Struck-off Dr Hadiza Bawa-Garba wins appeal to work again

[LOAM]

Lets get some things straight here.

First doctors pay, she is a junior doctor so not that well paid base pay for 37h per week, we do 48 so do get paid extra for the extra hours. But its hardly big money.

Foundation Doctor Year 1, Year 1 £26,614
Foundation Doctor Year 2, Year 2 £30,805
Specialty Registrar (StR) (Core Training) Year 3 and 4 £36,461
Specialty Registrar, year 4 to year 9 £46,208


As others have said the buck did not stop at her, she was working under a consultant.

http://54000doctors.org/blogs/an-ac...ing-the-gmc-action-against-dr-bawa-garba.html

On the day in question:
The team were relatively new due to the February change over and Dr Bawa-Garba had not received Trust induction after over a years maternity leave

The registrar covering CAU did not attend. Dr Bawa-Garba was doing their job.

The consultant covering CAU was in Warwick. Dr Bawa Garba was doing their job.

Due to hospital IT failure the Senior House Officer was delegated to phone for results from noon until 4pm. For this period Dr Bawa-Garba was doing their job.

Therefore on this day Dr Bawa-Garba did the work or three doctors including her own duties all day and in the afternoon the work of four doctors.

Neither Dr Bawa-Garba (due to crash bleep) nor the consultant (due to rosta) were able to attend morning handover, familiarise themselves with departmental patient load and plan the day’s work.

Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning 4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls.

Even when the computer system was back on line, the results alerting system did not flag up abnormal results.

The patinet jack was given a blood pressure lowering medication (enalapril) by his parents which may have precipitated the arrest/death of the patient which was not prescribed by Dr Bawa

If anything they should have prosecuted Jeremy Hunt.

 

[SexyGreyFox]

the GMC are the investigating body. They are the regulatory body for doctors for this purpose. Noting loopy about them doing the investigation,

I send a lot of stuff to the GMC and they are ruthless, if they have cleared her I trust their judgement.

Not anywhere I’ve worked in the last 10 years (including the LRI where Jack died) have I come across anything I’d consider even close to hushing up. The culture has changed significantly in the period I’ve been practising, very much for the better.

I've worked in the NHS Legal system for 8 years and if there's one thing I can say is that Clinicians will give each other up in a heartbeat.
When asked for reports it is quite common for a Clinician to admit Breach of Duty.

 

[tom_nieto]

I send a lot of stuff to the GMC and they are ruthless, if they have cleared her I trust their judgement.

The GMC did the opposite and struck her off the register. They went against the expert panel which suggested a ridiculous amount of mandatory retraining (which every doctor would probably benefit from as training can be very limited in the NHS sometimes) and then a year suspension. The GMC decision was overturned in the high court.

The regulatory body isn’t the most frightening aspect, it’s being laid open to criminal charges when making an isolated mistake under complex circumstances that is terrifying.

 

[Tefal]

The doctor who pulled the head off the baby is back working again too

 

[aoaaron]

If you read into detail about the case from a semi-medical educated point of view, its actually really sad for everyone concerned.





Firstly, the department is understaffed to the extent that one registrar is covering multiple registrar posts. At this point common sense should prevail that a consultant steps down and provides cover on the ground.
Paediatrics is a VERY senior led speciality in most areas and its common in places where I've worked its VERY consultant-led.

Secondly you have IT issues which makes the job incredibly hard as all results, images we see processed are via IT. It makes EVERYTHING slower and sadly people are usually not more helpful, for example in this case the person handing over the results on the phone could have easily highlighted results which were deranged. Again the bottom line is if you work in a system which demands perfection, there should be fail-safe measures in place for when IT systems go down.

There was also an issue with the venous gas machine from what I read. So the first gas showed a very poor pH around 7 and a lactate of 11... according to the panaroma report, the second gas did not have a lactate but showed an improved pH. Sometimes the lactate is supposedley due to the sample clotting but commonly its the machine playing up.

