progress in her training; she was deemed competent. How then did she suddenly become this dangerous criminal that the GMC felt they had to strike off?
Overlooking the flaws and failings of systems for patient safety, the GMC favoured restoring public confidence over restoring the confidence of doctors. With this case, the GMC has given the green light for people to point the finger at any doctor if the desired outcome is unpalatable. This has not restored any confidence in the public: doctors now look at their patients with fear and patients believe we could harm them.
We cannot express our errors, we cannot learn from our reflections openly and honestly for fear that they could be used against us. We, as a profession, are seriously panicking and nobody is listening.
There are simply no positive outcomes here. Instead of standing up and admitting that there were several factors that made this doctor’s job impossible to perform safely, our judicial system has used Dr Bawa-Garba as a scapegoat to make it all go away. It won’t go away. It will continue to happen again and again until the Government, the GMC, and the public support our plight and press for safer working environments.
I just wish the public could see us for what we are. We are not superheroes, to be elevated one minute and disgraced the next; we need compassion and empathy for the ridiculously hard work we do. The modern day world shouldn’t criminalise us; it should acknowledge that, like everyone else, we are only human.
In the wake of this case, the GMC has announced that: ‘… we will bring together health professional leaders, defence bodies, patient, legal and criminal justice experts from across the UK to explore how gross negligence manslaughter is applied to medical practice, in situations where the risk of death is a constant and in the context of systemic pressure. That work will include a renewed focus on reflection and provision of support for doctors in raising concerns.’ As doctors, we will be eagerly awaiting the outcome of these meetings, to see if they will provide any real and meaningful changes to address our concerns moving forward.