Some thoughts on Dr Bawa-Garba and our faith in the jury system

I’m loath to tread onto terrain that I do not usually cover in my modest knockabout criminal practice, but the case of Dr Hadiza Bawa-Garba has caused such tremors in the medical profession that I thought, vainly, that I might throw my two pence in.

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Misery is so ubiquitous in the criminal law that it feels trite if not otiose to start with the observation that this – as inevitably with any that makes the news – is a very sad case, but there is something about the cumulation of tragedies spinning out from Bawa-Garba that stands it out as particularly upsetting. A seriously ill six year-old child, Jack Adcock, died in hospital on 18 February 2011 after what were alleged to be  – and accepted by a jury as being – serious failings in diagnosis and treatment by Dr Bawa-Garba, the responsible doctor.

On 4 November 2015, she was convicted of gross negligence manslaughter and sentenced to a suspended sentence of imprisonment, having been initially informed by the CPS in 2012 that she would not be prosecuted at all. Her fitness to practise was found to be impaired by the Medical Practitioners Tribunal in June 2017, and she was suspended for a period of 12 months. Last week, the High Court ruled, following an appeal by the General Medical Council, that this sanction was insufficient, and substituted the sanction of erasure from the medical register – effectively ending Dr Bawa-Garba’s career.

I shan’t rehearse the complex medical evidence and arguments advanced at Dr Bawa-Garba’s original trial; a summary of the arguments can be found in last week’s judgment here (and in the judgment from the Court of Appeal dismissing her application for leave to appeal against conviction, here). But, reducing the arguments down to a digestible core, the prosecution, relying on the testimony of medical experts, argued that the decisions and omissions of Dr Bawa-Garba were so serious, and her conduct fell so far below the standard of care expected by competent professionals – “truly exceptionally bad” being the test set for the jury – that she was guilty of manslaughter by gross negligence, it being said that these failings caused Jack to die significantly sooner than he would otherwise have done. Dr Bawa-Garba, for her part, denied gross negligence, arguing (also with the support of expert evidence) that Jack’s case was complicated, and that excessive demands placed upon her by a multiplicity of systemic and (other) individual failings meant that she had done her clinical best in difficult circumstances.

The jury returned a guilty verdict, and professional disciplinary proceedings followed. The decision by the High Court last week to allow the GMC’s appeal has caused widespread upset among the profession (see this excellent blog by Dr Rachel Clarke for an explanation).

The reason for the High Court’s decision was that it found that the Tribunal had, in imposing a suspension instead of erasure, attached significant weight to the aforementioned “multiple systemic failures” at the hospital at the time, which included

“failings on the part of the nurses and consultants, medical and nursing staff shortages, failings by nurses and consultants, IT system failures which led to abnormal laboratory test results not being highlighted, deficiencies in handover, accessibility of the data at the bedside, and the absence of a mechanism for an automatic consultant review.”

What is the problem with this? Well, the High Court ruled that these systemic failures had already been considered by the jury at the criminal trial, and that the jury’s guilty verdict represented their finding that Dr Bawa-Garba’s mistakes were “truly exceptionally bad”, even taking into account the conditions in which she was forced to work. Therefore, the High Court concluded, the Tribunal fell into legal error in effectively disregarding the verdict of the jury and reaching its own views as to the level of culpability. If a jury has found Dr Bawa-Garba’s actions to be truly exceptionally bad notwithstanding the systemic conditions, it’s not for a professional disciplinary tribunal to try to form its own opinion based on the systemic failings and downgrade the doctor’s actions to only ‘really quite bad’, in other words.

Doctors who are plunged regularly, if not daily, into the type of systemic chaos that prevailed on that fateful day are now understandably panicked about the ramifications in the event of an avoidable tragedy. Not only, it seems to them, is there a risk of criminal sanction, but the professional regulator – the GMC – will seek to have doctors struck off for what are partially – if not mainly – failings caused by understaffing, lack of resources and defective working practices. What, it has been asked, is a doctor to do upon arriving at work to find themselves in Dr Bawa-Garba’s position? Do one’s best to help patients and risk the same fate? Or down tools citing unsafe working conditions?

