Dr Bawa-Garba Case - NHS Medicine Hot Topics & Interview Questions

Aspiring medical students need to be prepared to discuss hot topics like medical ethics during their medical school interviews. One recent and relevant case is Dr Bawa Garba, which has important ethical implications for medical professionals and patients alike.

This case raised important ethical issues surrounding mistakes made by doctors and how they are supported. Combine your reading here of medicine interview questions and model answers with medicine interview tutoring or 1-1 mock interviews to boost your answers and delivery.

The Dr Bawa-Garba case is a relevant and recent case that aspiring medical students should learn for their medical school interviews. In this case, a 6-year-old patient with Down's Syndrome died from sepsis due to errors made by Dr Hadiza Bawa-Garba and the NHS Trust.

Dr Bawa-Garba was convicted of gross negligence manslaughter and was suspended from, then struck off, the GMC register. However, she was later reinstated and is now practising medicine again.

The case raises various ethical issues, including the extent to which doctors should be held accountable for errors made under unsuitable working conditions and the role of teamwork and communication in preventing medical errors.

Aspiring medical students should be prepared to discuss these issues during their interviews.

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Six-year-old Jack Adcock was admitted to Leicester Royal Infirmary’s Children’s Assessment Unit on 28/02/11 in the morning. He presented with diarrhoea, vomiting, and difficulty breathing on a background of Down’s Syndrome, which affects the heart. Later that evening, at 9:20pm, he died from cardiac arrest secondary to sepsis.

Dr Bawa-Garba (ST6 - a 6th year specialist paediatric trainee), was solely responsible for the whole ward as there was no senior consultant available. An IT failure on that day delayed the receipt of test results - for instance, despite ordering blood tests at 10:45am, Dr Bawa-Garba did not receive them until 4:15pm.

During a handover meeting later in the day, Dr Bawa-Garba did not ask a consultant to review Jack. She also did not inform the patient’s mother that his heart medication - enalapril - should be discontinued, so his mother gave him his usual evening dose at 7pm when she should not have.

When Jack ‘crashed’ an hour later, Dr Bawa-Garba performed CPR. However, she briefly discontinued this due to confusing him with another patient who had a DNACPR. This was not deemed to have contributed to his death.

Jack passed away at 9:20pm.

In 2012, the GMC received a referral about Dr Bawa-Garba from Jack’s parents and began to investigate her for misconduct. Additionally, the NHS Trust informed the GMC of the incident and Dr Bawa-Garba was subjected to 3 months of supervised training and taken off the on-call rota.

In 2014, Dr Bawa-Garba was charged with gross negligence manslaughter along with two nurses. She continued to be employed at this point for around a month, then was temporarily suspended before a successful appeal, at which point she continued to practise medicine. She was then convicted on her gross negligence manslaughter charge and suspended for 12 months.

Later, following an appeal from the GMC to the Medical Practitioners’ Tribunal Service, Dr Bawa-Garba was struck off the register entirely in 2018. Jeremy Hunt, then-health and social care secretary, launched a review of manslaughter in healthcare.

Dr Bawa-Garba later appealed against her case. She had widespread support from both doctors and the British Association of Physicians of Indian Origin, who were interested in the potential role of racial discrimination in the case.

The appeal was successful, and Dr Bawa-Garba was reinstated as a doctor with certain conditions to ensure her safe practice, particularly given that she had an extended period of absence from medical practice.

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Various ethical issues are raised by the case of Dr Bawa-Garba. It’s important to think about:

The NHS continues to face increasing systemic issues related to underfunding and understaffing. As conditions on the wards continue to deteriorate and doctors face more and more challenges, questions are being asked about the extent to which they can be held liable for errors made under these stresses.

In Dr Bawa-Garba’s case, it is clear that some systemic issues contributed to Jack Adcock’s death - such as the IT failure and the lack of a consultant. There are questions about the extent to which failings on Dr Bawa-Garba’s behalf were exacerbated by systemic issues as well.

In particular, would she have made those same errors if she were not solely responsible for managing a hectic and understaffed ward? At what point do poor working conditions affect what we can expect from doctors? Many doctors are concerned about a ‘blame culture’ where clinicians are scapegoated for systemic and governmental failures.

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Importantly, some of the errors that were made were due to insufficient communication. For example, Dr Bawa-Garba did not seek advice from a consultant when one became available later in the day. Nurses did not sufficiently update Dr Bawa-Garba on Jack’s condition, and no one informed his mother that his heart medication should be discontinued.

This raises questions about who should be held responsible in these scenarios, and how clinical communication between members of the multidisciplinary team can be improved.

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Many concerns were raised about whether Dr Bawa-Garba’s self-reflections were used in the court case. In particular, doctors were worried that this would have discouraged honest reflections. A boycott was called on using self-reflections in appraisals, and even making these reflections in the first place, on the grounds that doctors were afraid to honestly admit to their mistakes and learn from them.

Whilst Dr Bawa-Garba’s personal reflective notes were not used as evidence in court, they were included in materials seen by expert witnesses that may have influenced their testimonies.

The case of Dr Hadize Bawa-Garba and Jack Adcock’s death is a complex one, with numerous factors contributing to the tragic result.

On a surface level, Dr Bawa-Garba did make mistakes - for instance, she did not seek a consultant review at her handover meeting, and confused Jack with another patient who had a DNACPR so temporarily stopped CPR. Even if this did not contribute to his death, it was still a mistake.

However, there were much broader systemic issues at play. Dr Bawa-Garba was solely responsible for an understaffed ward and did not have a senior consultant available. It is impossible to know whether she would have made exactly the same mistakes if her working conditions were better, but I have to imagine that they at least contributed somewhat to what happened.

Given this, Dr Bawa-Garba did make mistakes. However, they were not ‘unforced errors’, but rather the result of systemic failures in the NHS that must be addressed moving forwards. It is hard to pass judgement one way or another on the full extent of her culpability without reviewing the evidence much more thoroughly.

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Overall, questions about Dr Bawa-Garba can provide a valuable opportunity to reflect on the ethical challenges that can arise in medicine and to demonstrate your ability to think critically about these issues. Please read our other articles on Charlie Gard, Abortion, Harold Shipman and more!

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