May 3, 2002

American College of Domiciliary Midwives

 

Mennonite Midwife Freida Miller Arrested in Ohio 
for properly using a safe anti-hemorrhagic (Pitocin) to prevent a dangerous PP Hemorrhage

A Clear case of "No Good Deed goes unpunished"

Plain Dealer Reporter
 Millersberg, Ohio

 Statement by the Ohio Midwives Association in reply to
the two newspapers who covered the court proceedings

Daily Record Wooster, Ohio

 
Statement on behalf of OMA to the two newspapers who covered the proceedings...
The Ohio Midwives Alliance supports Freida Miller in all decisions she has made with respect to the recent legal charges by the Holmes County Prosecuting Attorney. We strongly support the actions she exercised in this case as a shining example of exemplary midwifery care consistent with the highest standards of the Midwives Model of Care practiced nationally and globally.
 
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes and includes:
    monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle;
    providing the mother with individualized education, counseling, and prenatal care,   continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions;  and identifying and referring women who require obstetrical attention.
 
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
 
It should be of great concern to the public of Ohio that one of its citizens has been prosecuted for providing appropriate care. The Ohio Midwives Alliance calls upon the Ohio Legislature to act swiftly to ensure in the written law of this state that such a miscarriage of justice will never occur again and midwives serving in home settings will be fully supported in their work of assuring safe births for Ohio's families.
 
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MIDWIFE ADMITS SHE WAS WRONG TO ADMINISTER PRESCRIPTION DRUGS

John Horton
Plain Dealer Reporter
 
Millersburg - A Holmes County midwife yesterday admitted she was wrong to inject prescription drugs into a woman in her care, ending a case that some say defines firm ground rules for her profession in Ohio.
 
Freida Miller spoke softly as she apologized in Common Pleas Court yesterday for her actions on Dec. 17, when she illegally administered the drugs Pitocin and Methergine to try to halt a mother's bleeding after childbirth.
 
"I need to obey the law of the land," Miller quietly told White.
 
Miller, 47, of Berlin Township, pleaded guilty yesterday to three misdemeanor charges related to her work, ending the first such case ever filed against a lay midwife in Ohio.
 
The outcome was declared by some of her supporters as a set-back for midwifery and home birthing in the state.
 
Miller pleaded guilty to attempted unauthorized practice of medicine and two counts of possession of dangerous drugs, all first-degree misdemeanors.  She had been indicted in March on felony charges of practicing medicine without a license and selling and possessing dangerous drugs, which were reduced as part of Miller's plea agreement with county prosecutors.
 
The agreement also requires Miller to consult with doctors on all future high-risk pregnancies she oversees, a "watchdog" condition that some in the midwifery community called a disturbing precedent.
 
Others, however, called it a step toward safety.
 
"Hopefully, this will deter midwives from getting into situations where they even have to think about using drugs," said Stephen
Knowling, assistant county prosecutor.
 
"A mother has a right to choose where and how she gives birth, but the state has a right to ensure the child is not put at risk."
 
Judge Thomas White pushed for Miller to openly acknowledge that it is inappropriate for a midwife to use prescription drugs.
 
Only qualified medical personnel, which does not include lay midwives, can carry or use medications such as Pitocin or Methergine in Ohio.
 
Many midwives, however, say both drugs are commonplace in their profession and are carried for use in emergencies.  There is a legislative effort under way in the Ohio Statehouse that could license midwives and eventually give them the authority to use such drugs.
 
"No one is above the law, regardless of what we think should be a licensed activity," White told Miller.  "That's a battle to be fought in the halls of the legislature, no in the halls of the courthouse."
 
But the conditions set in Miller's plea agreement bring their own implications, said Kelly Kupcak, co-coordinator of the Ohio Friends of midwives.  She said the treatment of Miller will increase the "climate of fear" that many midwives already work under because they feel threatened by the medical community.
 
Currently, lay midwives are not licensed by the state or recognized by Ohio law.
 
Abby Kinne, President of the Ohio Midwives Alliance, said White and the Holmes County prosecutors have "taken steps to make the practice of midwifery unsafe".  Kinne said Miller's use of Pitocin and Methergine probably saved the life of Jan Joyal, the mother in Miller's care December 17.
 
White fined Miller the maximum of $3,000 and sentenced her to 360 days in jail, which was suspended providing that Miller comply with terms of her probation.  Miller also was ordered to perform 200 hours of community service and to write a letter of apology to the community.
 
Miller is permitted to continue working as a midwife provided she does not administer prescription drugs.  In 17 years as a midwife, Miller estimates she has assisted at nearly 2,000 births.
 
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MILLERSBURG ~ Daily Record (Wooster):
Midwife Freida Miller was sentenced on Wednesday. Mike Schenk photo

A Holmes County midwife, facing felony charges after a complicated Dec. 17 home birth, pleaded guilty Wednesday to three misdemeanor charges and agreed to consult with a physician on high-risk pregnancies.

