tag:blogger.com,1999:blog-2186593343917545414.post7433816181361700782..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: To err Is homicide in BritainGalen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-2186593343917545414.post-10113925111746493672019-02-25T22:22:38.470-08:002019-02-25T22:22:38.470-08:00On 4 November 2015, Bawa-Garba was found guilty of...On 4 November 2015, Bawa-Garba was found guilty of manslaughter by gross negligence in Nottingham Crown Court before a jury directed by Justice Andrew Nicol. The following month, she was given a 2-year suspended jail sentence. She appealed against the sentence, but the appeal was denied in December 2016.<br /><br />The Medical Practitioners Tribunal Service suspended Bawa-Garba for 12 months on 13 June 2017. The General Medical Council successfully appealed and Bawa-Garba was struck off on 25 January 2018.<br /><br />On 13 August 2018, Bawa-Garba won an appeal against being struck off, restoring the one year suspension.<br /><br />Many healthcare professionals have raised concerns that Bawa-Garba is being unduly punished for failings in the system, notably the understaffing on the day.[<br /><br />https://en.wikipedia.org/wiki/Hadiza_Bawa-Garba_caseGalen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-83689137543234755232018-02-26T08:48:44.836-08:002018-02-26T08:48:44.836-08:00There is broad agreement that serious errors were ...There is broad agreement that serious errors were made in Adcock's treatment. However, there has been a public debate about the background, context and pressures in which doctors work, and what happens when mistakes are made. The discussion centres on the issues of what systems and processes are in place that make mistakes less likely, and improve the chances of detecting them when they do occur. In the case of Bawa-Garba, the NHS Trust in question has recognised there were systemic failures and pressures which contributed to the death of a patient. Dr Jeeves Wijesuriya, the then junior doctors committee chair for the British Medical Association (BMA), argued that these systemic shortcomings were not adequately considered in the initial trial.<br /><br />At the end of January 2018, BMA council chair, Chaand Nagpaul, expressed concerns over doctors fears and challenges in working under pressure in the NHS. He explained that without clarity from the General Medical Council (GMC) and others, issues surrounding recording reflective learning would result in defensive practice and failure to learn from experience. <br /><br />The GMC released a FAQ about the case, covering issues such as what doctors should do if concerned about staffing levels and reflective practice.<br /><br />https://en.wikipedia.org/wiki/Hadiza_Bawa-Garba_caseGalen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-75394154186568149102018-02-24T22:19:27.256-08:002018-02-24T22:19:27.256-08:00I was watching the General Medical Council take ad...I was watching the General Medical Council take advantage of its relatively recently acquired right to appeal the result of a doctor’s fitness to practice hearing. The right of appeal was given to the GMC by an amendment to Section 40A of the Medical Act. As I watched the proceedings and the way the GMC argued the case, I wondered whether the GMC should have been given this right at all.<br /><br />Sat in the public gallery, I found myself sitting next to the doctor at the centre of the case, Dr Bawa-Garba. This lady is a junior doctor who has been convicted of manslaughter for her part in the NHS’ negligent treatment of Jack Adcock, a 6 year old boy who died of sepsis at Leicester Royal Infirmary in February 2011. In amongst a catalogue of system failures and having to do the job of two doctors during a double shift, Dr Bawa-Garba failed to spot the early signs of sepsis, did not act on significantly deranged blood results and delayed starting antibiotics after wrongly making an initial diagnosis of Gastroenteritis...<br /><br />I have a 6 year old son and a 4 year old daughter and cannot even come close to imagining the pain that would come as a result of losing one of them, or the suffering of Jack Adcock’s family. But as I sat there next to Dr Bawa-Garba, I could see first hand, another kind of suffering that may well be just as difficult to imagine or understand. Having suffered a bit myself as a result an NHS whistleblowing case, I wanted to show my support for a colleague in a very difficult situation. I find it hard to believe that a junior doctor has found themselves having to respond to legal action brought against them in the High Court by the General Medical Council - supposedly in the public interest, to challenge a decision by the MPTS not to strike them off the medical register...<br /><br />The Judgment from the Court of Appeal refusing Dr Bawa-Garba leave to appeal her conviction set out several factors that Dr Bawa-Garba relied on in her defence of manslaughter;<br /><br />· A failure in the hospital's electronic computer system that meant that ordered blood tests were delayed and not received from the hospital laboratory in the normal way and Dr Barwa-Garba was without the assistance of a senior house officer as a consequence.<br /><br /> · Dr Bawa-Garba had flagged up the increased CRP infection markers in Jack's blood to the consultant, Dr O'Riordan, together with the patient's history and treatment at the handover meeting. The consultant had overall responsibility for Jack.<br /><br /> · A shortage of permanent nurses meant that agency nurses were being used more extensively.