Charge

From 8 – 11 May 2023 the Health Practitioners Disciplinary Tribunal (the Tribunal) considered a charge laid by the Professional Conduct Committee against Ms Sanaz Khodaverdian, registered Midwife of Auckland (the Midwife).

The charge is summarised as follows:

1. When practising as a Lead Maternity Care (LMC), between 1 January 2014 to 13 August 2018, the Midwife submitted claims for payment to the Ministry of Health which:
   1. did not comply with the relevant specifications,
   2. were claims for services she had not provided,
   3. and totalled $197,738.90 of public funding which she knew or ought to have known she was not entitled to receive.
2. Upon being notified that her claims would be audited and when the audit commenced, the Midwife altered and/or created and supplied inaccurate and/or false records intended to mislead the Ministry of Health, in particular:

2.2          altering or creating notes and entries retrospectively into the Expect Maternity software programme,

2.3          these entries were inaccurate and/or false with details of antenatal and postnatal visits that had not occurred.

3.       After being directed by the Ministry of Health post-audit that she must submit all her claims manually for review, the Midwife purposefully circumvented that oversight by:

3.1          using the claiming details of Ms H, another registered Midwife, and their Expect Maternity account to register five of her own clients without that Ms H’s consent,

3.2          transferring the registration of three of her patients to Ms E, another registered Midwife, and continuing to provide services to them, seeking payment directly from Ms E rather than the Ministry of Health.

4.       During the manual claims process imposed by the Ministry of Health, the Midwife submitted inaccurate and/or false claims for the payment of twelve visits that she knew had not occurred.

5.       Submitted claims to the Ministry of Health for ten antenatal visits which she knew had not occurred and/or had occurred over the phone rather than in-person as required.

6.       On approximately five occasions between 1 January 2014 to 13 August 2018 the Midwife failed to obtain the informed consent of her clients to their registration with her and/or failed to record confirmation of their informed consent.

7.       On a further 45 occasions from 1 January 2014 to 13 August 2018 the Midwife failed to obtain the informed consent of her clients and failed to record such information.

8.       The Midwife failed to provide documentation of the provision of Midwifery care and provided inadequate Midwifery services at the risk of the health and safety of her clients and their babies, particularly:

8.1          failing to provide adequate first, second, and third trimester antenatal care by conducting infrequent and irregular visits,

8.2          failing to consult with a number of her clients during their third trimester,

8.3          failing to arrange a back-up Midwife on 53 occasions,

8.4          failing to arrange a back-up Midwife on 37 occasions and/or was not present at the birth,

8.5          failing to remain with her clients for the minimum period of two hours post-birth.

9.       Failed to protect the privacy and confidentiality of her clients’ personal information, including health information and NHI number, by:

          9.1          unlawfully and knowingly allowing her husband access to that information,

9.2          and failing to notify any relevant authority that her clients’ privacy had been breached.

The alleged conduct in Charges 1-9 amounts to professional misconduct. The alleged conduct also amounted to malpractice, negligence and conduct that has brought or would likely bring discredit to the Midwifery profession under section 100(1)(a) and/or section 100(1)(b) of the Health Practitioners Competence Assurance Act 2003.

Details of the full charge can be found at: https://www.hpdt.org.nz/

Background

The Midwife was practising as an LMC from 2010 to 2022 in the Auckland region. The charges summarised above arose from an audit process undertaken by the Ministry of Health after the Midwife was identified as overclaiming for services that she did not provide. This finding was referred to the Midwifery Council and an investigation by the PCC after concerns arose that the Midwife’s overclaiming meant she had more clients than recommended, thus compromising their care.

The principal charge is in relation to the $197,738.90 the Midwife received for provision of Midwifery services which she was not entitled to. The charge also alleges that once the Midwife became aware of the audit, she was intentionally deceptive in providing further false or inaccurate information. The Midwife also deliberately subverted the manual claims process imposed by the Ministry of Health as a mechanism for review of her claims by assuming the details of another registered Midwife and seeking payment directly from them.

The investigation led to a myriad of other findings by the PCC that identified further various and prolific inadequacies in the Midwife’s provision of services. These failings were exacerbated by an excessive case load which meant the Midwife was stretched too far, thus compromising the care of her clients. On a number of occasions, the Midwife failed to attend the births of her clients, failed to remain with the client and their baby for two hours post-birth as required, and failed to adequately visit and consult her clients throughout all stages of their pregnancy.

The Midwife did not defend the charges and the hearing proceeded by way of formal proof.

Finding

The Tribunal found Charge 1 established due to the pervasive integrity issues identified and the high rate of non-compliance. The explanations that the Midwife provided for the overclaiming was found to be implausible given the Midwife was highly experienced and was also alerted to her non-compliance via the Ministry’s audit process. The Midwife has since entered into a Repayment Deed with the Ministry of Health for which she has been making regular and ongoing payments. The Midwife’s behaviour was found to be highly unethical and in clear violation of the Code of Midwifery Professional Conduct.

Charge 2 of retrospectively altering/falsifying client records was found to be dishonest, and the Tribunal was satisfied that the Midwife intended to deliberately mislead the Ministry. Charge 3 was partially established, with Charge 3.2 not proven. Charges 4 and 5 were also established. Charges 6 and 7 relate to the Midwife’s failure to obtain the formal consent of her clients for the provision of her services. These failures were established and found to be a serious departure from the standards excepted by the Midwifery profession.

Charge 8 contained a lengthy list of particular failings by the Midwife to provide care to clients at various stages of their pregnancies. The Tribunal found this charge wholly established. The final charge, Charge 9, breach of client information was not established, as there was no evidence available that her husband had accessed the personal information of the Midwife’s clients.

The Tribunal found that reasonable members of the public, informed and with knowledge of all the factual circumstances, could reasonably conclude that the reputation and good standing of the Midwifery profession was lowered by the Midwife’s conduct. The very nature of the Midwifery profession serving a vulnerable population requires adherence to expected professional standards and the requirements of all LMC midwives to adhere to the Maternity Notice and for the proper use of public money for these services. The conduct was found to be sufficiently serious to warrant disciplinary sanction.

Penalty

The Tribunal ordered the following penalties:

• Cancellation of registration;
• Censured;
• Ordered the Midwife to pay 55% of the costs of the Tribunal and PCC investigation, fixed at $210,000.00.

The Tribunal directed publication of its decision and a summary.