For what little it’s worth, I understand the anxiety entirely. But I do wonder whether the consternation in fact burrows deeper than last week’s decision. Because there’s an undeniable logic to the High Court’s judgment: If a criminal court has found, beyond reasonable doubt, that someone’s actions are truly exceptionally bad, it’s a bit off for a different legal tribunal to decide that, actually, the actions were simply honest mistakes. And while anger at the lack of sympathy displayed by the GMC is natural, the ultimate “fault” lies a few stages back – with the verdict of the jury.

It was after all the jury that heard all the evidence of the systemic failures, the clinical decisions taken and not taken, and the errors on the ground, and was still sure of Dr Bawa-Garba’s extremely high personal culpability. It was the jury that weighed the competing expert evidence as to best clinical practice and concluded that these were not simple honest errors but something far, far more serious. And while I don’t seek to second-guess the verdict, nor the competence of the twelve men and women who tried what was no doubt an extremely difficult case to the best of their ability, this case provokes difficult questions as to the suitability of a lay jury to determine complex matters of professional competence.

Trial by a jury of one’s peers is one of the most proudly-hugged rudiments of our criminal justice system – Magna Carta and all that jazz – predicated as it is partially on the notion that disputes of facts falling within the experience of everyday folk should be settled by everyday folk. But where criminal liability hinges on competing interpretations of professional standards, we can see a tension rippling across the surface of our definition of “peers”.

There has been online debate among medics as to whether, based on the evidence summarised in the publicly-available judgments, Dr Bawa-Garba’s conduct was correctly determined to be grossly negligent. Clinical opinions have clashed and war stories of identical climates and narrowly-averted tragedies have been traded as doctors re-litigate the nub of the criminal trial, and in particular the question over whether the jury did, or could, fully appreciate and understand the reality on the ground. While I ordinarily fall into reproachful tutting at armchair juries, there is something about all of this that resonates, louder and more violently than I expected.

I think it’s because, for me, the thought of 12 non-lawyers being called upon to make judgments on my professional standards fills me with horror. Working in the criminal justice system on any given day is, I have no doubt, akin to working in the climate of systemic failure suffered by Dr Bawa-Garba and her colleagues. There is insufficient everything, both material and temporal. What there is, doesn’t work. It is often a miracle that anything resembling justice is fired out at the end of the production line of disorder that comprises many criminal cases. I worry about every single case I have – not simply because of the high stakes or the complexity, but because I cannot trust a single other element of the system to work as it should. Disaster is a heartbeat away at every turn. If I avoid its icy grasp, it’s been a brilliant day. When mistakes happen – and they do, for all of us – it is our individual responsibility of course, but I would plead that they usually arise against that backdrop. And if I found myself in a court of law, trying to convey that reality to twelve laypeople, I know for a fact that I could not even begin to make them understand. Neither could any expert, nor any other witness, no matter how eloquent.

I couldn’t do justice in words to the panic of having several hundred pages of tardy disclosure dumped on you by the indolent prosecution on the morning of a trial where your client is facing a possible life sentence, and having to take full impromptu instructions in the court cells as your violent, psychiatrically unwell client screams and smashes his head against the cell door, while the unsympathetic judge, conscious of the need to “get things started”, tannoys every ten minutes for you to return to court. I cannot paint an adequate portrait of the problems posed when the Crown Prosecution Service instructs you the night before on a trial that they have hitherto kept in-house, and which has not even been looked at by the CPS advocate, and the thudding pressure of arriving at court with a shopping list of urgent missing evidence, disclosure and legal applications, to find that the court WiFi is down, the CPS caseworker assisting you is covering two other courtrooms, the court forgot to book an interpreter for your witness  and your police officer in charge of the case has phoned in sick and sent a replacement bobby who knows nothing about the trial. I cannot convey to a layperson the sheer madness of the magistrates’ “list” system, where the most junior lawyers are dumped at a few hours’ notice with half a dozen badly prepared trials, all listed in the same courtroom before a bench of three non-legally qualified magistrates, and expected to prepare the trials, plug the gaps, chase the missing witnesses, advise and take instructions from overwrought CPS lawyers over the crackling phone lines, soothe the impatient bench and somehow run a series of seamless, effective, just trials.

