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20 Criminally negligent manslaughter
e best advice to a health care professional is to do their job at the highest stan-
dard to avoid the criminality of their conduct ever being called into question.
However, the law recognises that all professionals are human and may make mis-
takes: ‘Mistakes, even very serious mistakes, and errors of judgment, even very
serious errors of judgment, are nowhere near enough for a crime as serious as
manslaughter to be committed’.
4
HOW IS AN INVESTIGATION TRIGGERED?
Usually, a criminal investigation is triggered by the coroner referring the case
to the police for investigation, although families can also ask the police to look
into the circumstances of death. e Crown Prosecution Service (CPS) considers
whether it is in the public interest to prosecute the relevant medical professional
and whether prosecution is a proportionate response.
WHO DECIDES THE CASE?
A jury decides the case in a criminal court.
To secure a conviction, the jury must be satised beyond all reasonable
doubt that the individual or trust committed the crime of gross negligence
manslaughter.
PENALTIES
e oence of gross negligence manslaughter carries a maximum sentence of life
imprisonment.
EXAMPLES OF GROSS NEGLIGENCE MANSLAUGHTER
CONVICTIONS
Some examples of gross negligence manslaughter convictions include:
●
In 2007, Stevenson, a GP, injected Marjorie Wright with six times the correct
dose of diamorphine for a migraine. He admitted to manslaughter but was
spared jail. His 15-month jail term was suspended for 2 years.
●
An 80-year-old patient, Winifred Bowman, died at the Royal Sussex County
Hospital due to complications from a hip operation in 2005. Nurse Amaro
was found guilty of gross negligence manslaughter in 2008 aer it was
discovered that she failed to properly monitor Bowman’s vital signs. She was
sentenced to 30 months in prison.
●
In 2010, Ubani, a German doctor working for an out-of-hours service in
Cambridgeshire, administered a lethal dose of diamorphine to a patient
named David Gray. Dr Ubani was found guilty of gross negligence man-
slaughter and was sentenced to 9 months in prison.
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Examples of corporate manslaughter convictions 21
●
Hadiza Bawa-Garba, a trainee doctor, was found guilty of gross negligence
manslaughter in 2015 when she failed to diagnose and treat sepsis, resulting
in the death of a 6-year-old boy, Jack Adcock. She was sentenced to 2 years in
prison, which was later reduced to a suspended sentence on appeal.
●
In 2017, Richard Neale, a pharmacist, was found guilty of gross negligence
manslaughter in the death of a young girl who was given ten times the pre-
scribed dose of an epilepsy drug. Mr Neale was responsible for dispensing
the medication and failed to notice the error before it was administered. He
was given a 9-month suspended prison sentence.
CORPORATE MANSLAUGHTER
Corporate manslaughter was established in UK law via the Corporate
Manslaughter and Corporate Homicide Act 2007, which, for the rst time,
allowed for companies and organisations to be found guilty of corporate man-
slaughter as a result of serious management failure resulting in a gross breach of
a duty of care.
As a result, gross negligence manslaughter cases can no longer be brought
against companies and organisations.
e threshold for establishing corporate liability for manslaughter is very
high. It must be proven beyond all reasonable doubt that:
●
e defendant is a qualifying organisation.
●
e defendant owed a duty of care to the deceased.
●
e defendant grossly breached that duty of care.
●
Senior management played a substantial role in that breach.
●
e breach caused or contributed to death.
In the medical context, NHS trusts may face criminal prosecution for corporate
manslaughter if a patient dies as a result of gross negligence. If found guilty, the
health care trust may be ned and/or ordered to take steps to remedy any de-
ciencies in its health and safety policies, systems or practices.
EXAMPLES OF CORPORATE MANSLAUGHTER
CONVICTIONS
Few health care trusts in the UK have faced prosecution for corporate man-
slaughter. However, examples include:
●
Maidstone and Tunbridge Wells NHS Trust was prosecuted in 2009 follow-
ing an outbreak of Clostridium dicile that caused the deaths of 5 patients
and contributed to the deaths of 22 others. e trust pleaded guilty to
charges of corporate manslaughter and was ned £750,000.
https://t.me/med1917
22 Criminally negligent manslaughter
●
In 2013, the Mid Staordshire NHS Foundation Trust was found guilty of
corporate manslaughter in relation to the deaths of patients who received poor
care at Staord Hospital between 2005 and 2009. e trust was ned £200,000.
●
In 2021, Southern Health NHS Foundation Trust was prosecuted in relation
to the death of a patient, Conor Sparrowhawk, who drowned in a bath in
its care. e trust pleaded guilty to charges of corporate manslaughter, was
ned £2 million and received an additional ne of £950,000 for breaching
health and safety laws.