Then you have a CONSULTANT, this is a senior clinician, who is aware of the poorly child and decides not to review despite knowing they are short on the ground with new trainees. This to me is the VERY VERY scary point. What is the point having a consultant if they do not take responsibility during an understaffed and dangerous period of time in a paediatric department...


Even if a CONSULTANT had made the errors Garba did up to this point, I'd be very forgiving of someone who is very much so evidently trying to fulfil multiple human roles as one person. No matter how good you are, you can NOT be in 2 places at once. Doing an LP on a patient for suspected meningitis which she was doing sadly is very important and can be a very time-consuming task. Its also something only the reg + consultant can normally do in paeds. Then being asked to also attend to a poorly patient is also hard.

Also the issue with the antihypertensive medication I believe being given to the patient despite it not being prescribed.. its very very hard to blame this on the registrar. According to the panaroma review, she was not asked but a different nurse + junior were asked if they could give the medication. Common sense prevails in a senior-led speciality where children can deteriorate quickly with a patient who is poorly, that this question should be asked to the registrar or consultant at a minimum... or at leas the doctor who actually clerked in and saw the patient and is aware of what is going on. From what the program stated, it was a junior who advised the nurse of the policy that supposedley parents can give medications not prescribed...
This is also IMO a very very weird policy which is just asking for trouble. Outside of Parkinson medications, anti-epilipetic meds and basically any very ESSENTIAL medications, if you're in hospital for an acute issue, everything should be assessed by a clinician before you take it as sadly medications can cause a variety of presenting complaints due to the side effects.


Also to those highlighting the term REGISTRAR... a registrar is a TRAINEE. It can range from ST3 to ST7+ and an ST3 has only F1/F2 and then CT1/CT2 experience in their speciality. This can basically translate to a maximum of 2.33 years of paediatrics experience before becoming a ST3 reg and for something as complex as paediatrics, I'd hardly call that enough time/experience to be deemed near consultant level of seniority to be able command and steady and understaffed department on a busy day...






----
The one issue is the resuscitation and DNAR. I understand she was overworked but in reality, if you call of a DNAR once its in action, you need to be very calm as a senior member of staff. Checking the patients notes at a minimum and calmly asking the resuscitation team if they were aware before stopping it. However I believe the expert opinion was this did not contribute to him passing away.





Sorry for the rant.. just my 2 cents... Its so sad how the facts really aren't represented properly and things can be taken out of context.

When multiple components go wrong in a department with staffing as a very very important issue, I struggle to understand how one person can be blamed like she was.

 

[dowie]

The doctor who pulled the head off the baby is back working again too

That one is ridiculous.

 

[angel102]

IMO a doctor (especially a trainee) who loses a patient because they were set up to fail either by mismanagement, government underfunding or in this case both should never be punished.

If you put a work experience student in charge of a nuclear plant, cut the budget to less than it needs to function then lay off half the maintenance staff, then something bad will happen and holding the student responsible for the result is as stupid in that analogy as it was in this case.

I think I've seen that episode of the Simpsons.

 

[aoaaron]

Unforutely there are several very high profile cases of doctors doing similar and having their lives and careers left in ruin. All sorts of legal battles have been raging the last year or two over the issue. Particularly the Chris Day case:

https://www.bmj.com/content/357/bmj.j2235

This doctor blew the whistle on his employer for unsafe conditions. He had his training stopped by Health Education England, who fought tooth and nail not to be recognised as an employer wasting huge amounts of public cash and eventually lost. Years later is still waiting employment tribunal having finally proven who his employer was. He was also written off by the BMA, our main union, under very shady circumstances.

It’s feels a very risky time in our profession at the moment. If you go wrong you’re open to criminal prosecution, if you blow the whistle you’re left with your life in tatters, all whilst demand is increasing and funding is cut.

I don’t think Hadiza will be the only case of this type.

I wish the public knew more about the Chris Day case.

As a doctor I now advise everyone have a second source of income.

 

[Orionaut]

Medical professionals are human and they will get it wrong..

I think it is rather more subtle than that.

The development of the high tech aspects of medicine, particularly over the last 20 years or so has deluded both the public (And possibly even the medical profession itself) into believing that Medicine is a technical profession carried out by trained technicians who either get it right by following the procedure or dont because they didn't.

