‘A terrible confusion…’

We were away last week and missed the Panorama programme about the death of Jack Adcock and the erasure and then reinstatement of Dr Bawa-Garba from the medical register. There’s a lengthy piece written by Deb Cohen, a medical journalist, here. I wasn’t surprised it’s biased because a previous article by Cohen demonstrates her support for Bawa-Garba. I am surprised it’s being touted as a balanced piece of journalism by (some) medics.

As usual, raising this on twitter generates some pretty low level insults/attack.

“…suggest Sara contacts or shuts up”.

Or this:

There’s also no dot joining with sense offered by other twitter peeps.

Ho hum. Here are some reasons why I think it’s not a balanced piece of journalism.

A poor start…

The article starts with a sweeping statement;

When a junior doctor was convicted of manslaughter and struck off the medical register for her role in the death of six-year-old Jack Adcock, shockwaves reverberated through the medical profession.

There were no shockwaves reverberating through the medical profession when Bawa-Garba was found guilty of gross criminal negligence nearly three years ago. The #IamHadiza hashtag probably emerged some time late last year as medics started to realise there may be implications for their own practice.

Differential treatment

Bawa-Garba is treated differently to other people referred to within the article. She’s presented as a devoted mother, daughter and doctor with elaborate descriptions like “writing till her pen ran out of ink…”

In contrast, mention of the Adcock family is perfunctory and largely brief other than a few paragraphs capturing some of the family trauma and Jack’s character.

This difference is clear from the first mention of Jack and Bawa-Garba in which additional context is offered about the latter.

Jack Adcock wasn’t himself when he returned home from school. He later started vomiting and had diarrhoea, which continued through the night.

Trainee doctor Hadiza Bawa-Garba arrived at work expecting to be on the general paediatric ward – the ward she’d been on all week. She had only recently returned to work after having her first baby.

When Jack or his mum are mentioned sentences are typically short and factual without much or any additional commentary or explanation.

The boy’s hands and feet were cold and had a blue-grey tinge. He also had a cough.

But they [parents] say they heard very little from the hospital. They were sent a copy of the Leicester Royal Infirmary investigation and invited to discuss it, but they didn’t want to.

Cohen repeatedly fudges and fills in the gaps for Bawa-Garba. She doesn’t do this for Jack or his family. They are left with a careless ‘didn’t want to’.

‘But…’

Liberal use of ‘but’ is sprinkled throughout the article in relation to Bawa-Garba. There are few ‘buts’ about the Adcocks.

Fewer ‘buts’ are arguably better in terms of journalistic (or broader writing practice) but the ‘but’ differential suggests Cohen falling off the balanced and informed journalistic perch. (The old ‘mistake’ creeps into the first example here with a dramatic, unevidenced statement.)

But she didn’t consider that Jack might have had a more serious condition. It was a mistake she regrets to this day.

Dr Bawa-Garba looked for Jack’s blood results from the lab. She had fast-tracked them an hour-and-a-half earlier. But when she went to view them on the computer system, it had gone down.

But Dr Bawa-Garba says she wishes she had given him antibiotics sooner.

Bawa-Garba is quoted in full throughout the piece. She isn’t paraphrased, a practice which introduces doubt over authenticity and validity. The Adcocks (and others) are paraphrased.

It was only then, the Adcocks say, they heard the “true facts” and “listened to the detail” about the errors that Dr Bawa-Garba had made.

The use of minutes taken by a family friend during a meeting with the Trust as evidence also suggests questions around the validity of the family evidence. Bawa-Garba however is given space within the article to explain, account for and/or have the accounting/explaining done for her by Cohen:

“I knew that I had to get a line in him quickly to get some bloods and also give him some fluids to rehydrate him,” says Dr Bawa-Garba. He didn’t flinch when she put his cannula in.

Dr Bawa-Garba tried a number of extensions before managing to speak to someone. They read out Jack’s results and she noted them down. She says she was looking out for one particular test result called CRP, which would confirm whether Jack’s illness had been caused by bacteria or a virus. She noted it was 97, far higher than it should have been, so she circled it. But she says she was concentrating so much on the CRP that she failed to register that his creatinine and urea were also high – signalling possible kidney failure.”

