18 February 2011 Six-year-old Jack Adcock was admitted to the Children’s Assessment Unit (CAU) at Leicester Royal Infirmary. He had Down’s Syndrome, a known heart condition and had been suffering from diarrhoea, vomiting and difficulty breathing.
Dr Hadiza Bawa-Garba, a specialist registrar in year six of her postgraduate training (ST6) who had recently returned from maternity leave, was responsible for Jack's care. There was no senior consultant available, leaving her with sole responsibility for the whole CAU.
There was also an IT failure which led to delays in obtaining test results. For example, although Dr Bawa-Garba had ordered blood tests at about 10.45am, she did not receive them until about 4.15pm.
During a handover meeting later that day, Dr Bawa-Garba did not ask a consultant to review Jack’s condition. She also failed to specify that the enalapril medicine Jack took for his heart condition should be discontinued, and his mother gave him his usual evening dose at 7pm.
When Jack ‘crashed’ around an hour later, Dr Bawa-Garba confused him with another patient and briefly put a stop to CPR – though this was not deemed to have contributed to his death.
At 9.20pm, Jack died of cardiac arrest as a result of sepsis.
April 2012 University Hospitals of Leicester NHS Trust informs the GMC that a serious untoward incident investigation had occurred, which resulted in Dr Bawa-Garba being made the subject of three-months' supervised training and taken off the on-call rota.
The CPS decides not to prosecute Dr Bawa-Garba.
June 2012 The GMC receives a referral about Dr Bawa-Garba from Jack's parents and undertakes a misconduct investigation. The decision is postponed pending the inquest into Jack's death.
July 2013 The inquest into Jack's death is adjourned pending further inquiries. The CPS begins a review of its decision not to charge Dr Bawa-Garba.
December 2014 Dr Bawa-Garba, along with two nurses, is charged with gross negligence manslaughter. Prior to this, she had continued her employment with the trust. After being charged, the trust continues to employ Dr Bawa-Garba.
8 January 2015 The MPTS imposes an interim order of suspension on Dr Bawa-Garba’s registration for 18 months pending the outcome of the GMC's investigation into her fitness to practise.
24 March 2015 Dr Bawa-Garba succesfully appeals against the interim order. After the appeal and until her trial, she continued her employment in a patient-facing role in a neo-natal ward.
4 November 2015 Dr Bawa-Garba is convicted of gross negligence manslaughter and receives a two-year suspended sentence.
8 December 2016 Dr Bawa-Garba applies to appeal her sentence in the Court of Appeal but this is denied.
12/13 June 2017 The Medical Practitioners' Tribunal Service (MPTS) suspends Dr Bawa-Garba from working for 12 months, rejecting an application from the GMC to strike her off the register as ‘disproportionate’.
30 June 2017 The GMC lodges an appeal contending that the MPTS decision to impose a sanction of suspension on Dr Bawa-Garba is not sufficient to protect the public.
25 January 2018 Following a successful appeal by the GMC, the Divisional Court substitutes the sanction of erasure for that of suspension, meaning that Dr Bawa-Garba is struck off the medical register. Former health and social care secretary Jeremy Hunt says he is ‘deeply concerned’ by the decision.
29 January 2018 Thousands of GPs sign a letter warning that the case could 'frighten doctors of all grades away from honest self-appraisal'. At the same time, pressure group GP Survival urges doctors to boycott reflective entries during appraisal, despite Dr Bawa-Garba’s e-portfolio not actually being used against her during the court case.
February 2018 Former health and social care secretary Jeremy Hunt launches a review of manslaughter in healthcare, saying: ‘The recent Dr Bawa-Garba case has caused huge concern. Today I have asked Professor Sir Norman Williams, former president of the Royal College of Surgeons - my senior clinical advisor - to conduct a rapid review into the application of gross negligence manslaughter in healthcare.’
A crowdfunding appeal to support Dr Bawa-Garba’s legal challenge against the GMC raises more than £300,000.
