Clare Gerada: influence on UK medical practice and ME/CFS management

Sarah said:
"The review will consider whether GNM cases properly take account of the role system pressures can play in cases when patients die, and look at how GMC guidance and communication around reflective practice could be improved. It will look at what happens after a fatal incident; the impact of criminal investigations; inquiries by a coroner, procurator fiscal or sheriff; and the regulatory process and GMC fitness to practise procedures.
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Sarah said:
"She said at the time: 'We have many cases similar to that of Dr Bawa-Garba. Doctors who have made errors and been erased and not made the headlines. She has come at a tipping point. We have pointed out the disproportionate nature of some of the cases.'"
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Quoting from

Before :
LORD JUSTICE GROSS
MR JUSTICE OUSELEY
- - - - - - - - - - - - - - - - - - - - -
Between :
GENERAL MEDICAL COUNCIL
- and -
DR BAWA-GARBA

Hearing date: 7 December 2017

However, the Decision on Sanctions, on a fair reading, shows that the Tribunal did not respect the verdict of the jury as it should have. In fact, it reached its own and less severe view of the degree of Dr. Bawa-Garba’s personal culpability.

It did so as a result of considering the systemic failings or failings of others and personal mitigation which had already been considered by the jury; and then came to its own, albeit unstated, view that she was less culpable than the verdict of the jury established.

The correct approach, however, enjoined by R34 of the Rules, is that the certificate of conviction is conclusive not just of the fact of conviction (disputed identity apart); it is the basis of the jury’s conviction which must also be treated as conclusive, in line with what the Rule states about Tribunal findings.

Mr Larkin did not dispute that the Tribunal had to approach systemic failings or the failings of others on the basis that, notwithstanding such failures, the failures which were Dr. Bawa-Garba’s personal responsibility were “truly exceptionally bad”, and those are summarised in the judgment of the CACD.

Although Mr Larkin is right that such factors may reduce her culpability, they cannot reduce it below a level of personal culpability which was “truly exceptionally bad”. The Tribunal had to recognise the gravity of the nature of the failings, (not just their consequences), and that the jury convicted Dr Bawa-Garba, notwithstanding those systemic factors and the failings of others, and the personal mitigation it considered.

The jury’s verdict therefore had to be the basis upon which the Tribunal reached its decision on sanction. I cannot accept Mr Larkin’s submission that that is in fact how the Tribunal approached its decision.

p20 para 41
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Once the failings are found to be “truly exceptionally bad” personal failings by a jury, it is difficult to see how the systemic factors raised before it and rejected as adequate to reduce the seriousness of her failings, could play the significant role the Tribunal allowed them to play in mitigation of sanction, and indeed in its prior assessment of impairment, without the Tribunal contradicting the verdict. After all, they could not make her failings less than “truly exceptionally bad”.

p21 para 43
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10. In respect of Dr. Bawa-Garba, the Crown relied on the
evidence of Dr. Simon Nadel, a consultant in paediatric
intensive care. He considered that when Jack, as a seriously ill
child, was referred to her by the nursing staff, Dr. Bawa-Garba
had responded, in part, appropriately in her initial assessment.
His original view was that her preliminary diagnosis of gastro-
enteritis was negligent but he later changed that opinion on the
basis that the misdiagnosis did not amount to negligence until
the point she received the results of the initial blood tests,
which would have provided clear evidence that Jack was in
shock. As to the position at that time, however, Dr. Nadel’s
evidence was that any competent junior doctor would have
realised that condition. His conclusion was that had Jack
subsequently been properly diagnosed and treated, he would
not have died at the time and in the circumstances which he
did.

11. To prove gross negligence, the Crown therefore relied on
Dr. Bawa-Garba’s treatment of Jack in the light of those
clinical findings and the obvious continuing deterioration in his
condition which she failed properly to reassess and her failure
to seek advice from a consultant at any stage. Although it was
never suggested as causative, the Crown pointed to her attitude
as demonstrated by the error as to whether a DNR (“do not
resuscitate”) notice applied to Jack.

p4
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In somewhat greater detail, in particular failings on which
the prosecution case rested were, first what was said to be Dr.
Bawa-Garba’s initial and hasty assessment of Jack (at about
10.45 – 11 am) after receiving the results of the blood tests
which ignored obvious clinical findings and symptoms,
namely:

i) a history of diarrhoea and vomiting for about 12 hours;

ii) a patient who was lethargic and unresponsive;

iii) a young child who did not flinch when a cannula was
inserted (to administer fluids);

iv) raised body temperature (fever) but cold hands and
feet;

v) poor perfusion of the skin (a test which sees how long
it takes the skin to return to its normal colour when
pressed);

vi) blood gas reading showing he was acidotic (had a high
measure of acid in his blood indicative of shock);

vii) significant lactate reading from the same blood gas
test, which was extremely high (a key warning sign of
a critical illness);

viii) the fact that all this was in a patient with a history
which made him particularly vulnerable.

