Thread by @tribunaltweets

High Court hearing: HHJ Pearce (J) is sitting on the matter of the extension of the supension of Dr Helen Webberley (HW)'s license to practice as a doctor, while her tribunal is still in process.

Tim Buley QC (TB) is representing HW. Laura Barbour (LB) represents @gmcuk.

We are permitted to live tweet.

Counsel have submitted additional submissions.

TB - HW wants to put undertakings before the court. The GMc as applicant has failed to make their case for continued suspension.

Para 7 of written submission: HW's undertakings developed without GMC input or request.
1. She will follow the WPATH guidelines standards of care 7th edition and Endocrine Society (ES) guidelines, the ones she is alleged to have breached, so meets the charges re Pts A, B & C.

Public interest can be met through the ES guidelines. She meets the criteria for treating adults, prepubertal and adolescents.

My client accepts no PBs for prebubertal children. She has never treated prepubertal children,

ES accepts puberty blockers for adolescent (after they first exhibit pubertal changes).

Adolescents including under 16 year old - prescribe gradually increasing hormones after using a multi disciplinary team (MDT). HW will use an MDT
She will keep a log, available for the GMC.

If necessary for public protection, she will give an undertaking that she will not prescribe any medication.

It is offered if required, so she can at least begin the process of making a return to practice eg training and speaking at conferences.

TB refers to LB's submission. As in the case of Hue (sp?), LB doesn't dispute in principle that undertakings can be relevant. Relevant factors are the same factors as the IOT including gravity, nature of risk, (too fast) and for protection of the public and the public interest.

Fyi - IOT is @the_mpts Interim Order Tribunal. mpts-uk.org/hearings-and-d…

TB refers to para 4 of LB's submission that the measures in place have to cover all the concerns, and must be enforecable.

This is wring. Not all concerns will be capable of justifying a suspension. The relevant concerns must be sufficiently weighty to be addressed.

The reasons for suspension must be proportionate. It's been 4 1/2 years. GMC ask for another 8 months suspension.
Most of the concerns re Pts A, B & C do not justify that period of suspension. Using initials (prof college) after her name is not serious enough "for the birds".

Undertakings to a court are enforceable as a contempt of court. It may be less convenient to enforce. TB doesn't see why such udnertakings are not workable.

HW will keep a log of treatments. It would be very serious not to do so. TB notes the extraordinary length of time.

LB - in offering undertaking, HW tries to present the case as a narrow one about clinical concerns.

One is prescribing - and a complete blanket ban on prescribing.

Much wider issues.
1. the clincial undertakings don't go far enough
2. the issues are much wider

The hearing information sheet specifies the Pt B allegation 3 d iv - a faure to make proper enquiries on the pt's presentation in terms of puberty and tanner stages.

This case is complex. Concern abt whether HW hads the same understanding about what is required by the regulator

How can the High Court monitor in a meaningful way the undertakings?

J - no power or role in monitoring. Difference in interpretaion may make policing difficult.

LB - how will court be satisfied the conditions are met?

Enforceability requires identification of a breach and then action taken because of that breach.

Although the undertakings taken from a prepared bank, It won't be possible for the ct to know they were being met.

LB said TB said she would get training and speak at conferences to prepare for her return. GMC advise those things are available to HW now.

The submissions in writing prepared by TB was provided at 4pm on Friday so no blanme at one parties' door or the other.

LB Para 9 of her submission - specific allegations 2a i & ii and 4 and 6 that HW was in breach of these guidelines.

In certian circumstamces, agreed undertakings (u/t) could be relevant - maybe where a doctor has two areas of practice, not to work on one area under investigation

LB - the question of sufficiency to address all the concerns - taken sometimes individually and cumulatively the allegations are so serious that suspension is essentially.

Enforceability - been a breach? What can we do about it?

A lack of mechanism for the court to impose a sanction.

How can court do adequate monitoring?

Often restrictions in place there is a system of monitoring and/or supervision.

At IOT, HW couldn't find someone to supervise her nor a 3rd part to report on her work.

Not suggested today, because LB says, she can't find monitoring.

The court has no system for monitoring and dealing with a breach, and the harnm would be done.

Also the imposition of undertakings at this stage would jeopardise public confidence.

LB said TB said that nothing justifies suspension. Allegation 10, described by TB as "letters after the name" re RCGP membership. She has admitted she used them in witness statement. Additional dishonesty re RCGP membership remains to be determined.

Alleged dishonesty categorised as letters after the name and "for the birds" fundamentally misunderstands the serious of that alllegation. Probity is at the heart of public confidence - and there are other allegations to be determined (Eg Frost Pharmacy)

TB objects to this as it goes a long way beyond the GMC's submissions last week.

J notes the difficulty but says seriousness is important.