Inexcusable failings like missing the significance of blood results are buried in words. Unsubstantiated words that offer flimsy excuses or explanations. Bawa-Garba was concentrating so hard on something else... Cohen almost trips over herself with excuses, explanations, ‘buts’ and the downgrading of what is basically shite practice to ‘mistakes’.

Dr Bawa-Garba had been on call for more than 12 hours when an emergency call went out for a patient who had suffered a cardiac arrest on ward 28 and doctors and nurses rushed to help. In the morning, Dr Bawa-Garba had had to intervene to stop doctors from trying to resuscitate a terminally ill boy who had a “do not resuscitate” order. She assumed it was the same boy. What she didn’t know was that Jack had subsequently been moved to the same ward as the boy who had crashed in the morning – ward 28.

A terrible confusion was about to follow.

She is seemingly oblivious to a doctor basing her medical practice on assumption and guesswork and ignoring the evidence in front of her. Ironically, Cohen seems to be doing a similar job in this article.

A terrible ‘confusion’…

Only one of the numerous failings Jack experienced that day is prefaced with a fanfare ‘failure’ statement:

It was at this point that another failing in Jack’s care occurred.

Any guesses which failing? Yep. The administration of enalapril by Jack’s mum. Cohen includes the inquest evidence that Jack’s mum acted responsibly doing this and that the impact of this drug on Jack’s condition is inconclusive. Despite this evidence she still positions this failing differently.

The inclusion of micro detail at times speaks to a determination to funnel out any whiff that Bawa-Garba did a poor job.

She asked one of the doctors in her team to chase up the results for her patients, and took on some of that doctor’s tasks.

Within this reification of Bawa-Garba’s medical ability, the work of medics is kind of lost. Work is work. Bawa-Garba was doing her job like other staff present were doing their jobs. The guilty manslaughter charge was based on the layers of exceptionally poor care Jack received. Bawa-Garba remains guilty of this charge. A vague statement about taking on some tasks does not mitigate this.

And the unsaid…

There’s so much unsaid within the article I can almost hear tumbleweed blowing through it. While I understand constraints on what can be written in terms of length/word count what is left unsaid is deeply problematic.

Cohen mentions the crowdsourced legal fees by medics which raised over £300k. She doesn’t mention the Adcocks remortgaged their house to cover their legal fees.

She refers to the negative commentary Bawa-Garba has received from members of the public on and offline without mentioning the negative commentary Nicola Adcock has experienced (blaming her for the death of her son).

She speaks to various medics and includes tweets from medics in the article. She doesn’t include interviews with, or commentary from, the wider public. She doesn’t include tweets by non-medics. Presenting ‘us’ and ‘them’ is clear in intent and execution. This is about a ‘wronged’ medic and her rattled peers. A medical guild. There is no ‘public and patient involvement’.

Cohen ignores various inconsistencies; medics belatedly joining Bawa-Garba’s fight, denouncing scapegoating while scapegoating, talking about a ‘no blame’ culture while blaming, ignoring the proceedings of a lengthy trial and appeal process, ignoring the nursing staff.

She doesn’t comment on unchecked inappropriate commentary from some medics circulating on social media.

Or how public confidence must be dented by this demonstration of arrogance, refusal to engage with evidence and self-preservation.

She doesn’t make the link to evidence around the premature deaths of learning disabled people or ask why Jack was the recipient of such exceptionally poor care

In short, Cohen has decanted and deliberately funnelled a particular version of events. In doing so, she’s captured the (medical) sediment and lost the oxygen, the life, the flavour and basic humanity. Cohen had an opportunity to demonstrate skilled, balanced and informed journalism. To explore what happened to Jack with his family, Bawa-Garba, Theresa Taylor and Isabel Amaro and relevant others. She chose instead a route of overly-sensationalising what happened or didn’t happen and erasing other parts. Perhaps feeding on or being being fed by the agitation of a group of medics who appear to have lost sight of what constitutes evidence in their determination to protect themselves.

25 thoughts on “‘A terrible confusion…’

  1. Why does this offended application of group power and cash – against proven evidence that one of their own is so seriously incompetent they are a danger to patients – feel like their response in 1947 – to the suggestion that their profession should be free at the point of need – to ordinary – people.

