Dr. Robert Biter and “midwife” Rowan Bailey: compare and contrast

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At first glance, obstetrician Robert Biter and unlicensed “midwife” Rowan Bailey appear to have a lot in common. Both presided over homebirth deaths and both face serious consequences as a result. It seems to me, though, that the differences between the two cases are far more instructive than the similarities. Moreover, those differences tells us a great deal about the professionalism of doctors, and the utter lack of professionalism of homebirth midwives.

Consider:

1. Rowan Bailey broke the law and Dr. Biter did not.

This is a critical distinction that seems to have escaped most homebirth advocates. The Medical Board of California found that Dr. Biter demonstrated gross negligence in his care of patients and was both dishonest and unprofessional. However, Dr. Biter was practicing under a valid medical license. At no point did he ever represent himself as something he was not. In contrast, Bailey was practicing midwifery illegally and was allegedly misrepresenting her credentials to parents.

Had Dr. Biter presided over the death of a baby while unlicensed, he almost certainly would have been arrested as well.

2. Dr. Biter carried malpractice insurance and Rowan Bailey did not.

In keeping with the legal requirements for practicing medicine in California, Dr. Biter carried malpractice insurance. The patients that he has injured may be able to collect compensation. In contrast, Bailey offered no such protection for her patients.

3. Dr. Biter was disciplined by his own profession.

The medical system did not close ranks to protect Dr. Biter. First he lost his hospital privileges, then he was placed on probation by the Medical Board of California, and currently he is facing revocation of his license. In contrast, no midwifery board or organization took any disciplinary action against Bailey. Indeed, they didn’t even bother to investigate.

4. No doctors rallied around Biter when he lost his hospital privileges.

They understood that the loss of privileges represented a very serious accusation against Biter and withheld judgment until more of the facts were known. Indeed, the only people who rallied on Dr. Biter’s behalf were homebirth advocates, including Ricki Lake, who made no effort to determine the facts of the situation and blithely accepted Biter’s claim that he was being “persecuted.”

5. No doctors or medical organizations raised money to support Dr. Biter.

Why? Because the medical profession does not feel threatened when bad doctors are disciplined. In contrast, homebirth midwives feel threatened when incompetent midwives are investigated, charged, tried and punished. They do not want to be held responsible for their actions or any carnage that follows in the wake of their actions. They want to be able to entertain themselves by attending births and getting paid for it. They apparently feel no responsibility to make sure that their actions are safe.

These differences make a mockery of the claims of homebirth advocates that there is a double standard for obstetricians and for midwives. Preside over a death while practicing without a license and you may go to jail regardless of whether you are a doctor or a midwife. Commit malpractice as a physician and you will not be protected by your medical colleagues; they will not support you; will not rally for you and will not raise money on your behalf. They will discipline you and even drum you out of the profession. There are very real and very serious consequences for physicians who fail to care for patients appropriately and no one is arguing that penalties for malpractice are unjustified.

You have to give homebirth advocates credit for one thing, though. They are ideologically consistent. Commit negligent acts, commit malpractice or preside over a perinatal death at homebirth, and homebirth advocates will insist you are being “persecuted” whether you are a doctor or a midwife. Homebirth advocates are consistent in their morally bankrupt behavior.

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  • Alexis

    Newest reports declare Robert Biter DID NOT HAVE INSURANCE and filled bankruptcy earlier this year to protect his personal finances:

    http://www.nbcsandiego.com/news/local/Couple-Who-Lost-Baby-to-Protest-Birth-Center-277114711.html

    • Amazed

      He’d make a great CPM.

    • mythsayer

      I am totally speculating here, but I have a feeling the people who lost or have injured children because of him and couldn’t collect on insurance (or even some who could) will file an adversary proceeding in his bankruptcy case, which could make his debts nondischargeable. It would be based upon fraud… his misrepresentations… if there were any (I suspect there were…. any mediocre attorney could come up with some)

  • Disgusted

    OT, but I saw this story and totally thought of this blog first. An OB who was visiting Nigeria developed, along with her husband, a solar powered birth kit to use in the many places without electricity so that when babies are being born in the middle of the night, they can still help them.
    http://www.cnn.com/2013/02/28/health/cnnheroes-stachel-solar-power/index.html