 Unless you’ve been there, you simply can’t understand.

It is no different, I expect, for NHS staff. Unless you have been there, unless you know, you cannot absorb the experience vicariously. And if you don’t understand the reality, how can you properly, fairly, judge standards of competence exercised by someone ragged in the winds of unpredictability and chaos?

I make clear-  I am in no way doubting or otherwise seeking to undermine the verdict in this case. I was not present at trial, I was not privy to the evidence that went before the jury, and my personal knowledge of matters medical is at best below average. I am confident that the complexities of the evidence and the conflict between the competing experts was clearly explained and made intelligible to the jury by the highly experienced counsel and judge. Furthermore, Dr Bawa-Garba’s conviction has been considered by far better informed and brighter lawyers and judges than me, and has been upheld as safe. Nor am I calling for an immediate revolution in jury trials on the back of this single emotive case. But I do think this raises provocative questions that we in the system perhaps do not pause to examine.

Maybe it’s simply special pleading. Maybe I’m guilty of rank arrogance in assuming that mere members of the public can’t begin to understand the pressures upon us in the ‘traditional professions‘, and am dismissively oblivious to the extraordinary strains placed upon all manner of people outside of law and medicine, and the ability of juries to digest and empathise. I may well be – subconsciously or otherwise – simply writing out my mitigation, or my excuses, to be relied upon at a later date when my professional competence is held up to scrutiny and found wanting. I don’t know. It’s difficult to write objectively about these things.

But what I think I do know is that, while the virtues of jury trial are drummed home from first-year law school, we shouldn’t be afraid to re-examine our shibboleths, particularly when the underlying concepts – juries of our peers – are stretched and strained. I like to think that the expert presentation of complex criminal cases is sufficient to ensure that juries have all the tools to arrive at informed and just verdicts. But I do have sympathy for the anxiety of those who feel that explanation and experience are too different, too far apart, for the former to be a proper substitute for the latter.

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In forgetting our fundamental principles of justice, The Trial’s fascinating run fell down at the last

*SPOILER ALERT: If you have not seen the end of The Trial: A Murder In The Family, don’t read on. Unless you’ve no intention of watching it, in which case do as you please.*

Last night, Channel 4’s The Trial: A Murder In The Family drew to a close. At the end of a five-day run showing edited highlights of the augmented reality trial of Simon Davis for the murder of his estranged wife Carla, the finale dragged us inside the emotional furnace of the jury room as the twelve jurors deliberated with a ferocity belying the academic nature of their task.

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The Trial: A Murder in the Family, Photograph by Channel 4

Despite the judge giving a majority direction – where instead of a unanimous verdict, a court can accept a verdict agreed by 10 of the 12 jurors – the factfinders remained aggressively deadlocked. Eight were unpersuaded of the prosecution case, influenced by the evidence pointing to the possibility that the culprit was in fact the deceased’s scorned boyfriend, Lewis Skinner, and dutifully voted Not Guilty; four were sufficiently sure to cast a ballot for Guilty. The jury were hung, in the legal lingo, and so were discharged. At some future date in that parallel universe, Mr Davis will be retried at Berkshire Crown Court, but for now he remains a free man.

And a lucky one, we learned. For, in a curious creative decision, the producers decided to “reveal” through dramatisation what had really happened: Just as prosecuting counsel Max Hill Q.C. had told the jury in his opening and closing speeches, the defendant had indeed attended the former matrimonial home and, upon learning of Carla’s decision to end the fledgling rekindling of their relationship and up sticks to Scotland, had strangled her with his bare hands. The big reveal, it was none-too-subtly implied, was that The Jury Got It Wrong. Lest we be in any doubt as to the editorial perspective, the episode closed with close-up shots of the burdened jurors, their individual verdicts stamped across the screen, before the following captions rose:

“On average, two women are killed by a partner or ex partner every week in England and Wales.”

and

“In this case eight jurors voted not guilty, four voted guilty.

