Dr Michael Webberley

[DomesticatedZombie]

• haven't had a chance to keep an eye on his tribunal, but from what I'm reading:

'Dr Michael Webberley applied for voluntary erasure from the GMC register. The Tribunal say it is "unfortunate" that was not determined prior to the hearing today.

MW had two requests for postponement declined & has now provided new medical evidence for an adjournment'

twitter.com/tribunaltweets2

@tabbycatstripy

I’m sure the expert witness is telling the truth but actually, what it says to me is that this area of medicine is experimental and can’t be done safely. Exploring ‘available gender roles’ and options for being a parent once one has been rendered infertile in pursuit of the impossible and then put on mood-lowering drugs doesn’t sound good for any kid, frankly.

tabby, I've been reading this trying not to bloody cry.

Obviously it's clear why MW isn't attending - this is literally indefensible surely? Does anyone know if his lack of attendance/refusal to engage will have any bearing on the case/outcome?

Yes and no. The panel won't assume he's guilty because he's not turned up, but he'll lose his opportunity to give his side of the story.

In these things, the prosecution goes first. The case can look incredibly damning when they've finished, and then a clever defence lawyer comes and picks it all apart, and suddenly you're in a very different place. He loses his opportunity to do that, which may mean things are proved that could have been defended.

Where it's likely to make the most difference is at the sanctions stage. When deciding on sanction, the panel starts from the bottom and works their way up. They have to give the lightest sanction which addresses the concerns raised. The MPTS has the following sanctions available:

1. Do nothing
2. Agree undertakings
3. Conditions
4. Suspension
5. Erasure

Clinical failings are typically dealt with by undertakings or conditions - you have to work under supervision, or not do these types of care, or do this sort of retraining or that sort of audit. The idea is to retrain the professional back to safe practice. But they're really only on the table if someone engages in the process - you can't retrain someone who doesn't want to know.

So, assuming faults are found proved not turning up basically forces the panel to either do nothing or, if that's not appropriate, move to suspension or erasure.

This was back on today, in court, and now adjourned until at least the 22nd. I believe the GMC now retire to consider all the evidence and make decisions.

If anyone is on twitter, would you be able to do a 'thread unroll' thing, so we can get a full thread on here, pretty please? I'm looking at them on nitter but they are all jumbled up and out of order.

twitter.com/tribunaltweets2

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 .

You're a star, thank you Boadicea2!

' 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.'
' Plainly Gilick competence cannot happen in 10 minutes'

@DomesticatedZombie

You're a star, thank you Boadicea2!

' 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.'
' Plainly Gilick competence cannot happen in 10 minutes'

10 minutes...no words for that level of incompetence. Thanks for the C&P, I've been really busy and it's good to have it all in place.

That means that both HW and MW's cases are heard, I wonder how long until the outcomes?

This was back on today, in court, and now adjourned until at least the 22nd. I believe the GMC now retire to consider all the evidence and make decisions.

It's the MPTS making the decisions rather than the GMC. The GMC has taken its case about MW to the Tribunal. I'm hoping they've brought enough strong evidence for the outcome we all want.

thanks, iklboo, for the clarification.

Assuming Child B was seen in 2017, and was 9 then, she's 14 at most now. Five years of puberty blockers if she persisted with them, or more likely if her parents made her persist with them. Poor, poor child.

Oh yes, and many thanks for the tweet thread, @Boadicea2.

TribunalTweets2 have tweeted to say "We expect to report the Medical Practitioners' Tribunal finding of facts in the case of Dr Michael Webberley tomorrow morning. It has been delayed since 6 May."

Oh that is interesting @PrelateChuckles. I'm not on Twitter atm but hopefully it will on MN at some stage

still nothing yet ...

Nothing yet.
You shouldn't need to be "on" Twitter, just go to twitter.com/tribunaltweets2 (unless you get the prompt to sign up/log in, which Twitter have started to put up more and you can't click out of it any more and just see the page )

5:30pm and nothing? Is the office shut now?

Seems really odd to me.

I’m on an iPad, so when I get the sign up/log in prompt I press “sign up” (as I don’t have a Twitter account) this takes me to a new window which I am able to close and can then view to my heart’s content. Hope this help you non-Mac peeps

I'm working through the determination now (bloody hate these things, so long!). Short summary: lots found proved, some not proved. They have found him to be dishonest. There will be a further hearing to determine what sanction, if any, will be imposed. As I said, very short summary!

drive.google.com/file/d/1Xsv8zghhgvbzCSZADpaFGeTxgMemS9hq/view

Not sure if that will work. It's a beast of a document (again).

From Tribunal Tweets:

The medical practitioners tribunal has found that Dr Michael Webberley, who ran an online clinic prescribing testosterone to men in the UK and Gender GP, an online transgender clinic, failed to provide good clinical care to patients and was dishonest.

Some allegations were found not proved, on the balance of probabilities, the civil standard of proof used by the tribunal.

The decision has detailed consideration of the law and expert evidence and each element of the allegations and is 305 pages long.

The tribunal found Michael Webberley's failure to provide good clinical care for patients related to consultations, history taking, examination, diagnosis, prescribing, delegated communication, follow up, assessment, working within the limits of his expertise and the guidance.

Patient consent forms contained information that was untrue and informed consent was not obtained. Michael Webberley failed to establish an adequate Multi-Disciplinary Team. The tribunal also found his actions were dishonest.

The tribunal will now consider if Michael Webberley's fitness to practise as a doctor is impaired.

Sanctions may be imposed to protect the public, maintain public confidence in the medical profession and proper professional standards and conduct for the members

The tribunal will continue (dates tba) with evidence of Michael Webberley's fitness to practice.

It can place conditions on the doctor's registration, suspend registration or erase the doctor’s name from the medical register, so he can no longer practise.

There were a number of allegations of dishonesty.

Allegations 83- 88 concerning facts on operation of Gender GP & the involvement of suspended Gender GP, Dr Helen Webberley were found proven.

Allegation 89 on dishonesty related to use of the Gender GP name was found not proved.

For the love of all things good Mumsnet, what is going on with paragraphs!,

Screenshot

I'm on an android tablet, your paragraphs are showing @Imnotavetbut

Sorry, thank you !

Very heartening to see the large number of watchful doctors out there that spotted something wasn’t right and made the referrals.