Notice

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Ms Hanburymorie is guilty of professional misconduct in that she did not comply with the standards of practice under Section 39 (1) (b) of the HPA.

1.

The Panel found Ms. Hanburymorie's resuscitation of the newborn to be inadequate in three cases. They found that resuscitative efforts were not initiated in accord with the standards set out for the resuscitation of newborns in the Canadian Neonatal Resuscitation Program accepted as the standard of care by the College. They further found that some of her actions could further jeopardize an infant in trouble.

2.

The Panel found that Ms. Hanburymorie did not document her surveillance of fetal health in labour clearly and this made it difficult to assess if intervention was required.

3.

The Panel found that Ms. Hanburymorie improperly managed a postpartum hemorrhage, and that delay in transportation of the woman to hospital and improper follow-up cause further deterioration of the woman's condition.

4.

The Panel consistently found Ms. Hanburymorie's intrapartum documentation to be confusing and sometimes inconsistent with the actions performed, which may have contributed to other professionals involved in care having incomplete information.

5.

The Panel found that poor inter-professional communication was a contributory factor in some of these cases, and that midwives should be able to communicate effectively with other health professionals.

6.

The Panel found that Ms. Hanburymorie failed to follow-up with her clients appropriately.

1.

To successfully complete a full Neonatal Resuscitation Program (not a recertification) taught by an instructor approved by the Committee who will report on her competence, in reference to the CMBC's Competencies of Registered Midwives Section II.A.20¹ and II.B.22², to the College. This course must be completed prior to resuming registration as a midwife in BC.

2.

​To successfully complete a Fetal Health Surveillance Course approved by the College that addresses auscultation of the fetal heart, electronic fetal monitoring and charting, taught by an instructor approved by the Committee who will report on her competence, in reference to the CMBC's Competencies of Registered Midwives Section II. A. 7³, and II.B.4⁴, to the College. This course must be completed prior to resuming registration as a midwife in BC.

3.

​To complete a course on the management of maternal and neonatal emergencies (ALSO, ALARM or ESW) taught by an instructor approved by the Committee who will report on her competence, in reference to the CMBC's Competencies of Registered Midwives Section II. A. 9, 10, 11, 13, 16, and 19⁵, and II.B.3, 5, 6, 8, 13, 19, and 20⁶, to the College. This course must be completed prior to resuming registration as a midwife in BC.

4.

​To complete a course on documentation focused on how to document care in the client health record, informed choice discussions and clinical decision-making from a primary care perspective, taught by an instructor approved by the Committee who will report on her competence, in reference to the CMBC's Competencies of Registered Midwives General Competency 15⁷ and consistent with the CMBC's Policy on Records and Record Keeping and Policy on Record Content, to the College. This course must be completed prior to resuming registration as a midwife in BC.

5.

​ The College will provide Ms. Hanburymorie with the names of courses available in British Columbia that are acceptable to the Committee. The Committee will consider and not unreasonably withhold approval of courses suggested by Ms. Hanburymorie to fulfill these requirements in paragraphs 1- 4.

6.

​ To be supervised as a conditional registrant by a supervisor (or supervisors) under a plan approved by the Committee for 10 courses of care which meet the CMBC's requirements for continuity of care, and to be supervised for an additional 10 births where Ms. Hanburymorie has met the client at at least one visit prior to the onset of labour. An approved supervisor must be present and observing Ms. Hanburymorie's management of labour from the onset of active labour for the first five deliveries. Once a Supervision Plan is in place the Supervision Panel of the Registration Committee (the “panel"), shall have responsibility for monitoring the plan. Supervisor(s) will report to the panel every month regarding Ms. Hanburymorie's progress and the practice issues described in number 7 of this Consent Agreement. Ms. Hanburymorie and the College will work together to identify a qualified Supervisor(s) acceptable to the Committee.

7.

​Ms. Hanburymorie's Supervisor(s) will focus on Ms. Hanburymorie's:

Ability to communicate clearly about the best available evidence, and present a balanced view of risks and benefits of various therapies and treatments to her clients in informed choice discussions in the antepartum, intrapartum and postpartum period and to document these discussions appropriately in the client's health record;

Ability, in particular, to carry out informed choice discussions related to Group B streptococcus, and to follow-up with appropriate testing and with antibiotic prophylaxis in labour when required.

Ability and willingness to provide care within midwifery standards, including consultations and transfers of care consistent with the CMBC's Indications for Discussion, Consultation and Transfer of Care, Indications for Planned Place of Birth, Standards, Limits and Conditions for Prescribing, Ordering and Administering Drugs and the CMBC's Policy for Client Requests Outside Midwifery Standards;

Ability to carry out antenatal and postnatal assessments, including well-woman physical assessments, and to document antenatal and postnatal care appropriately in the client's health record;

Ability to assess and document fetal and maternal vital signs appropriately in labour;

Ability to assess and manage labour and birth and to document her clinical decision-making from a primary care perspective;

Ability to measure, assess and document maternal blood loss in the immediate postpartum and respond appropriately;

Ability to carry out neonatal resuscitation that is consistent with the standards set out in the Neonatal Resuscitation Textbook (5th Edition), to initiate transport when required, and to appropriately document her assessment, resuscitation and management of newborn care in the newborn record; and

Ability to communicate with other health professionals in both urgent and nonurgent situations, and when consultation and/or transfer of care is required under the CMBC's Indications for Discussion, Consultation and Transfer of Care.

8.

The Supervisor(s) will identify to the Supervision Panel of the College any concerns they have about unsafe practice, or practice that does not comply with the College bylaws, the College's statement of Competencies of Registered Midwives, its Standards of Practice, the Code of Ethics or the Model of Practice, and the Supervision Panel shall be at liberty to require Ms. Hanburymorie to undertake further remediation in response thereto, if appropriate.

