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.
Days 34 & 35 are brought to you by Know your stuff!
(Thursday and Friday) [week 9] of the public hearing.
Anticipated starts at 09:30am each day.
More of the same?
Both Thursday and some of Friday (as it turned out) were a continuance and end respectively to the evidence from Dr HW herself.
This must be the first time in a long time the tribunal has sat for a full 5 days in a week in the hearing. Not only that, but it has also been an incredibly intensive week all round.
Not only for this weeks to protagonists, Dr HW and SJ, but for the panel and backroom staff.
The intensity of the week has been daunting. Putting these blog posts together to keep up tales 3-4 hours per night and on some nights at least myself and @truesolicitor have been reviewing and mulling over the day’s events and updating our audiences of the same.
He with a cut thumb and plaster leaks, and me with an intensive workload and a kitchen in pieces.
Between us being up to well after my normal turn-in of the witching hour. Not up so late/early as to startle the larks, but close.
Well, that’s a surprise.
We are well used to SJ springing surprises firth thing in the morning. On Thursday, this was no different. In the end, it all backfired, and his tactics came to nothing.
He announced, somewhat happily, that the GMC had decided they didn’t need to question Patient A or his mother. This drew gasps from the fuller than usual public gallery. Why? Hypocrisy again.
The GMC had spent time and effort earlier in this hearing trying to argue that Pt A and his mother shouldn’t be allowed to appear, and that written evidence wasn’t acceptable. IN the end, at that time both were scheduled to attend.
Over the last week or so, their anticipated appearance has been deferred day by day. This due to earlier SJ tactics and latterly by him being unsure as to how long his cross-examination of Dr HW would actually take.
They had been booked and scheduled to appear on Thursday, then Friday. To decide they weren’t wanted at all now and that the written evidence submitted was allowable on its own was a step too far.
IS got as cross as we had seen him. He pointed out, in no uncertain terms that this wasn’t on. The panel decided to deliberate on this during Thursday and decide.
They decided that both should be allowed to attend and that it was important they did so. So, the earlier victory by SJ in getting more evidence allowed has been wiped out by this loss.
What’s been covered?
SJ has taken Dr HW through her evidence in her statement and referred to a large number of different topics. Those relate to the remainder of the GMC charges.
The pace has been intense and the questions numerous. Dr HW will have been on the stand for 3.5 days straight. All that time, apart from a little flagging at the end of Thursday (more later) she has been resolute, stoic, calm and positive.
All those qualities are essential if the responses are to convince the panel of her fitness to practice.
So, what of SJ?
I want to reflect on SJ here. He has had a very difficult job to do, and this is his chance to shine. Sadly, on many occasions, he didn’t. So why?
As I have said before, a QC will only ask a question he already knows the answer to. Well, he SHOULD do that. Why? Because, they are using the trail of questions, with the expected answers to get the final ‘killer’ answer they want. That ‘killer’ answer is what proves the case they are making. It’s the same as IS.
This is important because the early responses to questions, close off avenues that give the witness no option to answer the ‘killer’ question in the desired way for fear of laying themselves open to inconsistency. That is bread and butter to a QC.
I say “should”, but SJ hasn’t been so good at that. This is because Dr HW responses have been so comprehensive, it gives SJ nowhere to go and that the question trail, hasn’t had the ‘killer’ question. That or the ‘killer’ question is a damp squib.
But why is that? That’s because, as we have seen, the evidence against Dr HW in many of the counts against her is very flimsy.
On top of that, IS has already filled SJ’s powder bag with holes, from the responses he extracted from the GMC witnesses. On many, many occasions to the extent they AGREED with Dr HW.
SJ has tried desperately to weave together what shreds are left and create some sort of comfort blanket.
Most of time its failed.
On several occasions Dr HW has been able to turn the tables and show SJ a clean pair of heels by just undermining his whole line of argument. How? Either just bared faced, actual facts and or the lack of detail and preparation put into the questions/evidence by the GMC.
SJ has quoted, more than once, an out-of-date document or guideline, that is no longer used. This is instantly batted back by Dr HW and his paper trail of questions ends.
Dr HW has shown consistently that she has been caring and patient centred. That her records are generally thorough and complete. Yes, there have been gaps, and reasons given.
Another of SJs tactics seems to be trying to ask the same question but in different ways, to get a different response. This may be to try and catch out Dr HW or just that his avenues for responses are limited.
On training, SJ asked about this on many occasions. Each time trying to establish what or what hadn’t been achieved. This became a bit tiresome, and the frustrated Dr HW dropped in a “ Mr Jackson” now and again to show this. The point being, as she should well understand from all the witnesses thus far, his own included, “there isn’t any!”.
