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Fitness to practice

​​​Shelby works in a group midwifery practice—two teams of three midwives each. Every summer, the midwives get locum coverage so the team can go an an overnight practice retreat to Shelby's cabin. This has become an annual tradition and a much-anticipated event where they can relax and reconnect.

Friday night everyone has a few drinks and on Saturday they have a few mimosas with breakfast and a bottle of wine with lunch. The midwives head back to the city around 4 pm.

Shelby and Anita are both on call for their respective teams on Saturday starting at 8 pm. Around 3:30 am Sunday morning, Anita calls Shelby for back up at a home birth. Both midwives arrive at the same time and the baby is born shortly thereafter.  Once the birth is complete Shelby notices that Anita smells strongly of alcohol. “Wow Anita, you smell like a brewery! Have you had anything to drink since I last saw you?" Anita replies, “Not since lunchtime on Saturday." Shelby asks Anita if she can continue to provide care for the mother and baby, and Anita assures her that she can. Shelby leaves shortly afterward.

Two hours later, Anita asks Shelby to cover calls but won't tell Shelby why. Shelby covers for Anita. Later that day Shelby calls Anita and finds out that Anita was pulled over for impaired driving on the way home from the home birth and has had her car impounded. Anita begs Shelby not to tell anyone. Shelby advises Anita to remove herself from practice until she seeks treatment and is fit to practice and that she needs to report her criminal charge to the college as stated in the Bylaws (84.2). Anita says she'll get help with her drinking but that she can't afford to take time off right now.

What is Shelby's professional responsi​​bility?

The Health Professions Act (HPA) (section 32.2) states that a registrant must report to the applicable regulatory body if they believe, on reasonable and probable grounds, that the continued practice of a registrant might be a danger to the public because of a physical or metal ailment, an emotional disturbance, or an addiction to drugs and/or alcohol. One does not need to have all the facts or proof but must report if they believe there might be a danger to the public.

In this case, Shelby considers what she witnessed on the weekend, what she observed while acting as the second birth attendant, the fact that Anita said she was fine but was found to be impaired, that Anita acknowledges having a drinking problem but will not stop practicing.

Shelby also considers the consequences of not making a report to BCCNM. If Anita continues to practice midwifery and causes harm, Shelby realizes she would likely be found in violation of the HPA for not reporting her concerns to BCCNM.   

Shelby acts​​

Shelby considers the level of risk associated with Anita's continued practice and Anita's lack of insight into these risks.  Shelby meets with Anita, expresses her concerns about Anita's continued practice, and explains that she has a duty to report her concerns about Anita's fitness to practice to the midwifery lead and to BCCNM.

Shelby documents her observations including dates and details of specific incidents and shares them with Preeti, lead of the midwifery practice. Together, Shelby and Preeti outline the concerns in writing and file their complaint with BCCNM.  Preeti and Shelby change the schedule so that Anita is not providing any clinical care. They notify Anita of the changes, encourage her to take a leave of absence and to find a locum.

What happens to Anita?​

BCCNM suspends Anita's practising registration while they investigate and collect evidence of the impact of Anita's behaviour on her midwifery practice and public safety.

While Anita is on leave, a doctor diagnoses her with alcohol use disorder. Anita is given a recovery plan and treatment, connected with a recovery community, and enrolled in a medical monitoring program.

After treatment, Anita's doctor finds that Anita is in early recovery and thinks Anita is fit to return to work with medical monitoring and supports in the workplace. The midwifery practice works with Anita to accommodate the doctor's recommendations.

Anita and BCCNM reach a consent agreement, in which Anita accepts the findings of the investigation. To protect the public, the agreement set limits and conditions on Anita's registration that reflect the workplace supports.

With a BCCNM consent agreement in place, Anita begins to plan her return to work. ​​​​