Helen Webberley

[Signalbox]

Looks like Helem Webberley's substantive case has finally been listed for 26th July 2021

www.mpts-uk.org/hearings-and-decisions/medical-practitioners-tribunals/dr-helen-webberley-jul-21

"DRW: Good medical practice is intensively cooperative.

But also apparently, ‘buy drugs direct on-line for any self diagnosed ailment, regardless of where you live’.

Quite, and importantly it’s known that mental health issues, depression or suicidality can affect capacity and decision making.

As can trauma. I'm writing a thing and was just researching the effect of trauma on the brain - actual structural changes that result in impaired decision making in high stress situations and/or day-to-day life.

23rd Sept

Thread 1

twitter.com/tribunaltweets/status/1440958731718692865

Discussion between GmC/defence/chair because defence have said they don't want to question patient A's mother or patient A. SJ says that the tribunal "must not be used to give a platform to witness so closely involved". SI is "perturbed" that the GMC may not want to question her.

The expertise on this thread and the analysis is so wide ranging (and fascinating).

The result of a lot of interested parties coming together in one place.

Its not the first time I've wished that those concerned would have a read on here, before coming to their judgment.

I'm interested in this idea of consent by poetry.

As an aside, a fair number of health workshops use poetry, it's an established idea. It's not common but also not that unusual for creative work to be put forward as part of an appraisal case or special funding application in healthcare. I should think it's commonest in younger people.

I can't believe she didn't keep any records in relation to discussions she had relating to risks and benefits for such life changing treatments. And no records in relation to counselling.

twitter.com/tribunaltweets/status/1440970187403145216

Indeed. And not keeping records is one thing, and bad enough, but not keeping records, because there's nothing to record, is quite another.

What fascinates me is the way that this is being reported on twitter by TAs. They think she is nailing it.

I think she has a point about her training - there are no established competencies to measure her skills against, because there are no guidelines, because there is no evidence. So, she may well self declare that she is competent (because SG thinks she is, which is a staggering thing to say given that SG is not a medic and so has no way of establishing HW's competency) - but the fact that she thinks she can be competent in the absence of evidence or without demonstrable critical thinking is, well, damning.

Her defence seems to be "this is what the patient wants so I give it to them" Seeing as how the treatment causes infertility, will probably lead to cardiovascular disease and osteoporosis and dementia in female patients, remove any hope of a sexual relationship as an adult, not address mental health or neurodiversity co morbidities, and has no evidence of long term positive effect, then her approach seems at odds with "first do no harm".

@Datun

Indeed. And not keeping records is one thing, and bad enough, but not keeping records, because there's nothing to record, is quite another.

Yes I suppose Pt A's mother could potentially shed some light on whether it's a record keeping failure or a consent failure (depending on the credibility of their evidence). Presumably why the defence are so keen to hear from Pt A's mother.

What fascinates me is the way that this is being reported on twitter by TAs. They think she is nailing it

Yes it's weird isn't it? I sometime try and put myself in the head of a TA to see if I can fathom their mindset. I find it bizarre that anyone would want their child to be treated by a clinician who has avoided registering with the relevant regulators. I mean she was essentially black market. She'd been explicitly told to stop and refused to do so.

@Signalbox

What fascinates me is the way that this is being reported on twitter by TAs. They think she is nailing it

Yes it's weird isn't it? I sometime try and put myself in the head of a TA to see if I can fathom their mindset. I find it bizarre that anyone would want their child to be treated by a clinician who has avoided registering with the relevant regulators. I mean she was essentially black market. She'd been explicitly told to stop and refused to do so.

To be fair, isn't this in line with the right to self-medicalise (even to the point of surgery) that is present in some relevant manifestoes? iirc, Jess Bradley was an author of one and this was part of it.

It's not inconsistent if that is their perspective. And the standard advice is to obtain black market items in order to coerce a GP into shared care.

I have a tangential interest to this. A fair number of hypothyroid middle-aged women and men obtain their preferred hormones on the black market. However, judging by UK health forums, a fair number of them have no shared care and have been informed that if they continue to take these items, they'll be removed from a GP's list.

