Dear all:

I have just had a huge series of complaints amongst the members of the New York Lactation Consultant Association (NYLCA) about fee splitting or kickbacks (I'm sure Liz Brooks would have something to say on the specific language).  One of the former board members had investigated this when she was asked to provide a portion of her fee in return for a referral and discovered it was illegal in New York State.  The fact that this is well known among other types of practitioners was confirmed by my husband (a clinical psychologist) and another LCs husband (a pediatrician).  They immediately both said, "that's illegal".

A colleague who used to work in California once felt obliged to pay the kickback fee.  When she later refused to take referrals from this person again, she was bad mouthed by the person wanting the kickback for the rest of the time she worked in California.  A few months ago we had a baby store in Brooklyn contact many LCs in the area offering to pay kickbacks to us if we referred parents to buy their products.  Over President's Week, a doula was apparently calling around requesting she be paid $25 in return for the referral.  Turns out there is apparently more than this one doula.  Another doula who is a licensed social worker (and therefore should know this is illegal) appears to be encouraging this practice amongst the doula groups. 

I felt obliged to send a message to our members and other "friends" about how the practice is illegal in New York State and even if it weren't illegal, it violated NYLCA's Bill of Rights and Responsibilities for Clients. We expect those who list their services on our website to abide by the WHO Code and a set of standards that includes this Bill.  We specifically expect lactation consultants to refer to others if they can't see a client in a timely manner or if the problem requires expertise beyond the scope of practice of the lactation consultant.  

In response to my email, I felt like I had opened the door for all the resentment and anger that lactation consultants, doulas, childbirth educators, and others (many different breastfeeding helpers are in our email group) feel when colleagues try to gouge them for a kickback fee.  It was like opening the door for discussion about the nasty things mothers hear when they are trying to feed their infants. 

So, while it may not be illegal in other states, my take home message is that if you really want to alienate other professionals, demand a kickback fee for referring to them. You will ensure that many of your peers resent you for it and might even put yourself in jeopardy of violating the law.  If you want to gain their trust, refer to others based on the needs of the client and the skills of the person you are referring to.

Sincerely,
Susan E. Burger, MHS, PhD, IBCLC

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