en English

Day 15 was taken up with procedural discussion. This was due to the introduction of evidence that Dr Webberley’s team had asked to be included, some of which was then considered to be admissible. As new evidence was now allowed, the GMC had asked their experts to review their statements in light of the new evidence and this meant that at least one of Dr Webberley’s witnesses, Dr Pasterski, also had to review her statement.

Day 16 saw Dr Rob Agnew, a psychologist specialising in forensic services and autism, taking the stand as an expert witness for the GMC. Dr Agnew was primarily speaking to the value of MDT teams, an area in which he has experience, though as we later found out – not within trangender healthcare.

Mr Samuel Jackson, QC asked Dr Agnew to elaborate on the importance of an MDT team when treating youths (this despite the fact that the GMC’s previous witness, Dr Klink – who is experienced in trans healthcare – had previously informed the tribunal that there was no evidence that MDT’s provide a better outcome for trans youth.)

 

 

Dr Agnew stated the importance of a MDT as he said that it was important to be sure that a young person’s gender issues weren’t as “a result of peer pressure or parental influence” this discredited assumption completely ignores the fact that young trans people are far more likely to be pressured into a cisnormative gender expression. It also runs the risk of spreading the debunked ‘social contagion’ argument used by anti-trans groups to suggest that children can be ‘turned’ trans. That Dr Agnew would even consider this should cast doubt on his ability to provide expert witness testimony, and certainly any criticisms he makes of Drs Webberley and Pasterski’s approach.

 

 

Dr Webberley’s counsel, Mr Ian Stern QC took Dr Agnew through his CV where it was discovered that he had worked in over 30 different jobs since 2008. Dr Agnew confirmed that he had never treated patients with gender dysphoria, and also that he had never worked with adolescents for more than a few months at the time.

 

 

Ian Stern QC then asked how, if Dr Agnew had never studied or provided trans healthcare, he could state what was the best approach and what wasn’t? He pointed out that large parts of Dr Agnew’s report had been simply copied and pasted from the NHS specifications and the WPATH Standards of Care. Ian Stern QC suggested that Dr Agnew had simply read through these documents and then made an interpretation of those documents. He asked Dr Agnew if he had ever read WPATH before this case, and Dr Agnew admitted he had not.

 

 

Despite emphasising from the outset that an MDT was vital to providing youth care, when asked how he could know that this was the best approach, Dr Agnew simply said “because it’s in the guidelines.” When challenged by Ian Stern QC as to the motives behind the NHS’s use of MDTs, Dr Agnew refuted the suggestion that they were more about distributing responsibility than best for the patient, saying that “everyone is responsible for their own duty of care”.

Ian Stern raised the issue of Patient A who had been prescribed puberty blockers by Professor Butler at UCLH and his family GP had been instructed to continue with the prescribing. Ian Stern QC asked Dr Agnew if this arrangement constituted an MDT? Dr Agnew admitted that it did not.

Mr Stern QC delved further into the actions of UCLH and read out small writing in the margin of a document relating to Patient A: “Current Issues, fully consented, discussed fertility.” Mr Stern QC said that he couldn’t see a reference to capacity on the document and asked Dr Agnew if he was saying there should be? Dr Agnew confirmed that  there should have been documentation relating to capacity on Professor Butler’s records. These issues are important as Dr Webberley is accused of not keeping proper documentation with relation to capacity, and of not working within an MDT. 

Dr Agnew said that Dr Webberley’s standards do not stand out from the NHS’s in regard to records of capacity to consent. He also conceded that Doctors do not routinely seek capacity to consent when dealing with Patients under 16, though he added that he feels they should. One of the criticisms Dr Agnew made of Dr Webberley was that she failed to liaise with Mermaids in regard to Patient A. Dr Webberley’s counsel asked Dr Agnew if he was aware that it was Mermaids who had first suggested that Patient A contact Dr Webbberley and that a Doctor cannot disclose private information about Patients without their consent. Dr Agnew said that in the NHS they work with implied consent, where consent is there, and that Mermaids could have functioned as part of an MDT in lieu of any other support. 

 

 

Dr Agnew’s report stated that Patient A having his medication stopped (by UCLH) had caused a deterioration in Patient A’s mental state. He indicated that whoever changed the medication was ultimately responsible, but that anyone involved with his care also had a duty of care to him. When asked about the care provided by UCLH to Patient A – , Professor Butler and a therapist – Dr Agnew said two people do not constitute an MDT. Counsel of the GMC interrupted to point out that Dr Agnew had not been asked to assess the work of UCLH or Tavistock. The Chair of the tribunal then said that it was fair that Mr Stern be allowed to follow this line of questioning as Dr Webberley stands accused of not upholding standards of care, it is reasonable to look at the standards of care being applied to other practitioners in this area.

 

 

GMC Counsel Mr Simon Jackson QC reiterated that it was unfair to ask Dr Agnew to comment given that he didn’t have all the UHLH records. Mr Stern QC then stated that he had asked UCLH for all their records and if the GMC had more, or knew of more, would they kindly pass them on. Mr Jackson QC said that Professor Butler had indicated that there might be more records and that he would look into it over the weekend.

 

 

Dr Agnew in his report was critical of Dr Webberley’s mental health assessment into Patient C. He said that Patient C had been seeing CAMHS previously but admitted that he was aware that Patient C had not found CAMHS to be helpful and that as a result of his non attendance at appointments Patent C had been removed from the CAMHS services. Mr Stern QC suggested that Dr Pasterski’s statement regarding Patient C was more accurate as she was involved with Patient C and is very experienced in treating gender dysphoric youths. Dr Agnew said he disagreed. Dr Agnew then (incorrectly) said that WPATH states that any other mental health issues should be treated before treating gender dysphoria.

 

 

When asked about Patient C, Dr Agnew conceded that if Dr Webberley had not intervened Patient C might have been waiting 18 months or more for treatment. He even added that there was a possibility that Patient C’s referral to CAMHS might be rejected. He accepted that although MDTs are the ‘gold standard’ they are expensive, time-consuming, and have led to prioritisation of protocols over patients.

It is hard to understand how the GMC will be able to continue to press this allegation. Is the suggestion that young people should be routinely denied treatment in the interests of protocol, and that protocols should be followed even when widely-known to be ineffective?