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Midwife gives up license

Last modified: 1/2/2011 12:00:00 AM
A midwife who founded a Concord birthing center has surrendered her license to practice following an investigation by the New Hampshire Midwifery Council into a series of complaints about the care she provided to her patients.

Two of those patients are also suing Jeanne Browne, accusing her of failing to take proper precautions when delivering their babies. In one of those cases, the mother developed an infection and underwent a hysterectomy two weeks after giving birth.

In the other case, the child suffered severe brain injury. She'll never be able to walk or talk, according to the family's lawyer, and will require 24-hour care for the rest of her life.

Those cases are also described in a file obtained by the Monitor from the midwifery council under the state's Right-to-Know Law.

According to that file, the council received complaints in 2009 from Concord Hospital, Dartmouth-Hitchcock Medical Center and an obstetrician about the care that Browne had provided to patients they later treated. Browne gave up her license in June.

Concord Hospital's complaint concerned eight patients, while the complaints from Dartmouth-Hitchcock and the obstetrician each concerned one patient. Each complaint alleged that Browne didn't manage the cases appropriately.

Browne has denied all allegations of wrongdoing. In a written statement given to the Monitor by her lawyers, Browne said the investigation into her practice had been 'biased and ungrounded,' and she disputed the content of a settlement agreement proposed to her, which she said 'contains numerous factual assertions that I know to be false.'

But she said she decided to surrender her license rather than challenge the complaints because the process was costly and 'seemingly unending.'

'I stand by my work and my judgment,' she said. 'I believe the standard of care and decisions I made in practice are comparable to any other midwife in New Hampshire.'

Browne's lawyer, Michael Pignatelli, said he couldn't comment on the allegations because of the pending lawsuits. But, he said, 'I have had the cases reviewed by independent midwives and obstetricians, and they have been very supportive of how Jeanne handled the deliveries.'

Browne was first licensed by the state in 2005. The Monitor profiled her and the Concord Birth and Wellness Center in 2008, when she was assisting in about 60 births a year, making hers one of the busiest practices in the state.

She gained a good reputation on mothering websites, where her name was often passed on to pregnant women seeking a New Hampshire midwife.

'Absolutely adore her - she's a fabulous, intuitive, just all-around awesome midwife,' said one of those recommendations, posted in May 2009.

'Jeanne Browne is the best,' said another recommendation from the same month. 'I've recommended her to 4 of my prego friends in the last year and they all love her!'

The complaints

Browne voluntarily surrendered her license June 30, and another midwife has since taken over her practice.

But she previously faced restrictions on her license after entering into a settlement agreement with the midwifery council in 2008 about her handling of a birth the year before.

During that birth, which took place at Browne's center, Browne didn't get emergency help in a timely manner, according to files provided by the midwifery council. She also failed to monitor the labor properly and to follow resuscitation protocol, according to the files. The baby died, according to the file.

The council determined Browne had been negligent in her conduct. In June 2008, she entered into a settlement agreement with the council, agreeing to practice under another midwife for three births and to participate in continuing education on fetal heart rate monitoring and medical charting.

That same year, she handled a number of births that would again trigger allegations of misconduct.

In March 2009, Concord Hospital submitted a complaint to the midwifery council about the care Browne had provided to eight patients who were later transferred to the hospital.

Four of those cases are described in the file provided to the Monitor by the midwifery council. One involved a mother who had previously delivered a baby by cesarean section, another who was older than 40 but had never delivered a baby, and another whose baby was in the breech position - all circumstances that state midwifery rules say should have prompted Browne to consult with an obstetrician.

But Browne failed to do that, according to the allegations in the file.

In one of those cases, the mother had an infection, and Browne didn't follow recommended guidelines for when to administer antibiotics, failing to appropriately assess the risk to the baby, according to the allegations in the file.

The baby required IV antibiotics and was taken to Dartmouth-Hitchcock Medical Center four days later after having seizures, according to the file.

In the fourth case from Concord Hospital, Browne was unable to locate the baby's heart rate for an extended time near the end of the labor.

She didn't call for emergency transport then, she didn't call when the baby was born and not breathing, nor did she respond to the baby's father when he asked if they should call 911, according to the allegations.

Instead, Browne allowed a student midwife who had never completed a neonatal resuscitation course to try to revive the baby, according to the allegations.

The baby was resuscitated at Concord Hospital and later taken to Dartmouth-Hitchcock Medical Center for seizures, according to the file. She was hospitalized for 21 days.

In June 2009, Dartmouth-Hitchcock submitted a complaint to the council about the care Browne had provided to a mother who had developed an infection after giving birth and later needed a hysterectomy.

