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September 9, 2018

Medicine Balls, Private Eye Issue 1477, 24 August 2018
Filed under: Private Eye — Dr. Phil @ 10:00 am

A convenient scapegoat

Was the General Medical Council merely grossly incompetent in pursuing Dr Hadiza Bawa-Garba through the courts to strike her off following the death of six-year-old Jack Adcock on 18 February 2011? Or is it complicit in a wider cover-up of where accountability should lie? An internal investigation by Leicester Royal Infirmary admitted “79 domains of systemic failure” in Jack’s death, and made 23 recommendations, including that the consultant on call for emergencies should review all the new admissions in person (something that was already happening in units providing a decent standard of consultant-led care).

Dr Bawa-Garba made a serious error, which she openly admitted, in not recognising the significance of Jack’s very abnormal admission blood test results, which made a diagnosis of sepsis more likely. However, her consultant Stephen O’Riordan made an even more serious error – given his seniority, experience and responsibility – in failing to spot that same risk of sepsis. He was told the abnormal pH of 7.084 and the fact that the blood lactate concentration was high, and wrote them down in his notebook. At that moment, the overriding duty of care for Jack was passed from junior doctor to consultant, and O’Riordan became responsible for acting on these very abnormal results. And yet he chose not even to review Jack. Sepsis is particularly hard to spot if you’re nowhere near the patient.

The GMC even tried to defend Dr O’Riordan by making a ridiculous assertion about consultants. Its counsel, Ivan Hare QC, claimed that “a consultant is only there to deal with matters drawn to their attention”, prompting the appeal judge to reply: “[You] conjure up a picture of a consultant sitting in a chair, waiting for them [junior staff] to come and get them.”

MD disagrees with the GMC’s argument. It is surely the consultant’s duty to use his or her wisdom and experience to know the significance of test results. The GMC seems to have rejected the concept of consultant-led care in its desire to have Dr Bawa-Garba erased.

All doctors make mistakes – it’s what happens next that matters. After Jack’s death, Dr O’Riordan and Dr Bawa-Garba should have visited the parents together, expressed their deepest sympathy and promised an independent, open investigation to ascertain the full facts. Instead, Dr O’Riordan insisted on seeing Jack’s parents without her. Given the parents’ sudden change in attitude to Dr Bawa-Garba from thankful to extremely hostile, it seems likely that blame for Jack’s death was apportioned to her. And O’Riordan even forbade her from talking to the parents because she was “under investigation”.

This fuelled a vicious cycle of blame that has seen her go from a highly regarded paediatrician with an unblemished career to being found guilty of gross negligence manslaughter, fined £25,000 and only escaping imprisonment for two years as she has a disabled son and her spouse was working abroad. Summing up at her trial, Mr Justice Nicol told her that “your career as a doctor will be over”. The deanery removed her training number, she had to sell her house to pay her fine, her passport was held back by police, her criminal record made it impossible for her to get insurance for anything, and she had to move house because of racial abuse, threats and trolling sparked by aggressive media reports.

Meanwhile, Dr O’Riordan quietly removed his name from the GMC register, moved to Ireland and re-registered with the Irish Medical Council, which has allowed him to carry on consulting and thus far has not investigated him. The GMC erased or suspended 119 doctors from the medical register in 2014, 50 percent of whom are known to be black and minority ethnic (BME). This could be because the GMC is racist, or somehow softer on white doctors, but in MD’s experience BME doctors are very likely to be completely open and honest – almost to a level of naivety – when serious errors are made, particularly if they have a strong religious faith. This makes them sitting ducks for blame.

Perhaps the most serious error in Jack’s care had nothing to do with Dr Bawa-Garba. Jack’s mum quite reasonably asked a nurse if her son could have enalapril, a drug used to take the pressure off his heart after surgery to repair a heart defect had left it scarred and weakened. However, enalapril is a very risky medication to give to a child with Jack’s combination of lactic acidosis and altered kidney function, as it can cause a sudden lowering of blood pressure. Dr Bawa-Garba had correctly not put the drug on Jack’s drug chart, but another junior doctor sanctioned its use when called by the nurse. an hour after being given enalapril, Jack went quiet, blue and into cardio-respiratory arrest.

This terminal error has barely been mentioned as it wasn’t “one of hers”. As Sir Liam Donaldson, the former chief medical officer, once put it: “To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.” To which MD would add, to shift the blame on to someone else is criminal.