All four guilty votes were cast by women.”

and finally

“Next year more than half a million of us will be called to decide the fate of a fellow citizen.”

The official Twitter account for the programme has since run polls, including asking viewers:

I’m still struggling to make sense of this all.

Taking the above together, the only possible interpretation of the editorial line is: “This jury should have convicted. They didn’t, ergo they failed. What does this tell us about juries? (Clue: Maybe it’s sexism.)”

Which would be fine, had that been the premise of the programme. But it wasn’t. At least, not as far as we’d been led to believe. It was billed – accurately – as a groundbreaking docu-drama in which we would be given a unique insight into the way that juries operate. The opacity of the jury room means that, notwithstanding academic studies attempting to recreate its conditions, we know little about how juries approach their task. We have a fervent cultural faith in the inherent supremacy of trial by jury; let’s, Channel 4 suggested, cut open this sacred cow and have a rummage around inside.

The concept as advertised was not to present a jury with an obviously guilty man, and see whether a jury rationally assessed the evidence to come to the “right answer”, or whether they were waylaid by bias.  That may well have made for a fascinating programme – but it wasn’t the stated purpose of this exercise. Rather, this aimed to present a typically complex and borderline case, and to offer a fly on the wall insight of a jury striving to reach its verdict.

And so much was right about The Trial. Authenticity was plainly its guiding principle. We had some of the country’s very best barristers, with a retired Crown Court judge, and police and expert witnesses played by real police officers and experts. The case and evidence were expertly crafted and balanced on a knife edge by David Etherington Q.C. and Max Hardy. The 12 jurors came laden with a typical breadth of life experiences, replete with the assumptions, cognitive biases and individual prejudices that afflict us all, and which their fellow jurors were quick to identify and challenge. The conditions enabled what in televisual terms comes pretty close to a scientific experiment.

But the ending took that claim to objective inquiry and violently throttled it. Because in the final episode, we suddenly were not interested in how the jury works, but whether they arrived at the right answer. And by “right answer”, the producers meant “truth”. Thus, not only was the bulk of the final episode frustratingly concentrated away from the jury deliberations and onto the reveal of the WhoDunnit, but it risked leaving the non-lawyer viewer with a wholly distorted view of the function of juries.

Because the dirty little secret that The Trial left out is this: Jury trial is not about finding the truth. It can’t be. The truth, in most cases, is indiscoverable. It does not arrive in the courtroom, packaged with a neatly tied bow, at the end of the case, for jurors to benchmark their performance. Even after a verdict, the legal imprimatur of Guilty or Not Guilty, we are still no closer to knowing whether the verdict is factually “true” than we were when the jury retired to deliberate. While we obviously want legal verdicts to correlate with the truth – the factually guilty always convicted and the factually innocent always acquitted – our system recognises that this is unachievable. There are in most criminal cases, as with most human interactions, simply too many complexities and information gaps for us to say with certainty whether someone definitely did or definitely did not do what the state alleges they did. If we were to require juries to find the truth of every case, we would inevitably require them to indulge in speculation and guesswork, with the appalling consequence that factually innocent people would be convicted on that basis.

So we don’t ask juries to guess at the truth. Instead, we present them with as much relevant evidence as we can, and ask them one question: Are you sure that this person is guilty? If yes, the state will take coercive action. If the jury is anything less than sure, they must acquit. Not guilty does not mean innocent. It means that the jury cannot be sure to the very high standard required that, on the available evidence, the defendant is guilty. This inevitably means that factually guilty people are acquitted. But it is the sacrifice our system makes to minimise the risk of the greater peril: a factually innocent person being convicted and punished.

This cornerstone of our justice system – the burden and standard of proof – was The Trial’s glaring omission. While the judge’s summing up and legal directions were understandably edited to the bare minimum, holding (even judges would concede) little televisual interest, would it have been too much to leave in a brief few seconds of the judge reminding the jury, and the viewers, of the essential basis of how to approach their task?

