I've had a go. It's a bit massive.
Good morning. Sophie is today’s tweeter. Reminder of abbreviations:
MW: Dr Michael Webberley
SJ: Simon Jackson- QC for GMC
RD: Ryan Donoghue - counsel for GMC
Chair- chair of panel
Panel- other panel members
We are due to start at 9.30am.
Continuing with submissions from SJ.
SJ: There are one or two issues with consent to do with Gender GP. Could I focus on Patient B. Patient B relates to time between 15 June 2017 to September 2018.
SJ: Patient B’s mother is emailed the consent form. Patient B’s mother replies. MW has written a capacity statement. SJ referring to bundle we don’t have access to.
SJ: This is a document we’ve seen in lots of different patients. It’s a consent form that’s being signed in relation to puberty blockers. The question for the tribunal is; What is the duty? Did the child give informed consent to the treatment provided?
SJ: MW has satisfied that he is competent in full physiological assessment. MW has satisfied himself that consent was given from patient. We know that there has been a counselling session. SJ: we submit there is no indication there has been a full physiological assessment.
Most early paragraphs (of consent form) are talking of testosterone- this is not relevant for the patient as their consent was for puberty blockers. (Patient B was 9 years old)
SJ: Statement on consent form ‘I wish to take puberty blockers and testosterone’. This was signed by parents on 29th June. Was signed by patient on a different date.
SJ: MW makes the statement that the 9 year old was Gillick Competent. The 9 year old (Patient B) had only been present on a video call for 10 minutes. MW has said he spoke at length to patient B about how patient felt ‘he was a boy’.
SJ: MW states of patient B, ‘he completely understands that puberty blockers are fully reversible and can be stopped at any time.’
SJ: Plainly Gilick competence cannot happen in 10 minutes we submit. Dr Kieran states that there should be assessment from an endocrinologist.
SJ: MW stated that blockers should be started immediately for patient B. Physiological assessment cancelled, not record of MDT meeting. This was MW’s assessment only.
SJ: clinical records should include who is making decisions, actions made, any drugs prescribed. That is basic medical practice. There is NO RECORD of any of this in relation to Patient B.
SJ: MW was acting in isolation. MW said if puberty is allowed to go ahead, there is serious risk of self harm. SJ: as no evidence of physiological assessment, there was no evidence for this self- harm statement from MW.
SJ: Can we go back to written submissions and Dr Keiran’s evidence. Our criteria for consent is that patients know the advantages and disadvantages of treatment and the child’s ability to recall this over time.
SJ: If we can go into the charges… Patient V: because Dr A was no longer authorised to prescribe, whether or not that affected the status of Gender GP. Here it’s raising the issue of whether that should’ve been disclosed.
SJ: GMC go on to submit that misleading information was given in order to persuade patient V’s parents to use Gender GP and that was financially motivated.
SJ: We submit MW was incompetent to prescribe for children. We submit that Gender GP continued without Dr A is due to financial motivation.
SJ: MW’s primary duty was to not practice outside of his competence. He has failed because we submit he did practice outside of his ability.
SJ: When one is looking at dishonesty, we need to look at motivation. We respectfully submit it is right to link dishonesty to Patient A and Patient R. On other patients, it is right to deal with motivation and dishonesty separately.
Clarification: dishonesty relating to MW’s dealing with Patients A and Patients R, not dishonesty of the patients.
SJ: In relation to heresy, we need to identify which documents are heresy. Chair: I agree there is evidence admitted and is direct evidence. I will make it clear the heresy evidence (the witnesses- they were told by someone something) will be distinguished from direct evidence.
SJ: I think it would be appropriate to say something about circumstantial evidence. What was the pattern behind ‘balance my hormones’? Who was involved in what stages? Evidence in one patient may be similar to another.
SJ: There is pay upfront before patients were considered for treatment. Chair interrupts: One should not give directions to law unless they are strictly (missed). It does appear that the essence of allegation from GMC is that there is a pattern of behaviour towards patients.
Chair: It is inevitable we will need to consider if these patterns of behaviour were repeated. I am wondering if reference to cross admissibility is necessary.
SJ: If we’ve got two, three, five patients all saying they same things, it is the number of people making the same allegations. It is the question of number and coincidence, wether or not you find propensity.
SJ: Agrees with chair. You need to look at the pattern. We submit that would be the correct approach to look at the unlikelihood that all the arguments of collusion (are incorrect?). They are independent allegations from each patients that (follow a pattern).
Chair: talking of motive. My reference to motive is that there is not something that has to be found before you find dishonesty. However it can be considered what his dishonesty is motivated by.
For example; if MW’s motivate was finical gain, that could be considered in relation to his dishonesty.
Chair: Do you suggest that no issue should be raised regarding motive? SJ: just stating that there doesn’t have to be a motive found for someone to be dishonest. Chair: I agree.
SJ: MW should have the benefit of having his previous good character submitted. He’s not given evidence. We accept that. Whether or not you add that in (his character?) is a matter of judgment.
SJ: I’m just wondering could we go into private very briefly. Chair: yes.
Have left.
