One writer from Florida stated:  OUr Florida lactation consultants assoc is
having a "very
>heated debate" regarding the efficacy of using domperidone.  It has been
>stated that it is ILLEGAL for physicains to write the Rx!!

Pat G. replied: It is not illegal for a physician to prescribe any
compounded drug that
she/he needs to. Compounding pharmacies work with physicians all of the
time. A physician can prescribe a compounding of whatever is needed. It is
also not illegal for her/him to prescribe a drug to a Canadian pharmacy. It
is also not illegal for a person to order drugs from another country if it
is for personal use only.

Actually, the debate has not been about the efficacy of domperidone as a
galactagogue. That fact is not in dispute. The questions are about
liability, for the most part. If a doctor prescribes any medicine for a use
other than that for which it is approved, who is held liable in a court of
law if there is an untoward outcome? Will the doctor's malpractice insurance
company stand behind him/her if he/she is sued? What would the defense be?
"Well, they prescribe it (or use it) like this elsewhere in the world." In
malpractice law, is that an acceptable defense? And what if the doctor said,
"The lactation consultant said it was good for  (whatever the med is
supposed to be good for)." Could the lactation consultant be sued as well?
Perhaps this is too close to practicing medicine without a license,
according to a court of law? Those of us who are nurses in addition to being
lactation consultants would stand to lose our nursing licenses as well in
such situations.

We already know that health insurance companies many times won't pay even
for approved medicines if they are prescribed in a dosage that is outside
the normal range. Haven't you had patients who can't get the right treatment
with Diflucan, for example, because the 150 mg dose is considered a one time
dose only?

All of us in the lactation field, whether we hold other professional titles
or not, are here today because we care so much about the Moms and babies we
try to help. We care about their relationship, their nutrition for life and
all the things we know that breastfeeding encompasses. Those of us who are
questioning certain issues here are also realizing that we hold these very
tiny lives in our hands as well sometimes and we have a responsibility not
to treat that in a cavalier manner. We all want what's best for Moms and
babies. That's why we brainstorm and consult with each other.

Perhaps this liability discussion pertains to those of us in the US only.
But thank you to all who contribute to widening this knowledge base.

Jean Macomber, RN, IBCLC
Jacksonville, Florida

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