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MPTS Hearing Days 33-34

by | Sep 24, 2021 | Advocacy Archive, GMC / MPTS, MPTS_Hearing, News

MPTS Hearing Days 33-34

As the last two days were taken up entirely with Dr webberley’s cross examination so instead of a blow-by blow we’ll bring you some of the highlights of the hearing, you’ll find a fuller coverage of the days events on Twitter at @mpts_hearing.

Mr Jackson QC began by suggesting that there is a fundamental difference between the approach of the other experts who attending the hearing, and Dr Webbeley’s approach to trans patients, “in that your approach you don’t feel it’s part of your role to assess and investigate dysphoria but rather you’re simply accepting of patients presentation and description of their own identity?”

It’s shocking that counsel for the GMC uphold an adversarial, mistrustful approach to patients as a Gold Standard, over an approach based on belief and empathy.

 

 

Dr Webberley explained that by virtue of her experience working with trans people she was very aware that by the time someone comes to a Doctor they have usually done a lot of their own research.Trans patients will long since have developed their own understanding of their gender identity, and that, despite what the GMC may think, it is not for a Doctor to try and prove that a patient is wrong about themselves.

 

 

Mr Jackson suggested that Dr Webberley did not try and undertake any learning from UK centres treating trans youth to which Dr Webberley replied that she had tried to form such alliances, without success. Dr Webberley spoke of one occasion when she was asked to a meeting with Dr Dean and Professor Butler, only to later discover that they had gone ahead with the meeting while she was out of the country.

Mr Jackson cited an example of a nurse who had undertaken further training in order to prescribe for trans patients and he asked why Dr Webberley hadn’t undertaken the same course of training. Dr Webberley responded that by virtue of her own degree she was already able to prescribe for any condition she had knowledge of and competency in and that the management of hormones is a routine factor of a GPs work.

 

 

Regarding Dr Webberley’s decision to prescribe Testosterone for Patient A, Mr Jackson QC proposed that 12 was too young for hormones therapy treatment. Dr Webberley spoke of prescribing for harm reduction, and said that as Patient A was suicidal due to not being able to progress in puberty alongside his sibling and peers, she often wonders if she would have ended up before the GMC if she had refused to prescribe for Patient A. Mr Jackson QC reiterated NHS guidelines that suggest 16 is the correct age for gender affirming hormone therapy. In response Dr Webberley detailed the origins of the age of 16 as having come from Dutch legal protocols rather than based on any evidence like studies or research on trans youth.

 

 

In contrast, Dr Webberley pointed out that there is plenty of research and data on the safety and efficacy of Testosterone in younger patients, due to studies on cis children with delayed puberty. Mr Jackson suggested that Dr Webberley had failed to provide her patients with psychological interventions for the distress they were experiencing, referencing Dr Kierans from KOI and KOIs practice of only seeing trans youth who have first attended CAMHS before they are allowed to see someone for their gender issues. Dr Webberley said that forcing patients to attend sessions with mental health professionals was detrimental to the patient-doctor relationship and a form of gatekeeping.

 

 

Mr Jackson said that there was an onus on Dr Webberley to address Patient A’s distress, and Dr Webberley explained that the distress Patient A felt was not due to his gender identity, but due to his Doctors refusing to allow him to progress through his preferred puberty. Mr Jackson asked Dr Webberley about a letter she had written to the GMC in which she described a UCLH clinician as “inflicting psychological torture, by preventing puberty & was irresponsible for failing to follow Gillick/Fraser Gdlines in a severely distressed child.” Mr Jackson implied that these words were harsh as this clinician was only following NHS protocols. Dr Webberley replied that she stood over her comments and that this person had created the protocols.

 

 

Mr Jackson then suggested that Dr Webberley’s passion and advocacy work for the trans community may have clouded her judgement as a Doctor, a claim that Dr Webberley rejected. WPATH SoC 7 says “Health professionals should support clients and their families as educators & advocates in their interactions with community members & authorities”.

 

 

Mr Jackson put it to Dr Webberley that she must have known that her prescribing for Patient A would be found out and would inevitably result in Patient A’s care from UCLH being stopped. Dr Webberley said that at that time she found it hard to imagine that a Doctor would ever cut off a patient’s care for accessing private care elsewhere.

Finishing day 33, Mr Jackson asked, “In a patient presenting with distress, assessment of capacity must be shortly before consent form is signed… as where somebody is presenting with comorbid psychological problems that is an allied psychological issue?” Dr Webberley pulled Mr Jackson up on the use of the word comorbid, as it implies that being transgender is a disorder.

 

 

Day 34 began with the announcement that the GMC no longer wished to hear from patient A or his mother. Mr Stern QC reminded the tribunal that the GMC had tried to exclude Patient A’s mother’s letter from the evidence and that she had been waiting 4 years for her opportunity to speak. The Tribunal later ruled that they would like to hear from Patient A and his mother. This means that one trans person will be heard at this hearing, that is primarily about the care of trans patients.

 

 

Mr Jackson queried Dr Webberley’s care of Patient B, he asked Dr Webberley why she had not undertaken a physical examination of Patient B as per Dr Klink and Professor Butler’s practices. Dr Webberley replied that it was unnecessarily distressing for trans patients and that there are other ways for the information needed to be gleaned.

 

 

Mr Jackson read from Dr Klink’s report which was critical of how Dr Webberley had handled Patient B’s care. Dr Klink said that Patient B should have had his dosage upped to an adult dose to suppress menstruation, and that patient B should have been discussed with an MDT. Dr Webberley said that she didn’t know what psychological professional he would be calling on for medical advice on hormones.

 

 

Dr Webberley also defended her clinical decisions regarding the dosage for Patient B, she stated that after only 3 months of Testosterone and increase to an adult dose would be too much for a 16 year old and that there were gentler ways to stop menstruation, including the use of blockers as well. Then Mr Jackson implied that Dr Webberley should have given Patient B what they asked for. Dr Webberley said that if she had agreed to increasing Patient A’s dosage that she doubtless would have been accused of having given in to patient’s wishes (something that Mr Jackson has accused Dr Webberley of, several times in the course of the cross examination).

 

 

Not long after, Mr Jackson QC said, “Part of your approach to this cohort is that you believe long assessments are unnecessary, Your approach is very much driven by the patient’s wishes to shorten period & reduce amount of time & investigation.”

Dr Webberley said that there was no data that proved that having a certain amount of sessions over a certain amount of time was beneficial for patients. Dr Webberley added, “Prolonged assessment periods are unnecessary, in terms of this tribunal & my career I can see the damage to patients experiencing longer than necessary waiting times, in that period dysphoria & puberty does not go on hold during the assessment.”

 

 

Mr Jackson then strayed dangerously close to suggesting that parents are making their children be trans, a statement that has no basis in fact. Dr Webberley replied that in her years in practice she was never faced with a situation where parents wanted to go faster than the child. “There was never any child reluctant and following parents wishes.”

 

 

Much of the social media commentary following from the last few days of Dr Webberley’s testimony has been praising Dr Webberley’s patient-centred approach to care, and fury at some of the insensitively worded questions of the GMC counsel. Tomorrow one of Dr Webberley’s patients has the opportunity to speak, the first time a trans voice will have been heard at this hearing.