KEY POINTS:
An independent midwife fabricated medical records after a baby was stillborn to make her handling of the case look better than it was, an investigation has found.
Anket Leon Kesar died about 24 hours before he was delivered at Middlemore Hospital in South Auckland on August 8, 2005.
Problems with the placenta, affecting his oxygen supply, have been blamed.
Health and Disability Commissioner Ron Paterson has referred the midwife for possible charges before the Health Practitioners Disciplinary Tribunal after finding she gave unsatisfactory care.
The midwife is still practising although this is the second case in which she has had an adverse finding against her.
The baby's father, Davinder Singh, believes Anket would have survived if the midwife had called in doctors to deliver him by caesarean section when his wife, Rizawana Hussein, was in hospital, two days before the stillbirth.
She was briefly admitted because of raised blood pressure and her concerns over slower fetal movements.
The couple subsequently had a baby boy, Arsh Leon Kesar, now 7 months old, but want changes to avoid others suffering the same fate they did.
"I challenge the Midwifery Council decision that the midwife is still working," Mr Singh, a Vodafone manager, said yesterday.
The council considered suspending the midwife last year but decided not to, concluding that she did not pose a risk of serious harm to the public.
Mr Paterson's report said "numerous aspects of the care recorded contradict the recollections of Mrs Hussein and Mr Singh, particularly in relation to bleeding, pain and fetal movement - or whether [the midwife] was contacted at 6am on August 8.
"I find the account provided by Mrs Hussein and Mr Singh more credible than [the midwife's]."
Mr Paterson was particularly concerned at the midwife's changes to clinical notes after Anket's death and that she "manufactured" a labour record called a partogram, purportedly recording maternal and fetal heartbeats on August 8, when there could not have been two heartbeats, as the fetus had died the day before.
The midwife's lawyer, Kelly Rowell, had suggested she completed the partogram retrospectively to provide a full picture of events.
But, Mr Paterson said, "the fabrication of such a vital observation cannot be described as an attempt to provide a 'fuller picture'."
He said that although no overt signs of fetal distress existed on August 6, the midwife should have got Mrs Hussein to begin a chart recording the baby's movements.
Other omissions included:
* Failing to establish the nature of Mrs Hussein's lower abdominal pains on August 6.
* Not checking fetal heart rate and maternal blood pressure the next day.
* Failing to monitor and record fetal heart rate and maternal blood pressure and pulse on August 8.
Relying on expert advice, Mr Paterson attributed Anket's death to a blood clot behind the placenta.
"It is very hard to say whether the baby would have survived if this had occurred in hospital," he said.
Ms Rowell said in the report that the midwife made a "poor decision" by adding to clinical notes without dating the additions, not understanding at the time the importance of dating additions.
She had not intended to mislead and she did not act deceitfully in her responses to the commissioner's investigation. She was extremely distressed by the case and her "judgment was clouded".
The death was not caused by her client, Ms Rowell said.
The report said that after a 2003 stillbirth, Mr Paterson found the midwife in breach of the code of patients' rights, which led to Midwifery Council-ordered reviews covering her case-load, standards of care, clinical outcomes, communication and record-keeping.
Ms Rowell said her client had taken significant steps of her own accord to keep proper records.
Council chairwoman Sally Pairman said it would be premature for her to comment on the latest report, which she had not seen.
Mistakes by midwives were rare "in terms of the number of midwives practising safely every day".
The midwife declined to comment last night. "I don't want to answer any of your questions at this moment because I'm going through a very bad time in my life."
