Does anyone know if it is legal for an occupational therapist in private
practice to see a mother and baby without a physician's referral, if the
mother requests her?

I sent an assessment to a pediatrician after a follow-up consult with a baby
who, after 2 months of poor feeding and damaging his mother's nipples had
his tongue clipped. His feeds are still inconsistent. I recommended a
particular OT,  trained and experienced in helping breastfeeding babies, who
will make home visits. Mother prefers not to take the baby out.  Baby and
toddler  have had many colds and baby recently hospitalized with RSV.  The
OT made several phone calls to the doctor's office with the intention of
explaining her services, but the physician would not return her calls.  The
Ped. phoned me to say I should not have recommended someone without speaking
to her directly about it first. She did not feel that my faxed assessment
was enough. She refuses to give a referral.  She has ordered an upper GI to
check out the baby's stridor and possible reflux.  She doesn't feel an OT is
needed, and besides, she feels the mother isn't really breastfeeding.  I
have a lot of contact with this mother and know she is nursing as best she
can, pumping, although baby is mostly formula fed now and taking motilium.

Mother wants to go ahead  with the OT consult, and pay the OT directly.  I
don't want to see the OT in hot water.    Also, as an LC, was I out of line
in recommending an OT -someone specific, and by fax instead of in person to
the Ped?  Should I have not even mentioned the OT's services to the mother?
My heart is pounding. I've never been called on the carpet before.

Anne Grider, IBCLC

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