The Bawa-Garba case is one that shook the medical world and arguably highlighted the ‘blame culture’ that exists in the NHS and health systems worldwide. The case is based around the circumstances of 6-year-old Jack Adcock’s death in February 2011. Jack Adcock, who had Downs Syndrome, was brought into the Royal Leicester Infirmary with nausea, diarrhoea and breathing problems. A large part of the tragedy of this case was caused by a technical system failure which occurred in the hospital computers on the day that Jack was taken to hospital. Dr Bawa-Garba, who was the paediatric registrar in charge of Jack’s care, ordered a chest x-ray and blood tests, but due to the technical fault, these were not available to view until 6 hours after they were carried out. When they did become available, they indicated a chest infection, and so Dr Bawa-Garba immediately prescribed antibiotics, which were given to Jack an hour later. The blood results demonstrated a severe infection, although it is difficult to ascertain whether the severity of this was understood by Dr Bawa-Garba at the time. While handing over to a consultant, Dr Bawa-Garba mentioned Jack’s case, but no one made the decision to go and review him again in person. As well as this, Jack had pre-existing heart problems which required certain medications, and these were not to be used in conjunction with the antibiotics. Jack’s parents were not informed of this, so that evening they gave him his standard medication. An hour later, Jack became extremely ill, and a crash call was put out for resuscitation. Dr Bawa-Garba answered the call, but mistook Jack for another child who had a do not resuscitate order, and delayed CPR for about a minute, before realising the mistake and continuing. Jack died at 9:20pm.
Dr Bawa-Garba was suspended from working, and later struck off the GMC medical register, which meant that she was unable to work as a doctor. This caused major outcry, as the death of Jack Adcock was not solely Dr Bawa-Garba’s fault: although she did accept that she made mistakes which contributed to Jack’s death, she was working in less than ideal conditions, with many absent staff and a computer system with technical faults. This case lasted all the way until 2018, at which point Dr Bawa-Garba was allowed to work as a doctor again, but at a much less senior position and also under strict supervision from a variety of peers to prevent against further negligence.
What was the Bawa-Garba case?
The Bawa-Garba case involved Dr Hadiza Bawa-Garba, a junior doctor, and Jack Adcock, a 6-year-old child who was admitted to Leicester Royal Infirmary under her care. He died on the day that he was admitted, partially due to failings that had been made in his treatment. Bawa-Garba, along with a nurse, was found guilty of manslaughter through gross negligence, and struck off the professional register. Bawa-Garba would go on to have the decision overturned at appeal. Much debate was made over the use of her reflective notes as evidence, and about her role vs the role of the system that she found herself in (e.g. a consultant that didn’t properly supervise her).
What lessons can we learn from it?
We should consider how systemic flaws in hospitals can impact both patient care and the doctors and nurses responsible for providing that care. We should ensure that doctors’ reflective notes are not to be used as evidence in trials, or it will impact their personal professional development, as they will feel that they cannot properly reflect on negative incidents. We should reflect on how and why consultants should become involved in-patient care, and whether there could be clearer protocols for when junior doctors can involve their consultant. Consultants should make a real effort to be approachable, and to ensure that handovers are of a good enough quality to guarantee patient safety.
What went wrong?
Bawa-Garba was unfamiliar with the Children’s Assessment Unit yet would receive little help with this. Jack Adcock was a complex case, and tests would take more than an hour to be performed after being ordered. After Jack was given fluids, he showed some improvement – however, his chest X-ray showed pneumonia, yet was not shown to Bawa-Garba until late in his admission, due to the hospital computers being down. His mother gave him his normal medications, despite being told not to do so by the doctor. The senior consultant, despite being urged to examine the boy by Bawa-Garba, elected not to do so after handover – he was not shown worrying ABG results, and was told that Jack had improved. Later that same day, Jack’s sepsis as a result of pneumonia would go on to cause organ failure – and a mistaken belief on the behalf of Bawa-garba that Jack was subject to a DNR led to a delay in resuscitation.
