I have been asked to provide a comment on the current ongoing case of the GMC v Dr H Webberley. The Tribunal hearing is being held at the Medical Practitioners Tribunal Service (MPTS).
Firstly, this blog is an opinion on matters as they proceed, and I have no part in the case. I am merely viewing aspects from the outside, like many others. I am preparing this in a non-professional capacity, but I do have some experience at giving expert evidence at tribunal over many years.
I am getting updates from ‘live Tweets’ from the hearing provided from the Tribunal service and will see if I can get a press update as well. I am also thankful to @truesolicitor and others for their updates on this case. We are aware of other live feeds but are also aware that these are not as accurate and the reporting is, let’s say, skewed. ‘live tweets’ are taken from them being in the room and hearing and seeing proceedings. Apart from being there, it’s the best we can get.
I am trying to remain faithful to the feeds and comments made, but to report the facts and give a background to the proceedings and how the trial system works.
In this case, and current tribunal hearing, Dr Webberley (Dr W) is accused of practising medicine outside the rules and regulations of the General Medical Council (GMC) during the period March -November 2016, A failure to hold a proper safeguarding policy, and (2018) a failure to be registered as a practice in Wales. But there is more to it than that.
This update is from day 27
Day 27 is brought to you by Its only half time
(Friday) [week 7] of the public hearing.
The intended start is at 10:30am.
What’s on today?
Today is intended to be the final day of the GMC case. They will have put up all the witnesses and evidence they are going to give on this matter.
Most of this has already been covered.
Today is the final cross-examination of Dr KS based on her time at the KOI in Northern Ireland.
We will then find out what happens after that in preparation for Dr HW’s defence.
Here on day 27 of hearing week 7 and on the LAST DAY of the GMC case, they present MORE LATE evidence!!
The evidence now produced is a response (from Dr KS) to Dr Bouman’s report (Dr HW witness) and includes a reference to a separate document. Whilst Dr Bouman’s report was submitted late on in the hearing, as I said then, that was a direct result of the GMC not providing their own evidence to Dr HWs legal team in a timely manner, thus allowing the defence to be properly complied BEFORE the hearing began.
Dr KS is ready.
Chair asks SJ to “introduce” the new evidence and questions Dr KS on that.
This is what Dr KS has to say:
1) That MH seems to be uppermost in her mind in assessing young GD people. “if distress is having an impact on their functioning…it indicates and needs for a thorough MH assessment.
2) DR KS says there could be “lots of different reasons” why someone is presenting with “those difficulties”, hence MH assessment. She is treating GD as an MH disorder against WPATH and WHO guidelines!
3) That a “single assessment” is insufficient as there is “so much to cover”. She then lists a number of reasons and why an MH assessment is needed beyond anything else.
4) She reasserts that ALL patients seen by the KOI MUST be assessed via CAMHS. SJ asks how this would affect Pt B. She is resolute in her approach. Everyone is assessed by CAMHS WHATEVER! (6 or 96, you WILL be assessed, you MUST have an MH issue, we just have to find it!)
5) Dr KS says that even if trans people have grown up feeling excluded, have GD and other social anxieties as a result, even ‘transition’ won’t solve those, and YOU MUST have an MH issue!. You just MUST!
6) Even when SJ points out (and he’s the GMC QC remember) that Pt B had self-harming issues, overdose risk surrounding MH engagement and delays, Dr KS STILL feels that MH assessment is VITAL and there must be another reason. She then lists any number of reasons why a person may feel disengaged and dissatisfied but avoids the elephant in the room, GD! She seems desperate to hunt in every corner, nook, and cranny to find an issue whilst totally avoiding the entire reason the patient is there in the first place!