9.

In her practice as a midwife, Ms. Hanburymorie agrees to provide each of her clients with a copy of the CMBC's Indications for Discussion, Consultation and Transfer of Care and Indications for Planned Place of Birth, and to provide every client considering a home birth with a copy of the CMBC's Home Birth Handbook and to ensure that every client who plans a home birth in her care signs the Home Birth Consent from this handbook and that a copy is retained on the client's chart.

10.

In her practice as a midwife, Ms. Hanburymorie agrees to notify the hospital, and to call an ambulance for transport to hospital, whenever she is in a situation where transport is required under the CMBC's Indications for Discussion, Consultation and Transfer of Care and/or Indications for Planned Place of Birth, and to do her utmost to encourage the mother to follow the College's requirements and go to hospital, or take her newborn to hospital, for assessment by a physician when indicated.

11.

In her practice as a midwife, Ms. Hanburymorie agrees to measure maternal blood loss in the immediate postpartum period and, should that blood loss equal or exceed 750 milliliters or if the woman require medications or intravenous therapy beyond a single dose of 10 units of oxytocin to control bleeding, Ms. Hanburymorie agrees to notify the hospital, and to call an ambulance for transport to hospital, and to do her utmost to encourage the mother to go to hospital for assessment by a physician.

12.

​Ms. Hanburymorie agrees to report to the College any instance where a client refuses transport to hospital as required under the Indications for Discussion, Consultation and Transfer of Care and/or Indications for Planned Place of Birth, and to submit a copy of the client's health records for chart review to the College if requested.

13.

​Ms. Hanburymorie agrees to continue to carry out a monthly chart review of active charts for the following: all clients who are 34 weeks gestation or more and all mothers and newborns from birth until 10 days postpartum, with a midwife or midwives approved by the College for a period of 12 months after resuming registration as a midwife.

14.

Ms. Hanburymorie agrees to have a Quality Assurance practice audit carried out on her midwifery practice by an auditor appointed by the College after she has been practicing as a general registrant again for at least six months. This audit will consist of:

The auditor observing a minimum of three antepartum visits, two postpartum visits and one birth conducted by Ms. Hanburymorie;

A chart audit of 10 randomly selected charts documenting client care and will include home births, hospital births and at least two charts from births where care was transferred from a planned home birth into hospital. (This audit will replace the audit referred to in the Consent Agreement signed March 19, 2005, and will also include the issues to be addressed in that audit* - All other undertakings agreed to in that March 19, 2005, Consent Agreement continue to apply.)

​ ​ ​The audit will focus on:

​Informed choice discussions in the antepartum, intrapartum and postpartum period and their appropriate documentation in the client's health record;

​Inter-professional communication and its appropriate documentation in the client's health record;

​Care within midwifery standards, including consultations and transfers of care consistent with the CMBC's Indications for Discussion, Consultation and Transfer of Care, Indications for Planned Place of Birth, Standards, Limits and Conditions for Prescribing, Ordering and Administering Drugs and the CMBC's Policy for Client Requests Outside Midwifery Standards;

​Antenatal and postnatal* assessments and documentation of antenatal and postnatal* care;

​Assessment and documentation of fetal and maternal vital signs in labour;

​ Assessment and management of labour and birth, and documentation of clinical decision-making from a primary care perspective;

​Measurement, assessment and documentation of maternal blood loss in the immediate postpartum;

​Neonatal resuscitation consistent with standards set out in the Neonatal Resuscitation Textbook (5th Edition) and documentation of assessment and resuscitation of the newborn;

​Documentation of postpartum care*;

​Documentation of phone calls with clients in their charts*;

​Documentation of PKU testing and/or the client signing an informed refusal;*and

​Documentation of when test cards are sent to the provincial lab*.

The Auditor will identify to the College any concerns arising from the audit about unsafe practice, or practice that does not comply with the College bylaws, the College's statement of Competencies of Registered Midwives, its Standards of Practice, the Code of Ethics or the Model of Practice, and the Committee shall be at liberty to require Ms. Hanburymorie to undertake further remediation in response thereto, if appropriate.​ ​

​If the Auditor is satisfied that Ms. Hanburymorie is consistently and appropriately assessing, managing and documenting maternal blood loss in the immediate postpartum, the Auditor may recommend to the Committee a change or removal of the requirement, as set out in item 11, that Ms. Hanburymorie must measure blood loss in the immediate postpartum.

Knowledge of neonatal resuscitation to the standard established for a primary care provider in Canada (includes successful completion of a provincially recognised neonatal advanced life support program).

Ability to perform neonatal resuscitation to the standard established for a primary care provider in Canada.

Knowledge of fetal heart rate patterns and their significance.

Ability to assess fetal heart tones by auscultation and electronic means, including application of scalp electrodes, document, and take appropriate action based on these assessments.

Knowledge of: the significance of ruptured membranes and methods of reducing risk of infection; abnormalities of labour; prevention, assessment and management of exhaustion and dehydration during labour; indications and procedure for episiotomy; prevention and treatment of haemorrhage; obstetrical interventions used in emergency care.

Ability to recognise abnormal labour patterns and identify the probable cause(s); determine the status of fetal membranes, perform amniotomy where appropriate, and assess amniotic fluid; recognise a full bladder and catheterise; perform an episiotomy when indicated; recognise and manage postpartum haemorrhage; and recognise signs of maternal shock, initiate treatment and perform ongoing assessment.

Knowledge and skill necessary to establish and maintain comprehensive, relevant and confidential records.