en English

The last few days saw the GMC finalise its case against Dr Webberley with the last two expert witnesses, Dr Dean of Exeter GIC and Dr Kierans, formerly of KOI Belfast.

  During Dr Dean’s testimony he made a startling indictment of Dr Kierans’ Knowing Our Identity service in Belfast and of Professor Gary Butler’s handling of Patient A’s case. As Dr Dean’s testimony continued, his criticisms of Dr Webberley’s practice began to fall like dominos. Accusations he had earlier made were retracted, for instance, after being corrected on the dates of the events involved he agreed that Dr Webberley’s follow-up of Patient B was adequate. He also reiterated that despite appearing as an expert witness in a case about the care of trans youth – that the care of children and adolescents falls outside his experience. Dr Dean again stated that there are no formal qualifications in the field of transgender healthcare – facts that surely impact his ability to act as any kind of expert in this hearing. He once again mentioned BAGIS – the British Association of Gender Identity Specialists, of whom is a member – but the fact that this association has not produced a single clinical guideline in seven years hardly speaks to expertise. Dr Dean said that the GMC had not provided him with a key report provided in this case from Dr Johanna Olson-Kennedy, an internationally renowned expert on transgender healthcare for young people. It’s unclear why he was not provided with this document, but the fact that he wasn’t suggests the GMC are failing in their responsibilities to the defence, and impairing their own witnesses’ ability to provide proper testimony.

  Dr Dean stated that harm reduction is an acceptable reason to prescribe hormones to younger patients, so long as the GMC’s guidelines are followed. He argued that Patient B’s case does not constitute harm reduction, but it’s hard to see how he came to this conclusion. Patient B, like far too many young people, was a clear-cut case of long waiting lists leading to denial of care leading to adverse mental health outcomes and a serious suicide attempt. Surely Dr Webberley’s interventions were both in line with the letter of the GMC’s own guidelines and the spirit of harm reduction in the truest sense?

  Last, but not least, Dr Dean’s testimony seemed to directly contradict the expert opinion of Dr Allana Kierans. Dr Kierans supports the (outdated) view that a mental health referral (via CAMHS or similar) is necessary to access gender-affirming care. However, Dr Dean said that not only should no trans person have to go through a mental health referral in order to access care, but that his own training around transgender healthcare had specifically emphasised the depsychopathologisation of gender incongruence – that is, getting trans identity away from ideas of mental illness. Dr Dean spoke at length about the Callen-Lorde clinic in New York, extolling their practice which centres around primary carers like GPs providing care to the LGBTQI community, including the prescribing of hormone therapy. Dr Dean confirmed that Callen-Lorde follow WPATH guidelines.

  GMC counsel Mr Jackson QC put it to Dr Dean that Dr Webberley had not undertaken appropriate assessments of Patient A. Dr Dean disagreed and said that best practice would be to rely on the previous assessments provided they weren’t older than a year and nothing significant had changed in the patient’s life since they’d been undertaken. Dr Dean said it can be distressing for patients to be re-assessed and he also took issue with Professor Butler’s explanation as to Patient A’s emotional turmoil.

  Dr Dean indicated that the sudden withdrawal of treatment is “wholly inappropriate” and carries a risk of physical, mental and psychological harm to the Patient, including risk of self harm and suicide. Patient A had his treatment suddenly withdrawn by Professor Gary Butler at UCLH. Dr Dean also said that use of puberty blockers for more than two years (as was proposed by Professor Butler for Patient A) carried risks for the Patient.

  Responding to these risk factors, the Chair asked Dr Dean what UCLH’s plan was for Patient A who was put on blockers at the age of 11. Dr Dean said that his perception was that it would be undesirable for a Patient to be on blockers for five years and that if it was his child he would be asking the endocrinologist to explain why they thought it was ok. The Chair then asked why the treatment of gender affirming hormones is delayed for trans youth, given their efficacy in treating feelings of dysphoria. Dr Dean cited potential regret as a cause for lengthening the process. (We have previously written about the regret myth here.)

