Charge

On 28 June 2021 the Health Practitioners Disciplinary Tribunal (the Tribunal) considered a charge by the Director of Proceedings against Ms Helen Marie Bakker, registered midwife of Whakatane (the Midwife).

The charged alleged:

1. While the Midwife’s patient was in labour, the Midwife directed that the patient be administered normal saline instead of pethidine for her pain, despite what she knew or ought to have known of the patient’s wishes for pethidine; 
2. The Midwife directed that an IV be inserted into the patient’s arm for the purpose of administering pethidine but intended to administer a placebo to the patient;
3. The Midwife deliberately misled the patient by telling her she was being administered pethidine when she it was normal saline;
4. While the patient was in labour, the Midwife directed that the patient be administered normal saline when she had not obtained the patient’s informed consent for normal saline to be administered nor discussed its risks or any alternatives;
5. The Midwife acted unethically when she administered a placebo to the patient in the context of clinical practice and outside the context of a clinical research trial;
6. The Midwife failed to document in the patient’s clinical notes and/or medication chart, the administration of normal saline;
7. After the patient had given birth, the Midwife failed to adequately explain to the patient and/or ensure that the patient understood what medication she had been administered during labour;
8. The Midwife failed to document the conversations she had with the patient regarding her options for pain relief during labour and the risks and/or benefits of each, including pethidine; and the medication that was administered to the patient during labour;

The alleged conduct amounted 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.

Background

The Midwife engaged with the patient in 2018.  The patient’s birth plan showed that the patient planned to use pethidine for pain relief if needed.

The patient arrived at the Hospital in labour. Throughout the birth process, the Midwife was accompanied by a student midwife who was observing and assisting.

The Midwife instructed the student to insert an IV into the patient’s arm for the purpose of administering pain relief.  Both the student and the Midwife went to the dispensary to obtain pethidine. While at the dispensary, the Midwife told the student that she intended to give the patient a placebo (normal saline) instead but would tell the patient it was pethidine.

The labour progressed slowly. The Midwife instructed the student to go back to the dispensary to get more ‘pethidine’ (more normal saline). During one of the trips to the dispensary, the student met another midwife practising at the hospital. She explained what was happening and the midwife told the student that it was illegal. 

Between approximately 9.30am and 12.30pm, the student acting on instructions from the Midwife, administered a total of four 10ml syringes of normal saline to the patient.  Despite her requests, the patient was not given pethidine between 9.30am and 1.15pm. 

By 12.35pm, an obstetrician at the hospital had become involved in the birth process.  At 1.15pm following the consultant’s assessment and recommendation, the Midwife administered 50mg of pethidine to the patient intramuscularly.  The baby was delivered safely later that evening.

After the patient was discharged from hospital, the Midwife told the patient that she had not given her pethidine but had administered saline instead. She did not sufficiently communicate that the patient had received pethidine by way of intramuscular injection after the consultant’s recommendation.  The patient initially believed that she had not been given any pethidine during her labour.  It was agreed that the patient told the Midwife that she was glad about that.  The Midwife did not make any notes of that conversation.

Later, in the afternoon, the Midwife who had met the student in the dispensary reported the Midwife’s actions to the hospital. Subsequent investigations at the hospital led to a report to the Midwifery Council about the incident. 

Finding

The hearing proceeded on an agreed summary of facts. The Midwife admitted that she was guilty of professional misconduct and that the charge justified disciplinary findings against her.

The Tribunal found that the Midwife’s conduct amounted to malpractice. The Tribunal also held that that the Midwife’s conduct fell seriously short of that which might be considered acceptable.  The conduct reflected a deliberate, unjustified, and unethical approach to the Midwife’s care of the patient. It was conduct that brings discredit to the profession.

Penalty

The Tribunal:

• Censured the Midwife;
• Imposed conditions upon the Midwife;
• Fined the Midwife $3,500.00;
• Ordered the Midwife to pay costs of $10,000.00.

The Tribunal directed publication of its decision and a summary.