HCSA urges protection for trainees to prevent manslaughter scapegoating

HCSA has today called for new legal protections to halt the scapegoating of trainee medics accused of Medical Gross Negligence Manslaughter, including a state of “legal quarantine” to shield them from initial prosecution.

The only professional association and trade union dedicated solely to hospital doctors issued the call in its submission to the Williams Review into Medical Gross Negligence Manslaughter (MGNM).

The quarantine call is one of a raft of HCSA recommendations aimed at easing the current crisis of confidence within the profession of the learning and regulatory regime, a situation which HCSA is concerned could itself impact on the quality and safety of patients.

As HCSA’s recommendations were published, the Association’s medical lead on MGNM, Consultant Cardiologist Dr John West, warned that the impact of the Bawa-Garba would be felt in recruitment and retention.

“There is now a tangible sense of fear among junior doctors that they are always one mistake away prosecution. This is a toxic effect of the current inadequate framework.

“We want a system of legal quarantine for juniors and the investigatory spotlight to turn first to the whole culture of learning, systems and management within an institution before leaping to make a sacrificial lamb of trainees in court.

“The GMC has allowed the pendulum to swing too far towards bowing to cries for revenge around what are inevitably tragic cases personally.

“We need a sense of balance – where a professional is judged by experts to be a perfectly competent doctor who has made a mistake, then in many cases that should be enough, with caveats, to allow them to continue to practice.

“Essentially we must accept the fact that no-one is infallible – what is important is to distinguish between those individuals whose actions are malevolent or reckless and cases where mitigating circumstances play a major role. Otherwise you have a situation where dangerous cultures continue while good doctors have their careers ended.”

The review, led by Sir Norman Williams, was established amid anger across the medical profession over the treatment of trainee doctor Hadiza Bawa-Garba, who was struck off by the High Court in January after the tragic death of a young patient in 2011. The GMC had sought the ruling after a professional tribunal ruled her fit to practice.

The HCSA submission to Williams calls for:

  • Protection from prosecution for Doctors in Training until the wider details of cases are established – a legal “quarantine”
  • Protected legal status for reflections by Trainees to supervisors, rendering them inadmissible as evidence
  • A meaningful process of engagement with Doctors in Training to establish and act on their concerns over the current reflective process
  • A comprehensive, centrally defined and mandatory induction process for trainees and locums
  • Ringfenced allocation of time for Consultants to properly supervise and coach junior doctors
  • The litmus test for applying MGNM charges should automatically consider the grade of the individuals concerned, with the bar higher for Trainees than other grades
  • A specially trained police team to investigate MGNM cases, only after consultation with and under the supervision of the Attorney-General
  • An automatic test to consider corporate manslaughter charges
  • Reform of law to introduce a specific crime of Medical GNM, acknowledging the significant differences between cases in this and other sectors/circumstances
  • Reversal of the GMC’s legal right to force disclosure of self-incriminating material such as personal reflections
  • Removal of the GMC right to appeal MPTS decisions
  • Review of the MPTS to ensure it is able to act independently to carry out its role