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 24
Day 24 is brought to you by Why are we here exactly?
(Monday) [week 7] of the public hearing.
Intended start at 14:30
Dr D is back today to finish his evidence (hopefully) as he is poorly. He may need two sessions across the week.
During the week, the GMC are expected to complete the prosecution case against the Dr HW allegations. The red team should have thrown all their punches in these opening rounds and be ready to soak up some return punches from the blue team.
When the time comes, SJ may well have a few counter punches lined up ready for his cross-examination of Dr HW witnesses, but how forceful they will be, on the back of what we have learned so far, we will have to wait and see.
So far, even though the red team have been throwing the punches, the blue team, have blocked well and thrown a few of their own, to leave the red boxer, a bit tottery at times, and close to collapse.
Later in the week, other GMC witnesses will return to finish their bits of evidence left over. Some of this will be based on defence witness statements, about which there has been a bit of argument.
So, it could be a full week and the GMC will expect to complete evidence and cross-examination by Friday.
Dr D is settled and ready. (he is poorly, remember.)
IS continues his cross-examination for the session. Remember, Dr D has had all the questions in advance, and, arguably, has had time to research his responses.
From the questions known, IS establishes the following from Dr D:
1) Dr D Acknowledges that a lack of communication between Pt A’s mother and UCLA can be difficult when communication breaks down, especially when that Dr “is acting in a way that may potentially cause harm.” NOTE Here we are question 1 and already Dr D is suggestion the treatment from UCLH (Tavi) is potentially harmful.
Why is it, that Dr W is on trial here AND NOT OTHERS? The GMC are sitting on their hands!
2) Dr D hedges his bets and say, “there is argument both ways”. IS prompts him and says, “you’ve set out only one.”
3) From the Notes regarding Patient B, Dr D seems a little hesitant. He suggests his responses in his report aren’t as clear as they could be. (he has the advance questions, so knows what’s coming). He clarifies and says that that consent for antibiotics, isn’t implied capacity for GD patient’s as far as capacity for PBs or hormones is concerned. (Isn’t that discrimination? Isn’t capacity, capacity?)
4) It is established that Dr D, has got the wrong year, the wrong Dr W, and the wrong chronology in his report regarding Pt B. The issue is the dates are important, as it is during the crossover when The GMC told Dr HW to stop practicing. Other Dr’s had to continue her work, “to avoid harm”.
5) Once given the correct order and clarification by IS Dr D the agrees that Dr HW was indeed competent in her notes and processes. Dr D states“, If it was given for harm reduction then it wouldn’t be below the standard.”
6) IS asks Dr D to clarify that point, which he does, readily. He clarifies, “so long as it was given in the patients best interest and within the GMC rules.” (which he accepts was the case)
WHY ARE WE HERE?
7) IS again asks Dr D to be sure on this point, as its important. Dr D checks his own report and email train regarding GMC prescribing guidance in 2016. He again is asked to assert it was ethical, and for harm reduction and thus within GMC guidance. Dr D Accepts that as correct.
8) Dr D is asked to clarify, that treatment of children and adolescents is outside his areas of practice.
9) For Patient C, IS runs through the notes. He states there are TWO Dr’s assessing the patient at the time Dr P and Dr HW. There are “a number of measurements taken” and questionnaires completed.
10) The Dr P’s report was copied to the patient’s GP, but Dr W’s was (at the time). IS states this WAS sent but separately. Consultation was Feb 2017 and sent to GP March 2017.
11) The matter of fertility (in the patient) was discussed at length, as IS points out, but Dr D thought it hadn’t. (in his report)
12) IS runs through matters relating to blood tests, a shared care agreement (later on) and the matter of sharps protocol for needles. (A local RGN, who knows the patient’s family said she would do it and had the procedures in place)
13) Dr D accepts that these matters were in place, but then a few days later the right to practice by Dr HW was withdrawn. Dr D also accepts that there is no follow up from Dr HW, as she wasn’t allowed to.
14) Dr D then accepts there was a dating in a letter he relied upon his report and that this led to his confusion regarding follow-ups and by whom. With the corrected information, all is in order. (why are we here?)
15) That Dr D HAD NOT seen a report by Dr Olson (a Dr HW witness). The GMC, AGAIN, did not send one of their own witnesses a vital report about each of the three patients, their respective treatment by the NHS and the subsequent treatment by Dr HW. This is pure manipulation OR total incompetence.