How might she have reacted differently to save Jack Adcock’s life?
Bawa-Garba was to some extent a victim of circumstances. However, she did make serious errors. She didn’t ask the on-call consultant to review Jack during the handover, despite sharing worrying lab results with him – as evidenced by the consultant having these in his notebook. The consultant explained that he would have expected Bawa-Garba to stress worrying results to him. She also did not make it clear enough to the patient’s mother not to give enalapril – although she did omit it from the drug chart. She also confused the DNR status of the patient, although this would have little impact on his fate. She should have called the consultant to see the child at handover and communicated better with the parent.
Was it fair for her to be struck off the register?
I believe that the decision was fair, although some of the methods used to reach it were not so. All junior doctors in the UK must work in an environment lacking in staff, resources and time – but this doesn’t mean that mistakes like this can be seen as permissible. The court labelled her mistakes as ‘not simply honest errors, but truly exceptionally bad.’ A septic patient should be noted and treated as such, and a medical student would be aware of this – so we should expect a senior trainee to be more than capable in this situation. She also failed to communicate with the patient’s parents adequately, which directly contributed to his death, and also failed to communicate properly with her consultant – who would have had the knowledge and expertise to realise the severity of Jack’s condition. In order to show respect to the family of the patient I believe that the correct decision was made – although her personal notes should not have been used in the case against her.
Was it right that she was reinstated onto the register?
I believe that the decision to reinstate her was the correct one. She did not simply return to the same level and status as before, with no changes made. Instead, she must resume work at a lower grade than before, having undergone a significant amount of remedial work. She will be closely supervised whilst she returns, and a tribunal has decided that she will be unlikely to put another patient at any risk of harm. Therefore, a phased return seems a fair option for Bawa-Garba.
Should doctors shoulder the blame for a patient’s death in a situation like this?
Doctors should not shoulder the blame for the failings and errors of the system in which they work. Therefore, if the issue was one entirely of failings of the hospital, rather than those made by a doctor, I would argue that doctors should not be scapegoated. For example, if the death was due entirely to delayed tests and computer errors making a diagnosis and effective treatment entirely impossible, then blaming the doctor would be unfair. However, ‘in a situation like this’ we must acknowledge the culpability of the doctor as well – and also acknowledge that the nurse treating Jack Adcock was struck off too. This isn’t a case of unfair treatment of a doctor, rather of both a doctor and a nurse taking the blame for both their own actions and, to some extent, failings of the system around them.
What mitigating factors were present in the Bawa-Garba case?
There are multiple mitigating factors in the case. Chief amongst these is the hospital computers being down, leading to a delay in Bawa-Garba seeing the CXR. She was also unfamiliar with the area of the hospital in which she was working. She was also unaware of the hospital’s policy on parents giving regular medication to their children – although she should have communicated better with the parents. Her senior consultant should perhaps have checked on Jack as soon as he heard the lab results, rather than relying on Bawa-Garba to ask him. Her confusion over the DNR was caused by Jack being moved into the bay of another patient who did have a DNR in place, and only lasted for around two minutes until she realised her mistake.
While talking about any case, the best approach is to talk about both sides of the argument. This ensures that you are proving to the interviewer that you can balance arguments and see the bigger picture, rather than just focussing on one opinion. In, addition to this, it is extremely important to bring in the four principles of medical ethics, which are very relevant to this case. You can talk about justice, beneficence and non-maleficence in this case, although autonomy is less applicable. As long as you present a balanced argument and include the principles of medical ethics, your final decision on any part of the Bawa-Garba case is correct, as you have formed a solid and coherent argument.
In most interviews, there is a question about a current or past medical news which has caught your interest. The Bawa-Garba case is the perfect example to use, as it has many both ethical and practical factors that can be considered. It can also be referenced while answering questions about medical ethics to show off your knowledge of the issues surrounding the NHS and medicine in general.
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