 
The crowd of more than 200 that packed the Holmes County Courthouse for the March 11 arraignment of Freida M. Miller was replaced by a small gathering of 16 supporters who watched her plead guilty to the misdemeanor charges -- one count of attempted unauthorized practice of medicine and two counts of possession of dangerous drugs.She was sentenced to jail time -- which was reduced to probation -- fined and ordered to perform community service. She also was ordered to publish a letter of apology.
 
Miller, 47, of 5552 Rhine Road, Berlin, originally was charged with practicing medicine and surgery without a certificate, sale of
dangerous drugs and possession of dangerous drugs for sale, all felony offenses.
 
Following the Dec. 17 delivery of a baby at Miller's home, the 48- year-old mother suffered extensive bleeding, requiring an emergency trip to Pomerene Hospital in Millersburg, according to court records. While in the emergency room, Miller allegedly told hospital personnel she'd given the woman prescription drugs to slow bleeding. Miller told Common Pleas Judge Thomas D. White she believed she was permitted to administer the anti-hemorrhagic drugs to stop bleeding in an emergency situation. Doing so may have been a life-saving measure, Miller said. She said she "kind of, should have" known doing so was illegal.
 
"I agreed to see if I could possibly help some of those clots to come out of her by examining the lady," Miller said of her decision to perform an in-hospital exam in the emergency room.
 
On Jan. 25, Miller gave investigators from the sheriff's office and the Ohio State Board of Pharmacy several vials of prescription
medication.
Wednesday's hearing provided her an opportunity to speak to her actions.
 
"Before God and all of you present, I would like to apologize for the wrong I have committed to possess those drugs that are not legal for me to have. I was wrong not to search it out carefully, those laws concerning them and obey them. With God's help, I will no longer carry any illegal drugs," Miller said.
 
"I also realize that my actions in the emergency room were out of order, and I am very sorry and apologize for them also."
Judge White explained that, "For an unlicensed person to attempt to examine or provide medical care to a person who has already presented to a hospital is not only contrary to law, is not only contrary to common sense, it also opens the taxpayers of this county to significant liability."
 
Miller's purported lack of knowledge that possessing and administering drugs was illegal "was probably a studied ignorance,"
White said. "I think it's very easy to find out whether possession and administration of those drugs is illegal."
 
"But, both for you, those in your profession and for this community as a whole, I think that this case needs to make a statement that (possession and administration of dangerous drugs) is illegal, that there are significant side effects to misdiagnosis, to the
misapplication, to the overdosing of dangerous drugs, and that the laws of this state that do control the administration of dangerous drugs are good for the overall community.
 
"Finally, I think that this court needs to make a statement that no one is above the law," White said. "Regardless of what we think should be licensed or unlicensed activity ... that is a battle to be fought in the halls of the Legislature and not the halls of the
courthouse."
 
Pending in Ohio is legislation that would establish a board to license and regulate the practice of lay midwives in Ohio, which some say could include a provision granting authorization to administer lifesaving drugs.
 
White sentenced Miller to a total of 360 days in jail, a sentence that was suspended -- with the state's blessing -- in favor of three years of probation.
 
As a condition of her probation, Miller was ordered to develop and implement a consulting protocol for high-risk pregnancies. The protocol would involve patient referrals to physicians, who, along with Miller, can adequately inform parents in high-risk situations of the risks of a home birth versus a hospital birth, explained Assistant Prosecutor Steve Knowling.
White ordered Miller to pay a $3,000 fine, complete 200 hours of community service and publish a letter of apology to the community. "I think this is a good resolution," Knowling said. "It's a difficult situation for everybody, especially the courts. It's a difficult balancing act between a mother's right to a birthing experience she chooses and the state's right to protect unborn children who don't have a choice and can be put at risk because of parents' choices." Miller also was ordered to cooperate with all federal, state and local authorities in any investigations of criminal activity arising from her crimes.
 
While Miller has maintained her silence when asked about the source of the drugs in question, Knowling said, "We are not done
investigating where the drugs came from, and that will come back to her in the long run."
The past few months have been rough, Miller said, but she doesn't think the activity will affect her role in the community.
 
"The court sanctioned midwifery, and that's what we wanted to happen," said Miller's attorney, David Knowlton. "We didn't want to have it affect her practice, and (in pleading guilty to the reduced charges) she didn't admit to something she didn't already say she did."
 
As far as the consultation protocol, Knowlton said, "We would like to see it bring about more communication between midwives and doctors and hope there's more openness from both ends. We definitely want parents to continue to be the final authority (on birth choices)."
Reporter Christine L. Pratt can be reached at cpratt@the-daily-