  • Libelula

    Thanks for posting this. I live in the western NC area and I am disgusted by how people are defending Bailey and holding her up to be a martyr. Another thing that doctors presumably do not do when a doctor is responsible for a death is post on facebook looking for volunteers to put their house up as collateral for the doctor’s bail bondsman. I’m looking at you, Gloria Lemay. I don’t see how anyone with critical thinking skills can claim there is an unfair double standard here. Bailey choose to be treated differently than doctors or nurses by acting as an unlicensed provider. She can’t lose her hospital privileges because she doesn’t have any. She can’t lose her license or have it suspended because she doesn’t have one. She can’t be subject to any form of peer review because she isn’t a real professional, so she doesn’t have any peers–she doesn’t even have a CPM. The only option left was the legal system. A baby lost his life. Two parents will forever grieve the loss of their son. Bailey deserves to be in prison.

    • The Bofa on the Sofa

      Wow.

      I am generally unimpressed by commenters on blogs and stuff, having seen so many over the years, but this is absolutely a wonderful contribution. Thanks.

      • Libelula

        Thanks! I’ve been trying to ignore Dr. Amy for years and have slowly come to the unsettling realization that a lot of what she says is true. I believe women have the right to give birth how they want, whether it’s a home birth out in the woods with singing birds or by maternal request primary cesarean. But that doesn’t mean a midwife should be untouchable just by virtue of calling herself a midwife. Women having the right to control their bodies is a human rights issue. Midwives having the right to practice as they please and neglect a laboring woman is not a human rights issue. I’m just absolutely livid over this case, perhaps because I live in the area and have actually met Bailey (unlike a lot of the people who contributed to her bail fund), so it hits closer to home.

        • I notice patterns in stories. One pattern in home birth stories is the midwife barely arriving in time for a birth, or not arriving in time resulting in a woman having an unintended unattended birth. There’s been enough that I’ve lost count.

          A newer phenomena (to me) is the midwife who is busy with another birth, leaves a woman unattended while laboring. Then when she does arrive, she’s exhausted, does very little and falls asleep while she’s at the laboring woman’s home. She may leave a laboring woman alone, without even so much as a doula or assistant to monitor her.

          A midwife should arrange for back up if she isn’t capable or willing to care for her client. If she can’t arrange for back up, she should recommend the woman transfer to a hospital for care.

          As for women who plan on having a midwife attending their home birth – ask your midwife who her back up is. Ask your midwife if you can meet her back up. Heck, ask for the back up’s contact information. If you can’t get either, find another midwife.

          • Libelula

            I agree completely. If a midwife can’t competently care for her client, she needs to step up and arrange for back-up care or a transfer. I’ve heard a lot of the “oops, the midwife didn’t get there in time!” home birth stories too. Scary.

            It seems like the NB movement does so much to educate women about how you need to advocate for yourself in hospital births. But there is no education about home births and the need to advocate for yourself or the fact that not every home birth provider is responsible. For all the rhetoric about the OBs who just want to play golf and avoid lawsuits, there’s no corresponding information about the very real midwives who just want to avoid transfer and getting arrested. Bailey’s claim was that she wasn’t licensed because she worked for the mother. But when things got serious, she wasn’t there for the mother at all.

        • I believe women have a right to control their bodies too. But I have a problem seeing it as a capital letters Human Right because I think it misunderstands and cheapens what is important about those rights. Do we have a right to…cut ourselves, starve ourselves to some imaginary ideal weight? Maybe. But when you have claimed it as a right, do the rest of us have to stand back and applaud? And does that then give others the right to encourage harmful things? Will the singing birds in the woods comfort if you are holding a dead child sacrificed to your rights? It is too easy to hold on to that, and ignore responsibilities. Rights do not exist in a vacuum.

          • Eddie

            Very clearly put. And we do not have the absolute right of control over our bodies. If we make choices that lead to becoming a public health hazard, we can be held against our will in a hospital or other institution, for example.

