A woman who suffered a miscarriage has been fined by the NHS for claiming a free prescription during her pregnancy. Sadie Hawkes lost her baby before she had received the maternity exemption certificate that entitled her to free prescriptions throughout her pregnancy and the first year after birth. She has now been sent a demand for £56.10 for medication issued the week before her miscarriage. She’s been told that she can’t apply for a certificate retrospectively as she is no longer pregnant. “I had tried to pay for the prescription at the time, but the pharmacist had told me that I was exempt,” said Hawkes. “I miscarried nine weeks into my pregnancy, before I could see a midwife, so I never got a certificate and had no idea that I was therefore liable to pay.” Hawkes is one of thousands of women in England to have fallen foul of NHS red tape which penalises patients who qualify for free prescriptions because of a medical condition or pregnancy, but who have not yet been registered for, or have failed to show, an exemption certificate. Under NHS rules, pregnancy does not qualify women in England for free prescriptions unless their midwife registers them for a maternity exemption certificate that pharmacists are legally required to request. But two things frequently appear to go wrong: midwives make errors on applying for the certificates or forget to apply at all, and pharmacists fail to ask for proof of exemption. In Hawkes’s case, she lost her baby before her first midwife appointment, during which she would have been registered. Four months later, she has been ordered by the NHS Business Services Authority (NHSBSA) to pay a £46.75 fine plus the £9.35 prescription charge for medication prescribed the week before she miscarried. “The PCN [penalty charge notice] arrived on a day when I was feeling particularly ill and low [after] the miscarriage,” the 33-year-old veterinary nurse said. “It made me feel like a fraudster. I immediately called the NHSBSA and explained the circumstances to a robotic woman with zero compassion who said I was no longer eligible for a certificate because I was no longer pregnant. I was told the fine, but not the prescription charge, could only be waived if I got proof of pregnancy from my GP. That was really distressing to have to do, and made me feel I wasn’t being believed. It was the worst phone call of my life.” It’s estimated that as many as one in three pregnant women never receive a certificate. Many eligible patients are unaware of the requirement until they receive a PCN, usually months later. By then, those with complex pregnancies may find themselves liable for huge costs. Under government rules, registration can only be backdated by a month, leaving women facing charges even after providing proof of their pregnancy dates. Fines are five times the sum owed up to a £100 maximum plus the prescription charge. One woman who contacted the Observer was billed over £400 for medication. This month, the charity Maternity Action plans to lobby the government to change the rules so that certificates can be backdated to the beginning of a pregnancy. It wants NHSBSA to waive all current fines and charges for women who can prove they were pregnant when they claimed free prescriptions. “We know that midwives are overstretched and that exemption applications are sometimes overlooked,” said director Rosalind Bragg. “But it is grossly unfair that pregnant women and new mothers are facing fines due to no fault of their own.” The Department of Health and Social Care told the Observer that there are no plans to change the rules, although it “recognised” the stress of unexpected charges. “Patients are responsible for ensuring they are claiming an entitlement to which they are eligible, and making a correct declaration on their prescription form.” NHSBSA has now apologised to Hawkes and cancelled the PCN pending payment of the prescription charge which, it says, government regulations compel it to pursue.