You know, this sort of thing just gets my lawyer juices flowing.  I get so 
peeved when people abuse their positions of power.  Here is how I would 
handle the situation of the boss who calls you names, and tells you are now 
required to attend WHO Code-non-compliant formula-company  functions:

(1)  As a very practical first step, for any stinky situation like this, you 
have to take a good, long, deep, introspective look:  Ask yourself if you 
want to battle your boss.  Life can be made miserable for an employee -- who 
is fully within her rights -- who bucks the system.

(2)  Start (or continue) to be the most unbelievably professional, 
courteous, and conscientious employee you have ever been.  Every contact 
with colleagues involves a smile.  Every chart is filed out on time.  You 
arrive promptly; even stay late.  This is not the time to be sneaking peeks 
at computer games while you're at work.

Gather some documents and website info:
(3)  The IBLCE Code of Ethics (www.iblce.org) does not provide you with any 
recourse against your boss -- but you certainly should print it out, as it 
says that you are to be considered a health care practitioner for WHO Code 
purposes.  And as such, you must respect the Code.  And as such, you cannot 
accept -- nor should the forumla companies be offering -- any meals, gifts, 
trinkets, buttons, cups, sticky pads, lanyards, videos, samples of product, 
etc. etc.

(4)  Head over to www.waba.org or www.ibfan.org and print out a copy of the 
text of the International Codeofmarketing of Breast-milk Substitutes.

(5)  Look at www.nofreelunch.org which concerns itself with the influence of 
all drug reps on all medical professionals.

(6)  Get a copy of your hospital's HIPAA Notice of Privacy Practices.  I 
contend that having formula reps anywhere on the maternity floor puts the 
hospital at civil-and-criminal-liability-risk of violation of each patient's 
protected health information.

(7)  Pull up the work done in Massachusetts, at www.massbfc.org, on banning 
formula bags from the hosp. as a violation of perinatal regulations and 
policy.

(8)  Keep your eyes peeled on the ILCA web site www.ilca.org -- ILCA is 
producing a whiz-bang kit for use during World Breastfeeding Week, which 
this year honors 25 years of protecting BF by honoring the Code.  Yes, that 
is a shameless promo by a Board member, but you can be sure I will be 
ordering (and paying for) my own kit as soon as it is available the website 
-- within a month or so.

(9)  Check with your hospital Quality Assurance or Ethics or Legal or 
Whatever-Its-Called-At-Your- Hospital Dept. about their policy against 
influence peddling and health care promotion in the hospital.  I am willing 
to bet there is a lofty policy somewhere about the health care mission and 
objectives of your organization, including no toleration of conflicts of 
interest.  Nothing persuades better than the opposition's own words.

(10) Absolutely pay a visit to your Human Resources Dept., and discuss the 
hospital's policy of having to work in an environment of harrassment.  Being 
called names by your boss -- in particular, a name historically connected 
with a shameful period of genocide -- cannot possible be tolerated.  I'll 
bet there is a lofty policy tucked in their files, too.

(11)  NOW -- make an appointment with your boss, and bring another one of 
the lactation consultants with you.  Tell her it is discuss further her 
recent directive.

At the meeting -- remembering to use Kill-Her-With-Kindness demeanor -- 
gently lay each and every document onto her desk, as you explain:
(a) the IBLCE Ethics Code says you must respect the WHO Code;
(b) the WHO Code says HCPs (including, I might add, the boss) should not 
accept formula marketing gimmickery;
(c)  as an IBCLC you strive each day to enhance the public health of mothers 
and babies;
(d)  this is in keeping with the hopsital's own mission;
(e)  other entities and states recognize that drug rep. influence on HCPs is 
damaging to public health;
(f)  the hospital's own HIPAA compliance mandates that outsiders not have 
any access to areas where protected health information is likely to be 
learned;
and that, as such, you feel that:

(g) your required attendance at an unethical marketing session is not 
appropriate

AND

(h) you suffered public humiliation at the earlier meeting, by being 
name-called and ridiculed for seeking to comply with personal -- and 
corporate -- ethics objectives

AND

(i)  you will accept an apology, in an effort to resume a benificent working 
relationship, once the boss retracts her requirement that you involve 
yourself with the formula reps.

OR

(j)  you will need to continue your discussions recently begun with the 
Human Resources Dept. about the atmosphere of harrassment you feel has been 
created by your boss.



Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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