<br /><br />· The nurse involved had failed to properly to observe the patient and to communicate Jack's deterioration to Dr Barwa-Garba, particularly as Dr Bawa-Garba was heavily involved in treating other children between 12 and 3pm (including a baby that needed a lumbar puncture).<br /><br />· The nurse also turned off the oxygen saturation monitoring equipment without telling Dr Bawa-Garba, at 3 pm, when Jack was looking better.<br /><br /> · The nurse did not tell Dr Bawa-Garba about Jack's high temperature 40 minutes earlier or the extensive changing of the nappies.<br /><br />· It was correct to be cautious about introducing too much fluid into the [patient] because of his heart condition<br /><br />The Crown Court also heard that, Dr Bawa-Garba’s Consultant, Dr O’Riordan was aware before Jack died that he had a serum pH of 7.084 and a blood lactate concentration of 11.4 mmol/L, which he wrote down in his notebook at evening handover. However, he did not perform a senior review of the boy because, he said, he was not specifically asked to by Dr Bawa-Garba. He said he would have expected her to “stress” these results to him.<br /><br />http://www.54000doctors.org/blogs/whos-interests-are-the-gmc-really-trying-to-serve-in-the-bawa-garba-case.htmlGalen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-35205500869130225112018-02-24T22:05:27.462-08:002018-02-24T22:05:27.462-08:00Agree. A total collapse of the “system” even IT wa...Agree. A total collapse of the “system” even IT was down. Did I miss something who and how was enalapril administered?<br /><br />Retired MD<br /><br />Reply<br /><br />It was administered by the mother of the child, some 60 minutes before the arrest.<br /><br />Another reply:<br /><br />The parent. This is just an assumption, but it happens often on the wards when a parent simply continues the routine medications they've been doing at home because no one told them to stop,<br /><br />The article states it wasn't ordered and that no nurse gave it. That leaves only the well-intentioned parents.<br /><br />When admitting the patient, you need to specifically tell the parents not to continue home medications, that the nurse will do that and have the parents on board. <br /><br />I can guarantee you it was them, but I'm not sure why that wasn't revealed in the article.<br /><br />https://www.medscape.com/viewarticle/892210#vp_8Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-51295103527450389652018-02-24T22:00:08.263-08:002018-02-24T22:00:08.263-08:00Having worked as a Junior Doctor (SHO through Locu...Having worked as a Junior Doctor (SHO through Locum Registrar) in the NHS for several years, I can only attest: Everything in this article is true and correct. I have been in many similar situations as Dr Bawa-Garba. The problem is not a "socialized system", but a culture of underfunding that is deeply engrained; and tacitly approved by the mixture of "Helper Syndrome" and macho attitudes that characterizes the medical professional in general.<br /><br />https://www.medscape.com/viewarticle/892210#vp_8Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.comtag:blogger.com,1999:blog-2186593343917545414.post-7870786523637093972018-02-24T21:54:37.939-08:002018-02-24T21:54:37.939-08:00I trained at one of the largest residency programs...I trained at one of the largest residency programs in the US and deeply remember the desperate nights of understaffing and overcrowding that were more the norm than not. I recall taking care of patients on guerneys in hallways drawing blood, placing the IV or central line and even placing chest tubes and performing lumbar punctures right there in the hallway because no one was available to help. I would be the assistant surgeon even as a medical student because the junior surgeons and interns were all in other operating rooms. I delivered many babies as a student because, again, the doctors were all with the high risk deliveries. A typical call lasted 40 hours with running up and down 18 floors of stairs the whole time because I never had time to wait for the elevator.<br /><br />Hearing about this case is so infuriating to me. No jury could ever understand the sacrifices we make on our own minds and bodies and spirits to put first another person’s child and mother and grandfather. If a physician is available for manslaughter convictions despite the inhuman sacrifices we make to love and care for everyone patient, I would imagine that fear would lead to young doctors refusing to come to work without ample staff support. If I were to show up at a hospital to find that I’m in charge of three stations instead of one, the best thing I could do for the whole system is to go home. To force my attending physician to cut short his teaching commitments. Why is he teaching when the hospital is so understaffed? Why aren’t patients diverted to other hospitals if possible when the hospital is understaffed? where are the administrators? How could anyone let this young doctor be placed in this predicament? The US made great changes to its rules on doctors-in-training two decades ago because of our awfully long work hours. Dangerous? Yes. Did it affect patient care? Of course. Did anyone get convicted of manslaughter? NO!<br /><br />Our movement started with a few students in Boston. Then Los Angeles. Then we went National. I hope that UK docs can find a similar way to protect doctors from taking the fall from system failures. My heart goes out to Dr. Bawa Garba.<br /><br />https://www.medscape.com/viewarticle/892210#vp_8Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com