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The morning was taken up with Mr Jackson QC’s final cross examination of Dr Webberley. He asked Dr Webberley about the Frosts spreadsheets that indicated that entries had been made using Dr Webberley’s user ID after the date of Dr Webberley’s suspension. Dr Webberley pointed out that there were a number of strange issues with the spreadsheet, including the entry under her User ID that had been initialled by TL, (an employee of Frosts), the entries apparently made by both Dr Webberley and her husband, Dr Mike Webberley at exactly the same time, and the fact that at the precise time of one of the entries Dr Webberley was in a car in Spain on her way to a restaurant. Dr Webberley introduced evidence to prove where she was at the time, by way of her flight booking and a copy of her Google Timeline information.

 

 

Then Mr Jackson QC moved on to the allegation that Dr Webberley repeatedly frustrated the Health Board Inspectorate of Wales’s efforts to investigate her practice. Dr Webberley explained that she repeatedly asked HIW for the terms of reference for the investigation and they repeatedly ignored her requests. Being concerned about fairness, Dr Webberley looked for guidance contained in the NCAS document where guidance protocol is laid out on how to carry out local performance investigation. Dr Webberley read from the guidance, “Under the heading ‘managing investigation’, it starts once terms of reference are finalised. Once the decision is chosen to hold investigation, practitioners should be made aware of the terms of reference and of who investigators are…investigation can then finalise & investigators will collect evidence, interview & weigh evidence’.”

Dr Webberley claimed that the Aneurin Bevan Health Board did not follow this protocol and that even the GMC were denied the terms of reference when they requested them from the LHB. Dr Webberley said that what has been described as “obstruction” of the investigation, was actually just her seeking fairness and transparency. “They failed to use their established system in this situation, didn’t use their own policies, NCAS policies or NHS department of health policies.”

 

 

After the conclusion of Mr Jackson’s cross examination the Tribunal members asked Dr Webberley about her learning and experience and Dr Webberley explained her route into becoming an expert in trans healthcare, including how she attended groups and meetings to talk to as many trans people as she could about their healthcare experiences and needs. When asked how her model of care differs from the GICs, Dr Webberley stated that her model revolves around assessment of need, rather than assessment of gender identity.

 

 

Dr Webberley shared some of the difficult stories her patients had come to her with, poor treatment from other medical professionals and a mother who had been reported to social services by their GP for supporting her trans child. Dr Webberley explained that she had never had a patient who suffered any adverse effects from blockers of hormone treatment nor had she had any patients who regretted their medical transition.

Patient A and his mother spoke after lunch but that part of the hearing was held in private session. Following their testimony Dr Schumer gave his testimony. Dr Schumer is a paediatric endocrinologist and assistant professor of medicine at the University of Michigan, and founder and clinical director of the Child and Adolescent Gender Services clinic at Mott, an international centre of excellence for the care of trans and non-binary young people.

Dr Schumer said that the use, prescribing and monitoring of puberty blockers and hormones isn’t particularly complicated and that “learning how to prescribe them isn’t that challenging if you’re motivated to do so.” He added that many paediatric endocrinologists aren’t well suited for this kind of work as many feel uncomfortable talking about gender identity with patients. He added that many of the best practitioners in this field of trans healthcare were not paediatric endocrinologists and that he has referred patients who have moved to other states on to clinicians who aren’t paediatric endocrinologists. Dr Schumer confirmed that GPs are among those who prescribe for trans youth in the US.

 

 

Dr Schumer made the point that in many ways GPs are better suited for this work as their training is in the care of the whole individual and that they can maintain a consistent relationship with their patients rather than their needs having to be met by a range of practitioners.

 

 

Dr Schumer went on to explain how the clinic he worked at during his fellowship ran, “The patient was referred from a community mental health professional, we would want a letter to come from them in order to be referred. Then we would schedule a series of consultations with psych to run through a battery of tests, interviews over the course of a couple meetings, and at end of those meetings a recommendation would be put forward, might include seeing MD on the team.”

Dr Schumer explained how that model of care had been developed in that clinic before he came, and that he noticed they had a lot of frustrated patients and family, “who felt they were going through hoops to prove to us they had ‘valid’ gender identity. In the end I found these battery of psych tests were not impacting if they would see MD, in my mind it was overkill.”

Dr Schumer said that the time period could take many months and during that time patients’ mental health would be deteriorating while they waited for the gender affirming care they needed.” Feedback from parents told us our model was frustrating from lived experience as parent of trans child that blockers were something they wanted to talk to a Dr about, and that the length of time and series of assessments following referral were not helpful.”

 

 

Dr Schumer explained how when setting up his own clinic he wanted to remove the access and barriers for trans youth seeking care so his clinic allows for self-referrals. His model of care involves a call from a social worker to triage and find out the goals of the family, followed by a call from a Dr. The Dr discusses the risks & benefits of treatment and if there are unmet needs for psychological help the patient will be connected to a mental health professional. In direct contrast to UK practice, unmet mental health needs are not seen as barriers to accessing treatment by Dr Schumer’s clinic.

Dr Schumer raised issues with the Dutch age of 16 as a standard for hormone therapy. “Puberty, gender dysphoria, growing up, it’s a very personal thing, and a developmental process is not suitable for an age cutoff.”

He said it is frustrating for clinicians working with trans children to know that Testosterone is likely to be very beneficial but are having to wait for a date on the calendar to start treatment, which doesn’t make sense.” Another cause for concern with the Dutch model is how long someone may be delaying puberty and the ramifications of that. Not being exposed to T or E is going to have an impact on adult bone mineral density.”

Finally Dr Schumer said that delaying gender affirming treatments can cause depression, and suicidality as adolescents watch their peers go through puberty.

 

 

After hearing from the GMC witnesses – many of whom have been accused of being gatekeepers by members of the trans community – Dr Schumer’s testimony provided a glimpse into how trans healthcare should be. He shared a model of care that when found to be harmful to trans patients, was changed to make it easier for them to access care. He described trans healthcare as being routine in Primary Care settings and dismissed the idea that only endocrinologists are able to prescribe for this patient cohort. Dr Schumer returns to continue his evidence on Monday, along with Dr Pasterski.