In fact, Dr HW had done more than most, having exhausted most suitable training (at the time) anywhere in the world. Few if any other trans HC specialist can boast that.
It has been clear from many responses that SJ has almost winced at the level and depth of detail given in the responses. That just shows the depth of knowledge, the passion for the subject and her patients. Those are not the qualities a prosecution QC is used to in a defence witness.
Truth and lies.
Another tactic of a QC is to establish fact and fiction. That is important in any hearing. Facts are the prime factor in a true decision.
Dr HW was questioned at length about a trip to Spain at the time she had been suspended and wasn’t allowed to practice (make medical decisions).
There were questions about unrecognised logins on the Dr Matt website and the type and phraseology of notes on the system. Each Dr had a unique login and code, and each entry is listed by that code. However, it was noted that a TL had made entries using Dr HW login ID. This came up in GMC evidence and no reason or answer could be given.
The point is that has to be ‘tested’ and challenged. Dr HW’s alibi? “I was on a plane and then a car in Spain at the time”. How could she be so confident? “here is my booking and my Google timeline.” Also, the Wi-fi in Malaga Airport is rubbish and has been for a long time.
That was challenged further, could you have logged on and made an entry etc.? A valid question, but the response, wasn’t absolute, it couldn’t be really, but the chances are remote and not to be realistic. However, the level lot detail and documents, shows the accusation can be batted away and only supposition is left. A bit like a Cheshire Cat, he fades from responses of fact until only supposition and conjecture remain.
You cannot be convicted on conjecture and supposition.
At times, and usually at the end of a sequence of questions relating to a specific charge, SJ has been quite bullish. Asking a direct question “ I put it to you Dr W that you did this/that. Or the other.”
Her response is robust in each case, I don’t agree, and this is why.
Weakness and compassion.
I’ve put these two together for good reason.
There are times that Dr HW has perhaps been found to be at fault. Usually, a nuance of a point or a secondary issue. A small victory perhaps for SJ. Generally, not such a weakness that would cause the panel to be too concerned, although that remains to be seen.
Compassion, That is a quality that Dr HW has shown more than anyone else giving evidence. This comes from her passion for the role, the passion and desire to treat patients as people.
That quality could help a lot at the time of judgement. Passion and a willingness to learn, understand and be better. OK, it’s not enough on kits own, but it could help swing the balance if needed.
Standard(s) by which to be judged.
It is evident, and I have covered this from the point of Hypocrisy and witch hunt earlier I the week, there are double standards at play here.
SJ, in his lines of questions has on several occasions sought to both establish then criticize Dr HW for not being MORE qualified/trained or well-read as the GMC witnesses/experts.
This is just mad, and arguably fruitless. It has been established, beyond reasonable doubt from both sides evidence that Dr HW is well qualified and well read.
To suggest or try to suggest that greater qualification such that is more than the GMC advocates is bonkers. It proves nothing. Dr HW has given a good account of herself by virtue of her experience, reading and training, that has left SJ in tatters at times. Dr HW is obliged to meet a standard and no more. If she exceeds that, all to the good. To try and criticize her for being above that, makes no sense. It may be testing to boundaries ok knowledge, but it isn’t really showing she has failed to meet any of the allegations, which is why we are here.
SJ at one point also tried to suggest that being a husband-and-wife team with Dr MW was a bad thing. This is not unusual in medical practices and isn’t really a problem frankly when both are working on the same type of care. This is really scraping the bottom of the barrel.
Who writes the standards and who interprets those is important to the GMC, especially if it creates a double standard. Dr HW is being criticized and charged with not following the rules and mis interpretation of standards. This despite her following WPATHWPATH World Professional Association for Transgender Health https://www.wpath.org guidelines, those of the GMC and other bodies, where she can find them. However, PGB, wrote HIS OWN standards and policy and follows that. How come that is MORE acceptable than following published guidance for someone no more qualified than Dr HW? This is an indication of the charade by which Dr HW is being judged.
SJ’s other tactic, is to try ALL the options and hope one fits. That, for a QC, isn’t really going to gain any points and is again fruitless.
SJ tried to argue, on the matter of Pt A’s Blocker dose that Dr HW had given too high a dose (the adult dose) as alleged by the pantomime villain PGB. Dr Klink (GMC witness) said her dose was acceptable.
SJ then tried to argue it was too low a dose. Why?
SJ also tried to argue it WAS the right dose but hadn’t been administered correctly. That’s a QC running out of ideas tactic.
Panel Questions
At the end of the cross examination of evidence by SJ, the panel asked questions, as they have done for others.
The type and flavour of those questions may give an indication of how perhaps they view this case.
The questions were several in number, but generally of a clarification style. Seeking to confirm rather than be pointed or challenging. As per SJ’s questions, Dr HW gave full and detailed responses, was conciliatory where needed and gave as much information as possible.