LB - when considering if possible to police the u/t (Expression used by J earlier), there are concerns abt this doctor's probity. It wld be entirely dependent on HW's reporting of her own work. Clincal practice concern, probity & willingness to be reviewed are all real concerns.

LB - This isn't a q of convenience. The ct wld lack proper input. The regulator and MPTS can't assist the court in establishing whether and to what extent the u/t are being complied with.

The approp mechanism is the statutory one. The concerns are very wide ranging and serious.

If the court doesn't agree, then LB asks the J to refer the matter to the IOT. It could then come back before the court for review.

The determinations of the tribunal 26/11/18 - re HW's lack of insight and candour in dealing with regulators, so there was lengthy consideration about workable conditions. They concluded suspension was the only during the tribunal.

TB responds - my client supplied the determination sheet and invited the barrister who appeared last week to comment on it. So aggravating to have submissions made on it this week as if the ct hadn't previously seen it.

What the measures require to do is to address the concerns relating to the public interest.

TB - it is for the GMC to satisfy the ct that the order shd be made. So one wld expect some proactive approcah from the GMC re variations so no GMC input.

TB the conditions are capable of being monitored by the GMC which can then apply to the ct for enforcement.
Two concerns - treating pts A, B & C and wider probity concerns.
Probity concerns are nt sufficient to justify suspension and such a long period.

TB - The allegations re RCGP - my client's (disputed) evidence puts those allegations in a different light. She passed the exams, she stopped paying the fee - simply wanted to make the point that she had the relevant qualification. A mistake.

Doesn't justfy erasure or suspension. It has never been explained how those allegations of dishonesty begin to be sufficiently serious - eg failing to notify a body, and taking issue with terms of review into her practice.

Nothing in 2017 IOT found it justified. 2019 IOT not even placed before the ct.

Matters have moved on - many broad ranging allegations have fallen away and not put before MPT. Also in length of time of the suspension.

Are the u/t sufficient to address the allegations re Pt A, B & C? Yes. GMC can take action and possibility of contempt of court.

TB refers to the broader u/t of no prescription offered. He says exactly analogous to the two practice doctor example. Completely enforceable.

If there are additional procedural actions, then that can be done. It meets the public interest and probity concerns as no prescribing. Very difficult to see how public protection (of pts) isn't met.

J will deliver judgment at 12.10pm.

HHJ Pearce - the overarching objective of the GMC is protection of the public and they have statutory powers to investigate and refer to an IOT. The IOT has power to make interim orders or suspension. Beyond 18 months, claimant may apply to the High Court for review.

The Ct may squash, revoke or vary the order on applications for extension that is no order, the claimant's request or shorten the order.

Parliament inserted a condition that allows extensions as longer periods than 18 months may be necessary, and exercised by the ct.

Ct acts as primary decision maker. Criteria are the same as the original order - gravity, nature of evidence and impact on public and reasons for extension.

Ct does not consider the merits. J quotes LJ Ardern on this matter.

Decision on extension and the allegations, not the merits of the case.

para 33 Hue (sp?) decision by LJ Arden - the Ct can look beyond the allegations. Para 29 - GMC reasons.

Delay - NatWestMarkets plc 2021 case - judgment handed down 19 months later. The general rule is deliver within 3 months because justice delayed is justice denied.

The delay in the NatWest & Bilter case was inexcusable. Delay alone does not allow setting aside a judgment. Special care is required.

J notes what TB said having issues of dishonesty hanging over the doctor and says mere delay isn't sufficient to interfere.

J summarises the length of the tribunal, which adjourned on 15 Oct. Tribunal will reconvene for 4 days ion jan and reconvene for it's findings in April, to consider Dr's fitness to practice and consequences.

J shares concern that it may not conclude until 2023.

Request for 8 months extension would not cover the case through to conclusion if impairment is found.

TB submtted u/ts were offered on behalf of the doctor. Even if the claimant cld make out an argument for extension, it would be disproportionate on HW.

The J adjourned the hearing last week to allow further submissions on this.

J summarises the history. CQC suspended an orgn HW worked for due to concerns abt inappropriate prescribing. Not all those concerns have been laid before the tribunal. Some have been.

10 areas of concern:
1. Pt A - prescription of testosterone inappropriate for a 12 year old. A gave evidence "probably life saving treatment."

2. Pt B - over 16 years

3. Pt C - under 16 yrs - TB said less serious as puberty blockers (think this was due to an implication its' reversible)

4 Pts D & E
5. Membership of RCGP
6. completion of form for Pharnacy
7. failure to notify phramacy suspension of
8. allegation she frustrated investigation by Aneurin HT
9. Gender GP involvement
10 - conviction of running an unregistered agency

J notes 5 & 7th involve allegations of dishonesty.

AllegatIon 9 is a disputed fact as to whether she operated and controlled Gender GP or not.

The tribunal allegations are not the same as those originally brought to the GMC - eg no allegation on Pt F before the tribunal.