Prosecutions of health care trusts for corporate manslaughter are rare, and most
cases involving health care providers tend to result in charges of gross negligence
manslaughter rather than corporate manslaughter.
NOTES
1. R v Adomako [1995] 1 A.C. 171.
2. The legal ‘test is the standard of care of the ordinary skilled man exer-
cising and professing to have that special skill. A man need not possess
the highest expert skill: it is well established law that it is sufficient if he
exercises the ordinary skill of an ordinary competent man exercising that
particular art’. Bolam v Friern Hospital Management Committee [1957] 1
WLR 582.
3. Meiklejohn v (1) St George’s Healthcare NHS Trust (2) Homerton
University Hospital NHS Foundation Trust [2014] EWCA Civ 120.
4. R v Misra [2004] EWCA Crim 2375.
https://t.me/med1917
23
5
Bawa-Garba and the use of
reflections in court
The case of R v Bawa-Garba [2016] EWCA Crim 1841 led to widespread debate
about the working conditions and pressures faced by health care professionals
in the UK. It has also shaped the use of a health care professional’s reections in
legal proceedings and has sparked a debate about whether a doctor’s reections
should be considered condential and whether they may be used against them
in court.
On 4 November 2015, before judge and jury, Hadiza Bawa-Garba, a trainee
doctor, was convicted of the gross negligence manslaughter of Jack Adcock and
was sentenced to 2 years imprisonment, which was later reduced to a suspended
sentence on appeal. e nurse on duty at the time, Isabel Amaro, was also con-
victed of the same oence, but the ward sister, eresa Taylor, was acquitted.
In Dr Bawa-Garba’s tness to practise hearing in 2017, the Medical
Practitioners Tribunal Service (MPTS) found her guilty of multiple charges of
professional misconduct, including failing to properly assess and monitor Jack.
e MPTS concluded that Dr Bawa-Garba’s actions fell signicantly below the
standards expected of a competent and conscientious junior doctor and that her
failings contributed to Jack’s death. e GMC applied for Dr Bawa-Garba to be
struck o the register, but the MPTS rejected this, saying that erasure would
be disproportionate given the mitigating and aggravating factors. Instead, they
imposed a 12-month suspension on her ability to practise. e GMC appealed the
decision, arguing that suspension was insucient to maintain public condence
in the medical profession. In 2018, the appeal succeeded, and Dr Bawa-Garba’s
suspension was replaced with the decision to strike her name from the medi-
cal register. Following a crowdfunding campaign, Dr Bawa-Garba appealed the
decision to erase her name from the register. e appeal was successful and the
decision overturned, with Dr Bawa-Garba being reinstated in the medical regis-
ter with a one-year suspension.
DOI: 10.1201/9781003179351-6
https://t.me/med1917
24 Bawa-Garba and the use of reflections in court
WHAT ARE REFLECTIONS?
Doctor’s reections are a key component of the appraisal and revalidation pro-
cess in the UK. Reection is the process of thinking about and analysing one’s
own experiences and actions, with the aim of identifying areas for improvement
and learning.
In the medical profession, doctors are encouraged to reect on their clini-
cal practice, including their interactions with patients, colleagues and other
health care professionals. is can involve thinking about how they approached
a particular case, what they learned from the experience and how they might do
things dierently in the future.
Reection can take many forms, including written reections, recorded audio
or video, discussions with colleagues or mentors and participation in peer reviews
or quality improvement activities. Doctors are required to document their reec-
tions as part of their appraisal and revalidation process, and these reections are
used to inform their ongoing professional development.
Reection is seen as an important tool for improving patient care and prevent-
ing errors in the medical profession. By encouraging doctors to think critically
about their practice and learn from their experiences, reection can help pro-
mote a culture of continuous improvement and innovation in health care.
THE USE OF DR BAWA-GARBA’S REFLECTIONS IN COURT
Contrary to several reports, Dr Bawa-Garba’s e-portfolio reections statement
on the case were not presented to the court or the jury during her trial for gross
negligence manslaughter.
1
However, Dr Bawa-Garba’s duty consultant, O’Riordan, did include his
thoughts following his meeting with Dr Bawa-Garba to discuss the incident and
learnings in his witness evidence. Attached to his evidence was a trainee encoun-
ter form not signed by Dr Bawa-Garba. e trainee encounter form was not a
component of Dr Bawa-Garba’s e-portfolio and did not contain any admission of
guilt or liability. Moreover, it was not referred to by either the CPS or the defence
during the trial and, therefore, was not considered by the jury.
In fact, the court was clear from the start that reections were irrelevant to the
facts of the case and that no weight should be given to any remarks documented
aer the event.