It isn't. Fixing people is not like fixing mass produced machines. Medicine (And particularity, surgery) is a very much a craft skill.

(And even fixing machines is more of a craft skill than many people would believe. There is a lot of instinct and gut feeling involved and yes, some Mechanics/Technicians have better instincts than others)

At the very least, some practitioners are simply better than others, it doesn't mean that the less effective are incompetent or negligent. It is simply that they are just not as good.

And people are not mass produced machines. Every one is different. The treatment that cures 99 patients might well kill the 100th, even with everything else all seeming to be equal.

This is actually why Doctors and surgeons really need a fair degree of latitude when it comes to making errors.

With craft skills, screwing up is actually one of the more important parts of the learning process, it really is how one gets better at it.

The Artisan who has never screwed up is the Artisan who has never learned anything more than he has been taught!

 

[angel102]

I think people expect doctors to be gods and never make mistakes either, the problem is often the very worst days of peoples lives are guided by the actions or inaction of medical doctors, and like others have just pointed out, they are still human no matter how many years of training and experience they have built up.

 

[aoaaron]

I think it is rather more subtle than that.

The development of the high tech aspects of medicine, particularly over the last 20 years or so has deluded both the public (And possibly even the medical profession itself) into believing that Medicine is a technical profession carried out by trained technicians who either get it right by following the procedure or dont because they didn't.

It isn't. Fixing people is not like fixing mass produced machines. Medicine (And particularity, surgery) is a very much a craft skill.

(And even fixing machines is more of a craft skill than many people would believe. There is a lot of instinct and gut feeling involved and yes, some Mechanics/Technicians have better instincts than others)

At the very least, some practitioners are simply better than others, it doesn't mean that the less effective are incompetent or negligent. It is simply that they are just not as good.

And people are not mass produced machines. Every one is different. The treatment that cures 99 patients might well kill the 100th, even with everything else all seeming to be equal.

This is actually why Doctors and surgeons really need a fair degree of latitude when it comes to making errors.

With craft skills, screwing up is actually one of the more important parts of the learning process, it really is how one gets better at it.

The Artisan who has never screwed up is the Artisan who has never learned anything more than he has been taught!

Yup you're right, and this is really in the best of circumstances.

The fact people are asking the impossible in a understaffed, short-on-the-ground, under-funded system is whats really damning.

When the junior doctors all did their strikes, it wasn't for a joke.

 

[Meridian]

That one is ridiculous.

It has always been a risk of forceps deliveries, which is one reason among many why forceps deliveries have been almost completely abandoned in favour of ceasarians - which also have risks. As does every form of childbirth. There are two things that spring to mind here:

1) As is usually the case, we are only hearing a small part of the story from the papers and main media. This is then tailored to whatever the editorial slant of the paper is. You need to do a fair amount of reading about to get a better idea of what happened.

2) As is usually the case, this was a person trying to do a job with inadequate resources. When she failed, she got the balem, not the people who failed to resource her unit properly. You get what you pay for.


I have a general rule for allocating blame when things go wrong. It's this: if everything had actually gone perfectly, and been a complete success, who would now be taking the credit? Well, they are to blame for any mess or disaster.

 

[Diddums]

Where is @dowie anyway? He stuck in the RSS realm again?

 

[Dr House]

If you read into detail about the case from a semi-medical educated point of view, its actually really sad for everyone concerned.





Firstly, the department is understaffed to the extent that one registrar is covering multiple registrar posts. At this point common sense should prevail that a consultant steps down and provides cover on the ground.
Paediatrics is a VERY senior led speciality in most areas and its common in places where I've worked its VERY consultant-led.

Secondly you have IT issues which makes the job incredibly hard as all results, images we see processed are via IT. It makes EVERYTHING slower and sadly people are usually not more helpful, for example in this case the person handing over the results on the phone could have easily highlighted results which were deranged. Again the bottom line is if you work in a system which demands perfection, there should be fail-safe measures in place for when IT systems go down.