IS finishes his cross-examination questions for now.
What have we learned?
That Dr D doesn’t seem to have been given ALL the information that would have led him to a different answer.
IS has not had much difficulty getting Dr D to agree that Dr HW’s actions were ACCEPTABLE.
IS hasn’t had much difficulty getting Dr D (and others) the agree that their own evidence was just plain WRONG.
This ISNT how it’s supposed to work, not with a properly and robustly constructed prosecution case. It is evident from what we have just seen, and what has gone before, the prosecution case is a long way short of those things.
Apart from WHY ARE WE HERE?, it has to be asked, The practice and procedures adopted by many of the KEY GMC witnesses, is WELL BELOW standard. And yet, they are here judging someone who has outperformed them.
IS has earnt his stripes on this, He has, thus far, pulled out most of the foundations on the case.
The red boxer is teetering. The question is: does he fall or is the towel thrown first. I suspect the former, as the GMC are hell bent on seeing this through.
SJ returns to the stand, to Re-examine the witness, and clarify any outstanding matters.
Essentially SJ covers old ground, but with added detail. What is odd is that you have to remember, from the responses below, that SJ is the QC for the PROSECUTION and not the defence. You wouldn’t know it though. Has his heart gone from this case? Has he just seen the game is up and is not really trying to find fault anymore?
1. That Dr D didn’t consider himself a specialist in 2000 and there was no formal training at that time (there still isn’t!)
2. At that time there were 7 GICs but no formal training or accepted qualifications in the Gender medicine field.
3. There was an “emerging group” in the US, which later became WPATHWPATH World Professional Association for Transgender Health https://www.wpath.org. [Footnote via @christineburns. She says WPATH was a renaming of The Harry Benjamin International Gender Dysphoria Association and was established in 1979 ]
4. Dr D had seen a growing No of patients in the years before and had an interest in this field of medicine.
5. He started to organise training programmes which developed over time into residential events. The holding of Tans/GD healthcare events developed more widely and BAGIS (British Association of Gender Identity Specialists) emerged from 2014
6. These provided learning resources for GP’s. one aspect was the depsychopathologisation. ( I had to use his word.) This is the removal of designation of being trans from a MH disorder. This aspect is recognised by the WHO.
7. Again, Dr D re affirms that his expertise is in adult trans health care.
8. That it’s difficult for trans patients to get access to healthcare in adulthood and that it must be the same for U16’s. SJ suggests a break (presumably for Dr D’s sake rather than his own. Dr D wants to continue.
9. Dr D HASN’T renewed his membership of WPATH (He’s not the only one. Why let this lapse? Not interested? Specialists in GD medicine, giving witness testimony who aren’t current members of one of the few global standards bodies?)
10. Dr D has been around the world at WPATH conferences between 2014-18
11. He met Dr HW at one such event where she was giving talks on two topics. He watched her “with interest”
12. SJ moves on to prescription protocol and runs through procedures and information (some is redacted, but he fills in the gaps
13. Then back to when Dr D met Dr HW (the two are related)
14. Dr D said, “she introduced herself as a GP with additional expertise and NOT a gender specialist.”
15. That the “nature of her prescribing” was one of harm reduction on patients who were ‘self medding’ and how she was trying to reduce risk through that practice.
16. Dr D also confirmed that prescribing for “harm reduction” is acceptable in that she doesn’t need to be a “Gender Specialist.”
17. Dr D “thought” she was prescribing for adults, but he wasn’t sure. The overview of her procedure given to Dr D at the time Was. He thought acceptable and WITHIN guidelines.
Chair intervenes, after a short discussion, regarding the week’s timetable, the session ends in private, and that, as they say, was that.
What have we learned?
That Dr D has no formal training but has wide adult GD experience and has worked hard to improve the extent and availability of learning on the subject.
That Dr HW herself has attended similar events and spoken to Dr D on similar matters.
That Dr D largely agrees with what Dr HW has done in respect of general protocol and the three patients concerned. This after some clarification and correct ordering of events.
In summary, so far, despite SJ’s best efforts, Dr D, for all his faults, and there are many, agrees with Dr HW. This a GMC prosecution witness.
WHY ARE WE HERE?
Back Thursday at some time (I think) as they’ve not actually said for (day 26).
Dr D will be back pm on Thursday
Dr Klink has to return, also Thursday perhaps.
Dr Kierans (KOI) has to return too, possibly.
To be continued…../