p4
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The second set of failings on which the prosecution rested
related to subsequent consultations and the proper reassessment
of Jack’s condition. More particularly, these were that Dr.
Bawa-Garba:

i) did not properly review a chest x-ray taken at 12.01
pm which would have confirmed pneumonia much
earlier;

ii) at 12.12 pm did not obtain enough blood from Jack to
properly repeat the blood gas test and that the results
she did obtain were, in any event, clearly abnormal but
she the failed to act upon them;

iii) failed to make proper clinical notes recording times of
treatments and assessments;

iv) failed to ensure that Jack was given appropriate
timeously (more particularly, until four hours after the
x-ray);

v) failed to obtain the results from the blood tests she
ordered on her initial examination until about 4.15 pm
and then failed properly to act on the obvious clinical
findings and markedly increased test results. These
results indicated both infection and organ failure from
septic shock (CRP measurement of proteins in the
blood indicative of infection, along with creatinine and
urea measurements both indicative of kidney failure).

14. Furthermore, at 4.30 pm, when the senior consultant, Dr.
Stephen O’Riordan arrived on the ward for the normal
staff/shift handover, Dr. Bawa-Garba failed to raise any
concerns other than flagging the high level of CRP and
diagnosis of pneumonia. She said Jack had been much
improved and was bouncing about. At 6.30 pm, she spoke to
the consultant a second time but did not raise any concerns....

16. The second detail is that for a short while, Dr. Bawa-Garba
had a mistaken belief that Jack was a child for whom a decision
had been made not to resuscitate: this was because she mistook
Jack’s mother for the mother of another child. Although this
was said to be indicative of the degree of attention or care that
Jack was receiving, it was underlined that this had no material
or causative impact.
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Aggravating Factors

The Tribunal balanced those mitigating factors against what it
considered to be the aggravating factors in this case:
  • Patient A was vulnerable by reason of his age and disability
  • Your failings in relation to Patient A were numerous,continued over a period of hours and included your failure to reassess Patient A following your initial diagnosis or seek assistance from senior consultants
  • Even though you expressed your condolences to the family of Patient A, there is no evidence before this Tribunal that you subsequently apologised to them.”
p15
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Source:
Code: 
https://www.blackstonechambers.com/documents/636/GMC_v_BAWA-GARBA.pdf



Edited to break up paragraphs and add emphasis.
 
It’s easy to complain. No risk to complainant . Sadly they kill doctors
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There are big risks to complaining.

  • Future discrimination
  • Psychological results if a just complaint is rejected unjustly
  • Psychological results of powerful people treating a factual recounting as fantasy
  • Allegations of being a serial complainer
  • Use of past allegations used against complainer
  • Psychological results of complaint(s) being used to try to discredit complainer as pathological
  • etc
I'll re-frame her comment in a different context. Imagine a complaint of sexual harassment at work against a manager.

"It’s easy to complain. No risk to complainant . Sadly they kill managers"

If that were still her view then I won't say what I think of her.
 
There appears to be a further difficulty. That tweet about complaining being easy and no risk to the complainant was dated 10 May. The announcement looks to have been made on 21 May. Is it credible that no one else connected with the selection process was aware of it? It calls into question the whole enterprise, notwithstanding that there are legitimate questions to be asked.
 
She seems very focused and intent on pushing her motto that patients complaining kills physicians.

And see she's now started using '#compaintskill' to help push it into twitter world. Alliteration is a good promotion tactic.

#Clarekills is another alliterative example.
 
i feel sorry for any Doctors where they are scapegoated by the organisation for systemic faults, or if they are falsely accused of something

Clare Gerada as a reasonably intelligent person should be able to see that systemic faults will badly affect patients, and systemic faults may include generation and perpetuating of a culture of disregarding certain categories of patients, and also a culture where poor practice is not identified

Also it is a fact that Doctors are human beings like other human beings, they are not infallible, they do make mistakes and exhibit poor behaviours.

If the complaint system is broken mend the system do not blame patients for that failure.

ETA #suppressingcomplaintskills
 
This "them and us" attitude kills.

Patients not complaining can kill.

I understand doctors are human and make mistakes. If they were more open and honest with patients and had a more equal relationship they would probably find patients don't want doctors scapegoated or punished unfairly.

Complaints kill? Just move along nothing to see here.....
 
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