It is the ultimate self-identification. I can self-identify as the opposite sex, so why not as a medical expert.

No need to go through specialist training, as my expertise is innate.

I thought it was standard practice for specialist treatment that if you went private you were removed from the nhs list? (not GP but consultant).

23rd Sept

Thread 2
twitter.com/tribunaltweets/status/1440989625175187459

Thread 3
twitter.com/tribunaltweets/status/1441025039214817283

(I mean the consent form)

Oh my...

For patient C (10 years old)

@tribunaltweets

DW = Helen Webberley

SJ: So looking at entry for Dec 8th. 'We fully discussed role of blockers which would prevent further female puberty developing and give a chance to decide which puberty would be best around age of 14. We did not talk about fertility...'

We forgot to talk about fertility but would return to it'. [DW's own record].
DW: Age 14 is a good age to decide which puberty is right.
SJ: So you felt putting this child on blockers for about 4 years was a safe and best course of action?

SJ: Starting gender affirming meds so soon after blockers, was your concern that it was too soon?
DW: As soon as puberty was started it was blocked so it's not length of time without blocker that's an issue it's the amount of time without sex steroids.

DW: We were talking about different groups with delayed puberty. Puberty can happen at broad set of ages so age is not only factor to consider when to start puberty but the issue is really when to start sex steroids.

SJ: When was fertility discussed before Patient C signed the consent form in Feb?
DW: I have put all this into my witness statements.
SJ: But in terms of dialogue did it involve patient directly?

DW: It involved me talking to his mother.
SJ: Why not the patient too?
DW: I thought it was appropriate to talk to the mother not the patient.

SJ: But Patient C signed consent didn't he?
DW: In this situation both parent and parent consented.
The Mum discussed with the patient not having children, and he was adamant he didn't want them, tho note at age 11 it's difficult.
SJ: You relied only on what the mother told you?

SJ: This is highly unusual isn't it, for the patient not to have talked to you?
DW: No I don't think so.
SJ then reads out the consent form which says 'my doctor has talked to me...' and mentions discussion of alternative treatment and fertility having been discussed w/ patient.

DW: There is lots to discuss at this point and that's only one thing. You have to consider what the child will understand. There is no long term impact on fertility of taking PBs. It's just a long term pause. I was happy I'd given Mum the broad overview & answered her questions.

SJ: Isn't there an area where some aren't accepting of identity, so the decision taken may reflect the desire of the parents depending on their attitude? Ensuring the child had been directly involved in the process, seeing the child with the mum in the meeting...

...that had happened before with Dr Pasterski, you'd met together, there was no bar to having a meeting with the child.
DW: I have never been presented with a situation with the parent leading the child, it's always the child telling the parent - in my experience of gender care.

DW: Fertility was discussed in several email exchanges with the mother...I answered her questions
SJ: You did not think it necessary to have a consultation with the child before February?
DW: I did have a meeting with child in Dec but did not think necessary to discuss fertility.

SJ: "He's adamant he doesn't want children but I'm not sure that's something a child of 11 can be definite about?...but I know PBs don't interfere with fertility, do they" - said the mother in her email to DW. There is still a question in the mum's mind yes?

DW: Yes, I said to the Mum that infertility should return if puberty stops being blocked and I also discussed egg retrieval whilst on blockers. The mum had had personal experience of this (egg harvesting) and I explained more about it.

SJ: One might think that a child of that age might not understand implications of this course of action. Is it appropriate to factor in what Dr Pastersksi was saying about this boy and his psychiatric history? [refers to bit read out before - ADHD possibility]...

Chair has said the committee do want to hear from Pt A and Pt A's mother tomorrow. (Not surprising really)

@Signalbox

Oh my...

For patient C (10 years old)

@tribunaltweets

DW = Helen Webberley

SJ: So looking at entry for Dec 8th. 'We fully discussed role of blockers which would prevent further female puberty developing and give a chance to decide which puberty would be best around age of 14. We did not talk about fertility...'

