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

In other words, Manderley, MW is applying the standards applied to transgender medicine to other medicine; self diagnosis, affirmation, self prescribing, and lack of evidence base for treatments.

I’m not on Twitter. Could someone who is perhaps @soniasodha with a link to the Tribunaltweets and a quick explanation of what the case is about? She seems willing to go where others fear to tread.

All of the charges are up on Tribunal Tweets2 (I'm late to the party) and it reads as bad as the tweets. Allegations such as:

You failed to declare:
Your lack of qualifications to manage the care of minors;
That Dr HW was no longer a credible MDT member as she was subject to an interim order of suspension;

Detailed an inadequate MDT make-up;

Stated that:

GnRHa was required to entirely prevent the onset of puberty in suspected transgender minors, which is contrary to expert guidance;

There was a 50% risk of attempted suicide in young transgender clients, which was not based upon UK statistics;

Dr TS was a Consultant Clinical Psychologist, when she was a qualified counsellor

I'm going to look at the rest now.

Does anyone know what's happening with HW? I thought hers was due to restart soon?

That Dr HW was no longer a credible MDT member as she was subject to an interim order of suspension;

that should be relevant to her case too as it suggests she was breaching her suspension/passing herself off as something she was not (a registered health professional)

There must be a crime of exploiting vulnerable people for financial gain.

Is that not what this is? A medical protection racket? "Pay us or your kid will kill themselves"

Tribunal resumes this morning. Dr Kieran is up to give her evidence. She's a clinical psychologist from NIreland who works in their GIDS service. I'll try to C&P some of it today but alas, I must work at some point!

Re: Patient W, discussing consent & treatment:

AK: there was enough information in the first written questionnaire, to seek permission to liaise with other professionals and CAMHS, and to offer W mental health support to explore gender identity. Makes reference to 15 suicide attempts, including one in the previous 30 days.

SJ: MW makes no attempt to assess W himself or ensure further assessments by other professionals.
What evidence do you see of MW making assessment of what's going on etc.
AK: No evidence of MW considering further assessment. Talks about medications.

AK: my experience of testosterone therapy is that it can be very difficult especially if there is history of disregulating emotions.
SJ: there is then a period of disengagement.
AK: after they start testosterone they stop payment. But then they come back.

SJ: there is then re-engagement with the patient. Lead counsellor is noting that I've just had a chat with U, is looking to restart prescription, Patient has not had a good time recently, [further background not provided]. What should have happened before any further

SJ: prescribing?
AK: there should have been a thorough psychological assessment and liaison with mental health professionals. There is a diagnosis overhang and all problems put down to gender distress. The patient had reported sexual violence also.

This is back on today.

nitter.net/tribunaltweets/

I'm not sure who 'AK' is, the witness being interviewed today. They're discussing the patient who was 9 at time of treatment from Dr W.

'AK: there are a few indications that the child might have communication challenges: dyslexia, ADHD, auditory processing difficulty. So difficulty in understanding either written or oral information. There were special communication needs.
SJ: did you see any evidence that the communication issues had been addressed ?
AK: I saw no consideration of those issues. There was no attempt to adapt the information to Patient Ts needs or age and understanding.'

The tweeting then gets a little confusing because it seems to move to Patient U (potential mishear of w?) but it is utterly shocking. A young person in supported living, receiving counselling due to borderline personality disorder and on antipsychotic meds (respiridone ffs) with a history of auditory hallucinations that they act upon, and what does MW do? Lob testosterone at them! No consideration around capacity or multidisciplinary working, no, just more meds. Wtaf was he thinking and how can he live with himself?! It's utterly appalling. Like others have said, how is this not criminal???

Oh, I'mnotavet, sorry, I somehow missed your posts!

AK: at the point of taking over the case there were only some email records, that was all that was available.
Chair: Dr K you said there were just email records, what would you have expected to see:
AK: we would expect to see clinical notes from all interactions with patient and family. We would have MDT records and reports. We would have personalised diagnosis and documentations, not form letters

@DomesticatedZombie

Oh, I'mnotavet, sorry, I somehow missed your posts!

