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.
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.
I’m trying to keep these reviews short and impartial. However, its proving difficult as each day a new present seems to arrive in the blue camp. Each time I think there can’t be more, another appears.
At this stage, You would have to say IS looks like he is standing by a large Christmas tree laden with presents whilst looking out to SJ, who stands with a bare bowl and asking for more, bu having given away all his presents.
This update is from day 13 and is brought to you by Well, I didn’t see that coming.
(Monday) [week 4] of the public hearing.
You will remember that we left this matter with IS (blue team QC) being very annoyed that evidence was being submitted late and the GMC didn’t seem to have access to readily available medical documents.
When you are in a hole, you could stop digging, but then…you could just keep digging.
It has to be said, that Friday’s games were only the start, as it got worse this morning.
IS told the panel, that his team had been sent ‘new’ evidence at 5:45pm on Friday.
This was ‘after hours’ and it was issued unannounced. It crucially contained detail regarding the witness that was due to be examined TODAY and that there was just insufficient time to consider this information, discuss it with Dr W and revise the line of questioning accordingly.
The issue here, is WHY are the GMC being so inept about this?
Firstly, it was thought this information was new. It was then established, it wasn’t so much as new, but COULD have been collated and provided with previous information that formed the complainants' case.
SJ (the red team QC) tried to make the best of it, but this isn’t the way to conduct such matters.
It became apparent very soon after that the chair of the tribunal panel was getting very disgruntled at these tactics, and rightly so. This tribunal is set to last 55 days. At this rate it could be double that!
In the most telling statement yet, the chair stated the panel would need fifteen minutes to consider this and the impact on the intended timetable. IS stated he needed more time to cross-examine the Dr’s concerned and that they now weren’t available when needed.
In the chairs words. “We don’t know if the GMC have been tardy in providing material…….We need to look at if any responsibility lays anywhere as a result.” And “The considerations we’ll make will be in the interest of justice.”
The panel are clearly annoyed with these tactics. How much more they can take, who knows. But, as I and may have said before they have had all this time to collate the documents and evidence to bring this case. Maybe, perhaps, there isn’t actually a case at all. Maybe they have backed themselves into a very tight corner.
After the initial shenanigans, we finally got at an actual real-life witness about an hour before lunch.
When an expert isn’t an expert
The new witness.
An ‘expert witness’ (see part 4) was sworn in. Dr K is a practitioner who practises in Belgium and has practised in Holland. This bit will be important later.
SJ leads off, as DR K is his witness. He askes a series of questions, mainly trying to clarify points and show how the evidence gives the impression that DR W hasn’t acted correctly.
Well, that’s what is supposed to happen. Essentially we were treated to some fairly inane questions, just confirming who Dr K is and what he did. We had some questions about his evidence.
Dr K responded to questions on a range of aspects of training and prescriptions plus action plans and team involvement, none based on NHS experience, as he has none. However, more importantly, Dr K started contradicting information given by the NHS professor (PGB).
This is not being helpful to the GMC case really. It’s almost like he is agreeing with Dr W. in that the ‘flexibility’ and patient-centred level of care was appropriate rather than the gatekeeping, coercive management of care provided by PGB and his team.
Dr K was also prepared to accept gender hormones could be given for those under 16 and down to age 14 and was carried out by other ‘centres of excellence.
Dr K also stated that genital examinations were ‘necessary in many instances rather than x rays or other methods of diagnosis on the effectiveness of treatment and the stage of puberty a child may or may not have reached. (more to come on such revelations.
So SJ seems to be struggling to make any evidence look damming against Dr W.
After SJ sat back down, it was the turn of IS to cross-examine. Remember, he is trying to find holes and weakness is the arguments put forward. He found quite a few, as seems to be a pattern in this trial. I would expect him to find some flaws and weaknesses, that’s his job. However, to make things look incredible and insubstantial is a bit mind-blowing really.
First IS starts with basic CV questions.
Just some ‘easy’ questions, to settle the witness.
What type of Dr are you? Are you a Consultant?
These started to rattle Dr K as he tried to explain where he sat in terms of competency and training.
IS then asked some more.
“Have you been an expert witness before?” “No”, was the response.
In a case like this? “Have you had any training in being an expert?” “No”, yet again.
“Do you know the legal ‘gold standard’ for this country or not?” “No, I use the gold standard for my country.” Dr K replied.
How many Christmases had come at once for IS, who really knows?