THE USE OF DR BAWA-GARBA’S REFLECTIONS IN THE
FITNESS TO PRACTISE HEARING
In Dr Bawa-Garba’s case, some personal reections – though not the e-portfolio
statement – were shared with the panel to show her remediation eorts.
In her reections, Dr Bawa-Garba acknowledged a number of mistakes that
were made during Jack’s care, including misinterpreting test results and not esca-
lating his care to a more senior doctor in a timely manner.
https://t.me/med1917
Advice to doctors 25
THE GENERAL MEDICAL COUNCIL’S POSITION
e case provoked widespread debate about the condentiality of a doctor’s
reections and the possibility of their use against them in court.
is led to a review of the General Medical Council’s (GMC) guidance on
reective practice, with the aim of clarifying the use of reections in legal pro-
ceedings. e GMC stated that doctors’ reections should be considered private
and condential and should not be used as evidence in legal proceedings. e
MPTS also stated that doctors should be able to reect openly and honestly on
their cases without fear of legal consequences in order to promote a culture of
learning and improvement in the medical profession.
THE CURRENT POSITION
e GMC has conrmed that it does not request reective notes from doctors to
investigate concerns in relation to them. However, an individual may choose to
oer them as evidence of their insight into their practice.
In a civil legal case, all written materials, including reections, are potentially
disclosable in the context of litigation, and there is no legal privilege shielding
reections or e-portfolios from disclosure.
ADVICE TO DOCTORS
Reective practice is a crucial aspect of professional development, as it allows for
ongoing learning, practice improvement and the cultivation of self-awareness.
Doctors are recommended to work with their supervisors to determine the
best approach to reecting on their experiences and documenting this process.
Documenting reections in a way that is meaningful and relevant could
include writing in a diary, completing reective forms or templates and discuss-
ing experiences with supervisors.
When documenting reections:
●
Keep it condential: Reective practice is a personal and condential pro-
cess, and doctors should ensure that their reections are not shared without
their permission.
●
Patient details in any reections and feedback should be entered anony-
mously so that individuals cannot be identied from what is written.
●
Be honest: Reections should be honest and include both positive and nega-
tive experiences to promote learning and growth.
●
Focus on learning: Reections should focus on learning and improvement
(learning outcomes) rather than blame or criticism, while factual details
should be recorded elsewhere.
●
Use a structured approach: Some doctors nd it helpful to use a structured
approach to document reections, such as the Gibbs reective cycle and the
Johns reective framework.
https://t.me/med1917
26 Bawa-Garba and the use of reflections in court
If uncertain about the admissibility of their reections in a legal context, doctors
should seek legal advice.
For furt her details, doctors should consider ‘e Reective Practice Guidance’
2
for doctors and medical students.
NOTES
1. https://www .gmc -uk .org/- /media /documents /20180419 -factsheet-- -dr
-bawa -garba -case -final _pdf-74385491 .pd f.
2. https://www .gmc -uk .org/- /media /documents /dc11703 -pol -w -the -reflec-
tive -practioner -guidance-20210112 _pdf -78479611 . p d f.
https://t.me/med1917
SECTION 2
Regulatory bodies
https://t.me/med1917
https://t.me/med1917
29
6
The General Medical Council
The GMC is a regulatory body in the UK that is responsible for setting and main-
taining the standards of medical education, training and practice.
WHAT IS THE ROLE OF THE GENERAL MEDICAL
COUNCIL?
e GMC plays a crucial role in maintaining public trust in the medical profes-
sion and ensuring that doctors in the UK are qualied, competent and practicing
to a high standard to ensure that patients receive safe and eective care from
their doctors.
e GMC has several responsibilities, including:
●
Setting standards: e GMC sets standards to ensure that medical students
and doctors in the UK receive the necessary education and training to
provide safe and eective care to patients. is includes the standards for
medical schools, the requirements to practice as a doctor and the training
and assessment needed to maintain registration with the GMC.
●
Registration and licensing: e GMC maintains a register of all licensed doc-
tors in the UK. To practice medicine in the UK, a doctor must be registered
with the GMC. e GMC also issues licences to doctors who meet its stan-
dards and requirements.
●
Fitness to practise: e GMC investigates complaints and concerns about
doctors’ behaviour or performance. is includes cases of professional
misconduct, poor performance and health issues that may aect a doctor’s
ability to practice safely. If necessary, it can take disciplinary action against
doctors who breach its standards. is may include suspending or revoking a
doctor’s registration if necessary.
●
Promoting good medical practice: e GMC promotes good medical practice
by providing guidance and advice to medical students, doctors, patients and
the public. It also publishes ethical guidance for doctors on issues such as
condentiality, consent, end-of-life care, best practice in clinical care and
communication with patients.
DOI: 10.1201/9781003179351-8
https://t.me/med1917
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