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Director of Proceedings v Kapua - Midwife

Health Practitioners Disciplinary Tribunal,  Mid08/103D

On 22 June 2009 the Health Practitioners Disciplinary Tribunal found Ms Monique Kapua, a midwife, guilty of professional misconduct. It held that her conduct amounted to malpractice and negligence and in many instances her conduct amounted to acts or omissions that would bring discredit to the midwifery profession.

The case concerned the care provided by Ms Kapua to a first-time pregnant woman (Ms C) throughout her pregnancy.  Ms C gave birth to a stillborn baby boy, following a prolonged pregnancy of 43 weeks. Ms C was 21 days past her estimated delivery date (EDD).  

Ms Kapua faced one charge consisting of six particulars and a number of sub-particulars, all of which were upheld. Ms Kapua failed to:

• Provide Ms C  with relevant information about standard midwifery tests and examinations throughout her pregnancy; and
• Undertake sufficient standard midwifery tests and examinations throughout Ms C's pregnancy; and
• Provide Ms C with relevant information about the risks involved in prolonged pregnancy or the induction process and the reasons for induction;
• Provide Ms C with information about access to, and choices of, obstetric and secondary care; and
• Recommend to Ms C that a consultation with a specialist was warranted and/or make adequate arrangements to ensure that this was done; and
• Provide adequate handover of care of Ms C when she took indefinite and prolonged absence in that she failed to arrange for another midwife to see Ms C in her absence; and/or provide her with Ms C's records; and
• Arrange for appropriate assessments for a prolonged pregnancy to be undertaken; and
• Adequately and/or accurately document the care she provided to her client between 1 January 2006 and 5 October 2006.

Tribunal Decision

Ms Kapua represented herself and placed some emphasis on the fact that she practiced what was described as traditional Māori birthing practices.

The Tribunal stated: (at paragraph 288 of the Tribunal decision)

"A lot of the emphasis in this case was placed by Ms Kapua on the fact that Ms Kapua had, in addition to her midwifery practice, an emphasis on traditional Māori aspects of birthing.  There was some suggestion that this Tribunal hearing might be a challenge to those practices. It is certainly not a challenge of those practices. Ms Kapua appears before the Tribunal in her role as a registered midwife and in that role has the obligations of a reasonably competent midwife to carry out all of the tests and analysis required by midwifery standard and to gather and document that information which is regarded as being standard care for midwives.  Ms Kapua's Māori Tikanga should be an additional (and desirable) part of her practice, influencing her care but never allowing it to mean that any women receives a substandard level of care. Tikanga Māori is an enhancement to safe practice, not a detriment to it."

The Tribunal further stated that Ms Kapua would not be guilty of professional misconduct simply because she had adopted the practice of traditional Māori midwifery.  The Tribunal confirmed that what was being judged was the practitioner's level of conduct against the level of other reasonably competent midwives whether they be Māori midwives practicing Tikanga Māori in addition to their midwifery practice, or Pakeha midwives from other ethnicities.  What was not being judged was traditional Māori birthing practice.

The Tribunal upheld all particulars and accepted the expert evidence of Ms Kani about the standards and accepted practice that applies to all competent midwives. The Tribunal was highly critical of Ms Kapua's approach to midwifery that was described in evidence by many as "very hands off" and which she explained meant that she provided information then supported the families' decision. The Tribunal stated the problem with that approach is that it placed the responsibility on the mother and/or father. The midwife's job is to provide information in a way that is not biased but not always neutral, in a way that advocates for the best interests of mother and baby.

In its penalty decision the Tribunal stated that there was no doubt that Ms Kapua's misconduct was very serious misconduct and her skills appeared to be woefully short of those required of a reasonably competent midwife. She did not appear to have recognised these shortcomings even at the hearing when faced with the evidence given by another Māori midwife Ms Kani. It was of the opinion that there was a significant risk to the public if Ms Kapua was allowed to remain on the register as a midwife and held that the only appropriate penalty was to cancel Ms Kapua's registration.

The Tribunal also made an order of censure because of the need to express its strong disapproval for the conduct which occurred in this case.  The Tribunal found that while Ms Kapua appeared to be in impecunious financial circumstances she should still be ordered to pay the sum of $10,000 in costs.

The Tribunal also imposed a condition that in the event that Ms Kapua sought re-registration she undergo a specified course of education set by the Midwifery Council of New Zealand in order to satisfy the Midwifery Council that she meets the competencies for entry to the Register.

It also recommended that in the event that Ms Kapua sought re-registration, consideration be given to Ms Kapua practising under supervision for 18 months, following re-registration.

The Tribunal's full decision can be found at:
http://www.hpdt.org.nz/Default.aspx?tabid=218