The Bawa-Garba Case: A Deeper Dive

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Dr Hadiza Bawa-Garba was a junior doctor (ST6) on 18th February 2011 when Jack Adcock was admitted to hospital, with symptoms of continuous diarrhoea and vomiting. Several mistakes occurred during his treatment including misdiagnosis of sepsis, meaning there is still heavy debate about Bawa-Garba’s return to the medical profession.

Jack was a six-year-old suffering from co-morbid diseases such as down’s syndrome and heart disease, put under the care of Dr Bawa-Garba. Due to the absence of an SHO, she was the most senior doctor present in the unit on this day and was required to work across 4 floors to overcome the understaffing.

The results of basic initial tests indicted that Jack’s lactate (lactic acid) level was 11, whilst the normal, healthy level should be around 2. This test serves as an indication of oxygen deprivation, with higher levels being more deprived due to the increased production of lactic acid in anaerobic respiration. A high lactate level can indicate that the organs are not functioning properly.

Jack was then diagnosed with gastroenteritis (inflammation of the GI tract) and dehydration. Following from this, Jack was supplied with large amounts of dripped fluid, which was the logical and correct treatment. However, professionals, with the benefit of hindsight, state that at this point, Bawa-Garba should have handed Jack over to a specialist or ICU unit as this level of lactate was a serious indicator.

In the morning, Jack had a cough so a blood test and chest x-ray were ordered. Misleadingly, he had seemed to be responding well to the fluid treatment given to him the night before, causing his parents and doctors to think his condition was improving. This meant that sepsis was, incorrectly, not regarded as a potential diagnosis.

Sepsis – a potentially life-threatening condition caused by the body’s overreaction to infection, leading to the immune system attacking its own organs and cells.

After an hour of waiting for blood test results, Dr Bawa-Garba noticed that there was a system error meaning that none of the results had come through; these results could have been used as an indicator of the severity of Jack’s condition. Also, due to understaffing and busy wards, she was not notified of the availability of Jack’s x-ray results until after three hours. The indication of a chest infection led to the prescription of antibiotics.

After this, Jack was handed over to consultant Dr Stephen O’Riordan. The communication during the handover was successful but, unexpectedly, the consultant did not visit Jack to check on his condition.

Due to Jack’s heart disease, he was taking the drug enalapril twice daily. Whilst under the care of Bawa-Garba, she had not noted this medication in his notes as it should not be prescribed if a patient has diarrhoea or vomiting. Miscommunication under the care of the consultant led to Mrs.Adcock being informed by the nurse that she was able to prescribe it to her son by herself. The effects of this drug can worsen a patient’s condition if they are suffering from sepsis.

Jack was moved to a different room during his treatment, which was unknown to Bawa-Garba – ward 28. After she returned to the ward, an alert sounded for a patient having a cardiac arrest. The previous inhibitor of ward 28 had a DNACPR request, which was known to Dr.Bawa-Garba. Unfortunately, she mistook Jack for the previous inhibitor, meaning she ordered staff to halt CPR. After a minute this was resolved, and reports state that this did not contribute to Jack’s death.

Ultimately, Jack passed away on the same day from sepsis and streptococcal infection, identified during his post mortem.

Dr Bawa-Garba
Dr Bawa-Garba [1]

After her trial in 2015, Dr Hadiza Bawa-Garba was found guilty of manslaughter by gross negligence. Her return to the court later in November concluded with her receiving a 2 year suspension, also received by nurse Isabel Amaro. In 2018 she was struck off by the GMC meaning she could not practise medicine, but this was revoked after judges concluded that this was unjust.

The main arguments surrounding this case were public confidence vs humanity. The GMC’s initial response to Bawa-Garba’s actions caused an uproar in the medical community, including a twitter hashtag, ‘#IamHadiza’. Medical professionals were sharing stories of times where they too have made clinical errors but were able to learn from these mistakes and ultimately become better doctors – this incident could have occurred to any of them. Many emphasised the importance of promoting a learning culture instead of a blame culture in the face of error, as there is never one person who is solely responsible.

A common opinion was that striking off Bawa-Garba would lead to fear in other medical professionals, leading to a reluctance to be transparent about errors made. This could gravely affect patient care and increase distress in medical staff.

There is a belief that this case highlights the systematic errors in the medical system, the main points being the understaffing of hospitals and the overworking of medical professionals. Dr Bawa-Garba was performing the role of two doctors without any senior supervision, as he was overbooked too. This occurred immediately after her return from maternity leave in a hospital that she was unfamiliar with, whilst coping with the collapse of the system holding blood test results.

Understandably, Jack’s parents wanted Dr Bawa-Garba to be struck off the register completely, and the GMC initially agreed with this. The council believed that the public would not have confidence in the healthcare system unless she was no longer a practising physician, which could lead to a reluctance to seek medical help. Ultimately this changed as the judges ruled that this decision was unjust.

It is clear that grave errors were made during Jack Adcock’s treatment, but it is crucial to consider the reasoning behind the mistakes rather than just taking it at face value.


References

  1. Deborah Cohen, ‘The inside story of a six-year-old boy’s death’, BBC News, August 2018
  2. BBC Panorama, broadcasted August 2018
  3. Amar Alwitry, ‘The Case of Dr Bawa-Garba – Where does the buck stop?’, EyeNews, August 2018

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