7) SJ asks Dr KS about her statement, “albeit they may be in need of reflective space”. Dr KS talks about gender identity, feelings, and sexuality. How those aspects “need to be explored” and the rights and wrongs of surgeries and hormones. Some of this is valid, but the approach is still an MH assessment, and do you understand? method. That is AGAINST WPATH guidelines
8) SJ asks her about her statement “International Guidelines of presenting difficulty”. Dr KS responds to say it’s from Nottingham GIC. In her view, “presenting Difficulty” is about distress, and this “must be thoroughly investigated.” Again, that seems to lean towards an MH diagnosis rather than treating GD as a disorder. It is NOT providing a clear path of treatment to alleviate distress as WPATH guidelines require.
9) SJ asks her about how the KOI views the context of its processes and “excessive hops” that exist. Dr KS says, “it’s a difficult question to answer”, and again states there are “many reasons” why a GD patient may present, and there are lots and lots of different issues that need to be explored. She then states they follow WPATH Guidelines, which It’s is evident; they don’t. she states, “we cannot assume all distress is to do with gender.” If it’s a GD patient, why not? That elephant is very, very big, yet she can’t and won’t admit it exists.
10) SJ asks her about MDT’s. and how WPATH “Make reference to feminising and masculinising.” Dr KS explains that anyone presenting with GD “needs to be considered holistically. And highlights the need for a network approach with all potential staff for their [the patients] best interest.” Are the KOI doing this? I’m not sure if they are only focussing on MH issues. Especially as Dr KS ISN’T a current member, has not paid her subscription!!
11) SJ asks her about an approach a practitioner should take when “acting outside the guidelines”. Dr KS replies that this should be communicated with the patient, advise why, and keep good records. I’m sure Dr B knows all this, but I’m not sure Dr KS implements it.
12) SJ asks Dr KS about Dr B’s report in respect of Pt C. In particular about timing of medication and ability to consent. Dr KS again says it’s all about an MH understanding and ‘stability'. This is valid in some ways and doesn’t appear to be going against what others say, it’s about the KOI’s approach and is this positive or negative towards the patient’s needs? By ‘wanting “stability”, the KOI put a patient in a catch 22 position. If the patient is GD distressed and ‘unstable’, they get NO treatment. If they are ‘stable’ and show no GD distress, they get NO treatment. That is akin to conversion therapy and unnecessarily delays treatment, which is BAD.
13) Dr KS elaborates on matters surrounding ADHD, fertility and how guidance may change over time, but again how guidance shouldn’t be only for GD but should allow focus on other (MH) issues. Again, she seems determined to avoid GD and assume there MUST be another reason. Only treating GD and its effects with reluctance. That is shameful.
That ends SJs questions.
What have we learnt?
That Dr KS is hell-bent on ensuring all patients have an MH issue if only they can find it. If they delay and ignore things for long enough, an MH issue will miraculously appear! This approach seems to be totally at odds with all the other witnesses and how they view GD patients. Yes, there are MH issues with GD patients, but that is because GD not causing GD.
Somehow the fact GD patients need to attend the KOI for treatment is somehow the patient's fault!
On to the home straight, ready with the batten.
IS continues his cross-examination from the previous session.
From the questions known, IS establishes the following from Dr KS:
1) Dr KS uses some remote services. Phone calls but not usually video calls.
2) Some patients struggled with video calls, while others were happy.
3) Dr KS isn’t a medical Dr and doesn’t have training in initiating, or dosing Pts on PBs or Hormones. This would be done through the Endo, but she would be part of that conversation (MDT?)
4) She worked 30hrs per week at KOI over 4 days.
5) That IS has found LIMITED information about KOI on the internet. Dr KS says there is a “a limited amount of information on the Health trust website and “a leaflet”. Gatekeeping by hiding the whole institution in the first place!! KOI doesn’t even have its own website. 1992 or 2021!!
6) Dr KS has NO IDEA about patient numbers seen. She was a founder of this organisation AND, at the time, the PRIMARY staff member. WHY DOES SHE NOT KNOW THIS?
7) Dr KS says that there may be about 80 people per year referred that “a very small number” would be under 12, and she sees ONE (yes ONE) patient per WEEK! More gatekeeping?