March 2018 LMC representatives back a vote of no confidence in the GMC following its decision to strike off Dr Bawa-Garba and call for the GPC to advise doctors to ‘disengage from written reflection’.
Lord Justice Simon grants permission for Dr Bawa-Garba to appeal the decision to strike her off the register.
The GMC announces the terms of reference for its own independent review of how gross negligence manslaughter is applied to healthcare. The findings are due in early 2019.
8 May 2018 The BMA is given permission to intervene as an interested party in Dr Bawa-Garba's appeal against the GMC.
June 2018 The Williams review, the government's rapid review of gross negligence manslaughter in healthcare, recommends that the GMC be stripped of its power to appeal against fitness to practise decisions made by the MPTS. However it rejects calls to give doctors' reflective notes legal protection.
Doctors protesting over the GMC's handling of the case urge the medical profession to join them in an act of 'civil disobedience' by refusing to pay their fees to the regulator via direct debit.
18 July 2018 The British Association of Physicians of Indian Origin (BAPIO) is given permission to intervene as an interested party in Dr Bawa-Garba's appeal against the GMC. Speaking to GPonline, BAPIO president Dr Ramesh Mehta says: 'We are interested from the point of discrimination and equality. If Dr Bawa-Garba was white she wouldn’t have landed in such deep trouble.’
25 July 2018 Dr Bawa-Garba’s two-day appeal against the GMC in the Court of Appeal begins. Her counsel James Laddie QC says that the case had turned out to be ‘something of a lightning rod for the dissatisfaction of doctors and medical staff in this country’.
He also voices concern at the decision to disregard 'systemic failings', which contributed to the environment in which Dr Bawa-Garba came to make the mistakes that led to Jack's death.
13 August 2018 The Court of Appeal overturns the decision to remove Dr Hadiza Bawa-Garba from the medical register in a landmark ruling, and restores a one-year suspension imposed by the Medical Practitioners Tribunal Service (MPTS).
The court ruled that the MPTS 'was entitled to take account of systematic failures at the hospital, and failures by other staff who worked there, when deciding what action to take in relation to Dr Bawa-Garba'.
The GMC confirms it will not seek to pursue the case any further.
19 December 2018 Dr Bawa-Garba's year-long suspension is extended by six months following a review of her case by the MPTS. The tribunal concludes that Dr Bawa-Garba’s fitness to practise ‘remains impaired’, adding that a further period of suspension is ‘appropriate and proportionate’ and ‘sufficient to protect the public and the public interest.’
The extension is agreed by both the GMC and Dr Bawa-Garba, who said she felt ‘unable to attend a public hearing at present due to personal circumstances.’
8 April 2019 On the first day of Dr Bawa-Garba’s review hearing, the MPTS rule that her fitness to practise ‘remains impaired’ because of her ‘extended period of absence from medical practice’. The decision was supported by both the GMC and representatives of Dr Bawa-Garba herself. However, campaigning group the Doctors’ Association UK (DAUK) tells GPonline that it is ‘likely’ Dr Bawa-Garba will be allowed to return to work ‘with conditions’.
9 April 2019 Dr Bawa-Garba is cleared to return to work from July 2019 by the Medical Practitioners Tribunal Service (MPTS). Her return to work is subject to conditions, which will remain in place for two years.
The list of nine conditions set out by the MPTS state that Dr Bawa-Garba will be monitored by a ‘responsible officer’, a ‘workplace reporter’, an ‘educational supervisor’ and a ‘clinical supervisor’ - the contact details of whom must be shared with the GMC.
The MPTS has also required that Dr Bawa-Garba ensure that the GMC is kept up-to-date with details of her job title, job location, any organisation where she has practising privileges and/or admitting rights and any training programmes she is enrolled in.
Dr Bawa-Garba must also design a Personal Development Plan (PDP) with ‘with specific aims to address any areas identified by her educational supervisor’ - a copy of which will be shared with the regulator.