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Garg v R, Court of Appeal, 30 November 2012

14 December 2012
The issues

Medical negligence – gross negligence – manslaughter – sentencing

The facts

The defendant was a Consultant Urologist at Bradford Royal Infirmary. He was appointed in March 2006. In August 2008 Lisa Quinn was admitted to the Accident & Emergency Department of the hospital. She appeared to be a healthy young woman complaining of abdominal pain, pain on passing urine and strong smelling urine and whose symptoms became bad enough for her to seek medical help. She died in hospital the Monday after the Friday she was admitted. Mr Garg was charged with the manslaughter of Lisa Quinn on the basis of gross medical negligence.

The allegations against Mr Garg were four:

  • failing to ensure that Lisa Quinn’s clinical condition was properly identified
  • failing to identify or diagnose the possibility of closed renal infection and the development of sepsis
  • failing to arrange urgent interventional treatment for a closed renal infection, of which there was early evidence in the form of the A&E x-ray and the patient’s clinical condition
  • failing to arrange a transfer to an appropriate hospital after 8am on the morning of Sunday 24th August.

This was the first occasion since the Criminal Justice Act 2003 came into force on which the Court of Appeal had considered an appeal against sentence in the context of gross medical negligence

Expert evidence demonstrated that if active intervention had been instituted even as late as the evening of the Sunday, she would probably have survived and her prospects of ultimate survival only became remote by the Monday. The experts instructed by the prosecution expressed the view that the breach of duty in this case constituted a very serious departure from normal professional standards and no reasonably competent consultant in this discipline would have failed to take action to exclude a closed infection, or have failed to take timely action to institute effective intervention. Mr Garg acknowledged criminal breach of duty in his guilty plea. After the death, Mr Garg changed the medical notes. He filled in a cremation certificate giving inaccurate information which had the result of causing the coroner’s office not to be alerted to the possibility that her death was due to negligence although Mr Garg’s intention was to deflect an internal investigation by the hospital. When sentencing, the judge acknowledged the pressures and responsibilities bearing on Mr Garg and his heavy workload before and during the weekend. The judge also recognised that some of the junior members of the medical staff of the hospital may by their actions have contributed to the tragedy. He took account of Mr Garg’s good reputation and genuine remorse. A psychiatric report indicated that there was no real risk that Mr Garg would reoffend or cause serious harm to the public and that he suffered from anxiety and depression as a result of the death. The judge imposed a sentence of 2 years imprisonment. Mr Garg appealed to the Court of Appeal.

The decision

This was the first occasion since the Criminal Justice Act 2003 came into force on which the Court of Appeal had considered an appeal against sentence in the context of gross medical negligence. Although the decision would no doubt be considered by other sentencing courts, beyond broad general observations this was not to be taken as a guideline decision purporting to encompass the full ambit of sentencing in cases of manslaughter by gross medical negligence.

Counsel for Mr Garg argued that prior to implementation of the Criminal Justice Act 2003 medical gross negligence cases were regarded as requiring levels of punishment at a more modest level than those appropriate to different forms of offence by manslaughter by gross negligence. The court agreed that there was nothing in the legislation or subsequent decision which suggested that any long established balance drawn between different types of gross negligence manslaughter should now be recalibrated. However, two clear principles followed from the implementation of the 2003 Act and had been identified in sentencing decisions of the Court of Appeal. First of all, Section 143(1) of the Act focusing direct attention on the harm actually caused by the offence, always involved harm at the highest level. Secondly the effect of Schedule 21 of the 2003 Act had been to increase the punitive element in sentencing for murder, and this had had an inevitable effect on sentences for manslaughter on the basis that the statutory intention was to underline that crimes which resulted in death ought to have been treated more seriously and dealt with more severely than before.

The judge’s starting point had been three years imprisonment subject to a discount for the guilty plea. There would be more culpable cases than this in the context of gross medical negligence. The essential features in this case were that whilst Lisa Quinn was in hospital, the negligence of Mr Garg continued for a lengthy period. There had been a number of different occasions when if his conduct had not fallen significantly below standards of accepted practice, danger would have been identified. In addition, there was the aggravating feature that Mr Garg had amended and altered the records in the hope of evading responsibility for his actions. Records should be sacrosanct. That was a serious matter of aggravation. In those circumstances the judge’s sentence was not manifestly excessive. Appeal dismissed.

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The content on this page is provided for the purposes of general interest and information. It contains only brief summaries of aspects of the subject matter and does not provide comprehensive statements of the law. It does not constitute legal advice and does not provide a substitute for it.

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