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 days 19 & 20
Day 19 is brought to you by I thought you were on our side.
(Wednesday) [week 5] of the public hearing. Start, as intended, at 9:00am.
After yesterday’s QC battles, today was about a witness. An actual witness.
Today was the second session from Dr Klink. He is a Paediatric Endo based in Holland and has written his expert report. He is a GMC expert witness.
The last time he was here, he had been examined ‘in chief’ by SJ and was now continuing to be cross examined by IS.
He has indicated he is on a strict time frame as he has actual patients to see. So IS needs to be expedient to get his questions asked and responded to.
IS wanted to talk to Dr Klink on several points and, in particular patients A. B & C.
These three patients are the three were those about whom the GMC were notified, whether directly by PGB (of the Tavi) or by other GPs, perhaps on the advice of PGB. These were those who had left or been ‘discharged’ by the Tavi for having gone to Dr W.
He starts with the matter of WPATHWPATH World Professional Association for Transgender Health https://www.wpath.org guidelines. He refers Dr Klink to the ‘delayed’ reports from the blue team and asks Dr Kink if he has read and does he agree with them?
Dr Klink says he has but there “is a difference of opinion”. That’s no surprise really.
IS asks if DR Klink agrees guidelines can be interpreted in different ways? Dr Klink agrees they can. Dr Klink also has a different interpretation to Dr Shaumer (Dr W witness) on the guidelines.
A strike for IS. The guidelines can be interpreted differently. Others have said this too. So why are the GMC so confident there is only ONE way? This has an effect on the use of MDTs. It seems the NHS interpretation is very narrow and that is the issue here. However, experts agree that flexibility is acceptable. There does seem to be a consistent pattern to that. Each is reflective of each patient, but flexibility is acceptable.
Patient A
Patient A is a trans boy with a twin sister. He had been through the GIDs system UCLH to get PBs and CAHMS but was finding life challenging and this led to MH difficulties. His mother contacted Dr W.
IS asked Dr Klink if, on reading the notes and information given to him by the GMC, he had any doubts about the trans status of Pt A and would Pt A change his mind? Dr Klink said No.
That is far more assertive than Dr A but does indicate that Dr Klink feels, even at the age of Pt A, he is trans. That is important.
There was an exchange regarding the attainment of and the confirmation of capacity for Pt A. Dr Klink was quite forceful on this and did push back on some IS questions. In the end he agreed that capacity assessments for PBs and Hormones are needed, but should be considered separately, even if the patient is being treated for both.
Dr Klink also considered that the package of information given to Pt A by PGB wasn’t to the standard he would like. We are not here to judge PGB, but Dr W, however as PGB is a GMC witness, it doesn’t look that clever really.
Mind you, Dr Klink does go on to say that he isn’t that impressed by the NHS way of doing things in some instances and it’s not the way he would do it.
IS asks Dr Klink about MDTs. Dr Klink suggests they are a useful tool, and that MH professionals should be consulted. However, he does say “Sometimes you don’t need to do an MDT, sometimes you can handle it with MH professionals. It’s a continuing process depending on the patient.”
That’s what Dr A said and Dr H. Again, it suggests a flexible approach, that the GMC don’t seem keen on, and why we are here.
IS runs through the patient’s record with Dr Klink. All fairly straightforward until… the Dr who says that patients shouldn’t be given hormone treatment below 16 or 14 as it’s not the done thing, even in special cases, such as Patient A, suddenly..… then admits in the hearing “I’ve provided to 13-year-old, yes.”
IS checks this and re asserts the question. The answer is the same.
IS then moves on to the T prescription for Patient A.
Dr K says, “I agree with the dosage.”
That is important. PGB stated he didn’t as it was an adult dose. Dr K directly disagrees and states it is acceptable. That is a big hole in the GMCs case. We have two witnesses disagreeing on the practice. Remember 1 (PGB) probably has an axe to grind, having high gatekeeper status and having ‘abandoned’ a child in his care. The 2nd (Dr Klink) who is an expert witness.
IS then runs through more records from Dr W. He takes him through notes, referrals, and comments.
All in all, Dr Klink suggests and agrees, stage by stage, that the level of care is acceptable.
In fact, Dr Klink also states that the care provided by Tavi and UCLH isn’t the level he would like.
IS continues and sets out the MH effects of Pt A from the treatment at CAMHS and Tavi and the mental state of the patient including self-harm and drinking (the patient is a little older by now).
Dr Klink then indicates he hasn’t seen this information before. This suggests selective record giving by the GMC to witnesses. Not sure that’s best practice. This has happened before AND SJ has the audacity to challenge IS on wanting to present evidence after new information from the GMC comes to light.
All in all, Dr Klink hasn’t been pulled apart but has been robust in his responses, even though he has left the GMC case more wounded than when he started.
