Briefly
Helen Webberley's representative is Mr Ian Stern QC
GMC's representative is Mr Simon Jackson QC
There was a lot of discussion this morning about the order of witnesses. It is important for some witnesses to be heard before others.
Today Dr Klink has been giving evidence. He can only give evidence today and tomorrow and there are concerns that this may not be long enough to complete the evidence so solutions discussed before evidence started. Also his evidence was only received by the defence on 13th August and they are asking for a delay.
Dr Klink is one of the GMC’s witnesses. I think he is one of their expert witnesses because the tweets mention his “report” being “his opinion of the concept of providing care as part of a multi-disciplinary team (MDT)”. Dr Klink is a Paediatric endocrinologist from Amsterdam Uni Medical Centre, Dept of Paediatrics.
Simon Jackson (SJ) (GDC) questions Dr Klink first…
Dr Klink sees patients from age 10 to early adulthood. The younger the patient the more a MD approach is required. And MDT would comprise mental healthcare, endocrinology, surgeons, physical therapists and speech therapists.
Dr K says that providers of gender affirming healthcare should be well qualified. From the tweets it looks like he is saying that to make an assessment that will lead to hormone treatment a clinician should be a paediatrician with 2 years additional training to become an endocrinology specialist. Dr Klink doesn’t think it is appropriate for one doctor to fulfil the role of the whole MDT. One person cannot be qualified to do this all by themselves.
He is asked about the assessment process and what this entails and what should be recorded. He is asked about irreversible changes.
He is asked about the appropriate ages for starting hormone treatments. He says generally 16 but in rare cases 15. These patients will have been patients at his clinic for several years. He says that there is not a lot of evidence to go on in this area so every centre has to rely on their own clinical experience.
He says in Amsterdam patients must have been seen at an early age in his clinic and have been on PB for at least 3 years and have received counselling on fertility and other surgical issues before being considered for HT.
He said guidance on this is not fully tested on adolescents so there is not a lot of data on how transgender patients will react to the drugs. Because it is so unknown it should be monitored by paediatric endocrinologists. You need a lot of knowledge of puberty to do this
Dr Klink is asked why he thinks age 12 is too young (HW prescribed testosterone to a patient aged 12). He says because of capacity to consent is more likely around age 15.
Dr Klink is asked about HW’s interaction with the MDT and an endocrinologist in view effects that these drugs can have (on bones, growth, sexual maturation etc.) Dr K says he cannot see from the notes that there was any communication between HW and the MDT or an endocrinologist.