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.
Day 37 is brought to you by Going down with the ship? [with bonus day 38 later]
(Wednesday) [week 10] of the public hearing.
Anticipated start at 09:30am.
Yesterday, Tuesday was a reading day. Matters needed to be considered and discussed by our two teams. It would seem the time was used to prepare summing up and reviewing evidence obtained so far. The Blue team are likely to be the happier.
What’s on today?
Today, we have Professor Bauman. He is the current chair of WPATHWPATH World Professional Association for Transgender Health https://www.wpath.org and the lead consultant at Nottingham GIC.
To avoid confusion with a certain GMC PGB, the tribunal have reported Prof Baumer as Dr B.
Dr B will be giving his evidence today and be cross examined. This is likely to be the last day of the defence case. After that its summing up, cases to be made to the panel, deliberation, and judgement.
In the usual way, IS (blue team QC) introduces his witness for the defence. He runs through DR B’s CV and experience for the panel and outlines some key aspects.
Dr B has seen and read the reports relating to Pt’s A,B & C, and is relying on his evidence as written. All fairly standard so far.
SJ to cross examine
SJ steps up for his crosse examination of Dr B. He knows this is a tough one. Let’s hope he has done his homework.
SJ asks Dr B whether he accepts that there are differences in and considerations to be taken into account for adolescents 16+ and pre pubertal children?
Dr B clarifies the question. And then responds, “No I don’t agree.”
So, here we are Question 1 and already the witness is at odds with the QC. This doesn’t bode well for the “ask questions you already know the answer to chapter.”
DR B Clarifies there is no difference, in assessment of a child of 15 and the same person , the next day being 16. The same applies, he says to and 11yo or even a 10 yo.
DR B says the treatment is “virtually the same” and he can’t see why other experts have suggested differently.
SJ, already floundering, rephrases the question and relates it to “stage not age.”
Dr B then agrees, that Stage not age is the defining characteristic moving forward and puberty is a characteristic of being GD.
SJ then tries to relate this to prescribing. Dr B responds by saying its still stage not age, but it’s about clinical judgement.
Dr B says he has not personally prescribed for a 12-13 yo. but that he “would do exactly the same as Dr HW, in these specific cases. He adds, that may not be the same for everyone. (The point is that for the patients who form part of this hearing, Dr B is happy. Every patent is different.)
Dr B then explains that the treatment given by Dr HW is “very similar to” Nottingham GIC in terms of information gathering and consultations.
Dr B then outlines how the process affects the patients. (largely ignored by the GMC witnesses and experts, who focussed on process and ignored individuality). He explains that a set number of meetings isn’t the point. It’s about establishing facts. Especially when delays and gatekeeping mean “the suffering is so severe some would rather be dead.” (that is damming indeed)
Dr B further adds that the treatment of patients by the KOI, he found, in his view “shocking.”
SJ, has had several punches thrown at him and is a bit wobbly now. So wobbly that he sort of forgets to ask an actual questions, but just talks. IS steps in to ask him to ask a question.
In the end, all SJ wants to know is if consent is an important part of treatment. Dr B agrees, adding and agreeing that dialogue and assessment are needed in all cases. (I’m not sure anyone is suggesting this isn’t the case, nor that Dr HW didn’t do this.)
DR B identifies the Nottingham waiting list is 2-3 years for 16+ trans people. And that consent forms part of the first appointment. But that there isn’t much difference between a 12 yo and a 16+ yo. Its about clinical judgement.
He adds that he feels Dr HW thought that Pt A had capacity and they “knew what they were getting into, and they had been looking for hormones for a long time.” (A further praise of Dr HW and a damming inditement of the Tavi.)
SJ asks if prescribing at Nottingham GIC is an MDT.
Dr B, obviously in a robust mood, says NO and that he has again been interested in reading the transcripts of others. He reflects that the concept of the MDT “is outdated and goes back to the 1970’s” (This isn’t going at all well for SJ. Nothing is getting through, and his question schedule is looking very shabby by now.)