No worries, I'm ranting away to myself. It's a fucking shitshow. My language is vastly deteriorating because I'm so bloody appalled!

@Lovelyricepudding

But four year olds believe in magic. As well as a potion to turn them into a boy they may also want one that would make them fly or invisible or turn them into a dog. It is not grounded in reality.

My four year old niece wanted to be a horse. When she went to the shoe shop for new shoes she would stand holding on to the chair seat and lift her feet up one at a time to be “shod”. Luckily no one offered her ketamine instead of calpol when she had a temperature. That’s what you do with four year olds, you indulge their funny little ways , and 99.999% they grow out of them. You don’t start talking to them about making permanent changes to their bodies.

SJ: what can you say about this report and the person's qualifications?
AK: the report is poorly prepared
AK: no context on number of appointments (appears to be one off phone call), wildly inadequate, no appropriate discussion, no liaison with mental health professionals .
SJ: questionnaire says no medical problems, is that accurate?
AK: this is the problem with a written questionnaire. There is plenty of evidence to suggest that there are mental health problems such as disordered eating, borderline personality disorder, etc.
SJ: do we see any evidence that the person has been properly diagnosed?
AK: there is no diagnosis given

...

AK: there was enough information in the first written questionnaire, to seek permission to liaise with other professionals and CAMHS, and to offer W mental health support to explore gender identity. Makes reference to 15 suicide attempts, including one in the previous 30 days.
SJ: MW makes no attempt to assess W himself or ensure further assessments by other professionals.
What evidence do you see of MW making assessment of what's going on etc.
AK: No evidence of MW considering further assessment. Talks about medications
AK: my experience of testosterone therapy is that it can be very difficult especially if there is history of disregulating emotions.
SJ: there is then a period of disengagement.
AK: after they start testosterone they stop payment. But then they come back
SJ: there is then re-engagement with the patient. Lead counsellor is noting that I've just had a chat with U, is looking to restart prescription, Patient has not had a good time recently, [further background not provided]. What should have happened before any further prescribing?
AK: there should have been a thorough psychological assessment and liaison with mental health professionals. There is a diagnosis overhang and all problems put down to gender distress. The patient had reported sexual violence also.
AK: just a rosy description of 2 years of stability and a great time to restart testosterone.
SJ: referring to lead counsellor description following skype, two years of stability, we need to support him, hormone therapy will help him move forward with his life, enough pain
SJ: does that meet the criteria for a diagnosis?
AK: no it is not sufficient and it is not an accurate picture of the patient's condition.
SJ: patient reports to MW, seeing a counsellor at MIND, and having 24 hour supervision where living. MW responds he is dealing with some issues raised. And will get back to patient soon. Then MW gets in touch. Is this adequate and what should have happened?
AK: no it is is not adequate. There is evidence that MW knows there are mental health professionals, on respiridone (?), has history of hearing voices and external commands on behaviour. MW should have been directly engaged with the patient, the physicians assessment and to engage with mental health colleagues. Patient U could have been acutely psychotic.

• there's quite a lot of this thread, and I'm getting a bit confused as nitter sometimes seems to jumble the posts up. But it looks like a terrible failing of this patient to have somehow not contacted the mental health team/HCPs already working with them before prescribing anything.

SJ: expand on how you knew mental health issues that MW should have known about.
AK: on the form, borderline personality disorder, on anti-psychotic meds, living in a supported environment, this is all clear evidence that the patient is well know to mental health professionals and he needs to get in touch
SJ: what if the patient says 'don't talk to my other health professionals'
AK: it is part of informed consent that there must be a holistic picture and knowledge of the patient, liaison with all other health providers, it is part of how to practice gender medicine
SJ: now going on to capacity and consent. Asking how mental capacity is assessed with the type of mental health issues that present?
AK: we wouldn't assume no capacity but things like voice and command hallucinations and active psychosis, substance misuse
AK: including suicide attempts might indicate that there is a lack of capacity. But not an automatic lack of capacity to consent.
SJ: Also you indicate capacity can come and go. Who is qualified to assess that capacity?
AK: this is where the MDT comes in.
AK: it's not helpful for one person to make that decision, it's very complex and difficult.
SJ: if it is one person, what skills do they need?
AK: they need skills and experience with assessing all of the problems that U presented with.
SJ: does the written summary represent an assessment of capacity
AK: not in my opinion.
SJ: what are problems with prescribing testosterone to this patient?
AK: first is the impact of the hormones themselves on the persons mental state
AK: the second is did the person have the capacity to consent at the time. Neither were covered in the written assessment

the impact of the hormones themselves on the persons mental state
... the second is did the person have the capacity to consent at the time. Neither were covered in the written assessment