Important to know the history and complexities and live allegations.

Conditions first made in May 2017.

Nov 2018 - IOT imposed suspension due to "serious and multiple concerns raised re clinical conduct and .... probity" and her conviction.

Nov 2019 - extended by order of the high court.

GMC Mr Stubbs' witness statement "serious and widespread concerns", inappropriate prescribing & assessments with care and treatment seriously below standards expected. LB said HW poses a risk to public safety and members of the public so IOT necessary.

GMC accepts investigation was lengthy. Mr Stubbs statement did not cover withdrawal of allegations (something else) and reasons for the delay to decisions in April 2022.

LB maintained that an interim order of suspension remains proportionate. She said the ct had no means of investigation, supervision or monitoring.

J says GMC considers how one knows if the Dr is complying with the conditions, and uses supervision and monitoring.

LB suggested a shorter period if necessary and referral back to the IOT.

TB said the Pts A, B & C were the most serious. Pt A is the most serious. TB drew attention to Dr Bauman & Dr Schumer's reports. J reads para 6 HW "acted in best interst of pt preventing years of suffering"

longer quote re listening to pts and stopping medical paternalism.

TB said that Dr Matt allegations , RCGP and conviction do not amount to suspension, as not proportionate in terms of length,

HW in witness statement - she has other actions required to practice again. She has been denied her livelihood, speaking, research and even didn't get involved in a medical emergency on a flight as she has no insurance. TB: balance of the public interest is her return to practice

2 proposals - that HW complies with WPATH and ES guidelines, keeping a log for every case onw hat she prescribed and why, or not prescribing at all.

J turns to consideration about the balance in this case.

J read Bauman - because different views and strong feelings. High levels of distress gender dysphoria.

Difference of expert opinion carries serious consequences for practice cannot absolve a dr from blame, and must examine & refect their own practice and be up to date.

J expresses no view on either set of opinions. The evidence is of serious allegations, not simply limited to pt treatment. Probity and/or failure of cooperation with regulatory process are serious.

GMC's duty of candour requires it brings not only the factual matters but also material relied upon by the Dr in defence, and shd include that some allegations were not brought forward. Risks the ct being seriously misled.

An uninformed reader could assume all the early allegations were before the tribunal. The GMC witness statement risks misleading the ct. Last week's GMC counsel said no harm done.

J says important that GMC discharges it's duty of candour with the full picture.

J says a regulator that has delays is likely to undermine public confidence. 3 months in commercial courts is not a target. It is a maximum.

The timeframe must have become predictable during the first stage. That shd have been considered then - resources of staffing and premises

shd have been taken in mind when making decisions on timings.

It is not possible to justify a delay to April nor to justify a suspension for a further delay.

It must be possible for MPTS to manage handing down the determination in public so the delay from Jan to April is simply incomprehensible,

Could a shorter period of suspension be justified?

In respect of the u/t, the first set are problematic. The High Court could be faced with dispute on whether HW had complied with guidelines.

J does not consider first u/t offered is enforceable or workable.

Not prescribing at all has an attraction - as facts will be clear, But GMC argument is that the ct is left without a clear mechanism to use.

With no monitoring a dr cld prescribe, and GMc be in ignorance. On a narrow balance, some form of suspension is proportionate.

Suspension for 3 months from today - so can be referred to IOT and MPTS gets tribunal.

J tells MPTS & GMC to consider his reasons if there is any return to the High Ct.

LB will draft an order for the J. In light of significant criticism of the GMC witness statement, no order for costs requested.

TB requests that soem proportion of HW's costs shd be born by the GMC.

TB: The GMC did not comply with their duty of candour. That had practical consequences. Significant work was undertaken by HW's legal team.

HW has not got (CPPR teference) what she claimed. A much shorter period could have been possible. But she is the successful party.

The logic may be that an IOT will be better placed to formulate ongoing conditions. TB said in circs and without GMC cooperation, GMC shd pay 40% of the costs.

J Claimant concedes judgment is critical of GMC. In truth, the claimant is the successful party as they got an order (albeit shorter period of time.)

"I am critical of the claimant's efforts."

But GMC were successful so balance with them.

No order as to costs.

The judge's elegant summation of the case and judgment will be posted here when we have it.

TLDR: Dr Webberley remains suspended for 3 months. GMC critcised for not inclduing full facts in witness statement. MPTS criticised for not scheduling decision within 3 months of hearing evidence.

We expect dates for the tribunal's Stage 1 finding of facts decision in January>

and dates for impairment and sanctions stags before 6/3/22 &/or an Interim Orders Tribunal &return to the High Court if a new IOT decision is not accepted by HW.

This has been @StoatlyL reporting today.
We'll be back in 2022 for the decision on facts.
mpts-uk.org/hearings-and-d…

@StoatlyL @threadreaderapp please unroll