This may have worried SJ, as he wished and was permitted to further question Dr HW on some of her responses to the panel. I guess he will use that information as part of his summing up.
IS, on the other hand kept quiet mainly. He had nothing significant to add to his exploratory questions, DR HW having done this for him. That shows how good a job Dr HW has done, in the IS didn’t feel it was necessary for any matter to have to be qualified or confirmed for his summing up and to be confident the panel had the right argument to consider.
Dr HW made the point in several answers, that how is listening and learning NOT being a Dr? That was not the impression given by many GMC witnesses. They took a solid and direct path without waiver, real compassion, or concern for the patient in front of them.
Dr HW has said she had never heard of children taking their own lives because they couldn’t access care until she worked in trans healthcare. This is as a result the general poor state of the system. One of the patients in this case had attempted suicide before coming to see Dr HW. This is WHY the system NEEDS CHANGE.
Patient A
After the charade of the GMC refusing to allow, then hoping to avoid testimony by Patient A and his mother, they both gave evidence on Friday. For the protection of identity, this was given in a private session. Details may be released as part of a future transcript, but it was not for public consumption at this stage. Patient A’s mother had previously written to Dr HW in support of her care and a copy of that letter is available publicly.
One can only imagine how they both felt to be here. A cannot think that they gave evidence in any way than to praise Dr HW and pour scorn over those who treated Pt A before Dr HW and of the system in general.
I presume the list of SJ’s questions was short, given he didn’t want to ask any the day before.
Dr Schumer (Dr S)
Dr Shaumer was also invited to give evidence. He is from the US and was attending via video link.
Dr Schumer is a Pead Endo and is a Medical Director of a child and Adolescent Gender Clinic. He is a Paed Endo ethics committee member and on an ethics review panel.
IS takes him through his qualifications and job positions. Dr S has worked with trans youths since 2012.
He has prepared a 24-page report and has treated of 300 GD patients via the WPATH “model of care” plus UCSF Guidelines and Endo Society guidelines. The guidelines are for adults and adolescents.
Dr S explains the guidance and methodology for the is similar for the treatment of GD, with PB’s and/or Hormones to “Alleviate or reduce GD.”
The prescription regime is outlines as Pead Endo, GPs prescribing, assessments and MDTs the “4th stage” starting T or blockers.
Dr S makes the statement in his report (referred to by IS) “T shouldn’t be confined to endo’s” IS asks him to expand on this aspect.
Dr S relates this back to the Dutch Dr’s who ..”noted going through the ‘wrong puberty’ was problematic from a MH perspective.” (its problematic because the GMC and certainly the KOI don’t seem to understand this..nor, is has been established the fact that nature won’t hang around for them to dither about it.)
This issue was discussed and established in adults and the considered opinion was to try and reduce the effect at puberty in adolescents. Also, he says “use of these isn’t particularly complicated, learning how to prescribe them isn’t that challenging if someone is motivated to do so.” (Dr HW was certainly motivated, qualified and unphased by the need to learn.)
Dr S then lists his “suitable qualities”. Passion, knowledge and comfort on GD issues and dysphoria.” (we have seen Dr HW has all those and more.)
DR S then says, “ a lot of Paed endos aren’t suite to this kind of work and feel lost and uncomfortable…” (many of those in the GMC it seems. Many who don’t want to understand perhaps)
He continues and says, “many of the best practitioners in this field are not Endo’s.” (this is a Dr HW witness. As such his testimony will be biased towards her cause, as he has chosen to stand for the red team. However, this is his line of work and opinion. He is not standing up directly for Dr HW here, just saying how things are, and that its, dare I say, “flexible”. It’s about learning and understanding, not just letters after a name.)
Dr S then says he would refer more often to those with passion and understanding for GD and Dysphoria regarding prescriptions, and not because they were and Pead Endo.
IS asks him if GP’s prescribe for “trans youth as well?” Dr S says Yes. (That is in the US)
IS says (from Dr S report) that while largest centres are run by Pead Endos, there are GPs who provide care and do so effectively. IS then asks if there is a bar on them prescribing PBs and hormones.? Dr S says “No, there’s not.” (OK this may not be the UK, but the guidelines are still there’s, the skills and training is still there, the passion and its legal to allow this. Not a lot different from the UK really is it?)
Via questions Dr S runs through some trans care history in the US and how treatment used the Dutch model of care and treatment is “the whole person”.
IS then asks Dr S about MDTs.
Dr S says he uses them, and they can cover a number of different specialisms. However (and an important however) is that they have to be “flexible” and this aspect “can’t be underrated.” Dr Klink (the GMC witness suggested this was acceptable and other GMC witnesses gave the impression this was the case but didn’t actually say so. Dr S says is about organising it to allow patients “to get the care they need.”