Dr B then said guidance from 1984 (40 years ago) stated MDTs should be used for MH cases and severe complex needs. Dr B feels that MDTs are outdated and not suitable for trans patients in most cases as it doesn’t best serve their needs. He has developed his system with Drs, nurse practitioners and others at Notts GIC and he wouldn’t call it an MDT. More complex cases are dealt with differently, but its still about discussion and dialogue.
Dr B explains to SJ that 85-90% of trans cases are “straightforward” and prescriptions can be made after two appointments. If patients have socially transitioned and comfortable in their roles, and having travelled a long way etc, why would they need to come back “just to see someone else.?”
Dr B adds, that when he started in medicine, he saw some very mentally ill patients (not trans), but when he started seeing trans patients, it took a while but “he realised there is no difference between trans people and me. I’m a cisgender man.” (Oh, look everyone, a person seeing trans people as, well people, and not walking MH disasters with complex needs and deserving of anything but what they need to make their lives better. i.e., a ‘normal patient! NOT a single GMC witness cam anywhere near close to saying that)
Please remember this is a ‘cross examination’ of evidence. I know it doesn’t seem like it. As I have said before, this is about the confidence of the witness, and the work done by IS in undermining the GMC witnesses early on. It has left SJ so very little. That apart from the fact that the basis of the whole case is very thin. That has become clear from many different angles. It gets worse for SJ…
Dr B refers to the giving of prescriptions and how that ‘junior’ staff are involved at times, they become prescribers with training and guidance and supervision. He also said that at one time he couldn’t get Endo’s from hospitals to be involved. Now he has Endos to screen some patients.
NONE of these people are being dragged over the coals by the GMC are they? We are here because Dr HW dared to step outside of the strangulation of trans healthcare by the NHS and, in particular the Tavi. Frankly, being a private practitioner put their backs out and they sought revenge. It can only be that, essentially as has been proven and is now well established by many witnesses, her care is hardly any different from the good practice being outlined here.
Dr B then explains the process about his first prescription for a trans patient. He didn’t know what to do, but sought advice, guidance and obtained the information he needed. HE arranged for the GP to prescribe. That was 14 years ago. (Not much different from Dr HW, yet Dr B isn’t in front of a hearing due to an investigation by the GMC. Why? He stayed in the NHS. He had people willing to help rather than those wanting to stab.)
Dr B also sates when Endos first arrived, they “knew nothing about trans care and endo for trans people.” (According to the GMC case, Endos know everything and are the ‘go to’ gods of trans prescription. It would seem that’s another GMC myth busted.)
Dr B explains, it about learning, getting support and guidance.
SJ asks Dr B about Dr Kieran’s lack of membership of WPATH and a favoured membership of BAGIS.
Dr B says it means she won’t have access to a wealth of information and learning available by email. As BAGIS organise 1 meeting per year and offer no training opportunity, that would be a disadvantage too.
Dr B adds that her seeing only 1 patient per month, “doesn’t make her an expert in trans healthcare, especially for adolescents.”
Dr B isn’t messing about here and is quite scathing of the GMC witnesses.
He says “Trans people face enormous discrimination every day, these people are Doctors, Policemen, not everybody has to have a qualification but its epidemic how badly most trans people are treated by health service and society.” (Boris et al, are you listening?) He continues, “ we have a long way to go to ensure trans patients are treated equally to cis people.”
This is STILL a cross examination remember! SJ is supposed to be finding holes in his evidence.
Dr B then states the following which was said by Dr Klink: “ to colleagues in the UK to embrace a more progressive stance on trans healthcare and not get stuck on the outdated age 16 & he himself said generally it is much younger. I will share with you honestly, there is a consensus of 14 years, globally, with all big players……but you have to look at stage, so there will be exceptions to the rule.”
He adds that 12-14 isn’t unusual and Amsterdam treated a 13 yo as a youngest patient. West coast USA tend to be 14 as minimum but San Fran 12-14.
