Thread by @tribunaltweets

Thread 8 of 22 - 9 - 2021.
SJ: now referring to series of correspondence between DRW and Dr Hindmarsh and Dr H's complaint. Quote 'furthermore I believe that a clinician was inflicting torture on Patient A by refusing to prescribe hormones for A'

SJ cont: I brought this up because you said that you respect the protocols of GIDS. DRW: I was attempting to acknowledge that other protocols and approaches can exist and can be followed. SJ: do you respect that he was following protocols.

DRW: the clinician in question wrote the protocol that he is following and I set out my feelings in detail for Prof Hindmarsh. SJ: you also said the Patient A was severely distressed. When and how was this distress presented?

DRW: mother of A previously mentioned that A's behaviour was horrendous, episodes of violence and doesn't care about anything. Behaviour troubles me immensely and is tearing our family apart. With tears streaming down my face I ask for your help again.

DRW cont: There was an interruption in A's care caused by another clinician. When I say I was presented by a severely distressed child, this is what I meant. SJ: referring to bone density problems arising from use of blockers in Patient A.

SJ cont: how is this correct if the plan was to stay on blockers until prior to the 16th birthday. DRW: in terms of blockers being correctly introduced, Patient A was part of the early intervention process at GIDS and had earlier access to blockers than 12.

SJ: what about harm from blockers? DRW: it is a definite consideration, and it comes from my experience with treating people with ovaries. Also I was feeling very passionate when I wrote to Dr H.

SJ: You said 'NHS England is out of date with international practice and acting illegally in regards to transgender health'. DRW: I was feeling passionate and perhaps illegal is overstating the case but the NHS constitution promising treatment in 18 weeks.

SJ: is your role as a voice for the trans community perhaps driving your approach too much? DRW: no, I'm a doctor first and would never lose sight of the medicine. SJ: Are you sure that your judgement becomes blurred by your passion and your advocacy?

DRW: no, I disagree. My judgement has not been blurred.

SJ: when you came to prescribe for A, (April 2016) did you have a clear plan for when to communicate with the Tavistock about Patient A? DRW: no I did not. SJ: you had to come to terms with the fact that they had a treatment plan that you disagreed with.

SJ cont: it was inevitable that your prescribing was going to become known? DRW: I had heard through the grapevine that patients of the Tavistock were being threatened for seeking private care. I was naive in thinking that a clinician would contact the GP and

DRW cont: persuade them to withdraw treatment. SJ: when we look at this chronology and the treatment plan, and you say you weren't aware of the possible reaction of the UCLH and Tavistock. Once you had prescribed did you have a duty to communicate with GIDS on this matter.

SJ cont: you must have thought about how to communicate with GIDS that there would be changes. DRW: I was hoping that I could work together with GIDS on the treatment of Patient A. It was my naivete.

SJ: It wasn't naïveté, you were actually saying 'I'm right, and they are wrong'. You should have fronted up to UCLH and explained what you had done and determined how to work together. You left it to the GP to do.

DRW: I didn't leave it to the GP, the GP chose to communicate with Dr Butler. I did not communicate with the Tavistock because the mother has asked me not to. It was not in the interests of the doctor patient relationship for me to communicate with GIDS.

SJ: you should have not agree with the mother of A that you would not communicate with the GIDS. You were the only source of hormones. It was always going to come out. The GP was going to talk to GIDS.

DRW: I don't believe that the GP had a duty to inform the other specialist that another specialist had been involved. I wish that Dr Butler had chosen to contact me rather than take the route that was taken and why we are here.

SJ: have you been a party to other shared care agreements. DRW: Yes. SJ: if another specialist had written to you and said I am now prescribing in conflict with the existing treatment would you not have brought this to the attention of the initial specialist.

DRW: I don't know what I would have done. I would have done the best thing for the patient. SJ: why did you not write to GIDS about what you had done? Were you not worried about the consequences? DRW: no I was not worried.

Tribunal chair: have we not exhausted this topic of disclosure we have spent quite a lot of time on it? Now discussing whether examination of DRW will conclude on schedule. I'm trying to manage the balance of cross examination. SJ: will try and finish on Patient A by 5 pm.

Last tweet of thread 8.