Collaboration with Primary Health Care Provider by LC

If an LC is also an RN, I believe that she is obligated to practice within
the RN scope of practice for that state.  If one is licensed by the state as an
RN, is she first an RN with an added certification as an LC? There is a lot to
consider here regarding practicing independently.

An LC  (RN or not) that practices independently without collaborating with
the appropriate Primary Health Care Provider is of concern to me.

Example:  Mom is seen by LC for symptoms of bilateral mastitis.  Instead of
collaborating with Mom's CNM or MD (if there is one), she gives the Mom advice
to treat symptoms.  Mom develops full-blown bilateral mastitis, cultures out
Group B Strep, baby comes down with late-onset sepsis because maternal
treatment was delayed, develops meningitis and has a poor outcome.   Who is
responsible?

Example:  LC sees Mom for latch problems at four days postpartum.   Baby is
too sleepy and lethargic to latch.  Poor urine/stool output.  LC does not
collaborate with a PHCP responsible for the baby, baby admitted to hospital on day
five with seizures due to electrolyte imbalance and dehydration.  Who is
responsible?

Just some things to think about.  I know how I practice.  I am a consultant,
part of the health care team.

Christy Ann Flynn, RN

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