It is deeply disappointing that the response from Ros Escott does not answer any of the important 
legal dilemmas by the scope of practice that IBCLE presented.  I'm perhaps reiterating what has 
already been said far more articulately, but here are what I see to be deep legal problems: 

First, in terms of HIPAA regulations, as I understand from Liz Brooks posting, we cannot retaliate 
against a client who wants to preserve her right not to give permission to discuss our visit with 
other health care practitioners.  HIPAA was designed to protect the rights of the client and it has 
turned into a paperwork nightmare that has been badly twisted from its original purpose.  To deny 
treatment is, in my mind, a perversion of the original intent.

Second, as mentioned many many times, we are required to provide evidence based information.  
Not doing so may put mothers and babies at risk.  There have been numerous examples on 
Lactnet of such situations.  Thus, this puts us in complete and total risk of lawsuits if a baby is 
compromised that could otherwise have been saved.  In fact, Lawrence Gartner spoke of such a 
case at one of the conferences when he spoke of hyperbilirubinemia.

Third, the IBCLE states that IBCLCs ARE health care practitioners on the website.  THerefore, if we 
learn something new and contradict what we previously told mothers to the best of our ability at 
the time, are we contradicting ourselves and could we have our credential yanked because of we 
contracdicted ourselves.

Fourth, the scope of practice that was taken down did not specify which health care practitioner.  
Health care practitioners contradict each other all the time.  OBs contradict pediatricians.  
Pediatricians contradict OBs.  Pediatricians contradict each other.  Contradiction is a form of 
dialogue that actually enables one to arrive at the best treatment possible.  

Fifth, I have not yet found any scope of practice description for any allied health care practitioner 
that has the specification that they not contradict a health care pracitioner.  Not one.  If anyone 
does find a scope of practice from another allied health care practitioner.  

Sixth, it seems to me that by saying we may not contradict someone is an infringement of US 
constitutional law to our right to freedom of speech.  This to me seems to be a huge legal 
violation.

Contradicting is not ignoring advice, nor is it prescribing.  We are the specialists and should be 
treated as such.  If this is the vision of the IBCLE and I hope it is not, then we are truly viewed as 
less than peer counselors and it will lead to a complete and total inability to help women.  Why 
would anyone want to enter a profession whereby we cannot politely contradict and educate 
others?  The pharmaceutical industry and the food industry would have far more freedom to 
distribute misleading information than we have to provide evidence-based advice.  

In fact, Nancy Morbacher's talk at the last NYLCA conference would be called into question in its 
entirety because it directly contradicted the obstetrician on the panel just prior to her talk.  Just 
about every bit of Nancy Morbacher's evidence based presentation contradicted the obstetrician's 
comments about pumping.  

I guess I should sign up for a CLE or CLC course right now.  I'd have no rules to abide by and 
parents would not even know the difference.  

I for one, thought this profession was a "specialist" profession whereby we would be held in 
esteem for our specialized knowledge.  To realize that we are really considered below a peer 
counselor to the point that we cannot even speak the truth is more than disappointing.  I feel 
completely and totally betrayed by the cheery message about what IBCLCs are supposed to 
represent.  

Best regards, Susan E. Burger, MHS, PhD, IBCLC (formerly proud of the last five letters and now 
deeply mortified)

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