    Like us.

  2. The confusion and obfuscation is deliberate. I have copies of internal e mails where senior members of the medical profession, deliberately and with malice tried to prevent me from placing my concerns with their Trust. They were assisted by the Chief Executive . This sort of cover up occurs at every level within the NHS.

  3. Refreshingly different is the letter from the CEO of Barnsley FC to a supporter with mental health issues, which went viral last week – I’m sure he would act similarly towards those with LD. CRASH has reposted the letter with comment at https://999crash.wordpress.com/blog/.

    Has anyone received such a kind, empathetic and sympathetic open invitation from an NHS Director associated with MH & LD issues? You will see that I’ve made a cheeky suggestion that Monsieur Ganaye applies for one of the current vacancies for Non-Executive Directors at Sloven.

    The details of NED vacancies with a full information pack are there too for any like-minded readers of Sara’s blog too.

  4. Some medics are really worried that they no longer can be like the monks of centuries ago who were revered and worshipped by ignorant and uneducated citizens because of their superior skills in language and laws. Nowadays we now have universal education, the internet and people can share experiences. Divide and rule is not working anymore.

    Doctors and nurses are not godlike, but most, thankfully, are wonderful, caring and good at their jobs. Some of them enter into medicine for the status, some for the money and I hope, most for humanitarian reasons. However, closing ranks against the public they purport to ‘do no harm to’ will only give them bad publicity.

    I agree with Sara the programme was biased against the family. The doctor was almost made to look like she was a sort ‘Mother Theresa’ type figure. Mother Theresa worked with the poor for no reward.

  5. There was another thing in the programme that I did not understand and was brushed over , something about the original hearing were not told about the 75 failings in connection with this case that were the responsibility of the NHS ? Why was the information not released ? Surely the whole and complete picture s necessary to get at the truth ?

  6. Dr BG was presented very well, and even I was won over, though I haven’t really followed the story.
    But I felt there wasn’t enough said about Jack.
    75 failings is a lot of failings and the consultant above Dr BG was clearly also responsible.
    Yes, Dr BG was very sorry, but she was still talking as if Jack was just one of many patients.
    He was everything to his family, and there’s no getting away from that – and re-mortgaging their house to cover legal fees shows how hard it was for them to represent him.
    At the end of the programme, the mother was shown as angry and unbalanced, but Dr BG not.
    This isn’t up to Panorama’s usual standards.

  7. I have emailed Ms Cohen (but received no reply) yo ask why she failed to address the most obvious question about this case, ie:
    Why did Bawa Garba never appeal against her manslaughter conviction??
    If, as her supporters claim, there is so much evidence that she was not to blame, why did she never fight to clear her name?
    Had the conviction been over turned the whole question of being struck off would have become a non issue.
    Yet there was no outcry from doctors when she was convicted, no crowd funding to appeal.
    They only made a fuss when she was struck off. They only raised money to appeal against the striking off. WHY?
    Just have a look at the vitriol posted online by doctors about the GMC. They hate the body which exists to judge them.
    Clearly Bawa Garba’s “supporters” were far more interested in using her case to stick it to the GMC than in actually clearing her name.
    Had they wanted to do that they’d have gone after the CPS not the GMC.

  8. Anne very sound critique. I reported a consultant to the GMC who refused to consider my complaint in 2015. I also reported the Trust he worked for , to the PHSO, for trying to cover up for him. The PHSO also rejected my concerns. I am now having to go through the stress of taking them all to court because they have all been covering up for each other.

  9. “‘An old boy’s culture’ among doctors, a lax approach to safety, secrecy about doctors’ performance and a lack of monitoring by management [and] an arrogance born of indifference” [Sir Ian Kennedy QC In his report on the high mortality rate of babies undergoing heart surgery at Bristol Royal Infirmary].

    “THE PATRONISING DISPOSITION OF UNACCOUNTABLE POWER” [The Right Reverend James Jones KBE commenting on his Panel’s report on deaths at Gosport War Memorial Hospital, when he referred to the title of his Report on Hillsborough.

    No more to be said!

