Dear all:

I read the following clause number 23 that has been coming up lately.  a
little differently than YOU MUST ALWAYS WRITE A REPORT TO THE PEDIATRICIAN.

23.  Require and obtain consent to share clinical concerns and information
>with the physician or other primary health care provider before initiating
a  consultation.
>
It says "share clinical concerns".  It doesn't say "always write a
report".  It seems to me, that unless there is a medical problem that would
involve the pediatrician, it would remain a professional courtesy to send a
written report for every single case. And one could even pick up the phone
when necessary.

Moreover, the above statement seems to be in DIRECT CONFLICT with my
reading of the HIPPA requirements (sorry for all of you who do not work in
the US about this one).  As I understand HIPPA you CANNOT refuse service if
someone refused to sign a consent form.  I've looked at various forms for
psychologists, my pediatrician, the ENT who performed a tonsillectomy,
adenoidectomy on my son, the Elizabeth Seton Childbearing Center forms and
they all include the right of refusal to consent and the mandate that one
cannot withhold services if someone refuses.

The one exception to this that I can think of is when there is a case of
child endangerment in which case you MUST report the incident.

So, I definitely think this needs someone to look at the legal implications
of this statement in light of the HIPPA recommendations in the US and may
also need some legal review in the many many other countries which have
IBCLCs.

AND to give you some clearcut examples of when I wonder if it would be be
unethical to share information, we often deal with clients who have had a
history of fertility programs and have resorted to IVF and egg donors.
Some of these women do NOT want their pediatricians to know.  Also, some
women have had a history of depression and also do not want the
pediatrician to know.  I have always allowed them to put restrictions on
the information that they share as long as I felt that they would not be
endangering their child. In light of the HIPPA requirements, and if there
is no sign the woman is endangering the infant, is there really a
requirement to report everything to the pediatrician?

Any medical ethicists out there willing to try to respond to this? Or those
working in hospitals where the medical ethicists have already hashed this
out?

Confused,

Susan E. Burger, PhD, MHS, IBCLC

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