          • Libelula

            I agree. People defending Bailey are claiming that it’s about a mother’s right to birth how she wants. But it’s not. Even if you accept that a mother has the right to birth how she wants, that doesn’t translate into the state being compelled to support every random person who wants to hang their shingle and call themselves a midwife. We certainly don’t have to applaud irresponsible or reckless choices or applaud when the NB movement encourages those choices (If it wasn’t clear, I was being tongue in cheek about the birds–sometimes when I read NB literature about home birth, it seems like they expect those little singing bluebirds from Disney movies to show up haha).

  • Great post, Dr. Amy.

  • hurricanewarningdc

    Good article and interesting observations that I wouldn’t have considered. All true.

  • AL

    Off topic but looks like Jennifer Margulis deactivated comments on her blog.

    • Eddie

      Too funny. Guess she can’t take criticism.

      • Amazed

        You know what’s really funny? That I fumbled there for a good 5 minutes, thinking that it waas Firefox mocking me again. 5 minutes of my life I’ll never get back because it didn’t occur to me that she’d actually erase over 100 comments.

        Aren’t I a silly one?

  • attitude devant

    Thank you for the quotes around “midwife”

  • Squillo

    The medical board is set up to protect consumers; midwifery boards are set up to protect midwives.

  • Squillo

    Do we know that Biter had med-mal when he presided over the homebirth death? He hasn’t had any hospital privileges since May 2010, and it’s unclear to me how long he continued to work at the surgery center after that.

    • Things are clearly different in the US, but I think the chances of winning a medical negligence claim in the UK would be rather low if you had a homebirth, unless the negligence was along the lines of failing to risk out, or some really awful dereliction. Damages here are strictly controlled to the cost of care, or loss of earnings, and anything that looks like “contributory negligence” – like not asking to be transferred, would reduce them. If a child dies or is injured because they were in the wrong place when an emergency occurred, I don’t think that would count as negligence, just a risk inherent in homebirth. Practising without a licence, however, is taken a whole lot more seriously, so no hobby midwives that I know of. As Dr. A says, a doctor who had been “struck off” would be in a whole lot of trouble.

      I also don’t think that negligence, or falling below the standard of care, automatically indicates a bad doctor. Several accusations might! But the standard is high, and the judgements aren’t always easy. It is the CS not done, the “false positive” that wasn’t false that makes things so difficult. Not too many clear absolutes, sometimes. Ruptures don’t happen, and footling breeches sometimes come out fine.

    • Staceyjw (Renee Martin)

      I doubt he had med-mall once he went into HB. He probably happily joined the ranks of HBMWS that think its not important.

      • laura

        Med-mal insurance for ob/gyns in CA is AT LEAST $65 K per year. What are the odds he could afford that when he lost his hospital privileges?

    • suchende

      Well, we know he had it at some point.

  • Captain Obvious

    Katie needs to update Dr Biter’s bio on her “Sisters in Chains” blog. I am sure the medical board would have an issue with his public comments at that conference for HRiC.

    • Susan

      I may be dense but can you spell out why the medical board will have an issue with his public comments? What would their position be regarding his public comments?

      • That he hasn’t learned much from his mistakes, and is therefore a menace? Rogue doctors do bring the profession into disrepute, and proper doctors take that seriously.

      • Squillo

        If the MBOC is still deliberating on whether to revoke his license, I can only imagine that any remarks suggesting he’s being unfairly persecuted–especially in light of the fact that he declined to mount a defence–won’t help him keep it. Which leads me to believe one of three things: 1. They’ve already informed him of their decision (it hasn’t yet been posted publicly); 2) He plans to voluntarily surrender his license; 3) He doesn’t care if he keeps it.

        • The Bofa on the Sofa

          Well, it’s easier to play the martyr when you’ve lost your license than when you admit you are wrong to keep it

          • Susan

            Thanks all.

      • Dr Kitty

        Doctors make mistakes. The profession accepts that.
        What we do not accept are doctors who make mistakes and either don’t acknowledge the mistake, or don’t learn from it.

        The British GMC, for example, is more inclined to forgive a bigger mistake where the doctor reacts with remorse and remedial action, than a smaller mistake where the doctor reacts with denial and arrogance.

        • Susan

          That makes a lot of sense. So it could affect their decision, if it hasn’t been made yet?

        • Hannah

          I think the phrase is “deep seated attitudinal problems” a la Wakefield