IS asks Dr S that and MDT can be different in different situations and locations, asking “do they have to be set or cast? “ Dr S says “No.”
IS then asks about the “hub and Spoke model of care”
Dr S runs through some history of his experience of MDTs and how that created the fact that in some centres, families of patients felt there were lots of “hoops and hurdles” to negotiate just to prove they had a “valid gender identity.” With this and other obstacles that came about, they looked at other ways of providing what was needed.
This developed into the ‘Hub and spoke model’ of providing care and allowing for self-referral to a clinic if needed. (This is the model used by Dr HW and one which would seem to be an issue for the ‘stick in the mud’ GMC. The use of this model has come about from her experience and learning. If certain GMC members and others did the same, then we might not be her at all.)
Importantly, IS asks Dr S (who has been using this method for 6 years or so (so at/before 2016)) “if he has had any reason to go back or alter the position he had when he was a Fellow?” (at Harvard)
Dr S says, “NO. Adding “ I find this model works very well and there is a lot of satisfaction for patients and families.” (Compare this with some of the GNC witnesses and ‘experts’ who had limited or nil experience in treating trans youth. Here we have an experienced and qualified practitioner using a different model but STILL following guidelines and regulations.)
IS then moves on to age of prescriptions. (This is probably the main reason why this case has come about.)
Dr S says it was generally 16, but this has changed over time. He talks about the history in this context.
An important milestone is when the person “is old enough” to talk about GD and be able to take a “balanced view” of opportunities and risks of care and prescriptions.
Initially 16 was “novel” to treat, but things “have changed”. It’s a personal thing and “not suitable for a cut off”.
Waiting for a date on the calendar before you can give treatment is “silly and wrong”. Dr S was critical of the Dutch model and had concerns about the ramifications of how long someone may be delaying puberty.
Dr S says that starting hormones before puberty isn’t needed, but that the average age of onset of puberty is 11 for natal girls and 11.5 yrs. for natal boys. (Pt A was 11.5 at the time and had been prescribed PBs by PGB)
Dr S’s evidence will be split into two parts, and he will be back on Monday afternoon.
After an intense week, that was it for Friday.
Dr S is showing with relative ease, how different models of care can work effectively and be a benefit to patients and families. He is experienced in these types of care and treats actual trans patients. I suspect that the GMC witnesses were the ones who wanted either to stick the knife in Dr HW and/or weren’t afraid to speak and/or were all that was left when the GMC cobbled together this case at the last minute. I also suspect there are many witnesses and experts out there, who weren’t prepared to go along with the GMC case and/or were scared for their own positions. This especially when we have seen the extent and control the GMC have given over the documents and information that has been passed to their ‘experts’ and witnesses.
The evidence given by DR S so far, should not put the panel under any pressure of a decision. This however remains to be seen, and SJ has yet to cross examine.
Where did we end up?
We ended up with a tired Dr HW and a bruised and battered SJ. He has gained some small victories, but probably not enough to cause significant damage.
IS showed he is on the case and can see through the charade and game playing of the GMC and has done so for some time.
The panel are seeing this too but are mindful of the rules in such aspects and have to play fair with what they can allow. Are their minds made up? We will have to wait and see.
They inflicted significant damage on the GMC case on Monday by removing many of the superfluous charges. S for the remainder, they had to stay, but how robust they remain will be seen. After this week’s evidence, many will have to be questioned as to if any relevance remains.
Of those that then remain, most will be secondary and have limited impact on the GMC case if accepted, which they may well not be.
In broad terms, the GMC case is a bit like Dougal from the magic roundabout (sorry I’m old) and its just running around in circles not making and real sense.
Why are we here?
Should the panel dismiss most or all of the remaining charges (not already admitted to), this should trigger a review of the system the GMC used to bring this case. Moreover, it should trigger a review of the protocol and procedures adopted in preparing this case. That aspects has been farcical at times and is really a shambles. This is probably because of how it came about, and the weakness of the case in the first place.
However, that may be a step to far yet and there are several days of this case left before any decisions or conclusions can be properly drawn.
Friday was Day 31 of the public hearing and day 44 overall. This hearing was set down for 55 days. Whether the tribunal think they are ahead or behind, is uncertain. It looks like another 2-3 weeks to go. The large factor of Dr HW defence evidence has now been completed. So, it’s turning on to the home straight from here and the last few rounds for our hypothetical boxers at this point.
Now what?
The panel have indicated a 09:30 start on Monday, assuming there is enough diesel to go round, and we will hear from Dr S in the afternoon with Dr P in the morning.
If the person who was involved in writing the WPATH guidelines can’t explain how they are to be used, no one can. That’s to come.
To be continued…../
Nicola
