Multiple violations published online in previous board orders, notice from Department of Health Professions
By Sally Voth
A midwife has received a reprimand from the Virginia Board of Medicine.
Peggy Lee Franklin, of Gainesville, was reprimanded, according to a post dated Wednesday on the Virginia Department of Health Professions' website.
A document related to the case was classified as "pending" on the site, and not yet available through the Practitioner Information website.
However, previous board orders and a notice that describes multiple violations were published online, as was a reprimand from last year.
According to an April 26, 2011, notice to Franklin from Virginia Board of Health Executive Director Dr. William L. Harp, she was to appear before an informal board conference last summer.
The notice identifies her as a licensed midwife and certified professional midwife.
It states Franklin may have violated board regulations by either not providing a 30-year-old patient with a written disclosure explaining her qualifications, experience and training; whether she had hospital privileges; that midwives can't prescribe or administer controlled medications; midwifery qualifications; and that midwives aren't covered by the Virginia Birth-Related Neurological Injury Compensation Fund, among other requirements, or not getting the patient's signature saying the requirements had been explained to her.
Franklin also neglected to tell her patient her options regarding referral to a doctor or to provide "evidence-based information regarding the health risks associated with birth of a child outside of a hospital or birthing center in the case of vaginal birth after a prior cesarean section," the notice states.
Additionally, Franklin didn't get the medical report about the patient's C-section, and therefore, didn't know what type of incision was used, it states.
Franklin also allowed the woman to remain at home despite the fact she hadn't yet had contractions nearly two days after her water broke. She's accused of either not talking with the patient, or not documenting such a discussion, about the increased risk of infection that can result from going more than 24 hours without labor after the rupture of membranes.
The patient showed up at Franklin's office about 26 hours after her water broke, the notice says.
"Although Patient A was still not in labor at that time, you did not recognize the critical and unsafe nature of the situation for Patient A and her infant if delivery was further delayed, and failed to recommend or effect transfer of Patient A to the hospital or other appropriate healthcare professional," the notice says.
Contractions didn't start until more than 46 hours after the woman's water broke, and Franklin went to her home about five hours after that, according to the notice. An hour-and-a-half later, the woman was taken to the hospital asking for an epidural, it states.
A bit more than an hour later, she delivered via emergency C-section a floppy baby that needed to be resuscitated due to respiratory distress, according to the notice.
It accuses Franklin of talking to the patient about lying to doctors about the length of time that had passed since her membranes had ruptured.
Franklin documented what happened before the patient went to the hospital, according to the notice.
"We discussed that it wasn't 'politically correct' to have [rupture of membranes] over 24 hours with OB standard of care vs. midwifery model of expectant management despite what the studies show...I asked what time they wanted to say the water broke and they suggested midnight, just 24 hours prior," the notice quotes Franklin's record. "This seemed reasonable to me, enough to ensure the staff would be aware of the prolonged rupture in their assessment of care and possibly enough to spare them (and me) of unnecessary criticism upon admission."
The notice goes on to state that Franklin never alerted the attending physician to the length of time since the patient's membranes broke.
According to an order from last August, the midwife told a special conference committee midwifery calls for giving mothers options and their risks, and then letting the mother decide what action to take.
She said the reason for deceiving hospital staff was to let them know the woman's water had been broken "for a long time," but to possibly still make a vaginal birth possible, according to the order.
"Ms. Franklin stated it is unlikely she would handle this situation the same way in the future," the order states. "She also stated that her patients will not be allowed to go over 24 hours with ruptured membranes."
The committee reprimanded Franklin, and required her to get continuing education in professional ethics for health care workers, the order states.
A Jan. 30 order states that Franklin had complied with the board's order, and fully reinstated her license to practice.
Franklin's Facebook page has numerous pictures of newborns and their parents, and says she owns Birth by Design in Chantilly, although the business' website was not accessible Friday evening.
Franklin is also licensed as a registered nurse, according to the Virginia Department of Health Professions' website.
Several years ago, the General Assembly amended the Code of Virginia regarding the regulation of midwifery. Midwives were then required to inform patients of added risks for vaginal home births after a c-section, breech births, high-risk pregnancies and multiple babies.
Franklin did not return a phone call Friday evening.