8) Whilst claiming to be “Very experienced”, she is neither a member of EPATH nor WPATH.
9) She may have attended some Tavi conferences; she’s not sure when or how many but could recall what they were about.
10) IS points out that the number of referrals to RGIS adult service in different years (to help her) and that in 2014/15 there were 33 referrals and 2015 39. That’s not 60-70 (or even 80). Dr KS remains in the dark but says she can get the figures (see later).
11) Of the probable 300 patients over 6 years, she would have seen each at, least once. When, whether before or after treatment, is uncertain and may vary, she says. She doesn’t know how many patients she saw after GA hormones.
12) IS then asks her about her statement, “adolescents aren’t mini-adults.” And asks if they have human rights.” Dr KS says they do.
13) IS asks if they are entitled to treatment like adults. Dr KS says they are.
14) IS asks if there are any studies to suggest (as Dr KS asserts) that adolescent brains are different to trans adolescent brains. Dr KS is initially confused by the question but says brains are still developing by age 25, and this relates to “stability”, which, she says, relates to MH and matters surrounding GD. We are back on her favourite theme of MH disorder in all cases.
15) DR KS then states the obvious (although she seems to hope somehow it isn’t) “If GD persists through adolescence, then it’s much more likely that dysphoria will continue into adulthood.” Is she a GC in disguise? Is this the “is it just a phase” question? This is frankly appalling!
16) IS then establishes from Dr KS that she says incongruence must relate to other factors and perhaps there is Autism somewhere. She says it's not about assessing identity (when it is) but about assessing understanding of consent. It's about the understanding of confusion about transition and not about preventing anyone from accessing treatment. (When it is) It’s a smoke and mirrors tactic that is continuing to look for the wrong reason and try to defer delay and prevent treatment.
17) Even IS is struggling to understand this line of responses being given. Dr KS seems to be really at odds with GD people and can’t believe that not all people are cis.
18) IS then says, “A trans is a trans is a trans, and why do I need to have to go through all these hoops to prove that?” Dr KS responds by saying the KOI need to take views and listen. It can be “a challenging dynamic to create a relationship where they understand we are not questioning their identity…” In many respects, previous responses suggest the KOI are doing exactly that. That trans elephant isn’t going away! GGP has published many accounts from service users of the KOI, during her tenure, stating just how bad it was.
19) IS asks is there any evidence that the KOI is a better model for patients? Dr KS suggests there aren’t any studies she is aware of. Maybe the various defamatory reports on how she ran the service, could be some help to her. Reports from patients and others dissatisfied with the service, may suggest it’s not.
20) Dr KS hadn’t heard of Callen Lorde, but “thought” she had looked into a clinic in Canada. IS advising that research into it “would be easy”.
21) Dr KS says they follow WPATH guidelines but that all adolescents must go through CAMHS and there “can be difficulties” in transfer from child GD to adult GD services.
22) Referral to adult MH is made at 171/2 years, and referral “as the waiting list is so long.” (I can’t think why that might be.)
23) IS then asks a very interesting question. “Just to reiterate the point made clear in documents, you’ve not been directed to any records or papers in this case.?” Dr KS replies, “yes.”
24) IS continues. “So, your opinion is based solely on your interpretation of Dr B’s reports?” Dr KS replies “yes”, adding “I’ve tried to read more generally points because I don’t know about the ins and outs of the clinical records.,
25) Why did IS say this? Because he states, “If I state there are errors in your reports, that would be because you don’t have access to records of patients, do you understand?” Dr KS replies, “yes.” Again. We have a GMC witness, asked to give detailed evidence based on her own opinion and expertise, but with only part of the information needed and without the same documents that others have had. How can she then give a full and accurate account?
26) IS then asks, if Dr KS agrees that the distress suffered by Pt B, after lengthy periods of a lack of gender affirmation and even though he was on T at i6, was a cause of his breakdown?” Dr KS agrees but was not aware if his identity was affirmed or not.