We forgot to talk about fertility but would return to it'. [DW's own record].
DW: Age 14 is a good age to decide which puberty is right.
SJ: So you felt putting this child on blockers for about 4 years was a safe and best course of action?

SJ: Starting gender affirming meds so soon after blockers, was your concern that it was too soon?
DW: As soon as puberty was started it was blocked so it's not length of time without blocker that's an issue it's the amount of time without sex steroids.

DW: We were talking about different groups with delayed puberty. Puberty can happen at broad set of ages so age is not only factor to consider when to start puberty but the issue is really when to start sex steroids.

SJ: When was fertility discussed before Patient C signed the consent form in Feb?
DW: I have put all this into my witness statements.
SJ: But in terms of dialogue did it involve patient directly?

DW: It involved me talking to his mother.
SJ: Why not the patient too?
DW: I thought it was appropriate to talk to the mother not the patient.

SJ: But Patient C signed consent didn't he?
DW: In this situation both parent and parent consented.
The Mum discussed with the patient not having children, and he was adamant he didn't want them, tho note at age 11 it's difficult.
SJ: You relied only on what the mother told you?

SJ: This is highly unusual isn't it, for the patient not to have talked to you?
DW: No I don't think so.
SJ then reads out the consent form which says 'my doctor has talked to me...' and mentions discussion of alternative treatment and fertility having been discussed w/ patient.

DW: There is lots to discuss at this point and that's only one thing. You have to consider what the child will understand. There is no long term impact on fertility of taking PBs. It's just a long term pause. I was happy I'd given Mum the broad overview & answered her questions.

SJ: Isn't there an area where some aren't accepting of identity, so the decision taken may reflect the desire of the parents depending on their attitude? Ensuring the child had been directly involved in the process, seeing the child with the mum in the meeting...

...that had happened before with Dr Pasterski, you'd met together, there was no bar to having a meeting with the child.
DW: I have never been presented with a situation with the parent leading the child, it's always the child telling the parent - in my experience of gender care.

DW: Fertility was discussed in several email exchanges with the mother...I answered her questions
SJ: You did not think it necessary to have a consultation with the child before February?
DW: I did have a meeting with child in Dec but did not think necessary to discuss fertility.

SJ: "He's adamant he doesn't want children but I'm not sure that's something a child of 11 can be definite about?...but I know PBs don't interfere with fertility, do they" - said the mother in her email to DW. There is still a question in the mum's mind yes?

DW: Yes, I said to the Mum that infertility should return if puberty stops being blocked and I also discussed egg retrieval whilst on blockers. The mum had had personal experience of this (egg harvesting) and I explained more about it.

SJ: One might think that a child of that age might not understand implications of this course of action. Is it appropriate to factor in what Dr Pastersksi was saying about this boy and his psychiatric history? [refers to bit read out before - ADHD possibility]...

OMG

What 11 year old can possible understand future fertility? Not that it appears they were really consulted in any case.

HW is being really vague about whether or not she carried on working for a couple of months after she was suspended. I wish I could see her evidence on screen. In the tweets her account doesn't come across as very credible but it might just be the way it's written up.

twitter.com/tribunaltweets/status/1441057928815935490

@Signalbox

Oh my...

For patient C (10 years old)

@tribunaltweets

DW = Helen Webberley

SJ: So looking at entry for Dec 8th. 'We fully discussed role of blockers which would prevent further female puberty developing and give a chance to decide which puberty would be best around age of 14. We did not talk about fertility...'

We forgot to talk about fertility but would return to it'. [DW's own record].
DW: Age 14 is a good age to decide which puberty is right.
SJ: So you felt putting this child on blockers for about 4 years was a safe and best course of action?

SJ: Starting gender affirming meds so soon after blockers, was your concern that it was too soon?
DW: As soon as puberty was started it was blocked so it's not length of time without blocker that's an issue it's the amount of time without sex steroids.

DW: We were talking about different groups with delayed puberty. Puberty can happen at broad set of ages so age is not only factor to consider when to start puberty but the issue is really when to start sex steroids.