Dr B is laying it on thick and saying don’t get hung up on this issue. Treat trans people as cis people and not as MH cases. That undermines most of the GMC witnesses and the so called ‘experts’ in the GMC case. He may be biased, given his position, but in his position, he has treated many trans patients and has spoken to a vast number of practitioners in the subject. This is actual knowledge not theoretical interpretation.
Dr B says that WPATH guidelines suggest age 14, but lower is acceptable. Its about flexibility. He adds (and he’s clearly not happy about this) “Dr Klink [GMC witness] made a joke about me, but I see people who are in severe stress every day , who self-harm & want to kill themselves. Let’s not forget, hormone treatment DOES relieve that.”
He adds that self-harm DOES STOP with hormone treatment. He isn’t at all happy with Dr Kierans saying, “well do a bit of relaxation to relieve your distress, that’s not going to help a Pt with GD.” Adding, and even more damming, “I found that quite shocking.”
Dr B is really telling kit how it is today. Poor SJ is getting a bit of a backlash. Dr B adds that the use of MDTs is “outdated, not fit for purpose and inefficient. I don’t think it’s useful for the patient.”
He suggests that GIDS had a “huge team of 40 people or something.” (This and they still failed a CQC inspection and are failing to see patients. I don’t see a GMC case being rushed through or an investigation into why? Maybe that’s to come once this hearing is done and the egg on the faces has washed off.)
DR B is asked about responsibility for prescription. He states that the “prescriber takes responsibility. And not the people who don’t prescribe, they don’t take responsibility if something goes wrong.”
SJ questions this. Dr B adds that Dr Kierans (KOI) who works with a Pead Endo, who does prescribe, if something goes wrong that she (Dr KS) isn’t responsible. (Dr KS was a GMC witness who essentially showed her own bad practice to the hearing yet is asked to give an opinion on another Dr (Dr HW) about something she neither does herself nor would have any responsibility for.)
Dr B was then asked about prescriptions for Pt A and the ‘duty of care’ imposed on Dr HW from those prescriptions. Again, Dr B is happy to show the state of bad practice and treatment of trans patients and the dilemma many face due to the state of the healthcare system for them. “This is a very painful point and [a] point I have rallied against since I entered trans healthcare. When a trans patient seeks private healthcare, as many do, and something goes wrong, they cannot come back to the NHS. I find that absolutely barbaric and terrible.”
He adds that as far as he is concerned patients can ALWAYS come back to him. He accept as the ‘no return’ isn’t just in trans care but it IS how the GIDS works and the “no way back puts families and patients in a very difficult position.”
Poor SJ tries to rephrase the question, but to no avail. Dr B isn’t going to let it go.
He says, in an exasperated way, that he “ has tried” for 5-6 YEARS to develop a working protocol with the Tavi (GIDS) but they are having nothing to do with him. (the head of WPATH let’s not forget). They have NEVER replied to his emails. If he asks a clinician at a conference the response is “its so complicated”. He deeply regrets they won’t communicate and work together “for the benefit of patients.”
He says Dr HW was criticized for not doing this. (How can she if it’s not possible?)
Frankly, this is as appalling as anything else that’s been said. This REALLY does show the vitriolic, vindictive nature of the way GIDS is run and how they want to control everything, being all knowing, when, essentially, they are falling further and further behind with the rest of the world just laughing and looking on in shame.
Dr B then agrees with what Dr HW does in communications on shared care agreements and that it is consistent with the way Notts GIC works.
SJ then decides to try and catch out Dr B with questions on a paper he and edited and but That Dr B personally knows each of the other authors. Given where we are, that’s not really going to work.
That ends SJs questions (only it doesn’t)
What did we learn?
That SJ made no progress and is probably no worse off than before he started.
That Dr B has laid out on the table his opinion of the practices and opinions of many of the GMC witnesses. He has also stated he has faith in Dr HW’s practices and that the UK system is in dire straits. He has had a shot at specific people responsible for this and some unnamed (but they know who they are)
We learned that trans people are people, as we did yesterday and not monsters from another planet to be experimented on as the GMC would seem to prefer.
