Charge

A Professional Conduct Committee (PCC) laid a disciplinary charge against Ms Christine Hawea (the Midwife) because of a lack of care that the PCC alleged amounted to professional misconduct.

The particulars of the charge were as follows:

1. That during the period 7 February 2007 to 30 July 2007 when in the role of midwife and Lead Maternity Carer for her patient Ms U (the Patient) and her son Baby EN (the Baby), born on 5 May 2007 Ms Hawea:

1.1. Failed to make an adequate number of post natal visits to the Baby, her last being on 28 May 2007 when the Baby was 23 days old.
1.2. Failed to refer the Baby to a well child provider within the required six week period.
1.3. Failed to formally end the midwifery partnership with her Patient.
1.4. Failed to have regular and/or ongoing involvement with the Baby and his caregivers despite confirming to CYFS on 17 May 2007 that she would.
1.5. Failed to submit on 30 April 2007 and/or following her final post natal visit to the Baby, resubmit on or about 5 June 2007, a correct and accurate referral to Family Start.
1.6. Failed to make adequate and/or accurate and/or complete documentation in her clinical midwifery notes.
1.7. When being interviewed at Rotorua Police station on 30 August 2007 acted in an aggressive, angry, abusive and violent manner towards the Police officers.
1.8. Acted in breach and/or failed to adhere to the New Zealand College of Midwives Philosophy and Code of Ethics, the New Zealand College of Midwives Standards of Practice (including Standards 1-7 and 9) and the Competencies for Entry to the Register of Midwives (Competencies 1-2 and 4).

 Finding

The Tribunal found that the charge was proved separately for all particulars but that particulars 1.5 and 1.7 did not separately warrant disciplinary action. Taken cumulatively the charge was established and amounted to professional misconduct.

Background

The Baby was born in Rotorua on 7 May 2007 to the Patient, who was seen by the Midwife 2 or 3 times ante-natally and 2 times post-natally. The Baby was whangai-ed (fostered) to her cousin.  The Midwife saw the Baby on 5 occasions after his birth, her last visit occurring when he was 3 weeks and 1 day old.

Shortly after his birth the Midwife had lodged a complaint with CYFS because she was concerned about the person she thought the baby would be living with.  She later spoke with CYFS, reassured them that the baby was healthy, told them she would continue to monitor the baby, and the CYFS file was closed.  However the Midwife saw the mother and baby only once (separately) after this, and she failed to refer the baby onto Tipu Ora, Plunket or any other well child provider until 28 July 2007.

On 26 July 2007 the Baby was injured while in her cousin’s care and was admitted to Rotorua and then Starship Hospital with what appeared to be a brain bleed and/or shaken baby syndrome. He also had an old healing fracture of the forearm, an undisplaced spiral fracture of the upper arm and bilateral retinoid haemorrhages.

Reasons for Finding

Particulars 1.1, 1.2, 1.3, 1.4 and 1.5 – Care for the Baby and Post-Natal Care for the Patient

The Tribunal found that the level of care the Midwife provided to her Patient and the Baby was generally sub-standard.  The Tribunal acknowledged that while the Patient and her cousin were undeniably difficult patients, the Midwife did not adequately discharge her obligations regarding the number of required visits.  Her Patient was very young and vulnerable, and although not particularly interested in her pregnancy and after-birth care the Midwife should not have given up trying to contact her.  The Tribunal was not convinced by the Midwife’s excuse that dogs prevented her from reaching the property.

The Midwife saw the Baby five times after he was discharged from hospital.  The Baby was acknowledged by all to be in a particularly vulnerable situation.  The Tribunal found that the Midwife did not discharge her obligations to visit the baby during this time.  It unhesitatingly accepted there were great difficulties in her ability to contact the Patient’s cousin and to visit the Baby but it considered that the Midwife should have persisted in doing this and in particular persisted past 28 May 2007.  After assuring CYFS that all was well with the Baby and that she would continue to check him, she saw him on only one more occasion.  The Tribunal found this a significant failure of her professional obligations.

The Tribunal found the Midwife failed to refer the Baby to a well child provider within the six week period and that this was a significant omission.  The effect of this was to leave the Baby without anyone being responsible for his care from the end of May until the end of July.  This was a critical period for the Baby who was highly vulnerable.

The Midwife acknowledged that her care of the Patient and the Baby fell short of her own view of the appropriate standards of care required.  The Tribunal agreed.  It found that because of this deficiency in care, all the above particulars were established and warranted disciplinary sanction, except on its own particular 1.5 would not have warranted discipline.

Particular 1.6 – Inadequate Documentation

The Tribunal found that the Midwife’s notes were inadequate and incomplete, and in some cases were inaccurate. Some were retrospective but it was not stated, and the notes were not very helpful in telling the Tribunal about the care of her Patient and the Baby.  The Tribunal found that this particular was proved and warranted disciplinary sanction.

Particular 1.7- Incident at the Police Station

The Tribunal found that the facts of this particular were proved, and that while a midwife should not behave in such a manner, it did not consider it was not serious enough to warrant disciplinary sanction.

Particular 1.8 Breach of Code and Ethics

The Tribunal found that the Midwife did not comply with her professional obligations by failing to protect the wellbeing of the Patient and her failure to enhance and protect the health status of the Baby who was in a very vulnerable situation.  It found that this particular was met, but that it was a doubling-up of other breaches in her care of the Baby and her Patient.  The Tribunal was satisfied that this particular did not create a need for a separate disciplinary sanction and instead added to the cumulative proof of the charge.

Penalty

The Tribunal was satisfied that it was not necessary to cancel the Midwife’s registration or to suspend her in order to maintain public safety.

The following conditions were imposed by the Tribunal on the Midwife’s practice for a period of 18 months:

1. The Midwife practise under the supervision of a mentor:
   1. The Midwife is required to meet with her mentor for at least one hour per month, to work out goals, implement plans and monitor progress.
   2. The mentor is to review the Midwife, and provide a written report to the Midwifery Council.
2. The Midwife is to undertake a further study in the area of documentation.
3. The Midwife is to meet the costs of the above conditions.

The Midwife was censured and was ordered to pay 30% of the costs of the proceedings; $10000 to the PCC and $5000 to the Tribunal.

The Tribunal recommended that the Midwifery Council undertake a competence review of the Midwife and her practice.