SJ: The last issue I wanted to raise in terms of formulation of intent to underline to your lay colleagues, we have heard no evidence that MW was psychologically impaired to practice.
Chair: Talking of propensity. MW is retired, has no criminal convictions and must regard him of a man of good character. Prior to these allegations, there has been no others. The GMC submits a pattern of conduct. MW behaved in a particular way. I’m questioning whether the GMC
gives guidance on propensity.
SJ: We’ve got Patient A in April 2017, then Patient B in June 2017. If one decided to look at ‘balance my hormone’ and conclude financial motivation and dishonesty. If we are talking about pattern, is that demonstrating a propensity?
SJ: It’s a question of coincide, a so-called pattern of behaviour or am I looking at propensity. Chair: This is an area of law of debate and perhaps directions wouldn’t help in this case. It seems to me that GMC’s case is that there is a pattern of conduct. We need to look at
the evidence in its entirety and on an individual basis. I am going to suggest we take a break and I give it some more thought. SJ agrees. Break until 11.30am.
*psychological
SJ has made reference to a doctor throughout submission. She is Dr Kierans.
We’re back.
Chair: SJ- I hope you’ve seen draft advice. I’ve corrected some typos etc. What you’ll see I hope if a section on cross admissibility. I’d invite your observations on whether it is necessary or not necessary.
SJ: Thank you. One of the factors I’ve reflected on is that we’re having this conversation in the absence of the doctor and your further direction is of patterns which we’ve outlined. It’s a question of whether we run the risk of over complicating it.
SJ: The view of the GMC is the importance of looking at each case individually. We can reach a charge of dishonesty without the need to rely on issues of so-called propensity. Where pattern is relevant is when talking of ‘balance my hormones’. Refers to bundle.
SJ: There is existence of repeated behaviour. The GMC reflect it would be far safer to go back to the first principle that each head of charge needs to be looked at individually.
SJ: The GMC submit that it is safety and fairer to look at finical motivation in isolation as regards to Patient B.
SJ: Whether or not you now decide whether the helpful draft.. and whether or not you take out the section of cross admissibility or focus on paragraph 1… (is up to the chair?).
Chair: It seems to me it wouldn’t be appropriate to give director on cross admissibility in relation to dishonesty. In terms of patterns of conduct in relation to different patients, I did consider that there are areas of evidence where, for example, we have clear medical records
that stick to a particular pattern. It may well be that there are instances concerning specific patients where we draw an inference and this may relate to other patients; it may have took a similar pattern.
SJ: Where we’ve got missing records and the tribunal knows the reason (they were not kept beyond 6 months) there would be particular caution of drawing an inference, one needs to be cautious where we know there are records missing… to go on and conclude that we should rely on a
pattern. I want to be cautious as to what proper inferences should be derived from patterns. If the records aren’t there, there may be different reasons why they are not there.
Chair: The evidence in relation to each patient is different but given the pattern that the GMC allege, it does seem to me that I should give some advice as to how such similarities are treated and where there should be an exercise of caution.
Chair: I am minded to give this advice as it is unless you would summit somewhere it is wrong in law.
Chair: The patterns of conduct are in relation to the provision of care and to obtaining consent.
Chair: Good character is separate to the question of propensity. MW has no prior history of conducting himself in the manner alleged. No evidence of propensity. However that is not to say that the tribunal, when considering the issue of cross admissibility might not find that
he had a propensity to act that way. It seems to me it’s uneccassary to go into that level of detail in the advice. We will consider each evidence separately but there may be some similarities between the evidence that we will deal with, with care.
SJ: The GMC have no further submissions and respect the judgement that you’ve come to. (To submit advice on cross admissibility).
Chair: The tribunal will now go on to consider each allegation. The tribunal will consider it each allegation is proved. The burden of proof is on the GMC, not the doctor. Is it more likely than not that the allegation is true.
The tribunal will consider each allegation separately, although it will consider similarities to help them decide on outcome. It is permissible for evidence to be used in this manner although evidence is independent of each other..
Inference. The tribunal will consider common sense evidence. In relation to some allegations, the tribunal has not received evidence or medical evidence. The tribunal won’t speculate.
Medical evidence: This may be outside the tribunals own knowledge. To assist the tribunal- a witness called as an expert may express their own opinion. The tribunal must bear in mind it doesn’t accept the evidence of medical experts. It is not bound to but must state it’s reason.
Dishonesty: The tribunal will consider MW’s state of mind and his knowledge or belief of the facts at the time. It will consider whether his conduct is dishonest.
Motive: The question of motive doesn’t have to be proved but the presence of motive is something the tribunal will regard.
Character: The fact of his good character is relevant. The panel will take it into consideration. The tribunal will now go into camera to consider the allegations.
Chair: Don’t expect to here from us until Friday week (a week on Friday). We will adjourn to a date tbc. I wish you a happy Easter. SJ: Good afternoon, thank you.
*It doesn’t have to accept the evidence
The chair did go into more detail about how the panel would consider each allegation but he read from a script and it was too fast to follow.
Dr Michael Webberley’s tribunal is now adjourned until at least April 22nd. Thank you for following. Sophie @StopfordianR .