Then IS starts to turn the screw a little. “Until 2014 did people who wanted to change their gender identity in your country people were required to have surgery which requires irreversible sterilisation, is that correct? Dr K replies “yes”. (it’s not the same now, but it was law in Belgium)
Dr K agreed with IS, that in his role in Belgium he wasn’t involved in trans healthcare.
Then IS moves on to some tough questions.
“Have you ever worked in the UK?” “No”, is the reply.
“Are you registered with the GMC?” No, is the reply as in “I think I applied but can’t remember.”
“You are not a member of the GMC “No”, again is the reply.
We have established we have a Dr who is not an expert having not given evidence before giving evidence based on some information presented to him about DR W but basing his assumptions (for the court remember) on a different standard to the UK and on matter about which he has some but not ‘expert’ experience. What could go wrong?
IS continues the line of question in some detail to Dr K about waiting lists, types of treatment use of Puberty Blockers (PBs)
IS then moves on to the 2008 NHS guidelines.
The questions regarding the rules in place by the NHS in 2008 (current at the time of the allegations in this case) are quite draconian in terms of how trans patients should be treated.
Essentially, Dr K is sounding more like a witness for Dr W than for the GMC.
IS questions Dr K on the practice and training of GP’s in the Netherlands. It seems to be very similar to the UK, especially in respect of the level of care and training that a GP can give a trans child/adolescent with ‘the relevant expertise’.
These are not the responses (albeit from and ‘expert’ witness that are showing how Dr W has acted so badly, as to be challenged and investigated. Instead, its showing both the GMC and the NHS in a poor light.
All of this brings us to the summary put by A Mere Solicitor
“This leads to the confirmation that GPs not only do provide this care but that the guidance backs them up on this..”
This is the ENTIRE reason this case is being heard. So has that one response undermined the whole GMC case more than it has already?
If that response is held to be correct, then it is a far cry from a Dr accused of unsafe practice and desperately wanting to help her patients and give them the care they need, where they have been refused care by the NHS.
Is this the slam dunk, the trump card, the Checkmate?
It may not be that simple but does further show that the GMC case is looking more and more shaky.
IS then moves on to questions based on the NHS guide from 2008.
These relate to the type of care a GP could provide, if competent, how this could be in conjunction with other specialists and with outsourced resources. Provided, as DR K agrees, the GP feels competent to do so and in conjunction with others as needed to the benefit of the patient.
IS asks DR K if he has heard of the ‘gatekeeper function by GIDS and the strict criteria some patients have to go through to get to CAMHS. DR K says he was aware of ‘gatekeeping’ but wasn’t aware of CAMHS. Well, he wouldn’t really as he is based in Belgium and has only (it seems) spoken with PGB who would deny any existence of it, given he is the main protagonist of it. However, he IS the expert witness for the prosecution covering a case dealing with adolescents and issues surrounding mental health.
IS then ties up Dr K in a bit of a tangle about the consideration for hormones with an adolescent trans patient presenting with suicidal thoughts.
It would seem Dr K is happy to refer them elsewhere and that merely being suicidal isn’t sufficient to prescribe. HE would seem happy to send them off to be suicidal somewhere else.
It also transpires from the questions, that Dr K hadn’t heard of the guidelines from 2016 relating to bridging prescriptions in the case of a risk of harm or suicide.
The example being used by IS was a patient as (A Mere Solicitor put it), doing well, had their healthcare withdrawn and suffered harm as a result.
If only there was a trusted, and experienced Dr who could step in and offer equal treatment and help these people? But where would one be found?
The GMC don’t seem to want one to exist perhaps.
Remember, the Prosecution (The GMC) are suggesting and trying to show that Dr W acted unprofessionally and incorrectly in prescribing medicine and/or treating patients without proper training or expertise.
After a few more questions regarding longstanding treatments, used on cis adults being used on trans adolescents and adults creating (unnecessary) “moral panic”, the chair was getting hungry, and the day’s session ended rather abruptly.
Its all back at the earlier time of 9:00 am for Day 14.
IS will continue his questions and we will see what happens.
What have we learnt today?
Yet again, the GMC is meddling with the protocol and affecting the timing of this tribunal The panel chair is getting rather annoyed, and the tactics have been noted.
We have an expert, who isn’t an expert appearing for the GMC who seems largely, on balance to side with Dr W.
We have found out that even for a non-UK expert Dr, he agrees the NHS trans healthcare system is in a shocking state. Especially given, he’s never worked here and is not really familiar with the guidelines.
It may be a question of how long before the panel just get bored and decide to abandon the whole thing.
I’m not them, but there is a distinct pattern emerging here.
To be continued…../
Authored by Nicola Rose @Nicola2019