This is the patient who sadly went on to take their own life, if I'm understanding correctly. This is appalling. How badly failed they were.

Yes DomesticatedZombie, I think this is that person (but not 100% sure). How did he not contact MH services? What was he thinking? He's a gastroenterologist fgs. I don't even have the words tbh. It's very clear why he hasn't tried to defend himself, there doesn't appear to be anything defensible.

I don't know what's happening with HW, according to tribunal tweets her case was due to resume this week.

This is just a disgrace. This man should be investigated for criminal negligence.

SJ: Moving on to Patient V. Message to support at 'MyWebDoctor' with history of patient, referencing issue of patient's identity. Written by parent on behalf of V. Desperate to get on hormone blockers as soon as possible, mood shifting etc. Patient just under 10 years of age

SJ; see a reply from MW to mother, 'very happy to help you (why do they have to go through puberty so young?), there is a big process to go through, who will inject the hormones, is your GP on board?, can the practice nurse do the injections or teach you?

SJ: what is your impression AK on this?
AK: mum's history is comprehensive and clear there is distress. But it is complete inappropriate to start out with the assumption that puberty blockers will be prescribed, negates the purpose of diagnosis and assessment.

SJ: now in AK's report. 2 professionals involved in V's care, both counsellors. Can you set out what you would have expected to happen?
AK: MDT assessment of child, family, expert in child development as well as GI, plus medical professional who is going to possibly prescribe.

SJ: what should be the sequence of contact with GP, other professionals and blood tests before assessment.
AK: we would engage the GP from the beginning following the shared care guidelines, endocrinologist would initiate and possibly GP would take over after 3-6 months.

SJ: Do they same starting points exist with this patient, that they should be followed.
AK: the child is 9 and the same considerations apply, how best to have a 9 year old participate in the assessment. The child didn't speak during the assessment only the parents.

AK: It is important that an expert with experience in dealing with children is engaged in the discussion, can build trust, encourage communication with the child.
SJ: Referring to written questionnaires and referring to get blood tests done. what is the relevance of blood tests.

AK: we wouldn't do blood tests until we were ready to prescribe so after assessment, and we would do it prior to agreeing that treatment could commence.
SJ: Referring to document, 'Gender Identity under the Age of 16'. Questions were read to 9 year old child by mother.

SJ: And if not applicable did not read them the questions. What do you think of that.
AK: The questions are described as under 16 but not appropriate for 9 year old. Reading the answers there is no way of knowing what the child thinks. And some of the questions mum deemed

AK: 'not applicable' we would certainly explore those areas with a 9 year old. Needs an experienced clinician to explore with the child. All of this through the lens of the mother.

SJ: GenderGP 'questionnaire answered fully', please send link for info gathering session.

SJ: Given that mother decided some questions were not relevant, how could counsellor deem questions fully answered?
AK: they weren't fully answered and this is the difficulty.
SJ: From records 'Responses reviewed by MDT, no issues raised' entry by MW.

SJ: is this an actual MDT?
AK: it should have been described as responses from a single member of the MDT, not the actual MDT.
SJ: is MW's role a proactive role or a reactive role?
AK: others should gather the info, but then discussed and agreed all together.

SJ: on the 'no concerns raised', is this adequate?
AK: many responses that I would like to explore further with the child, not to mention the questions that were not answered. I would like to encourage further exploration and differences between gender roles and gender identity.

SJ: counsellors and psychogender therapist, are you familiar with this?
AK: it's not a term that I recognise or I would use myself.
SJ: reads out elements of the report.
AK: first, they are inaccurately reporting the age of the child who is 9, not 12.