  10. Ms Cohen’s article describes how, after the striking off, other doctors wrote sarcastic letters to the GMC demanding to be investigated because they, too had made mistakes.
    Someone needs to ask Dr Day if any of his cronies ever wrote similar, sarcastic letters to the police or the CPS (who were after all the first to decide to go after Dr Bawa Garba). I’d be very surprised if they did.

    Doctors have made no secret about what they want: A GMC run by doctors. It will then become indistinguishable from the BMA, Medical Defense Union and all the other bodies that make up the cosy circle of doctors closing ranks.
    They’ll keep attacking the GMC till they get this.

    • Dr Day describes himself as (amongst other things) a Christian and a Father! There’s no sign of a good Christian in the tone of his Tweet above and no sign of a caring Father in addressing Sara this way. What would he have thought if Connor had been his son?

        • Hitler also believed in getting rid of “unproductive feeders”. Dr Day pretends that it is just coincidence that everyone who dies because “doctors are under pressure” or because “the NHS is underfunded” just happens to need care because they are old, disabled, or have dementia.
          In a further coincidence, just before Hunt came out in support of Bawa Garba, his department took on responsibility for Social Care. Meaning he would have had to find the money to look after Jack Adcock for the rest of his life…..had he not died age 6.

          • The NHS may (or may not) be under-funded but, before throwing money at the problem, strip out layers of non-clinical managers and bureaucracy and examine fat-cat salaries of non-clinicians.

            People with a degree in geography are capable (with proper training) of running an organisation but (having spent over £5 million on Leadership Training!) Percy on circa £250K (including pension and benefits) – NO! As ‘Scotlander’ in ‘The Oxford Mail’ commented on Percy:

            “She could be a poster girl for NHS incompetence, waste and indifference to public opinion.”

            More than the value of a life – https://999crash.wordpress.com/2017/10/14/the-value-of-life/

  11. Anne your reference to the “Medical Defence Union ” strikes a chord with me. After I complained to my G.P. partnership about the conduct of one of their partners , I was removed from the practice . They then passed all subsequent correspondence to the “Medical Defence Union ” I am still trying to drag information out of the GP practice under the 1998 Data Protection Act. There is no doubt about your assertion that they all hang together and cover for each other , a bit like the Masons or the Mafia. .

    • John – good luck with your subject access request (“SAR”). If you haven’t already done so, complain to the Information Commissioner’s Office, who (in our experience) are helpful. The problem comes when a Data Controller ignores their opinion but at least you then have expert written opinion to take the next stage. We escalated it firstly to the Department of Health (who the Trust ignored too) and then to the National Audit Office. The Trust succumbed 880 days after receiving the SAR. Read more at: https://999crash.wordpress.com/2016/02/02/cover-up/. In hindsight, it is quicker to file a claim in the County Court (Small Claims Track).

      Although you quote the DPA1998 please remember that the General Data Protection Regulations and the Data Protection Act 2018 are now in force, There are some advantages for Data Subjects in the new legislation.

      • Thanks your comments and advice re GDPR I have to say the 1988 DPA has been invaluable in obtaining not only medical records but also internal e mails and correspondence between ” Health Professionals” I would never have normally seen. . In a number on instances and amongst various different health bodies I have had to correct inaccurate information about me, which could have been life threatening . In the world of commerce and business every action is double checked , but in the world of health it seems everything is recorded but rarely double checked.

        • John – you make a very important point. It is vital in an SAR to make clear that all data are requested; not just medical records. Otherwise, most NHS organisations will just send medical records. It is internal communications and external communications with other official bodies, which often contain bombshells!

          Also, if an NHS organisation receives advice from an in-house legal team, check if they are certified to practice. This is important – Legal Professional Privilege applies only to correspondence between certified barristers/solicitors and their clients: an in-house legal team’s client is their employer. If they are not certified, you are entitled to see their advice. I have case law on this if needed.

  12. Pingback: Money, Money, Money | Campaign for Reform At Southern Health

  13. Here’s a really depressing thing I just noticed. Though the crowd funding page for legal representation for Dr Bawa Garba raised £300,000 virtually overnight, the crowd funding page for legal representation for the victims of the Gosport Hospital scandal has raised less than £5000 in two months.

    Says it all about how unequal this battle is…

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