I would love to be corrected if I'm wrong, but if the LC is part of the
hospital  "marketing" package of service and  the HOSPITAL does not have a
disclaimer under its  service listing that it may be limited by the choice
of each physician, then when physicians sign on with a hospital aren't
they accepting this hospital provided  maternity service ? Especially in
the cases where it is "free"? I can kind of see the potiential to limit if
the service is chargable to the patient or insurance (due to how our
system now runs and the penalties physicians face)if the insurance plan
calls for physician generated consults for services.
 To me, in the cases where this is part of that hospitals patient services
package and " marketing", then unless there are well documented concerns
about the LC service ( which the hospital should be addressing) an
arbitrary restricition  doesn't make good marketing sense for the hospital
to not clarify why this situation is occuring.  Even a simplistic example
would be the hospital marketing their "family centered care" by
encouraging suport persons to stay with a new mother and then an
individual physician choosing for what ever reason to say none of their
patients can have a support person stay. Unless there is a well documented
rationale, then denying "free" supportive services to promote a
comfortable transition  seems really weird and undermines the hospital's
marketing and patient satisfaction with the HOSPITAL services.
 I think I would discuss this with the Maternal Child Director, Service
Chief and Marketing director, write the physician asking him/her to please
address any concerns and look at what is said.  Maybe he's afraid that
while the LC service is free in the hospital, discharge followup is not
free and he's trying to manage after care costs. Otherwise, without
appearing spiteful or undermining, if things don't work out I would see if
the facility could draft a letter for this physicians patients that just
outlines that while these services are free and available, their specific
physician prefers not to utilize these services and his patients must have
a written referral before being assisted.
 The physician IS in " charge" of their patients services but that also
includes being responsible for explaining to THEM why he chooses to limit
free support services to meet their goals .
 Ahhh, it's ok to give out "free" formula bags because "we don't want to
deprive patients of things"  but we will support limiting access to
services that promotes infant and maternal health................... Don't
you love the logic in this world?
Lisa Jones

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