27) SJ interrupts to say that Dr Bauman wasn’t sent Patient records either.
28) DR KS continues to say that a lack of gender affirmation would be distressing for the young person. (This is interesting, as IS may be trying to establish that the stress Pt B went through would be similar if he had gone through the KOI protocol. That is an official licensed service. The point that Dr HW was providing a service to AVOID those issues and to restore previous harm done by the ‘official service(s).)
29) IS asks Dr KS if it's right that the distress of years of waiting doesn’t go away with a T but what we don’t know is what would have happened had T NOT been prescribed. Dr KS agrees.
30) IS asks, “You (Dr KS) say that T isn’t a cure for GD, so what is the treatment for GD if its isn’t T? Dr KS says it is a treatment, but “it’s not a cure.” And will not resolve all issues surrounding GD (Whilst that is sort of true, it’s a very strange way of looking at it, for a GIC. But not especially so, if GD is the large elephant that must be sitting on the MH disorder the KOI are so desperate to find.)
31) IS then asks, “doesn’t it depend on if that anxiety is the result of GD?” Dr KS then replies that coping mechanisms may have been developed from “the distress” but may remain if the “original source of distress is lessened.” (Yet again, she really shows she hates the GD elephant, it is such an annoyance to her!)
IS finishes his cross-examination questions.
What have we learned?
That Dr KS has again stuck to her guns on the protocol and how the KOI proceeds.
There are clear differences of how the KOI works compared to other GICs. Some of those are certainly not best practice, and many have been raised as serious causes for concern.
Some aspects go directly against WPATH guidelines and are at odds with the WHO designation that GD is NOT an MH condition.
That aspect seems lost on the KOI and Dr KS. It seems like there are convinced everyone has an MH of some sort; they just have to find it and aren’t fussed about how long that takes.
The manner in which they conduct that protocol is more likely to create MH rather than relieve it.
Again, it isn’t Dr HW that should be in front of the panel, but others, including a number of the so-called ‘experts’ put up by the GMC.
After a short break, the hearing resumes
SJ is back!
SJ, perhaps feeling a little weary, is back to clarify some IS cross-examination points.
1) Dr KS DID let her WPATH membership lapse but joined BAGIS instead.
2) Dr KS gave a summary of conferences attended and where she gave presentations.
3) On the matter of ‘identity’, Dr KS says that only the person can assess” whether they are male or female or nb its for the individual to define.
4) SJ asks about the numbers of patients who “don’t want physical intervention”. Dr KS didn’t give a number, but says some may require medication and assessment, but not surgery. Those who didn’t “would be more likely to be referred to CAMHS”. So, if you are trans, you can’t be; you MUST have an MH problem. However, we (reluctantly ) accept you are, and DON’T want surgery; you MUST have an MH problem! Yet she states, everyone is individuals! Absurd.
5) Dr KS says that KOI isn’t “just a physical treatment service.”
Did we learn anything?
I’m not sure what SJ was trying to establish here. All he has done is confirm that this GD elephant has to be ignored at all costs.
How this type and level of service can be acceptable, is anyone’s guess. I checked their website. It says it’s a referral only service, and all referrals are from CAMHS.
The panel chair asks some questions. These are to clarify responses in their minds. They are the ones making the decisions after all. In the past, the questions have been quite revealing.
1) A panel member asks a question stating that if GD isn’t an MH disorder, and that there has been an evolution over the years that transsexualism is a spectrum, what causes dysphoria and what gives rise to dysphoric manifestations?
2) Dr KS responds that society is “very binary” and associates with “assigned gender at birth which stays with us as we grow”. Those roles and “expectations are very damaging” for those who don’t identify with that original assignment. “minority become stressed in not fitting that expectation. Puberty causes “alien changes” in the body that is mixed with social, biological and physiological issues.”