AK: areas requiring further exploration: child was very shy and did not speak, mother answered all the questions. I would like to engage directly with the child to understand their feelings. No signs of mental health assessment, for example looking for autism spectrum disorder.

AK: and no discussion of fertility.
SJ: the phrase 'no reason not to prescribe, no reason not to help them'
AK: they haven't actually said how the patient meets the diagnostic criteria. It's not about being helpful or no, it's about meeting the diagnostic criteria.

SJ: reads out parts of the standard letter, will your GP help, do you need counselling,
AK: the statement 'we have completed the administrative side' appears as a tickbox exercise rather than a chance for the child to explore in a therapeutic space.

AK: also, the implication that counselling is the exception or shouldn't be needed, not the norm. Finally, asking for the detailed summary is an attempt to document the patients understanding. It is not sufficient, it fails at that.

SJ: now an email to Patient V & Mother, asking about surgery and stage of puberty. Where does that fit in, is it appropriate.
AK: it is appropriate, blockers are prescribed at Tanner stage 2. That's appropriate but usually undertaken by the paediatric endocrinologist.

SJ: then a reply from the mother, doing the assessment of puberty.
AK: I can only relate my experience, our endocrinologist would absolutely demand to do the exam themselves.
SJ: Quoting ME email I'm thinking about someone else to get your second assessment
SJ: an appropriate step?
AK: yes an appropriate step.
SJ: problems with email, also your paediatrician has expressed concerns, I will be making the final decisions, we will have our child psychologist undertake the second assessment.

SJ: what is the paediatricians concern?
AK: that the child was going on blockers, after no real period of assessment and via a private doctor and not the NHS.
SJ: now referring to consent form that combines puberty blockers and cross sex hormones.

SJ: is that appropriate?
AK: it is confusing especially for a 9 year old child. What side effect applies to which. It also implies that its a single step approach blockers plus x sex hormones.

SJ: now quoting MW notes from Skype assessment. Dangerous to not proceed. Recommends that child goes on blockers. What are your comments.
AK: the comments around danger and mental health problems are common in gender distressed children. But that's general not specific to

AK: this patient. Doesn't speak to this child's mental health. Says 'buy time and make further assessments'. But then no further assessments are actually offered or carried out. Treatment should be part of a care plan, showing how it will help,

AK: and what further steps might be contemplated.
SJ: now discussing MW comments on the need for the physical examination of the child and the psychological examination and assessment of the child. Does the Skype consult meet either of these criteria?

AK: no it does not satisfy those criteria. It may provide information to the child, moving towards informed consent. But it doesn't address the physical examination of puberty or mental health assessment by a child psychologist.
SJ: could MW carry out mental health assessment

AK: no I don't imagine he's competent to do that.

Chair: statement in document 'if puberty is allowed to progress further there is a very real danger of self harm or mental health issues'. Is there any evidence of these risks in the patient's records?
AK: I saw nothing that would indicate self harm or mental health problem

AK: this patient had many protective factors to mitigate the general harm.

Good to see the Chair asking pertinent questions.

This is absolutely horrific. Child V is 9, not far off 10, so year 5 in the English school system. I remember vividly what my children were like at that age. A long, long way from adulthood, still very much children. Child V didn't speak to Webberley during the Skype consultation. All questions were answered by the mother on child's behalf. Inappropriate information given to child - not written with a 9yo in mind. If I'm reading this right, Webberley wanted to go right ahead and put child on puberty blockers with no mental state examination, no physical examination and no blood tests. Consent form to be signed would be for puberty blockers and cross-hormones, which gives the lie to the oft-repeated statement that puberty blockers are just a harmless pause button, totally reversible.

This poor, poor kid. I wonder how things turned out.

Yes and the prescription for 'puberty blockers' is written within two minutes of the Skype consultation. I'll try and C&P more but things are a little busy with work so it may have to be later if it's of help to people?

I would appreciate it very much if you have time. Thanks to all who have taken the time and trouble to c&p across from Twitter to this thread. It's horrible but it's important.