Dr Harun Khan looks at the tragic case of baby Jack Adcock and the black, Muslim doctor who is taking all the blame
The case of Dr Hadiza Bawa-Garba, a British paediatric doctor who was struck off after the tragic death of a 6-year-old boy, was met with outrage amongst healthcare professionals. Jack Adcock died of sepsis (a bacterial infection of the blood) whilst he was under the care of Dr Bawa-Garba in 2011 at Leicester Royal Infirmary.
Initially, The Medical Practitioners’ Tribunal decided to suspend the paediatric trainee for 12 months for her indirect role in the death. However, the General Medical Council (GMC) – the public body that regulates doctors in the United Kingdom (UK) – fought to appeal the initial decision, which led to Hadiza being erased from the medical register for UK doctors.
By stripping the paediatric trainee of her membership, the GMC has sent a clear message to the British public that it is Dr Bawa-Garba who deserves to take-on complete responsibility for Jack’s death. However, it is increasingly evident the GMC has scapegoated Hadiza for systemic failings with the NHS – creating a place that can be very unsafe for doctors and patients alike. In essence, Hadiza’s shortcomings on the day of Jack’s death existed within a system that was designed to fail.
Let me explain.
Hadiza, a paediatric trainee with an impeccable record prior to this event, presented to work days after her maternity leave ended. She presented to work at an unfamiliar hospital and had received no formal induction.
She also presented to work on a day where the department was understaffed and there were no replacements. Her consultant – the most senior member of the team – was out of the city, and her registrar (a sort of ‘middle-grade’ who would otherwise share senior responsibilities with Hadiza) was also on leave. Thus, Dr Bawa-Garba took on the role of three senior doctors and, at the same time, was supervising two more junior doctors who were less experienced in paediatrics – this team of three looked after six wards across four floors.
Hadiza also accepted general practice (GP) referrals over the phone, advised midwives and gave input to paediatric surgery teams. She also held the “crash bleep” – an emergency pager that goes off when a patient is close to losing their life, Moreover, the computer systems, where all blood results are issued, was down. This means that Dr Bawa-Garba would have to call the lab for every blood result she wanted for every patient. This was Hadiza’s job, she made mistakes.
The GMC deemed her responsible for the blood pressure lowering drug, Enalipril, which was given to the patient by his mother. A regular drug that was actively not prescribed by Hadiza, but a drug that had a role in precipitating Jack’s death – according to the postmortem medical report. Although managing the patient for sepsis with appropriate antibiotics and fluids, she mixed up the “do not attempt resuscitation/DNAR forms” of 2 patients when Jack was “crashing.” She confused Jack with a patient who had “crashed” early in the morning and informed the emergency team to stop resuscitation efforts.
While Hadiza made mistakes, there were others she had no control over mistakes. The paediatric registrar was evidently over-stretched. She was the unlucky doctor who was left to take responsibility – not senior management who knew of the unsafe number of doctors on the hospital floor, not the senior consultant who was ultimately responsible for the patient and made unsafe decisions that we will see later, but Hadiza – the doctor who chose to stay at work and do a job that was never designed to be undertaken by one medic.
Not only are doctors angry that Hadiza was scapegoated for systemic failings within the healthcare system, many wanted to address the role of identity, especially race played in this case and the way it was handled.
There is a strong concern amongst many black and minority ethnic (BME) doctors in the UK who feel they are more likely to be formally disciplined by the GMC solely because of their race.
Race has been the conversation largely avoided by most, including medics, when discussing the case – the elephant in the room. Not only is Hadiza’s identity, as a black, Nigerian, hijab-donning Muslim woman, heavily politicised in media articles across the board – subjecting her to racist, Islamophobic and misogynistic vitriol online – the GMC has, on several occasions, declined to charge white doctors who have been involved in very similar cases.
The most obvious example is of the white male consultant – Dr Bawa-Garba’s senior – who was ultimately in charge of Jack’s care and did not review the patient after being informed of very abnormal blood results by Hadiza herself. Why was his role in the case so swiftly ignored – especially when taking into account the clinical hierarchy that is so often addressed within clinical medicine?
Why also did the GMC drop charges against the white female consultant who discharged Victoria Climbié shortly before her death in 2000? The 8-year old Ivorian girl was murdered by family members and was noted to have clear signs of non-accidental injury,
on multiple admissions, by healthcare professionals – including the paediatric registrar who discussed the case with the consultant shortly before her decision to discharge Victoria. By highlighting these cases, I do not wish for the firing of said clinicians – these are very complex cases – but I do ask the critical question: what was different in Hadiza’s case or the case of other BME doctors?
Even now, it has already been identified in the GMC’s “The State of Medical Education and Practice in the UK 2016” report that BME doctors who graduated from UK medical schools are more likely to receive complaints than their white colleagues. The Medical Practioners’ Tribunal Service’s “hearings calendar” – a formal diary of doctors who have received a formal complaint and must attend a hearing to defend their case – is also filled with appointments with doctors with non-English names. Statistically, these formal complaints disproportionately affect those with non-English names. Why is this? Although there are undoubtedly other factors, aside from race, that may have acted as pre-requisites to the complaints – what is the role of implicit racial bias, if any, within these cases? And why do BME doctors – lifelong victims of structural discrimination based on race – not have a more active role in assessing cases that may in involve race? Do white doctors understand why their non-white colleagues are more likely to be conscious of their race? Are white doctors truly qualified to dismiss cases of racial bias? Despite these awkward conversations, Hadiza’s case has helped unify British doctors across the country.
Along with other issues despised by British doctors, for example, the creeping Tory-led privatization of the NHS or the persistent lies of medical tourism that have been disproven by public health research – the case of Dr Bawa-Garba has helped healthcare professionals mobilise and take a lead in their fate. Only last weekend, thousands of doctors took the streets of London – some to rip up their GMC certificates in front of the official headquarters and many others to walk in solidarity with their paediatric colleague. Over £328,000 has also been crowdfunded by doctors to support Hadiza’s prospective legal fees to challenge the GMC. These successes were largely ignored by British media.
Overall, doctors go into the profession to provide the best care for their patients. Although Jack’s family need to fight for justice, we – the doctors who are on the hospital floor day-to-day – argue that, if not addressed, these systematic failures will lead to higher rates of morbidity and mortality. In this case, the GMC has not struck off a doctor who is a harm to the public, but the GMC has saved the lucrative salaries of senior officials who are well aware of the failings of our actively underfunded, soon-to-be-privatised healthcare system. Instead of protecting the UK, the GMC has left the UK with one less doctor to save the lives of the countless patients.
Dr Bawa-Garba, evidently a committed and talented paediatric doctor, has been scapegoated. And we will, as doctors and allied health professionals, fight for a system that is safe for both our patients and our staff – with or without the support of our regulatory body.
I urge readers to donate, alongside thousands of healthcare professionals, to Dr Bawa-Garba’s crowdfund campaign, which will fund for an independent legal opinion to challenge the GMC’s decision. You can donate here.
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Harun Khan is currently working as a junior doctor in the NHS and is passionate about issues relating to global health and social inequalities. He aims to use his clinical work, public health research and writing as a means of advocating for the most vulnerable communities worldwide. In summer 2017, he launched a non-profit, journey2uni.co.uk that aims to support students from low-income communities pursue higher education within the UK.
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