3) A member then asks that if she says, GA isn’t a cure, when “surely that is exactly what those individuals need.” Dr KS says that GA can go a long way but if the body is “wrong” it will always be “wrong and this creates other issues down the line. (The point is that ISN’T a reason for NOT treating at the time of presentation of the issue. Oh, you’re going to get old and die anyway, so let’s not bother!”
4) The panel then ask Dr KS about the success rate of her treatments. She says that “the majority” were satisfied with the treatments and interventions “as they were well prepared and supported.” (In a way, I presume it would be. Most people wanted that to start with, what they didn’t want was the wait and gatekeeping hurdles in between.)
5) The panel then ask, “is early intervention important and does delayed intervention exacerbate dysphoria?” Dr KS responds, “Early intervention is important & delaying it unnecessarily isn’t helpful.” Two things. WHY DO THEY DELAY THEN? and Why are we here?
6) Dr KS then undermines ALL of that answer with a follow-up answer. That some present with distress that will not persist, so early intervention becomes a complex question. However, once it is clear “an informed decision can be reached” the “prompt action is needed.” However (again) early intervention has impacts on surgery later on and it’s not a simple answer (yes, if you wait and wait and deny medication or… there MUST be an MH issue here, if only we can find it.
7) The panel then ask to clarify differences between her view and those of PGB. At the KOI (all?) patients go on to access hormone therapy, but PGB (at the Tavi) said 80% DON’T. Dr KS doesn’t answer really, just re-states that “most” end up in therapy at some point, either before or after 18.
That ends the panel's questions.
IS pops up to clarify a point in the last panel question and answer. IS says, he feels that perhaps PGB meant there is a higher %age of children who move out of the system whilst in and adolescents, there is a higher continuation. (That’s fair perhaps. However, children become adolescents. If, as children, they get no help, they depart the service and return when they will get help and, as such, stay. What it shows is how bad the system is, not how good it is!)
Chair states they will check PGB’s evidence.
The panel will also ask for and await the statistics re patient numbers from DR KS that she said she would provide.
There remains an outstanding matter of a note on information from Mr Stratton (Mr S)
Are we nearly there yet?
Well, yes, actually, very nearly.
SJ then announces to the panel and (after a prompt) to IS, that the GMCs evidence is complete.
A matter of Law
IS then announces to the panel, that he has “some matters of law” he wishes to raise at this stage.
On that procedural note, reflection and lunch is called.
After the lunch break a timetable was discussed, but the “points of law weren’t” (well not openly)
In the end this…
Back Next Monday at 09:30 (day 28).
That means what?
That is the commencement of the Blue team’s case and the defence to the charges.
That will give the chance for Dr HW to take the stand.
Her evidence will be key to this case. After all, it is her decisions and procedures that are being challenged and only she knows why she did what she did.
The QC roles will be reversed.
IS will be guiding the panel on the ‘good’ bits of the evidence from the blue team witnesses, while SJ will be trying to find holes, inconsistencies, and ‘bad’ bits of evidence in his questions.
The robustness of those responses and how they sit with those given by the GMC experts will decide the outcome of this case.
Thus far, most of the GMC witnesses have failed many of the tests that they are setting to judge Dr HW. Their case is relatively flimsy, but the bar is set low, and enough may be found to get the charges to stick.
The GMC will want to see this through. They will feel they can be victorious, but how IS covers this, and what holes SJ can find are both key factors that will direct the final outcome.
The indication is that the cross-examination of Dr HW could take 2-3 days. That is a long time, and it is presumed that SJ has a long list of questions. How Dr HW responds to the early questions and how much SJ can get her responses to deflect the panel to his way of thinking remains to be seen.
IS will have to be on the ball and brief the Blue team as best he can. The level of detail, the smoothness and the quality of responses could play well.
After the ending of the defence case (several days over a few weeks), each QC will summarise, and then, we wait.
This, unless one side or other decides to pull out, or there is an “agreement” not to continue. Those are unlikely, but possible scenarios.
That’s the end of this round, towels, water, and prepare for the next one.
To be continued…../