GLP - We’re suing a hospital for trans discrimination

What, exactly, would be the discriminatory motive on the part of the team? It seems probable that a gender specialist would be more appropriate both for diagnosis and treatment.

The real issue is surely the very long waiting list for gender referrals.

It's hardly a stroke of luck for the patient if the surgery is cancelled without any alternative treatment being offered and they are left in pain for years with their issue unresolved. Doesn't sound very "sensible" really does it. And once again, if nothing else, Lisa still deserves an explanation for why and how this happened, and why this sensible person didn't suggest another way to cure her problem if they were so convinced she didn't need surgery for it.

The only plausible variation on this

This isn’t true. This isn’t the only plausible variation.

It’s also plausible that some young enthusiastic surgeon said “yes, you have pain in your testicles, ergo removing your testicles will stop the pain. Simples.” And a senior experienced surgeon came along and said “What’s the source of the pain? What’s the rationale for removing them? What if it’s referred pain? How can you be sure the pain is physical? How can you be sure the pain will improve?”

Once again for the thousandth time, if the problem was that Lisa wanted a type of surgery that the surgeon couldn't perform, this would have been established during the consult stage and a date for surgery would not have been booked in.

The only plausible variation on this is if the surgeon themselves made a huge mistake by offering to do a procedure they weren't able or commissioned to do, and this mistake for some reason didn't come to light until just a week before surgery - this might not be discrimination but would still be a huge mistake on the hospital's part and one Lisa deserves a proper explanation and apology for (as well as an explanation as to why she wasn't offered an alternative surgery when the mistake became apparent). But I know that explanation is less appealing to some folks here as it doesn't demonize Lisa sufficiently.

If it was simply the case that the patient's symptoms didn't warrant surgical intervention, the surgery never would have been scheduled in the first place

This isn’t true. This sort of thing happens all the time. People are scheduled for surgery and someone sensible comes along and says “why on earth is this person having an operation for this?” It’s usually a stroke of luck that someone sensible gets involved. Of course the opposite happens too, where no one sensible comes along and people frequently undergo operations they don’t need.

Surgical intervention is not always black and white. It’s frequently subjective as to whether surgical intervention is warranted. The old addage is “a competent surgeon knows how to operate, a good surgeon knows when to operate, the best surgeon knows when not to operate.”

There are likely several different surgical procedures which all come under the broad heading of "removal of testicles". And various different kinds of follow-up care.

The devil will be in the detail: we don't know if the procedure offered to male-identifying men matches what would be offered as "gender affirming care" for a female-identifying man or what Lisa wanted or would accept.

Having watched GLP in action for a few years, I'm certain they have spun the story in several critical ways and when all the facts are laid out things are (from Lisa's perspective), at best not clear-cut at all.

GLP is thoroughly invested in maximizing it's income from public donations, the better to pay its principal. It's not a charity and it cannot be said that it acts for the public good, whatever it claims.

I’m not arguing. You’re completely making up what I’ve said and I can’t be bothered anymore.

A date for surgery would not have been set until after the surgical team had had as many detailed conversations with the patient as was necessary for everyone to be happy to go ahead and consent forms to be signed. I know I keep repeating this point but that's because it's true, and if you're going to invent some non-discriminatory reason why surgery might have been cancelled you have to account for the fact this surgery got to the point of having a confirmed date in the calendar which was only a week away at the point of cancellation. NHS surgeons - or private ones for that matter - don't book surgeries then consult with the patient, they consult with the patient then book surgery.

A bilateral orchidectomy for pain presumably ordinarily involves replacing the testes within the scrotum with prostheses, and prescribing follow up HRT (ie testosterone).

According to google, all NHS orchidectomy patients are given the choice whether to have protheses or not, so there's no reason to decline Lisa for choosing not. And prescribing HRT of any kind would not be the surgeon's job, if needed that would be referred back to the patient's GP (and again even for non-trans patients would be up to them - some might choose not to have HRT, and there's zero reason why a patient's choice around HRT would change the actual surgical procedure).

Also, not to keep banging my head against the wall about this, but if Lisa had been declined because she wanted a type of surgery the surgeon couldn't provide this is a discussion that would have been happening at the pre-surgical consult stage meaning the mismatch in expectations would have become apparent before surgery was ever scheduled. Believe me, they make you sign consent forms out your wazoo before they book you in for surgery, and part of that process is making extremely sure you understand exactly what you've signed up for. There is no date going in that calendar unless both patient and surgeon have agreed on what is going to happen.

But it at no point says Lisa insisted on surgery via a technique that wasn't offered and this was the reason for refusal, which is what you claimed.

But there is no evidence of any fraud being perpetuated, unless you assume the intention of the surgeon was to provide Lisa with gender affirming care but to conceal this by lying about testicular pain being the reason for surgery, which is quite the accusation with no evidence to support it.

You're possibly right that the cancellation of surgery was caused by someone panicking about funding and someone higher up assuming that trans patient + testicular surgery = gender affirming care, but again this is an issue that should have been settled before surgery was ever scheduled, so still does not reflect well on the hospital, and the onus in court would still be on them to prove the surgery was either not medically indicated (in which case they were wrong to schedule it) or that it wasn't cancelled because the patient was trans.

Just to be clear, when gender affirming care is performed on the NHS, it is a commissioned service. Only certain providers are commissioned to provide it so if this hospital isn't a commissioned provider, they can of course refuse to perform it. I don't think there is any evidence uncommissioned hospitals are routinely providing free gender affirming care to anyone, let alone in this case. Unless you can provide any?