Browne failed to conduct a physical or get medical assistance for the woman, despite her fever and abdominal pain, and she didn't keep up-to-date notes on the woman's condition, writing them after the fact with the help of the woman and her husband, according to the allegations.

In September 2009, an obstetrician submitted a complaint to the council about Browne's care of a mother whose baby had been in a breech position and was transferred to that doctor's care.

An ultrasound showed the mother had low levels of amniotic fluid, and the baby was far underweight for its age. But Browne didn't call a doctor at that point, according to the allegations in the file, instead trying to turn the baby on two separate days.

On the second day, she called the obstetrician, who agreed to see the mother the next day, according to the file.

But Browne had only told the doctor the baby was in a breech position, not mentioning the ultrasound results, according to the allegations. Once she did that - several hours later, according to the allegations - the obstetrician told the mother to come to the hospital for a cesarean section the same day.

In denying all the allegations, Browne noted in her statement to the Monitor that 'none of the initial complaints to the council came from my clients.'

The medical community, she said, 'has historically been unfriendly and uncooperative with homebirth/birth center midwives and the families who CHOOSE this option.'

The lawsuits

But after Browne surrendered her license in June, two of her former clients filed lawsuits.

The first, brought by Jonathan and Sarah Sadowski of Concord, was filed in July. They say Browne should have consulted with an obstetrician once she noticed signs that Sarah Sadowski's pregnancy was no longer normal.

It was their baby, Angelina, who was hospitalized for 21 days after birth and suffered serious brain injury.

The Sadowskis also say Browne failed to order appropriate testing during Sarah Sadowski's labor, failed to provide competent resuscitation for their baby and failed to call emergency personnel in a timely manner after the birth.

Their lawyer, Randolph Reis, said that injury could have been avoided with an emergency cesarean section.

The second, brought by Jennifer and Jesse Middlemiss of Canterbury, was filed in September and alleges that Browne failed to take proper sanitary precautions and infection control measures when delivering their baby.

Browne also failed to properly care for Jennifer Middlemiss after the birth, when she reported having a fever and abdominal pain, according to the lawsuit.

As a result, the lawsuit alleges, Jennifer Middlemiss developed an infection that wasn't immediately diagnosed, and she underwent a hysterectomy at the age of 28. She will not be able to have any more children and will require hormone replacement therapy for the rest of her life, according to the lawsuit.

Browne's lawyers have filed brief responses to both lawsuits, denying any negligence. They say Browne's actions didn't cause the injuries experienced by Jennifer Middlemiss and Angelina Sadowski.

The Middlemisses are also suing Ashish Chaudhari, an obstetrician with Concord Women's Care who was the attending physician the day Jennifer Middlemiss went to the Concord Hospital emergency room, five days after giving birth.

She complained of having a fever and abdominal pain, and Chaudhari gave her Vicodin but not antibiotics, according to her lawsuit.

Chaudhari's lawyer, Peter Meyer, said Chaudhari's care was 'reasonable and appropriate' given Middlemiss's symptoms.

Chaudhari also was not Middlemiss's obstetric provider, Meyer said, and he believed Middlemiss would go back to that primary-care provider for followup.

Surrender a first

The chairwoman of the New Hampshire Midwifery Council, Adrian Feldhusen, said Browne's case is unprecedented for the six-member council, which licenses and oversees the state's 21 lay midwives.

'We've never had a case we've actually had to investigate that has gone to a settlement or surrender of license,' Feldhusen said.

Midwives - who must take a college course in anatomy, study under a practicing midwife and pass a written exam to become certified in New Hampshire - are required to report to the council whenever a baby they deliver spends more than 24 hours in the hospital.

But in several of the cases that Browne is accused of mishandling, she didn't do that, according to the file from the council.

Without those reports, 'we don't know these cases exist, and we can't act upon them,' Feldhusen said.

But Feldhusen - a midwife herself who runs a birth center in Milford - said reporting is an issue in all health care settings.

The state's midwifery rules are clear on when to refer a mother to an obstetrician or the hospital, she said. 'There's not a lot of guesswork.'

Feldhusen said a version of the state's rules has been in place for 30 years, and 'when followed appropriately,' she said, 'they work beautifully.'

Carol Leonard, the Hopkinton midwife who trained Browne, also said she thinks the state's system works. Leonard - who is a member of the midwifery council but recused herself from the investigation of Browne's practice - estimates she has handled 1,200 births over the course of 35 years, and 'I think I can count on two hands when there's been a true emergency,' she said.

The key to avoiding those situations, Leonard said, is for midwives to screen out clients with complications - 'not taking risks, and not pushing the envelope, and not letting your ego get involved,' she said.

Browne's case, Leonard said, is 'an aberration.'

(Maddie Hanna can be reached at 369-3321 or mhanna@cmonitor.com.)


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