In order to serve their purpose and have the gravitas which is required of them in a legal setting, expert witnesses must be two things:
- Experts – in the field in which they are providing their expertise.
- Unimpeachable – Afterall, their insights are being sought as a yardstick against which to measure the individual whose approach is under scrutiny.
But what happens when there is a lack of expertise in the specific subject matter being scrutinised?
This appears to be exactly what has happened in the hearing of Dr Helen Webberley.
The General Medical Council Remit
The remit of the General Medical Council (GMC) is:
- to protect patients
- to improve medical education and practice by setting standards for medical students and doctors
- to supporting them in achieving and exceeding those standards
- to take action when standards are not met.
In the case of Dr Helen Webberley, the four year investigation by the GMC has been predominantly focused on assessing her approach to trans healthcare in relation to three individuals she treated who were under the age of 18.
In order to assess her competency, any expert witnesses must logically be able to judge the care provision in comparison with the steps they themselves might have taken in the same position. Indeed one would expect them to have a great deal of experience (more than Dr Webberley for example) in the area in which they were asked to comment.
This expertise is essential due to their need to be able to answer one very clear question: ‘did the care she provided meet the minimum standard required?’ If there is a lack of clarity around what that minimum standard is, how can anyone be expected to answer the question with any authority?
The hearing called upon several health care professionals. While all of the medical professionals are experts in their field, only some of them have treated trans patients, others have only limited experience of treating trans youth and some have no experience at all.
- Dr John Dean, former GP and current Clinical Lead for the NHS West of England Gender Identity Clinic at Exeter, has never assessed, diagnosed or treated trans youth.
- Dr Rob Agnew is a clinical psychologist, specialising in autism, mental health, and neuro rehabilitation. He admitted to having no experience in diagnosing gender dysphoria, nor having any experience treating patients for gender dysphoria. Dr Agnew told the tribunal that his only direct experience with trans patients was approximately 6-12 patients he treated for their autism. He also admitted that if other clinicians indicated that a patient he was seeing had gender dysphoria, as this was outside of his area of competence, his practice would be to refer them back to their GP.
- Dr Kierans has limited experience as a psychologist working in one centre in Ireland, she has no expertise of international best practice, and can only present her own working model of care.
And yet, the GMC has deemed each of these individuals appropriate and competent, despite having so little experience in the field in which they are deemed experts.
Professor Gary Butler, while being a more suitable expert witness, given his role as a consultant in Paediatric and Adolescent Endocrinology at University College London Hospitals, was himself the origin of the complaints against Dr Webberley which kickstarted the whole GMC investigation.
You may well ask why the GMC didn’t just call upon experts who have treated hundreds and thousands of young trans people? If 1-2% of the population is trans, surely there must be plenty of physicians out there who know exactly what best practise looks like and how to spot poor standards of care? The simple answer is that gender affirmative care is not the preferred approach to treating trans youth, therefore those with expertise in the practice don’t exist.
Real experts undoubtedly have a vital role to play when it comes to clarifying our understanding of complex issues but it is imperative that the experts are fit for purpose. If they are not, how can the hearing stand up to scrutiny? Indeed, if you have been following the proceedings, which have been picked apart by the community at every turn, you will have seen that it doesn’t.
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