You may remember last week the GMC decided they didn’t want to question Pt A and his mother and didn’t need them to appear. The panel said they had questions for the two of them and needed them to appear but in private. There have been ongoing discussions since about what information can be put in the public domain.
The revelation from IS was that the GMC didn’t ask either Pt A or his mother A SINGLE question in the session. This is a surprise as they had said they wouldn’t. However, as such IS says, he is now unclear as to what the GMC’s case really is. Bear in mind that the cases of patients A-C were only looked at by the GMC as PGB had been involved in all three and had complained to the GMC about Dr HW, implying his opinion of bad practice of them in her care.
If they don’t cross-examine and accept the patient’s evidence as written, how can that show bad practice, when the record from them will be in support of Dr HW? Has the GMC abandoned this aspect of the case?
IS wanted to make that point and the panel took that on board. All SJ would say is the GMC chose how to deal with the matter, and it’s their choice alone.
SJ tries again
SJ then continues his questions based on other evidence and wishes to cross-examine Dr B some more.
He wants to cover the details of patients A-C
Essentially this got SJ nowhere. He got muddled as to which documents he was referring to having to be corrected by IS AND Dr B.
Dr B has positive and considered responses for the points raised in each case. Most have been covered elsewhere, but SJ is just hoping to find a chink somewhere. He doesn’t.
Br B continues to show this by outlining the poor state of the trans care service in the UK and how patients are being badly let down or worse.
According to the GMC, this is STILL Dr HW’s fault!!!
SJ tries his hand at say Dr HW wasn’t experienced and her prescriptions didn’t have the same ‘authority’ as those from Dr B. (This seemed to upset Dr B) he told SJ (bear in mind this is a CROSS EXAMINATION) That Dr HW is very experienced and 100s of patients transfer to Notts GIC for surgery, and for that reason alone, not due to dissatisfaction. DR B says Dr HW has “a very good name”
SJ tries to justify the issue by referring to “one of the GPS in this case” as being “unsure of Dr HW’s experience.” (Rather than complain, maybe they could have done some research or flipping well ask! A doctor is being put to the mill for lack of communication by complaints from other doctors who could be bothered to communicate!)
SJ tries his luck with the care of patient B. Asking that this was lacking, and communication was poor plus that there was insufficient consideration for dyslexia etc.
Dr B is having none of it. “let’s not make it more complex than it is”. Dr B suggests to SJ that if he had met a person with ADHD, he would know in 1 second and they wouldn’t be able to sit and answer questions for 3 hours” He adds that the work of Dr P is well respected. And would rely on her expertise. Dr B adds that her nieces have dyslexia but are still in medical school. “Keep things simple and avoid unnecessary hoops and hurdles.”
Dr B adds further that “the fact patients are on the spectrum doesn’t impact treatment and isn’t as complex as some people believe it may be.” (looking at you KOI)
SJ tries again at the matter of consent, suggesting the fact Dr P met with Pt C and his mother, and they then met with Dr HW, that that needed more meetings to assess capacity and consent.
Dr B roundly dismisses this suggestion and says, “due process had been followed, the consent form had been looked at, discussed and signed.”
And with SJ getting in a pickle after Dr B having answered questions he hasn’t even asked yet; he decides to bow out gracefully and stop.
Have we learned anymore?
Not really. SJ remains in the hunt for anything to pin on Dr HW from Dr B. Dr B has reviewed everything and is happy with Dr P and Dr HW. He suggests the issues lie elsewhere and that a mirror for the GMC witnesses could show where the problem really lies.
IS returns to clarify some aspects.
IS then asks Dr B to outline to the panel his expertise in treating trans patients “without holding back.”