  The Chair then suggested that Patient’s A, B & C had fallen outside of the NHS system Dr Dean was extolling. Dr Dean agreed and said that it was unacceptable that there was only one way of providing care and that he saw no reason why people shouldn’t be able to access private care outside of the NHS.

  One of the tribunal members asked Dr Dean if dysphoric distress came from denying Patients the treatment they deserve. Dr Dean acknowledged that some people experience great distress as a result of gender dysphoria whereas others do not. Dr Dean claimed that the days of asking trans people to jump through hoops to access care were over. This statement provoked a backlash from trans people online, including many personal accounts of NHS gatekeeping being described.

  Dr Dean then almost immediately contradicted himself by saying that trans patients feel they have to meet certain criteria before accessing treatment and that this makes people understandably angry.

  On day 27 Dr Kierans returned to finalise her testimony. Dr Kierans was involved in setting up the Belfast youth gender clinic, known as KOI. KOI have a mandatory requirement that children must engage with CAMHS before being referred to them and during their time with KOI, a requirement that is not endorsed by WPATH. KOI have a long process that children using their services must undertake, and they also require a young person to be on puberty blockers for a year before they can be considered for hormone therapy, regardless of whether puberty has already completed or not.

  According to Dr Kierans testimony KOI explore all other avenues before treating issues arising from gender incongruence, including family relationships and the influence of peers. Dr Kierans stated that they would not give gender-affirming treatments to any adolescent experiencing a mental health crisis.

  Dr Kierans was accused of abelism by many members of the trans community for her comments about people with ADHD with many seeing her attitude as yet another form of gatekeeping used to delay access to gender affirming care to people in need of support.

  Dr Kierans claimed that KOI see around 80 patients a year. When asked about her own workload, Dr Kierans said that when she was working 30 hours a week for KOI she would see one patient a week, sometimes two if they were doing an outreach clinic. Mr Stern QC pointed out that according to a Health and Social Board document, in 2015 KOI had only seen 39 patients. Dr Kierans said she thought that was due to the service being in its infancy at that point. Mr Stern QC pointed out that in the six years Dr Kierans worked for KOI she would have only seen around 300 patients (50 a year), Dr Kiearans was unsure if that was correct but stated that she had seen every patient “at least once”. If NHS clinicians are only seeing one trans patient a week that may explain the years-long wait list trans people are experiencing.

  Mr Stern QC pointed out the disparity between how cis patients are treated and how trans patients are treated to which Dr Kierans replied that KOI go to great lengths to ensure that any distress the patient is experiencing is not conflated with gender identiy distress.

  When Mr Stern QC pointed out that the KOI approach could be seen as providing excessive hoops to jump through, Dr Kierans said that the voices of service users should be listened to and included. She then went on to say that KOI provide “a reflective space” for young people, which sounds an awful lot like a watchful waiting approach, yet another approach not endorsed by WPATH. Dr Kierans was unable to provide any evidence as to if the KOI process is beneficial to young trans people, and said she was unaware of Callen-Lorde, or the similar service in Canada. It appears that Dr Kierans did not do much research into centres of excellence in the treatment of trans youth before she undertook the setting up of such a service for trans youth.

  Dr Kierans finished her testimony by saying that there were risks with early intervention. This attitude focuses on the tiny minority of children who do not persist in their gender identity, as opposed to the vast majority for whom early intervention is vital to their physical and mental wellbeing. Not treating trans youth impacts hugely on their future, as the development of secondary sex characteristsics are only reversible with extensive surgery.

  After Dr Kierans, the GMC concluded their shambolic case against Dr Webberley. Over the last few weeks witnesses who have appeared for the GMC have contradicted themselves and each other, admitted to doing some of the same things of which Dr Webberley stands accused, and have at times agreed with Dr Webberley’s actions and decision making. From next week Dr Webberley will have a chance to defend herself and we will hear from the defence witnesses, including one of the patients Dr Webberley treated. As the letters from trans people to Dr Webberley were not deemed admissible, Patient A looks set to be the lone trans voice at this hearing that could determine the future of trans healthcare in the UK.