Lisa spoke about both-
“And a doctor said my treatment was aiming to maintain hormone function and fertility, even though he knew I was a trans woman and I’d had a vasectomy.”

The doctor who is used to treatment which preserves hormone function and fertility is less used to treatment that doesn’t consider those things. I said it may make sense at that point to send Lisa to a gender clinic which would have more experience.

Perhaps you need to read more carefully before telling me- more than once- I’m making it up. And perhaps apologise.

Very possible. Lisa may have additionally requested life long hrt but in the form of estrogen rather than testosterone. For a urologist this would.be against the standard protocol for treating a male patient hence the suggestion to seek gender affirming care.

I wonder if things started to unravel when the surgical team started having detailed conversations with the patient. A bilateral orchidectomy for pain presumably ordinarily involves replacing the testes within the scrotum with prostheses, and prescribing follow up HRT (ie testosterone).

When the patient told the surgeon what he really wanted, the latter may have thought it was outside his competence, and a gender specialist would have the best chance of achieving results that would satisfy the patient in the long run.

Also, this gave him a motive to lie about the pain, which can't be completely ignored, although it would be tricky to test.

OK, now this is bringing up one very important, but ignored issue around gender affirming surgery. One issue that I think is very under-reported.

This surgery; any surgery needs to be commissioned. This ensures that the hospital and the staff, etc, are reimbursed for doing the surgery. If it isn't commissioned, but they're just doing it anyway, there are two effects:

1. They're doing it for free. The hospital is losing money, as they cannot claim for the operation against their contract, because it does not cover gender affirming surgery.

2. If these are being done by gynae surgeons, then women who need gynae surgery are getting pushed further down the list for surgery, as free gender affirming surgery is being done instead. Similarly, if it is being done by andrology surgeons, men who need that type of surgery are being pushed down the list.

This is why it is being classed as 'testicular pain', so that the hospital can charge it against their commissioned (contracted) surgery. Someone, somewhere in this case has said 'no', as this is presumably classed as fraud.

One thing that we should start asking more about this surgery in the NHS, a one word question:

Commissioned?

Because if it is NOT commissioned, then it is free, gratis, and the hospitals are being made poorer, with longer waiting lists as a result.

Many thanks to GLP for bringing light onto how this fraud is being perpetuated.

Ok thank you. That still doesn't actually say what you claimed - Lisa was objecting to the surgeon talking about preserving fertility when she'd already had a vasectomy which is obviously a mistake on the surgeon's part. It also doesn't say she was ultimately refused surgery because she wanted a technique they didn't offer.

It does however provide an answer to some of @DrTemporary 's wonderings - seems Lisa's pain problem pre-dates gender affirming care so can't have been caused by hormones/blockers.

There are two links in the first post. I added it above for you.

And the link with everything I mentioned is here, @HouseLurcher

https://goodlawproject.org/tortured-by-transphobia-the-woman-left-in-pain-by-the-nhs/

The only link about the case that's been posted is this one, which doesn't say any of the things you've said https://goodlawproject.org/were-suing-a-hospital-for-trans-discrimination/

Everything I said was in that link a PP posted. There’s no way I’d either know it or be able to make it up. It’s totally outwith my experience.

As you say, pure speculation.

But again to get to the point where surgery has been scheduled and is due to happen in a week's time - obviously I've never found myself in Lisa's position, but I have been diagnosed with ovarian cancer and treated by having my ovaries removed, I can't even remember all the stages from initial visit to the GP with weird symptoms up to having surgery scheduled and ready to go, but I had so many appointments, visits, consults, scans, blood tests, and that's for a scenario where no one can possibly quibble that the surgery was unnecessary. It seems highly unlikely no one ever investigated other possible reasons or solutions for Lisa's problem before she reached the point of surgery, and if they didn't, again that in itself is quite a huge error in care.

Whatever you think of the GLP, it's highly unlikely they'd risk being found in contempt of court by releasing a press release containing verifiably false information.

It's also a bit of a reach tbh if the only grounds you can think of to insist the case is unfounded is to just ignore the information we do know about it, and smacks of someone determined to approach the scenario with the worst faith possible for some reason, can't imagine what.

@HouseLurcherthe GLP have successfully obtained a rerun of the inquest but @letsallchantwas referring to the number of cases won or partially won. Its by no means a certainty that they will win based on their track record. There is someone on here who keeps a running record.

I dont know if all suicides are subject to an inquest (but in any case, any suicide is a such tragedy for their family and community).

Edit. This is a sidebar. I dont mean to derail the thread. I did not know about Aiden Longmuir’ case.

I agree with you - it is rare to schedule something as unusual as an orchidectomy and then cancel. Hence my musings above for which I apologise for the terrible wording. I was not looking for studies to back up my theory - but decent meta-analyses on the physical side-effects of cross-sex hormones which are lacking. Leaving redditors and everyone else wondering.

Pure speculation, but could it be that the patient had not disclosed their oestrogen/blocker use until the pre-op, when the surgeons became aware of a possibly reversible cause for testicular pain, or at least that the indication for the surgery became more complicated? I can see the urologists getting cold feet at this stage - providing NHS orchidectomy to a person taking private hormones, and whilst the pain and gender dysphoria may potentially point at the same treatment, the counselling and conversations are completely different. Also the funding streams.

Like I said, speculation. But I think plausible.

Well, quite.