Dr B then goes into great detail about his history and how he found it important to treat patients in such a marginalized group. He was hooked and gained experience, learned from others, reading, and joining WPATH, meeting colleagues and attending conferences etc. (Apparently according to the GMC, Dr HW didn’t do enough of this! Bizarre really) he is privileged to be in the position he is in.
IS then asks him if he is qualified to treat under 16’s as it had been suggested he wasn’t.
Dr B says he has been ‘working for years to develop a ‘fluid’ service with GIDS and Notts GIC but it’s been a long haul, although could be about to happen. Diagnosis of pubertal 12-14 yo is “exactly the same” as 16 yo. Once puberty sets in “it would be cruel (yes, CRUEL) NOT to treat those patients.”
He said he would get referrals from 13-14yo’s but would have to refer them to GIDS. They came back with PBS, but for many “it was too late, and they were told “they were TOO OLD for the service.” (That is a VERY sad reflection on the standard and speed of trans healthcare from the ONLY place in the UK patients U16 can go! Let’s not forget that those SAME people are here as prosecution witnesses against Dr HW.)
IS then asks Dr B about Dr HW and his view of the competence of her reports.
DR B, with some prompting on numbers, states he has seen 100’s of patients, he has read all the referral letters and including those referred by Dr HW.
IS “have you found anything to be wanting?”
Dr B “I really feel I needed to say it, I feel she [Dr HW] has been a lifeline to many patients who fall through the net.” (and those excluded from the GIDS game or kicked out during the match. PGB looking at you)
IS wanted to ask one more question.
“in your opinion, relating to patients A, B & C by Dr HW, is there anything you want to alter?”
Dr B “Absolutely not.” Adding “we want to see trans people being trans as being part of the natural variation of nature.” (looking at you Boris et al )
What did we learn?
That Dr B has Dr HW’s back and that he is appalled by the level of care given elsewhere AND is trying his best to change this.
Thus far, the panel seem to have leaned towards Dr HW in the way questions have been asked.
On this occasion, one member suggested that they knew little about trans care at the beginning. However, some of the questions to Dr B seemed to be GC leaning, which is a concern.
They then tried questions on capacity (again) and STILL related this to Bell v Tavi (Does no one listen?)
Dr B says it’s down to clinical judgement. Questionnaires are good, but not the be-all and end-all. As has been said many times its “stage not age.”
The panel ask if Dr B sees issues in adulthood that could have been prevented with earlier intervention? “Yes there are lots of problems.” He replies and explains why and the costs of later interventions that could have been avoided, the distress and anxiety that could have been avoided. Stating that to sone “either they kill themselves or transition.” (Strong but valid words. I hope the impact of these statements gets through. This is not about ‘playing with medicine’, as GCs suggest, it’s about saving lives!!)
A panel member asks DR B about the future of trans medicine. Dr B relies on and says he hopes in 10 years “we won’t be having these conversations” everyone should be more equipped to have specialist routes to trans healthcare. It’s moving from MH to endocrine and more GP’s are training in trans healthcare (not sure quite how, as there isn’t any, but some is better than none.)
The panel move on to questions about current and future guidance and DR B explains how things are changing, but resistance to some aspects in the US (even under Biden-Harris) is creating problems.
The Chair then asks a few questions.
He asks Dr B was he happy with the referral(s) to his GIC from Dr HW?
He clarifies that most are referred to him, as adults (16+) by GPs but some have been seen by Dr HW.
Chairs asks that Dr B has seen the care given by Dr HW. Dr B adds “and telephone and in person interactions.”
The chair moves on to a short discussion regarding training and the type that is and can be offered at GIC. Dr B says its limited, due to patient numbers, but they offer some.
What have we established?
The panel seem mainly happy with how they view this, and questions are mainly appropriate.
Can’t really form a judgement but questions of clarification rather than any of hostility or reservation.
One last try SJ?
SJ smells an opportunity from the training question. He asks If Notts GIC offered training to “senior” practitioners could Dr HW have taken up that offer?
Dr B replies, saying yes, but it’s for those treating older adolescents not younger ones.