There was also an issue with the venous gas machine from what I read. So the first gas showed a very poor pH around 7 and a lactate of 11... according to the panaroma report, the second gas did not have a lactate but showed an improved pH. Sometimes the lactate is supposedley due to the sample clotting but commonly its the machine playing up.

Then you have a CONSULTANT, this is a senior clinician, who is aware of the poorly child and decides not to review despite knowing they are short on the ground with new trainees. This to me is the VERY VERY scary point. What is the point having a consultant if they do not take responsibility during an understaffed and dangerous period of time in a paediatric department...


Even if a CONSULTANT had made the errors Garba did up to this point, I'd be very forgiving of someone who is very much so evidently trying to fulfil multiple human roles as one person. No matter how good you are, you can NOT be in 2 places at once. Doing an LP on a patient for suspected meningitis which she was doing sadly is very important and can be a very time-consuming task. Its also something only the reg + consultant can normally do in paeds. Then being asked to also attend to a poorly patient is also hard.

Also the issue with the antihypertensive medication I believe being given to the patient despite it not being prescribed.. its very very hard to blame this on the registrar. According to the panaroma review, she was not asked but a different nurse + junior were asked if they could give the medication. Common sense prevails in a senior-led speciality where children can deteriorate quickly with a patient who is poorly, that this question should be asked to the registrar or consultant at a minimum... or at leas the doctor who actually clerked in and saw the patient and is aware of what is going on. From what the program stated, it was a junior who advised the nurse of the policy that supposedley parents can give medications not prescribed...
This is also IMO a very very weird policy which is just asking for trouble. Outside of Parkinson medications, anti-epilipetic meds and basically any very ESSENTIAL medications, if you're in hospital for an acute issue, everything should be assessed by a clinician before you take it as sadly medications can cause a variety of presenting complaints due to the side effects.


Also to those highlighting the term REGISTRAR... a registrar is a TRAINEE. It can range from ST3 to ST7+ and an ST3 has only F1/F2 and then CT1/CT2 experience in their speciality. This can basically translate to a maximum of 2.33 years of paediatrics experience before becoming a ST3 reg and for something as complex as paediatrics, I'd hardly call that enough time/experience to be deemed near consultant level of seniority to be able command and steady and understaffed department on a busy day...






----
The one issue is the resuscitation and DNAR. I understand she was overworked but in reality, if you call of a DNAR once its in action, you need to be very calm as a senior member of staff. Checking the patients notes at a minimum and calmly asking the resuscitation team if they were aware before stopping it. However I believe the expert opinion was this did not contribute to him passing away.





Sorry for the rant.. just my 2 cents... Its so sad how the facts really aren't represented properly and things can be taken out of context.

When multiple components go wrong in a department with staffing as a very very important issue, I struggle to understand how one person can be blamed like she was.

Nicely put.

I simply can not understand how Home meds can be given on the ward it’s asking for trouble.

This chase has changed the way we all practice medicine and not for the better.

 

[aoaaron]

Nicely put.

I simply can not understand how Home meds can be given on the ward it’s asking for trouble.

This chase has changed the way we all practice medicine and not for the better.

Yup, that policy really drives my mind into overdrive. There are many acute medications which have contra-indications to normally taken medications.. lets not even take into account this was PAEDIATRICS where you commonly see the BNF being opened to double check every single drug dose by everyone who is not a registrar (... heck I see consultants CONSTANTLY using the BNF in paeds and I think thats how it should be given dosing can be a pain in the butt)..

Its made me personally realise that medicine cannot be my sole form of income after the Chris Day and now this case.

 

[tom_nieto]

Its made me personally realise that medicine cannot be my sole form of income after the Chris Day and now this case.

Where will you find the time to generate a second income?

 

[aoaaron]

Where will you find the time to generate a second income?

I've already done it via investing in property.

But in general, yes its challenging but thats life.

 

[angel102]

Nicely put.

I simply can not understand how Home meds can be given on the ward it’s asking for trouble.

This chase has changed the way we all practice medicine and not for the better.

I got told off by a nurse for taking mine once when i was admitted, didn't even think the hospital would issue their own meds when I already had mine on me. She was attractive though, so I didn't mind.