SJ: When was fertility discussed before Patient C signed the consent form in Feb?
DW: I have put all this into my witness statements.
SJ: But in terms of dialogue did it involve patient directly?

DW: It involved me talking to his mother.
SJ: Why not the patient too?
DW: I thought it was appropriate to talk to the mother not the patient.

SJ: But Patient C signed consent didn't he?
DW: In this situation both parent and parent consented.
The Mum discussed with the patient not having children, and he was adamant he didn't want them, tho note at age 11 it's difficult.
SJ: You relied only on what the mother told you?

SJ: This is highly unusual isn't it, for the patient not to have talked to you?
DW: No I don't think so.
SJ then reads out the consent form which says 'my doctor has talked to me...' and mentions discussion of alternative treatment and fertility having been discussed w/ patient.

DW: There is lots to discuss at this point and that's only one thing. You have to consider what the child will understand. There is no long term impact on fertility of taking PBs. It's just a long term pause. I was happy I'd given Mum the broad overview & answered her questions.

SJ: Isn't there an area where some aren't accepting of identity, so the decision taken may reflect the desire of the parents depending on their attitude? Ensuring the child had been directly involved in the process, seeing the child with the mum in the meeting...

...that had happened before with Dr Pasterski, you'd met together, there was no bar to having a meeting with the child.
DW: I have never been presented with a situation with the parent leading the child, it's always the child telling the parent - in my experience of gender care.

DW: Fertility was discussed in several email exchanges with the mother...I answered her questions
SJ: You did not think it necessary to have a consultation with the child before February?
DW: I did have a meeting with child in Dec but did not think necessary to discuss fertility.

SJ: "He's adamant he doesn't want children but I'm not sure that's something a child of 11 can be definite about?...but I know PBs don't interfere with fertility, do they" - said the mother in her email to DW. There is still a question in the mum's mind yes?

DW: Yes, I said to the Mum that infertility should return if puberty stops being blocked and I also discussed egg retrieval whilst on blockers. The mum had had personal experience of this (egg harvesting) and I explained more about it.

SJ: One might think that a child of that age might not understand implications of this course of action. Is it appropriate to factor in what Dr Pastersksi was saying about this boy and his psychiatric history? [refers to bit read out before - ADHD possibility]...

A 10-year-old gave consent to a medical therapy with potential life-altering consequences without discussing those consequences fully with the medical practitioner involved? And that was OK because the mother received some of the necessary information from the medical practitioner and passed it on to the child?

As a former health practitioner I'm speechless.

Information is only relayed indirectly via a third party to obtain consent in cases of language barrier where an interpreter is used, and interpreters are trained to pass on information verbatim without putting their own spin on it.

It is well-established that patients (and their parents) correctly understand and retain only a portion of the information communicated to them in medical contexts. How can it be ethical to base informed consent on the assumption that a non-expert parent - with incomplete understanding and recall of the relevant medical information and without the expert knowledge to answer questions - will pass all the necessary information on to their child, without any direct input or quality control from the medical practitioner?

Consent by Chinese whispers.

It's shocking, yes.

Slightly more worrisome that Webberley doesn't consider the situation unusual...

[quote Signalbox]HW is being really vague about whether or not she carried on working for a couple of months after she was suspended. I wish I could see her evidence on screen. In the tweets her account doesn't come across as very credible but it might just be the way it's written up.

twitter.com/tribunaltweets/status/1441057928815935490[/quote]
The other live tweeting account has a bit more detail. I think it's from here and goes on for quite a lot if tweets. But she is vague and confusing, and never says 'no I did not work beyond that date' in a forthright uncomplicated way, but illustrates it by saying the spreadsheet shows when she had patients.
mobile.twitter.com/MPTS_Hearing/status/1441057058107715585

Part of webberly's defence of herself seems to be that it wasn't a life altering treatment, because pb are only a 'pause' and don't affect fertility in themselves. I know there's lots of evidence that that isn't a good way of looking at them, but it's possible the tribunal will agree with her on that.

It is weird how the TRA's think she's doing great - schooling the court on how to provide care.