Revamp urged for arraigning doctors

By Leslie Berry

Doctors’ organisations have welcomed a raft of recommendations from an independent review of gross negligence manslaughter and culpable homicide in medical practice.

The review was commissioned by the GMC following the Dr Hadiza Bawa-Garba case. 

Her prosecution and conviction for gross negligence manslaughter after the tragic death in 2011 of six-year-old Jack Adcock sparked a nationwide doctor outcry.

Their trust in the regulator was hugely undermined after it successfully appealed a Medical Pract­itioner Tribunal Service decision not to erase her name from the medical register. 

Responding to the review, Royal College of Surgeons of England  president Prof Derek Alderson, said its recommendations should help ensure greater consistency around how gross negligence manslaughter (GNM) cases were initiated and investigated. 

‘Our health and legal systems must protect patients from avoidable and unnecessary harm, while also providing clarity about the difference between gross negligence manslaughter and basic human error in medical practice.

‘Currently, there appears to be wide variation over which suspected GNM cases are referred to the police for investigation. We therefore support the recommendation that if a coroner feels that a doctor’s conduct might reach the threshold for GNM, they should discuss this with the Chief Cor­oner’s Office before the police are notified.’

Scrutinise the system

He also supported a recommendation that where a doctor is being investigated for GNM or culpable homicide, the system the person worked in should be scrutinised. If the doctor is a trainee, this should include the education and training environment.

The review said the GMC should make transparent its processes for recruitment and quality assurance of those doctors providing expert reports, again welcomed by the college. It also supports a register for expert witnesses in criminal cases if it is fully funded and properly scoped. 

Prof Jackie Taylor, president of the Royal College of Physicians and Surgeons of Glasgow, called for urgent action by government and NHS bodies to ensure doctors have faith that justice will be served after tragic mistakes.

She said it would not be easy to rebuild doctors’ damaged relationships with the GMC, but it was vital that action was taken to build on positive progress begun over the past year. ‘Doctors must have confidence that the system is not loaded against them when mistakes are made.’

Inadequate GMC processes

Her college agreed with the review that the GMC’s processes had been shown to be inadequate and it welcomed calls to urgently update underpinning legislation. 

Prof Taylor said the criminal threshold for the charge of gross negligence manslaughter in England and Wales was lower than the equivalent charge of culpable homicide in Scotland. 

English and Welsh systems could learn from the Scottish experience in developing a legal framework which encouraged transparency and commanded greater respect from victims, families, and healthcare workers.

The BMA welcomed a recommendation that all healthcare providers should be consistent when conducting local investigations and in line with the relevant national frameworks. This would alleviate issues of too much variation in who carries out investigations into serious clinical incidents, it said. 

Lose right of appeal

BMA Council chairman Dr Chaand Nagpaul expressed relief that the review, led by Leslie Hamilton, said the GMC should lose its right to appeal fitness-to-practise decisions made by its own tribunal service. 

The association urged the Government, the GMC, healthcare providers and other relevant bodies to urgently monitor, evaluate and regularly report on the implementation of the recommendations.

Prof Russell Viner, president of the Royal College of Paediatrics and Child Health (RCPCH), said: ‘We support the recommendation that, when there is significant criminal investigation into an individual, the systems around them must also be investigated. 

‘This is not about shifting blame or accountability, but recognising that individuals operate within a wider environment and should not become scapegoats – and failings of the system at large need to be addressed.’

The RCPCH also backed recommendations that:

 The GMC should not be able to appeal decisions by the Medical Practitioners Tribunal Service – and called on government to make the necessary legislative changes promptly to ensure this happened.

 Police investigating cases should have access to independent medical advice to help with decisions on whether to take investigations further. 

It said the burning question now for those who own the actions was how quickly they would be delivered.

• See ‘When safety is critical’