Amy, thanks for the Q -- but while I am a lawyer, I am not *your* lawyer,
nor am I *your hospital's* lawyer, so I will not offer any legal advice
specific to your particular situation.  I am willing to bet, however, that
your facility has a bucket of attorneys working for them ... who would be
more than happy to ponder your question as it affects your facility, its
employees, and its liability risks ... both the liability that you will get
sued on a tort theory, and liability that you won't get paid by mom (or)
reimbursed by the insurance machine without documentation of the visit.

When I am lecturing at conferences about legal and ethical issues for the
IBCLC, I often get asked about Warm Lines and Outpatient Clinics.  So let me
share some generalized information, applicable to the generalized audience.

Warm Lines and Outpatient Clinic (and support group gatherings for moms that
turn into mini-consults for each attendee) are a hot bed for legal/ethical
issues.

Mind you:  the "lactation part" in each of these settings is fabulous, and
usually runs like clockwork.  Mom is getting information, evidence-based
support, and a compassionate health care practitioner -- all in a setting
that promotes and protects BF.  What's wrong with that?  Not a thing.

Where things start to fall apart is in the ritualized chart-keeping that we
don't think twice about in more formal health care settings.  You can be
darned sure that somewhere along the line, before a patient is seen in a
hospital or a doctor's office, a "consent form" has been signed.  It may be
called something else, like an "admission form," or a "patient information
sheet."  Take a look at that little paragraph at the bottom, right before
they sign, and read what they are agreeing to.  I'll bet dollars to donuts
there is something in there about agreeing to the care provided .. agreeing
to pay or to provide info to the insurance company so they pay, etc. etc.

In a hospital setting, you don't have to worry about every nurse, doctor,
candy striper and IBCLC getting his/her own little consent form.  It is
covered by the Big Honking admission form (when they no doubt signed the
HIPAA papers, too).  In an office setting (pediatric office, OB, midwife)
the original patient intake papers probably have language that says
something like "patient agrees to treatment by and payment to this provider,
until further notice."

So, while you may not in a day-to-day setting be conscious of the fact that
the patient/client has "agreed" or "consented" to be seen -- you can be sure
it is there somewhere.

Now let's get back to the hot bed.

Outpatient Clinics for former hospital patients are fabulous.  If you don't
have an on-site consent/HIPAA form (as you should, sorry) then I think one
can make a plausible argument that Mom's agreement to deliver at the dang
place cover these sorts of follow-up visits.

But many Outpatient Clinics are open to the public at large.  So if you
don't have the Moms signing consents to be seen, it is just like me walking
into an eye doctor's office and asking for an exam and eyeglasses
prescription ... without me signing any papers, paying any money, sharing
health history, etc.  Do you think for a twinkling an eye doctor would let
that happen?

The myth is that this paper stuff has to be a pain in the neck.  It
doesn't.  A generalized sign-in sheet for Outpatient Clinics and mothers'
groups (run by a health care provider ...I'm not talking here about things
like LLL meetings) can say, at the top, "I agree to be seen by a health care
provider [or IBCLC] for my breastfeeding concerns.  Information about our
meeting may need to be shared with my other doctors."  For a group meeting,
it can say something like "I understand that if I share personal information
about me and my baby, everyone at the meeting will hear."

In a clinic setting, you can have a two-part, carbonless form where you
check off essentials of the history, consult, and care plan.  You get a
copy; Mom gets a copy.  Your form can say at the bottom that Mom should
bring this with her to her next doctor's visit for herself OR her baby (as a
rather loosey-goosey way of "reporting to her HCP."  Your files can be kept
by time (i.e. "November", vs. patient name), greatly reducing the hassle of
record-keeping.

For Warm Lines, you can keep a simple log in a wirebound notebook:  Columns
for date/time, Mom's name and phone number, brief description of her issue,
how it was resolved, and the person who talked to her.  No more than a
sentence or two for each column (because, of course, if you need more space
than that, it is a clue that Mom should be seen in person).

And ALL of these "policies and procedures" are spelled out in your
facilities policy and procedure manual for the operation of the Outpatient
Clinic or Warm Line.

 --
Liz Brooks JD IBCLC FILCA
Wyndmoor, PA, USA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome