LANSING, Mich. (WSAW) - The midwife who gave up her license in Wisconsin last year following two complaints learned Tuesday that she will be keeping her midwifery license in Michigan.
Two complaints investigated in Wisconsin by the Department of Safety and Professional Services over 2023 led to a settlement agreement with Pera to surrender her license in the Badger State last November, allowing her to avoid going before an administrative law judge. The disciplinary action triggered the investigation in Michigan. That includes a case where Marien Jo Schmidt, a Price County baby, died during birth in February of 2023.
On Tuesday, the Michigan Board of Licensed Midwifery's disciplinary subcommittee assessed the settlement terms Upper Michigan midwife, Sandra Pera and her attorneys negotiated with the Michigan attorney general's office regarding substantiated violations of the state's public health code.
The committee had the option to accept the order as written or reject it, with a strong encouragement to include a counteroffer. If Pera rejected the counteroffer she could continue to negotiate with the attorney general's office or it could also lead to a hearing with an administrative law judge. The committee discussed the terms and ultimately voted to accept the settlement as written. The settlement in Michigan was quite different than in Wisconsin.
Those terms include suspension of her license for 30 days beginning April 30, 2025, which will not allow her to practice for that period. Her license will also be probationary for a year and her practice monitored by two different types of reviewers. The committee stated the focus of the license review and requirements in the Michigan settlement were based solely on these cases.
According to the discussion in the meeting, the terms of the probation include that Pera will have an "affiliated monitor" assess her midwifery practice within 30 days. The monitor must share the summary report of the assessment with the state. Within 60 days, Pera must propose a "designated reviewer." The midwifery board has to approve the reviewer. Once approved, the reviewer will have quarterly meetings with Pera and look at five or more of her patient records; the reviewer must submit a quarterly report with each visit. Pera must also comply with the state's public health code and pay a fine of $1,000 within the next 100 days.
The monitor and the reviewer are not expected to shadow Pera during births or patient visits. The committee noted due to Pera's remote location, it was unlikely that anyone would realistically be able to physically monitor her during her interactions with patients. Some of the items they are supposed to focus on to ensure Pera is complying with the terms of her license include prenatal care, informed consent, fetal assessment in labor, and neonatal resuscitation skills.
One committee member questioned why appropriate informed consent related to GBS (Group B Streptococcus) was included in one of the continuing education items in the settlement offer.
"On the one hand, we have to have that as part of our license anyway, I could see, why not just include it in here, but it also feels like it's possible from what I have in front of me that there was a lack of informed consent and I would expect some continuing education or some kind of address of that issue that I'm not seeing."
In one of the two complaints Wisconsin investigated, the mother tested positive for GBS, a condition that carries infection risks for the baby after the mother's water breaks if left untreated during labor. Wisconsin DSPS found that Pera had not charted an informed consent discussion with the mother about the risks and benefits of GBS treatment or the mother's written refusal to be treated.
The mother told Pera she was "leaking fluid," but not having contractions. Pera did not visit the mother to evaluate whether labor had begun until five hours later. Three days later, following a series of other events, the mother was taken in for an ultrasound. She had not been treated for GBS during that time. At the hospital, Pera told hospital staff that while the mother was positive, she was not treating it because the mother did not have a fever, which goes against American College of Obstetricians and Gynecologists guidelines. Licensed midwives in Wisconsin must follow ACOG guidelines. Hospital staff informed Pera treatment was not for the mother's care, but to prevent GBS pneumonia in the baby.
7 Investigates reached out to the state to clarify what the subcommittee was basing its decision on, whether that was just the settlement agreement offer, the full Wisconsin review, Michigan's summary complaint based on Wisconsin's investigation, or something else. We have not gotten an answer as of this publishing.
7 Investigates emailed Pera offering a chance to comment on the decision and other complaints filed against her. She did not respond.
Following the decision about Pera's license, the meeting was open to public comment, however, people were not allowed to speak about "regulatory matters," or more specifically, Pera's case. Jane Crawford Peterson from the Wisconsin Guild of Midwives tried to speak but was stopped when she tried to question Pera's disciplinary decision. She provided this statement to 7 Investigates:
The Schmidts expressed frustration about the public comment rule, saying they had not been able to address Michigan on the matter of Pera's license.
Melinda Britton, a doula in Marquette, Mich. who had worked with Pera for several years and who was a patient of Pera's for the delivery of her own children, also expressed frustration. In order to ensure she could speak, she spoke in generalities rather than specifics about Pera, per the committee's guidance.
"I'm not going to make any statements about her," Britton said in response to the committee's interruption when she mentioned Pera's relation to her. "I'm not going to be making any statements about her, but I am going to go to my general statement. What is discussed in a board meeting is not reflective of what is happening in a community. Home birth in the UP is not safe and I guess we are going to have to protect birthing people and women ourselves."
Britton told 7 Investigates she filed a complaint against Pera's license with Michigan as well, sharing her experience under her care as well as half a dozen other mothers she witnessed Pera care for while Britton served as a doula. She said she was informed by the state that the investigation into her complaint was recently completed.
Meanwhile in Wisconsin, the Schmidt's John Doe case against Pera has not made much progress since the initial judge received the Price County district attorney's formal explanation as to why he would not file charges in the case. The case has since seen several judges assigned to the case. Currently, it is in the hands of Oneida County Judge Mary Sowinski. No future court dates have been scheduled.