Bawa-Garba case

On 13 August 2018, Dr Hadiza Bawa-Garba, a junior doctor specialising in paediatrics, successfully appealed a ruling that she be struck off the medical register after being found guilty of gross negligence manslaughter of a patient.

The Bawa-Garba case

On 18 February 2011, 6-year-old Jack Adcock died at Leicester Royal Infirmary, partly as a result of poor quality of care. Dr Bawa-Garba had treated Jack that day and, in November 2011, was found guilty of gross negligence manslaughter and given a 2-year suspended sentence.

Dr Bawa-Garba was convicted of gross negligence manslaughter at Nottingham Crown Court on 4 November 2015 and given a 2-year suspended sentence. In June 2017, the Medical Practitioners Tribunal Service (MPTS) suspended Dr Bawa-Garba from the Medical Register for 12 months, rejecting an application that she be erased from it.

The MPTS was established in 2012 to run independent hearings for doctors alleged to have breached General Medical Council (GMC) standards. The GMC had gained powers to appeal against decisions made by the MPTS from 31 December 2015 and it enacted this by appealing to the High Court against the decision regarding Dr Bawa-Garba.

On 25 January 2018, the High Court ruled in favour of the GMC that Dr Bawa-Garba should be struck off the Medical Register. However, she successfully appealed this ruling, with the Court of Appeal overturning the decision on 13 August 2018. Following this, the MPTS eventually cleared her to return to work from July the next year.

Concerns among the health care profession

The Bawa-Garba case raised concerns among medical professionals regarding:

• the appropriateness of gross negligence manslaughter convictions against health care professionals and the impact of wider system pressures on practice. On the day Jack died, there was inadequate senior consultant presence and a computer system failure delayed his blood test results
• the use of doctors’ own reflective practice in fitness to practise and criminal proceedings and its potential to discourage a learning culture. Dr Bawa-Garba’s e-portfolio of reflections was not used as evidence in court, but the prosecution team had sight of it prior to the trial
• the disproportionate representation of BAME doctors in fitness to practise proceedings, and whether Dr Bawa-Garba’s ethnicity meant that institutional bias had influenced the decision to proceed against her.

National reviews and recommendations

In January 2018, the GMC commissioned an independent review into how UK laws on gross negligence manslaughter and culpable homicide (in Scotland) are applied in a health care context. The review’s final report was published in June 2019 and made 29 recommendations to the GMC and other organisations involved in local, coronial, criminal and regulatory processes. The report concluded that the Bawa-Garba case had had a ‘palpable and profound [effect] across the medical profession’ and the GMC had to take ‘urgent steps’ to repair its relationship with doctors.

On 6 February 2018, Secretary of State for Health and Social Care Jeremy Hunt announced a rapid review of medical malpractice cases. The ‘Williams review’ reported in June 2018 and made recommendations (accepted by the Government), including to:

• remove the GMC’s right to appeal MPTS decisions
• remove the GMC’s right to require registrants to provide reflective material for fitness to practise proceedings
• develop a clear approach to gross negligence manslaughter allegations against health care professionals between relevant stakeholder organisations including the coroner services, the Crown Prosecution Service, and the GMC.