I do not think that any of us who are concerned about the wording of the scope of work have any 
intention of practicing outside our scope of practice, nor has anyone expressed the desire to 
prescribe.  I think most of us with concerns work collaboratively with health care pracitioners on a 
daily basis and put more effort into that collaboration than we receive in return.  

So, I'm completely confused by Barbara Wilson Clay's posting.  Not one person who has pointed 
out logical discrepancies in the scope of practice that make it completely impossible to determine 
how to procede in without violating the logical inconsistencies mentioned anything about 
prescribing or 

Barbara your very statement that "I typically mention to the parents that there are pediatric ENTs 
or dentists in our community who perform these evaluations" might very well contractict the scope 
of practice that states that we are not allowed to contradict another health care practitioner if that 
practitioner does not feel that such an evaluation is warrented.  The scope of work very clearly 
states that we cannot "recommend an alternative treatment" and many pediatricians consider a 
frenotomy to be an alternative treatment.  So, however judiciously one might choose to present 
that information, it seems to me that even mentioning it could be beyond the scope of our 
practice. And in the end, she states that if the parents ask for a referral she does provide it.  
Again, that could be interpreted by a lawyer as a "recommendation".  

Having had to sit on one month of Grand Jury Narcotics I was shocked to discover how juries 
interpret all sorts of picayune details in surprisingly different ways.  It was exceedingly clear to me 
that the precise wording of the narcotics laws were important AND could be interpreted in ways 
that defied common sense, depending upon the juror's bias.  Even though Barbara Wilson Clay is 
certain of her professional actions, even the most professional among us may have a client or a 
situation that ends up in court for reasons beyond our own professionality.  It will probably be a 
small minority of those of us who I believe do practice in a professional manner that will have this 
happen.  Nevertheless, those unfortunate few who are challenged in court despite having 
practiced in an ethical and professional manner will need clearly defined language to back us up.

While, I would love to believe that simply beleiving that professional actions are sufficient to 
compensate for vaguely worded language, I still have serious doubts that a lawyer would interpret 
the present scope of work as generously as Barbara Wilson Clay has.  Since our livelihood may at 
some point depend upon a "legal" interpretation of extremely vague language, it is not sufficient 
to merely accept the best possible interpretation of language that could be interpreted otherwise 
by the legal profession. 


Best regards, Susan E. Burger, MHS, PhD, IBCLC

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