Patient B
Patients B’s experience is a little different, although the experience of CAMHS is similarly bad sadly.
IS runs through the patient history with Dr Klink and the care given by Dr W. Again, he answers positively and sees no significant concerns regarding procedure or detail in most instances.
In the exchange, we DO have to remind ourselves this IS a GMC witness being CROSS examined. Whilst Dr Klink has pushed back in some instances, he is happily agreeing with the patient record and notes from Dr W. This isn’t the impression of a Dr having given a poor level of care.
More importantly, this patient record is one chosen by the GMC as a ‘good’ example of poor care in their eyes.
I’ve said this before: Why are we here?
There was a small issue with whether a physical examination was carried out or not and this may not have been down to Dr W as it was a share care agreement.
Patient C
IS was keen to get Dr Klink to stay to run through his points on Patient C, but Dr Klink was having none of it.
He will be back on 2nd September for his final session.
Dr Klink round up
In all Dr Klink was lucid in his responses, firm and polite. He certainly didn’t suffer from the destruction of previous witnesses although he left the ship a little more leaky than when he arrived.
He also seems to not like the NHS ‘way’ and certainly hasn’t much time for CAMHS.
On a personal note, I have had dealings with CAMHS with a family member. We have found them to be very good on the whole. I will say it wasn’t a trans issue but ADHD. Any way that was us and this tis them. It is evident that their treatment by CAHMs wasn’t what it should have been. Such services suffer incredibly from political interference.
In general, it seems, under cross examination, Dr Klink thinks Dr W’s care was acceptable. Does it meet the test? That’s for the panel to decide.
Then What?
SJ, who must be a bit worried about this by now , felt he needed a ‘private’ discussion with the panel.
It seems The GMC had received a letter from Dr W’s Solicitor requesting further information from the GMC.
So, it seems that the red team, whilst demanding Dr W’s statement, aren’t or are slow in releasing information to the Blue team (again) to allow her to defend the case.
Dr W’s defence statement is partially complete, the rest is due to be completed and we are advised will be issued this week.
The day ends with further discussion about the availability and timings of GMC witnesses. SJ indicates the prosecution evidence will be complete by 30th August. We then move to the defence case and response to the claims made and how IS delas with the nuggets the GMC witness have given him.
What next?
Back tomorrow (day 20) at the leisurely time of 10:30
Dr Dean, if he is well,, will be on the stand, and there may well be more arguments about evidence, late evidence, and admissible evidence.
Day 20 is brought to you by well that was short and sweet.
(Thursday) [week 5] of the public hearing. Start, as intended, at 10:30am.
Today should see the attendance of Dr Dean (Dr D) who is a former GP and the current Clinical lead for GIC in Exeter (known as The laurels).
There is some housekeeping to be dealt with first. Mainly to do with availability and timings of witnesses, as is normal for the start of each day.
SJ raises and issue regarding the witness statement from Dr Gale (Dr G) a GMC witness and information provided by Dr W. He says Dr W is relying on facts provided by Dr G but won’t go into details. It seems it’s about when Dr W was able to practice and when not. There seems also to be an issue with the ‘material’ that can or can’t be provided. The GMC withholding information? Surely not!
Dr Kearans is also booked for September 2nd. (two Dr K’s on the same day!). Dr Klink is only expected to be on the stand for 30 mins or so, as IS suggested that yesterday.
IS addresses the chair. He feels that we need to adjourn until 1st September.
IS then suggests times and dates for witnesses and how these sit with the intended timetable. He introduces a supplementary report from one of his witnesses, Dr Shaumer. IS clarifies this is supplementary rather than an amended previous report. He also refers to the 1st legal test of “adequate care”. SJ refers to this later, before the end of the session and requests that the GMC are aware of any response and considerations on this from IS.
IS clarifies that the rest of DR W’s statement will be available later today and they used the non-sitting time yesterday to complete this.
IS states that there will be matters that he will address and write to SJ about, and this may not be before the end of the GMC case.
There is discussion about the content of the ‘final submissions’ from each side. This seems cordial, but there is a sense of greater rivalry in the statements on this. The battle on admissibility may not yet be over.
Chair then states there are 80 bundles of documents in this case (so far) and that time is needed to be able to read and understand those.
Chairs suggests an adjournment until 10:30 on Tuesday (Monday is a bank holiday)
After a cordial discussion about timings, dates and who will be send what to whom, it was home time already. To be fair, there will be A LOT of work going on in the background for both sides in this case.
What next?
Back Tuesday (day 21) at the leisurely time of 10:30
There should be submissions to be made, discussion on admissibility and all paperwork up to date.
The panel should have read as much as they can, and we will be nearing the end of the prosecution case.
Next week will be a busy week one way or another.
To be continued…../
Nicola