In the event, a number of the jurors disregarded the burden of proof, casting themselves as detectives trying to crack the case – trying to prove the culprit was more likely to have been Lewis – rather than confining themselves to the sole question: was the case against Simon Davis proved on the evidence?

The tragedy is that this case was the perfect vehicle for a considered treatment of the burden and standard of proof. Here we had a murder where the offender could only feasibly have been one of two men – Simon Davis or Lewis Skinner – but where the evidence was arguably insufficient to prove the case beyond doubt against either. The producers could have preserved the integrity of the concept by declining to give us the “answer”, instead explaining – perhaps through the to-camera interviews with the barristers and judge – how it is that our system allows a situation in which we know that the offender was one of two violent men but cannot convict either, and how such an outcome is not an indictment of a jury “failing” in its task, but reflective of the correct course where, regrettably, the evidence is simply not enough to safely convict anyone. This is the build of our system, the programme could have said. Here’s why we do it this way, and here’s what the professionals think. What do you think about it? 

But that line of contemplation was abandoned, the producers instead deciding to grasp for an unconvincing gotcha moment and invite us to lay blame at the jury’s door. As I’ve said, if the producers were looking all along to make a point about juries failing to convict in the face of overwhelming evidence, they could have done. They could have asked the barristers writing the case to devise a deliberately strong case, littered with tripwires and victim myths designed to test the jury’s integrity. But this factual matrix was intentionally blurry. After the reveal, the prosecutor Max Hill Q.C. tweeted:

For what it’s worth, I agree. The evidence of the witness Mullen who (wrongly, we infer) placed the violent Lewis Skinner near the murder scene gave the jury reasonable cause to doubt the prosecution case. To take a knife-edge case and conclude, from the fact that the jury were on a knife edge, that something is wrong is simply bizarre.

Finally, the decision to highlight the gender of the jurors who voted to convict, without saying more, leaves me very uncomfortable. What was the message? That if you, as a juror, are sitting on a case involving an allegation of domestic violence you should be more inclined to convict? I genuinely have no idea what other interpretation we are supposed to draw. If I were defending a man accused of domestic violence today, I would be very nervous about any of the jurors having seen last night’s finale.

In fact, if it were prejudices that The Trial was hoping to root out, fuller pickings were arguably to be found among those who chose to convict. One speculated over the interpretation of DNA evidence, despite being directed not to do so. The famous Cherry, the self-professed “witch” so proud of her unfailing “gut”, appeared determined to convict from Day 1. And of the four convictors, three had direct or indirect experience of domestic violence, which they were quick to overlay on the evidence of the instant case. The final interviews with these four jurors also left us in doubt as to how sure-footedly they stood by their verdicts. There was a distinct impression that some had deviated from “beyond reasonable doubt” to the civil standard of “probably did it”. In fact, it was those who returned not guilty verdicts, despite thinking that Simon Davis probably killed his wife, who were the ones being true to their oath and to their (fictional) public duty.

This denouement is is a shame because in so many ways this programme has been a revelation in legal programming. Matthew Scott’s review of the first episode stands true – it has been in numerous ways a force for good; a powerful and gripping show educating the public on the workings of a criminal court with far greater accuracy and aplomb than is achieved by most dramas. Those involved should rightly be proud.

But by appearing to abandon its stated premise in the final episode, I feel The Trial missed a glistening opportunity to probe at some of those deeper questions about the way we do justice. Is our faith in juries misconceived? Should we entrust our liberty to the Cherrys of this world? How loyal are juries to their oath to reach verdicts on the evidence? Are they able to faithfully follow the judge’s directions on the law? Do they need greater scrutiny, or even screening? Should we demand that juries supply reasons for their decisions, instead of a binary one or two word verdict? Is our commitment to individual liberty a roadblock to catching the guilty, or an immutable principle of which we ought to be louder and prouder?

While there was enough over the five nights to allow us to entertain such thoughts incidentally, it is a shame that at the last the producers swerved off-road, rather than facing the difficult, perhaps more interesting, questions head-on.