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On Day 24 of Dr Webberley’s hearing we heard more from Dr Dean, and Dr Allana Kierans also appeared. Both of these doctors disagree strongly with Dr Webberley’s model of care – and both of them have run gender identity services that have been strongly criticised by the trans community.

Dr Dean admitted that at the time of the alleged offences there was no formal qualification that could be gained to become a gender dysphoria specialist, anywhere in the world. Dr Dean said that the youngest gender dysphoric patients he treats are aged 17, though he added that due to the Bell V Tavi case there had been a pause on their work with 17 year olds.

 

 

When asked to look at an academic paper which shows that testosterone doesn’t limit growth Dr Dean said he was unaware of the study and that he wished he had it when he was writing his report about Dr Webberley. Dr Dean, the clinical lead for the Laurels, said that he had “heard stories” about the delays for both adult and children’s gender services. A strange remark for a man who oversees a service that as of April 2021 had 2,702 people on their waiting list. In January 2021 the longest single wait for a patient on the Laurels was 2,092 days – five years and eight months without a first appointment.

 

 

Dr Dean aided the defence arguments by admitting that GPs could potentially have the competency to assess gender dysphoric patients but said that he felt that only a paediatric endocrinologist or a specialist endocrinologist would be able to to manage pubertal suppression in youth. Another bizarre statement given how routinely GPs prescribe these same medications for a variety of issues from precocious puberty to acne. It’s possible Dr Dean has forgotten the competencies of GPs, given that he has not practiced as one in 22 years.

 

 

Mr Stern QC asked why a GP would not be considered to be competent to treat someone about to turn 16 but a day later when they are 16 suddenly the same GP is considered competent. Dr Dean admitted that the age of 16 was quite arbitrary.

 

 

Dr Dean unexpectedly aided the defence case when he said that there was “significant risk” for patients who have their treatment suddenly withdrawn. This was the case for Patient A when UCLH stopped Patient A’s blockers and Patient A’s mother said they felt bullied into ceasing the hormone therapy that Dr Webberley had prescribed.

 

 

Dr Kierans, formerly of KOI gender service in Belfast, appeared as a further expert witness for the GMC. Dr Kierans is a clinical psychologist. She describes the KOI service as following the MDT model however the main other team member was a specialist nurse. Dr Kierans explained that a psychiatrist was available for short amounts of time each week and was used for more complex cases. Dr Kierans was one of the people involved in setting up KOI, a service that requires Patients to have accessed CAMHS prior to being referred.

 

 

KOI has received considerable criticism from parents and former patients in Northern Ireland not least for their arbitrary rules and mandatory wait times. Parents who spoke to GenderGP referenced years-long waiting lists, a lack of communication from the clinic and punitive treatment for children whose families were labeled ‘difficult’.

 

 

KOI have a condition that a child must be “stable” before they can access puberty blockers. When asked to elaborate on this, Dr Kierans said that if they felt a child was suicidal they deny them access to (fully reversible) blockers and would instead provide mental health therapeutic interventions. This statement caused outrage amongst the trans community as it is an example of the “trans catch 22” unfortunately experienced by adults and children alike. “If someone is distressed because they can’t get gender affirming treatment, we won’t give them gender affirming because they’re too distressed”.

 

 

Many commentators were likening some of Dr Kierans’ comments to a conversion therapy approach. Given KOIs mandatory wait periods, they appear to follow a watchful waiting process, rather than an affirming one. Mandatory wait periods are not advised by WPATH, nor is there any evidence base to show they are beneficial to trans children.

 

 

Mr Stern QC asked Dr Kierans about the KOI rule that each child who progresses to blockers must be on them for a year, regardless of their age or circumstances. Despite this seeming like yet another prime example of “process over patients” Dr Kierans defended this practice saying that it gave them time to explore and discuss with the Patient. This one year rule appears to be more in service of the healthcare professional than the patient, and KOI is an outlier in the practice of insisting on a one year period on blockers.

 

 

KOI also insist on a long period of time to enable them to ensure a child’s capacity to consent. Dr Kierans said this process takes 6 months to a year, or 3 to 6 appointments. She admitted that the length of time was largely due to the limited staff at KOI and their inability to provide appointments closer than 2 months apart. This is yet another example of a system that is failing trans youth by making them wait unnecessarily long time periods to access the help they need. Interestingly, Dr Kierans said that the Paediatric endocrinologist (that they refer children to) requires only one meeting with the child to ascertain capacity to consent.

 

 

Prior to accessing KOI, all children must be seen by CAMHS, even if they have no mental health difficulties.This seems like an unnecessary hurdle and one that ensures children will have to wait longer to be seen by the correct service. Though Dr Kierans professed ignorance about the waiting times of her former workplace, CAMHS waiting lists in NI as of February 2021 had wait times of up to 10months.

 

 

Some social media accounts alluded to KOI wait times that were much higher than those that Dr Kierans admitted to. Mr Stern QC asked what would happen to a 12 or 13 year old who was going through a distressing puberty, asking what KOI would do for that child? Dr Kierans said that they would explore their distress therapeutically and teach them strategies to manage their distress.

 

 

Then Dr Kierans said the quiet part out loud by stating that “medical intervention is not the only way to deal with gender dysphoria” and that they needed to “find out what makes them dysphoric”.

 

 

 

Finally Dr Kierans demonstrated considerable ignorance on the wealth of information and evidence that supports gender affirming healthcare for trans youth, by stating that “the evidence base is still in development”. Most recently is a study that found that access to puberty blockers have been shown to lower suicidality in trans youth.

 

 

A mother of a trans girl told GenderGP that during their third appointment at KOI, which was with one woman from KOI, her daughter was told she needed to go home and “try harder to be a girl”.

 

“When I asked what they meant by that, she was told to go away and put on a dress and makeup. She was also told if she didn’t go back to school in a skirt they wouldn’t do her referral to endo as she didn’t meet the criteria. They literally blackmailed her into going into school in a skirt when she was still presenting as male, her hair hadn’t grown out yet etc. She had already told them she wanted to wait to come fully out until she left school a few months later and went to college but that wasn’t good enough for them.”

 

This happened during Dr Kierans’ time at KOI. The mother of this patient made an official complaint about KOI which she says was not responded to. GenderGP has accounts from several parents alleging disturbing encounters and poor practice from staff at KOI which we will be publishing in the coming days.

Given what patients and their parents allege about the service it has very different values to those of Dr Webberley, who has always sought to place the needs of her patients over all else, including – as can be seen from this hearing – her own.