This was in reply to an extraordinary article in The Guardian on 19th February but rejected by Sarah Johnson, Commissioning editor, Healthcare Network.
It is refreshing to hear a junior doctor strike out against the consensus, especially on a case which seems to have riled the whole medical profession.
Hadiza Bawa-Garba (above) is the trainee paediatrician who misdiagnosed sepsis leading to a six-year old boy’s death, and in an unsigned article a fellow-trainee said she deserved to be convicted of negligent manslaughter and struck off the medical register. It is a courageous view from someone who is equally vulnerable to having the wolves set loose should he or she make a similar mistake.
But the argument was disappointing – as was the decision of this brave warrior for his profession to hide behind anonymity. In fact the anonymity itself rather defeated the logic, which was that doctors must openly bear the consequences of their actions. The secrecy suggests that junior doctors now, as ever, feel a constant pressure to cover up and protect their backs.
In fact the whole thesis was comprehensively muddled. Our shadowy critic of Bawa-Garba says she deserved everything she got because the high court concluded her mistakes “were not simply honest errors”. The writer, while admitting to being ignorant of the details, has, “come to respect the decision of the court – so should my colleagues.” Yet that reasoning is immediately undermined, if not inverted, with the following confession: “I am not sure whether the criminal court is the best place to hold a medical professional to account, and I welcome Hunt’s belated review into medical manslaughter.”
As it happens I agree – I have followed criminal courts for decades and retain a healthy scepticism about their capacity to grasp expert evidence – but your correspondent can’t seriously expect us to respect the verdict of a court which he or she concedes is not the best place to consider such issues in the first place.
It gets worse. The writer goes on, and I quote this in full and in context: “Medical professionals who do their utmost for patients should not live in fear of legal action for honest mistakes. Bawa-Garba was let down by the system that she worked in. I, like many of my colleagues, do not believe she should have been convicted of manslaughter.”
Ah, I see. Or do I? Now, it seems, the author does not respect the decision of the court.
Then it gets more confusing still. We are told that, even though Bawa-Garba should not have been convicted, the GMC was right to strike her off because she was convicted. What matters is public confidence in the profession. So, even if she did not deserve a bullet, she should get one.
Actually this is also the GMC’s bewildering position. Charlie Massey, its chief executive, has conceded to me that Bawa-Garba’s is a competent doctor. Her colleagues speak well of her and she worked uneventfully for four years between the child’s death, which occasioned all this, and the CPS finally concluding she should be arraigned for trial. So your writer, like the GMC, acknowledges Bawa-Garba is a fall guy, a sacrificial lamb for the profession. Are we expected to regard this as justice?
It may be rough justice, I suppose, but, if so, our unsigned pundit believes that such cases will become more and more common: “I can safely say, without evidence but with confidence, that every doctor with sufficient experience has made multiple errors… (and that) as demand for services rises and budgets fall, maintaining standards in the health service will become increasingly challenging and the risk of errors will inevitably increase.”
I agree, but most of us who are concerned for patient safety draw precisely the opposite conclusion. The GMC cannot maintain public confidence by striking off more and more doctors. Indeed maintaining public confidence should not be its role at all, and with the government’s current review into healthcare regulation I hope this will be addressed. It is for the royal colleges or the BMA to do PR. The GMC’s job should be to ensure that all physicians and surgeons are properly qualified and competent.
The writer worries that, “members of the public would not allow a doctor convicted of manslaughter to treat their children”, but other doctors have returned to work after suffering such verdicts and have unblemished records since. The public seems to be happy to be treated by them; why not by Hadiza Bawa-Garba? In fact I can think of no doctor less likely to repeat the error that Bawa-Garba made than Bawa-Garba. It is not just wrong in principle to criminalise someone who was trying to save someone else’s life; it is bad in practice. We, the public, need to become more tolerant of genuine mistakes made by other people who are overworked, understaffed and under pressure. We need to understand that medical mistakes occur hundreds of times each day, sometimes with terrible consequences, and that if we want better protection we need a culture of openness, not one of punitiveness, cover-up and fear.
So, all in all, I don’t believe your contributor has a logical case to make, nor one that would contribute to public safety or public confidence.
I leave you with yet another extraordinary inconsistency in the article – one I find simply inexplicable. Having congratulated the GMC for erasing Bawa-Garba from the medical directory, the writer says: “As a fellow junior doctor, I appreciate how easily errors are made and I will be the first to rise to Bawa-Garba’s defence.”
No you’re not, and you can’t have it both ways. Thousands of doctors, and lay people like me, rose to her defence, while you have simply risen to make a confusing counter-attack. Normally I admire people who are prepared to speak out against a prevailing fashion, but you make yourself sound like part of the problem, not the solution.