SJ then tries to get Dr B to agree what age Dr HW may have treated patients. Dr B ends up saying all age groups really.
I guess he thought those questions might help. We will see in his summary.
SJ retires at the end of his cross-examination and Dr B leaves, thanking everyone.
Well, what have we now?
We are back to discuss and hopefully, agree on what extent of the evidence given by Pt A and his mother can be given in public. They agree to consider this and agree over-night.
IS then refers back to information that was to be provided by Dr Kierans of the KOI of the cases seen by her.
In an email from 20/09/21 she states 74 (KOI) patients referred to Endo; 54 of those on PBs and 24 on hormones. 36 were treated with hormones Dec 2014-dec 21 (5-6 patients per YEAR!)
There is discussion and clarification on the Dr Gale spreadsheet from the apparent erroneous entries by TL. Some clarification may be evident from the log I codes that may have changed.
After that, there is discussion on timetable and that we will be back tomorrow (Wednesday) for the closing of the defence case.
Day 38 is brought to you by WHY ARE WE HERE – REALLY? WHY?
(Thursday) [week 10] of the public hearing.
Anticipated start at 09:00am.
We are ack to close the defence case and move forward to summing up.
Before that, it has been agreed that a summary of evidence from patient A and his mother will be read to the hearing. The contents have been agreed both with Pt A and his mother plus between IS & SJ and the panel are happy anonymity has been protected.
For the record, Pt A was a 11-12yo at the time of seeing Dr HW, having been refused care from the Tavi, for going private but after some initial consultations and being given PBs by PGB.
The two statements were read. Essentially both were heart-breaking and showed the impact of the getting of PBs at he Tavi and the excitement of the possibility of hormones from PGB. When that chance was taken away, Pt A was suicidal. As such the literal lifeline given to them by Dr HW was vital.
Pt A’s mother said the differences in Pt A once he started on hormones was astounding. Not physical changes, but the social and mental health benefits.
Mother A said that he had wanted to be a boy from about 2.5 years and that had not changed at all.
This statement is vital to the understanding of EVERYONE, especially doubters and GCs. This is the ACTUAL damage that is being done by ignorance and hate. It’s not experimental, it people’s lives and welfare at stake. They are people like all other people, except individuals and society don’t want them to be themselves. It is heart-breaking and that many take their own lives as a direct result of that is just shattering.
For those who hold the ‘it’s a phase”, this scotches all that. A trans person KNOWS they are a trans person, it’s just that elements of society can’t accept that.
Remember the GMC asked no questions of either statements given. Arguably how could they challenge such statements?
What is more the point, it is not any of the patients that have complained about Dr HW, it is those on the inside who fear her.
Given those two summaries alone, and we haven’t seen the full evidence, WHY ARE WE HERE?
This case should NEVER have happened.
The case is now adjourned until Monday at 9:30 am. We will then hear the summaries and closing statements by both SJ and IS on behalf of each of their clients.
After that, the Chair will give guidance to the panel members and the panel will go into private session and deliberate on the charges that remain.
It is suggested by the Chair, we will have a final judgement at the end of allotted 55 days of this hearing. Friday (15th October is day 55)
The panel will have to decide if Dr HW has met the standard required on each of the charges. Those main charges will have been carefully considered, one would imagine, and the bar is set by those. The remainder are secondary and on their own carry little weight. They are a bit of a ‘catch all’ scenario. Most were lost at the start of the defence case.
This is not over and while Dr HW has a lot to be happy about, the biggest hurdle remains. That is out of her control now and in the hands of SJ & IS at first before passing to the panel.
NONE of Dr HWs patients have complained about her treatment of them.
ALL of the complaints came from withing the Trans healthcare service from PGB and others.
Yes, there was a poor CQC report, but not about poor care.
There is a very bad CQC report about care at the Tavi and there are many complaints and ‘horror’ stories from patients about the KOI.
Both witnesses AND patients have said at this hearing that Dr HW SAVED lives.
To be continued…../