Gross Negligence Manslaughter and Doctors

Case Study:

In a recent appeal case, in which a consultant of urology admitted causing death through gross negligence, the doctor appealed a custodial sentence of two years – imposed by a crown court judge. The appeal was heard in the Court of Appeal. The sentence of two years imprisonment was upheld.

The doctor had made a number of errors in failing to check that certain aspects of care had been undertaken and failing to deliver appropriate care. As well as having made clinical errors, the consultant doctor also sought to cover up his shortcomings by tampering with the clinical records.

The appeal court observed that the doctor:

“took steps to conceal his neglect, by falsifying medical records and clinical notes by altering them, and substituting pages within them to conceal his inactivity. In particular the fluid balance charts were altered in an attempt to conceal the fact that her (the patients) intake of fluid significantly exceeded the output. This was directly related to the fact that the appellant appreciated that one of the contributory factors leading to death had been fluid overload. What is more the observation charts were altered by the insertion of a higher blood pressure reading so as to conceal the evidence that the patient was in fact suffering from low blood pressure, which in itself would have been an indication of sepsis. Moreover the effect of some of his own entries on the records was to conceal the fact that the patient was not responding to anti-bIOTics, and to attempt and convey the impression that the appellant had been chasing up the absence of any ultra-sound scan. As the judge put it, the appellant was trying to present a false picture suggestive of an improvement in her condition while she was in hospital over the weekend, whereas her condition was deteriorating, and a false report was provided to the panel at the hospital dealing with suspected untoward incidents. ” (para 34)

The court continued:

“…he (the doctor) was in charge of the team responsible for her care, and his responsibility went far beyond mere failures of oversight and supervision of those for whose work he was responsible. (The advocate for the appellant) drew attention to the appellant’s previous good character, the destruction of his medical career, his genuine remorse, and the damaging psychological impact on him, his guilty plea, and the long period between the date when he was first charged with manslaughter, and the eventual decision that he should be imprisoned. We have also considered evidence about the severe impact of the sentence on him. ” (para 46)

“With these considerations in mind we come to the starting point reached by the judge, three years imprisonment, subject to the full discount for the guilty plea. We have emphasised that so far as the medical negligence itself is concerned there will be more serious cases, and cases where the relative culpability of the defendant is less serious than it was here. The essential feature of culpability in this case is that, in relative terms, the negligence of the appellant while Lisa Quinn was a patient in hospital continued for a lengthy period. Although no express warning was given to him by anyone else about the risks to which the patient was being exposed, there were a number of different occasions when, if he had not fallen significantly below the standards of accepted practice, the dangers would have been identified, and the consequent risks averted. There is the additional aggravating feature, involving the amendment and alteration to the records by the appellant in the hope of evading responsibility for his actions. Although we recognise that this may not have been directed to the possibility of the evidence considered at the Coroner’s Inquest, and certainly not to the possibility of a criminal prosecution for gross negligence manslaughter, the documents which demonstrated that he, and indeed others for whom he was responsible, had fallen well below the necessary standard were of importance to any internal inquiry. Perhaps most important of all, these records represented what was supposed to be the true history of this patient’s stay in hospital and the circumstances which led to her death. These records should be sacrosanct. The amendments and alterations to them were designed to be a cover up. That is a serious matter of aggravation.” (para 47)

The two year sentence of imprisonment would stand. Appeal dismissed.

Read the full appeal case decision: Garg v R [2012] EWCA 2520 (November 2012)

Read the Court of Appeal Judgment quashing the conviction:

Dr Sellu v The Crown [2016] EWCA Crim 1716 (November 2012). Read the original BBC News Story: Dr David Sellu Jailed for Two and a Half Years for Patient Manslaughter (November 2013) . See also the news story that Dr Sellu was subsequently cleared at a MPT tribunal hearing: Dr Sellu Cleared of Misconduct. The news story also confirms that the CPS did not seek a retrial after the conviction had been quashed in the Court of Appeal.

Rose v R (Rev 1) [2017] EWCA Crim 1168 (31 July 2017) – Finding of Gross Negligence Manslaughter Quashed.

Bawa-Garba v The General Medical Council & Ors [2018] EWCA Civ 1879 (13 August 2018) – Finding of Gross Negligence Manslaughter Quashed.

Dr Balla Kovalli Jailed for Two and a Half Years for Patient Manslaughter (August 2013)