Culture of blame in the UK

**NICU Guy, BSN, RN** · Jan 26, 2018

Does Google have a English Medical to American Medical translation app? It was hard to follow since I don't know the UK Healthcare system. It seems to me that it comes down to an overworked doctor, covering way too many areas and a nurse giving a unprescribed medication. The doctor was never told about the medication. How is she responsible for the nurse's med error?

babyNP., APRN · Jan 26, 2018

Does Google have a English Medical to American Medical translation app? It was hard to follow since I don't know the UK Healthcare system. It seems to me that it comes down to an overworked doctor, covering way too many areas and a nurse giving a unprescribed medication. The doctor was never told about the medication. How is she responsible for the nurse's med error?

To answer your first question, I do not know of any, but I do have a UK nursing license. I had to take a class on the UK healthcare system to get it and my husband is a Brit so I can probably answer any questions you might have regarding that. I would of course also defer to the folks on this forum who are native to the UK and have worked extensively in the NHS (the healthcare system in the UK).

To answer your second question, she is not responsible, of course. But there has to be a scapegoat in the UK healthcare system. I noticed this when I did an assignment looking at the NMC (nursing council, equivalent of a state board in the US) disciplinary role with nurses. I was in a class of Canadians & Australians and we all commented on how the system seemed to very much "blame the nurse." One of the couples were Australian lawyers in addition to being nurses and they were shocked on the punitive nature of the NMC. Our teacher (lived and worked in Bournemouth in south of the UK, but originally was from Belgium) kind of wrung her hands and said that we were right but there was nothing much to do about it. Her colleague (a native English nurse) agreed...

Wuzzie · Jan 26, 2018

I wonder if the mother gave the Enalapril. That wasn't made clear. I find it difficult to believe a nurse would just give a medication that wasn't on the MAR.

spacemonkey15 · Jan 28, 2018

There have clearly been a number of failings within the hospital system and this doctor has been made the scapegoat for them.

skylark, BSN, RN · Jan 29, 2018

I don't see anything about going to jail, I see a SUSPENDED sentence, which is not the same thing.

And there seems to have been some pretty major errors here, not just one wrong medication as you imply.

Missing signs of sepsis and not knowing about a DNR status are fundamental.

Even if the IT system was down, basic vitals would have been available, and flags should have been evident.

Having worked in both the UK and the US, I can assure you that the blame culture is far more evident in the US.

NHS staff are rarely fired, and are generally well supported, as long as they function well and don't make basic mistakes like not recognizing sepsis.

I would like to know if the nurses taking vitals reported his/her concerns, and also where the junior doctors were when this was all going south.

vandiola · Jan 29, 2018

I live in Leicester and have worked at this hospital through my agency.

Firstly to note, this doctor was the only registrar covering 6 different areas with a consultant who was off site. The patient had been noted for previous deterioration and was receiving fluids and was improving. Someone then administered unprescribed Enaprilil, some assume it was the mother, as it was his regular medication, and he started to deteriorate again. CPR was started on the child but there was a lot of confusion at the time about his DNR status, there isn't any solid information as to why CPR was stopped but the jury were informed CPR would have had little effect.

The nurse has been removed from the register for 5 years and can return after that period. She was an agency adult nurse, but had previously worked on the unit before. Its been stated in her NMC hearing that she was struck off for not taking observations, not doing a fluid balance and not escalating concerns. I'm not condoning her behaviour, but she did inform the the NMC that staffing was very poor and she tried to escalate concerns to the senior nurse as staff nurses aren't allowed to contact doctors (to prevent their bleep going off all the time) and have to discuss with the senior nursing staff instead. She said the senior nurse ignored her concerns.

There were many other issues such as IT going down, lack of senior medical support and lack of experienced nurses on the unit. But both the nurse and doctor carried on working from 2011 when the incident happened to 2015 when they were brought to court, and had unblemished records. I have a lot of sympathy for the family of Jack, he didn't deserve to be the victim of poor care, but that poor care seems almost conducive to systematic problems. It seems like just the doctor and nurse were entirely blamed for the situation which doesn't actually address the problems in the system.

If anyone is interested, there is a facebook page that is supporting the doctor go to the high courts to appeal the decision. There is a lot more information about the case there

Burnvegas · Jan 29, 2018

I wonder if mum gave it too. I've had parents give meds before without our knowledge when they shouldn't have had them. I've had a baby double dosed with domperidone because the mum didn't believe we had given it... We ultimately got the blame when the docs found out and all hell broke loose, she watched smugly as we had to do an ECG and hourly obs. And still had the gall to complain about the incident to management resulting in the two of us nurses being reprimanded for giving the domp... Even though she gave the overdose but changed her version of events for the complaint... There's hundreds of parents like that, sadly.

Personally, I wouldn't be happy to give an ace inhibitor to a child without a written prescription... but maybe an adult trained nurse would think less of it because it's a more common drug to them?

vandiola · Jan 29, 2018

No nurse in the UK would give a non prescribed medication. He had a lot of heart problems and took the medication regularly. Many think the mother gave it to him, which is why it wasnt discussed in the courts

Wuzzie · Jan 29, 2018

No nurse in the UK would give a non prescribed medication. He had a lot of heart problems and took the medication regularly. Many think the mother gave it to him, which is why it wasnt discussed in the courts

If the mother gave it to him then she is the one who started the cascade of badness. That doesn't excuse a system that was fraught with so many other chances to cause harm but to lay the blame entirely at the feet of the physician and nurse involved was truly unjust.

babyNP., APRN · Aug 15, 2018

UPDATE:

366,000 GBP ($464,000) was raised by doctors and other healthcare workers in the UK and around the world to help mount an appeal. A 3 judge panel overruled the GMC (seems to be the equivalent of a board of medicine in the USA as far as I can tell) and said that the doctor should be able to be reinstated. Here's some good commentary...

Across the medical profession there has been a loud, collective gasp of amazement at the double tragedy of Jack Adcock's death and Bawa-Garba's painful seven year journey through the criminal justice system. The case has shined a very clear light on how "blame" never advances patient safety. Why was it that just two individuals (Bawa-Garba and Isabel Amaro) were convicted? They were working in a system so compromised that over 70 actions had to be taken by Leicester Royal Infirmary staff in order to improve how sick children were managed in future. Despite this, the Crown Prosecution Service (CPS) decided that there was not sufficient evidence of hospital culpability for Leicester police to pursue criminal charges.
Indeed, to date, no UK hospital has been convicted of corporate manslaughter. To err is human, though it seems legally it is much easier to convict an individual doctor or nurse than a hospital. Overall, the court of appeal assisted our understanding here by reminding us that gross negligence manslaughter trials focus on the personal actions of defendants: the trial judge remarked that there was a limit on "how far the systemic failings of the hospital and the actions of others could be explored in the trial." Whether race may have played a part in the conviction has also been questioned, although the numbers are too small to draw any firm conclusions.The trend, however, is worrying and should be further examined by the Crown Prosecution Service.

The long road to justice for Hadiza Bawa-Garba - The BMJ

I believe the nurse Isabel Amaro is still "struck off" the NMC register.

It gladdens my heart to see this overturned as a believer in overcoming systemic failures rather than individual blame. Now we will see if Dr. Bawa Garba will choose to appeal her manslaughter conviction...

edit:

Here is a great overview of events from the BBC. I will add it to my original post:

The doctor struck off for honest mistakes - BBC News

attachment.php?attachmentid=27281&stc=1