In the Matter of a Hearing before a Disciplinary Panel
between the College of Midwives of BC and Sara Day
Hearing Date: March 29, 2004
Member: Sara Day – former member, registration #1037, resigned July 8, 2003 On July 23, 2001, the College received a letter of complaint from a family concerning care provided during and after the delivery of their child by registered midwife Sara Day. The complaint was investigated pursuant to the
Health Professions Act, R.S. B. C. 1996. On October 28, 2003, a citation for a hearing was issued at the direction of the Inquiry Committee.
As a result, the Discipline Committee convened a Panel made up of one public and two professional members to conduct a disciplinary hearing which took place on March 29, 2004.
The allegations were presented by College counsel; the Panel was supported by separate legal counsel and the midwife was represented by her own counsel. The hearing was open to the public and a court reporter was present. At the outset it was noted that the respondent had voluntarily ceased practice, but it was agreed before the Panel that the Panel still had jurisdiction over her.
At the onset of the hearing Ms. Day admitted she was guilty of the allegations in section II and III of the Citation as follows:
I. | professional misconduct pursuant to Section 33 (4) (c) , 37 and 38 of the Health Professions Act, and a breach of Section 5 of the College's Code of Ethics in Appendix 2 of the College Bylaws; and |
| II. | a breach of the College's Bylaws pursuant to Section 33 (4) (a) of the Act. |
The College withdrew the allegation of incompetence in section I. of the citation.
After reviewing the Act, the Bylaws and the Standards of Practice, and hearing the submissions of both counsel, the Discipline Panel found Ms. Day guilty of professional misconduct and a breach of Section 5 of the Code of Ethics and Sections 60 (e), (m) and (r) of the Bylaws in respect of her having billed the Medical Services Plan for postpartum care that did not take place. In addition, the Panel found Ms. Day guilty of a breach of Bylaw 60 (e) in that she did not meet the standards applicable to midwives in British Columbia for appropriate care of a newborn and mother in the immediate postpartum period, particularly with respect to appropriate and timely follow up of rapid weight loss in the newborn.
Counsel for the College and Ms. Day made joint submissions on the nature of an appropriate penalty and presented a draft consent agreement for the approval of the Panel. The College also advised the Panel that Ms. Day had been subject to a prior period of supervision in 2000 as a result of an Inquiry investigation. The Panel agreed that the terms of the consent agreement presented were appropriate and would ensure that the public is adequately protected should Ms. Day choose to return to practice. They incorporated those terms into their Order:
Under Section 39 of the
Health Professions Act, the College of Midwives of British Columbia Discipline Committee ordered that the following conditions be imposed on the Registrant's practice should she return to practice:
1. | Ms. Day will be supervised for 20 courses of care. The supervisors will report to the Supervision Panel of the College every month regarding Ms. Day's progress and the practice issues described under “Duties of the Supervisor(s)" below. Ms. Day will be responsible fore identifying a qualified Supervisor (s) acceptable to the Supervision Panel. |
| 2. | For each course of care, the supervision will consist of: |
| a) | Weekly chart reviews of all postpartum midwifery care provided by Ms. Day to each client; |
| | b) | Direct supervision for one antenatal visit, the day-three postpartum visit (or the first at-home postpartum visit immediately after discharge from hospital if the mother and newborn remain in the hospital at day-three, and one additional postpartum visit for each of the 20 clients; |
| | c) | Ms. Day must notify a supervisor and discuss a plan of care at the onset of labour or induction for the first 10 of the 20 courses of care; |
| | d) |
Ms. Day must attend in person with any client who is being induced, and contact a supervisor by phone at the commencement of the induction and thereafter as directed by the supervisor; |
| | e) | Ms. Day must notify a supervisor when a client has delivered in her care and discuss her plan for care for the immediate postpartum with her supervisor; |
| | f) | Direct supervision of the first five primiparous births. Intrapartum supervision will focus on assessment of fetal and maternal well-being, assessment of the progress of labour, including fetal position, the development and implementation of an appropriate plan of midwifery care consistent with those assessments and appropriate contemporaneous documentation. |
3. | Ms. Day will provide each client with a current copy of the College's
Indications for
Discussion, Consultation and Transfer of Care" and discuss the document with each client. |
| 4. | An auditor appointed by the Supervision Panel will do a random audit of Ms. Day's charts, where care is completed to the final postpartum visit, every three months over one year or until a review of 20 charts is completed. This chart audit will include consideration of documentation of informed choice discussions; documentation reflecting an overall plan of care including assessments and management plans in the antepartum, intrapartum and postpartum; documentation of the assessment of the health, well-being, growth and development of the newborn, particularly in the first week of life; documentation of the assessment of the effectiveness of breastfeeding and strategies for establishing an adequate milk supply; documentation of the assessment of maternal well-being in the postpartum, particularly with respect to potential sources of postpartum infection; and an audit of the correlation between actual care provided and billings submitted to the Medical Services Plan. The auditor will have the discretion to decide if two additional chart audits are required after the complete of the audit of 20 charts. |
| 5. | Ms. Day's auditor and/or 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 may require Ms. Day to undertake further remediation if appropriate. |
| 6. | Ms. Day will attend courses approved by the Supervision Panel on the following topics: |
| a) | a communication course; |
| | b) | a documentation course with a focus on accurate documentation of events, assessments, informed choice discussions and an overall plan of care; |
| | c) | a lactation counseling or lactation consultant course with a focus on the skills needed to assess breastfeeding problems, to assess the health and well-being of the nursing newborn and to implement a plan of care to address problems; and |
| | d) | an ethics course with a focus of professional responsibility and ethical practice. |
The Panel made further comment, directed to the Supervision Panel and any future supervisor(s), that a major focus during Sara Day's period of supervision should be “her understanding of the responsibilities of a midwife to a client, particularly with respect to follow up that assures the safety of mother and baby". Recognizing that clinical issues and issues of appropriate documentation did arise, the Panel emphasized that “Ms. Day's failure to understand the importance of ensuring follow up for a baby experiencing rapid weight loss in the first week of life" was their most significant concern. The Discipline Panel asked that the supervisor report specifically on this aspect of Ms. Day's care and that this report be passed on to the Discipline Panel.
A formal reprimand was ordered placed on Sara Day's file to the effect that she billed the Medical Services Plan for postpartum care visits that did not take place and that this constitutes professional misconduct.
Because Sara Day is not currently practicing, the Discipline Panel made their orders related to her future practice subject to Ms. Day meeting any and all requirements for reinstatement of her registration with the College. Expressing concern that her absence from practice not be too lengthy, the Panel required that, in order to return to practice as set out above, Ms. Day must apply for and meet the requirements for conditional registration by July 1, 2005.
Sara Day was also ordered to pay the sum of $350 towards the cost of Discipline proceedings as agreed by both counsel.