Helen Webberley is at the Royal Courts of Justice today, appealing the sanctions imposed by the Medical Practitioners Tribunal Service (MPTS). The sanctions were imposed following a finding of misconduct.
See previous Tribunal Tweets coverage here: tribunaltweets.substack.com/p/tribunal-of-…
See previous Tribunal Tweets coverage here: tribunaltweets.substack.com/p/tribunal-of-…
We are hoping to live tweet her appeal and have applied to the judge for permission. We are waiting to hear from the judge. Proceeding will start sometime after 10:30 am,
Abbreviations in anticipation of being granted permission (to the extent known)
HW - Helen Webberley of Gender GP
GMC - General Medical Council
MPTS - Medical Practitioners Tribunal Service
J - Judge
HW - Helen Webberley of Gender GP
GMC - General Medical Council
MPTS - Medical Practitioners Tribunal Service
J - Judge
Barristers not identified at this point. Expected to be different from those used for the MPTS proceeding. Will be identified as:
AB - appellant’s (HW) Barrister
RB - respondent’s (MPTS) barrister
AB - appellant’s (HW) Barrister
RB - respondent’s (MPTS) barrister
We have been given permission to live tweet.
Respondents barrister is Peter Mant, abbreviated as PM
Judge has arrived. Dealing with preliminary matters. BBC Wales has asked for remote access; was granted but no sign of such access. Also permission to live tweet. No objections from other side.
AB - dealing with a case where patient C’s mother approached HW. Mother looking for puberty blockers, puberty blockers described as fully reversible. Signed consent, etc. Sufficient contact.
We know that PC wanted to be treated with puberty blockers. PC was aware of risks. Family was aware of risks. No assertion that the treatment was wrong, or inappropriate.
J inquiring about the process; was misconduct and impairment taken together?
AB - no separate
(Further clarification).
AB - central issue is that risks to fertility should have been discussed with PC.
AB - no separate
(Further clarification).
AB - central issue is that risks to fertility should have been discussed with PC.
AB - PC was 11 years old, how can fertility be reasonably discussed with a child that age but this is the ‘failing’ that lead to HW’s finding of misconduct, impairment and sanctions.
AB now outlining the scope of the courts powers in this case and asking the court to have reference to the fact that this is the first time the MPTS had to deal with transgender care.
J - one point on the law: discussion of various detailed points;
J - one point on the law: discussion of various detailed points;
J - asking AB to clarify various precedent cases sited, establishing appellant jurisdiction. Does the court have the ability to make a new finding of fact. If it is a question of whether or not to believe a witness, it doesn’t matter if it’s a review or an appeal.
AB - a complex case but the only finding that resulted in a sanction, was a narrow one that resulted in a sanction. And the GMC believes that the doctor should have fully explained the risks to the patient directly.
AB - explaining gender dysphoria treatment;
AB - explaining gender dysphoria treatment;
AB - two stages; puberty blockers asserting fully reversible, and second stage is affirming hormones. The GMC considers these phases separately, consent, discussion etc. The issue is what a child needs to be told at the first stage.
AB - referring to cases cited, these are relevant. Allegation 5, HW did not discuss risks to fertility with PC prior to commencing puberty blockers. Allegation that there had been no discussion. Not an allegation that this was a failure of informed consent.
(Doing our best to keep up) Submissions are difficult.
AB - Contrasting various allegations in the original charges.
J - asking about finding on 5E? Could the patient consent?
AB - It was not proven.
J - there is an oddity, other evidence that patient wasn’t Gillick competent
AB - Contrasting various allegations in the original charges.
J - asking about finding on 5E? Could the patient consent?
AB - It was not proven.
J - there is an oddity, other evidence that patient wasn’t Gillick competent
AB - discussing HW’s process on assessing capacity to consent, the discussions between HW and patient should have been face to face rather than via the parents. J is right to identify that oddity.
AB - 3rd point is timescale between initial consultation and treatment.
AB - 3rd point is timescale between initial consultation and treatment.
AB - a long time between first consultation and treatment
J - the allegation could have been better drafted, should have said not obtained informed consent at or after the initial consultation and before prescription.
J - the formulation of the allegation is unfortunate.
J - the allegation could have been better drafted, should have said not obtained informed consent at or after the initial consultation and before prescription.
J - the formulation of the allegation is unfortunate.
(Unclear why)
AB - difficulty of complex cases, a real risk that what started off as an insignificant aspect of the case over time becomes very prominent. This is an example of where the MPTS accelerated the risks of fertility, it is inconsistent.
AB - difficulty of complex cases, a real risk that what started off as an insignificant aspect of the case over time becomes very prominent. This is an example of where the MPTS accelerated the risks of fertility, it is inconsistent.
J - unfortunate but not fatal
AB - no not fatal, by the end of the case it was obvious what was important, HW had been cross examined on that basis, GMC had closed on that basis.
AB - the unfortunate aspect is that the charges weren’t specific about face to face discussion.
AB - no not fatal, by the end of the case it was obvious what was important, HW had been cross examined on that basis, GMC had closed on that basis.
AB - the unfortunate aspect is that the charges weren’t specific about face to face discussion.
AB - reassert that PBS are fully reversible, cross sex hormones are partially reversible.
J - if the whole lot had been proved, it would have been an extremely serious case, only some of the allegations proven.
AB - a vast case involving lots of competing evidence.
J - if the whole lot had been proved, it would have been an extremely serious case, only some of the allegations proven.
AB - a vast case involving lots of competing evidence.
Not for the court to challenge all of that evidence. It’s for this court to judge what’s on the paper that describes the reasons for the sanctions.
5th point (not sure what 4th was) - was there any discussions regarding PC’s fertility?
5th point (not sure what 4th was) - was there any discussions regarding PC’s fertility?
AB - now going to evidence, referencing core bundle. Initial contact from the mother. First appointment on 9 Nov 2016. Questions around whether child is truly transgender or has other mental health challenges. 1st face to face appointment in early December 2016.
Discussion of which is the correct puberty for PC. Child is 11 years old. Notes say fertility was not discussed at 1st meeting. Not an admission of failure but an oversight.
J - but its an implied failure; it should have been talked about, we didn’t talk about it.
J - but its an implied failure; it should have been talked about, we didn’t talk about it.
AB - it should be but its not a failure, she says she forgot and then going to address that. To say that oversight is putting the case too high.
J - looking at it isolation, I agree its too high. “Forgot on 8th Dec” is unreasonable as serious misconduct.
J - looking at it isolation, I agree its too high. “Forgot on 8th Dec” is unreasonable as serious misconduct.
J - but we need to consider context and GMC does row back from that.
AB - now reviewing correspondence between HW and PC mother. Discussions of puberty blockers.
AB - consent forms sent to mother on 7 feb 2017 with signature instructions.
AB - now reviewing correspondence between HW and PC mother. Discussions of puberty blockers.
AB - consent forms sent to mother on 7 feb 2017 with signature instructions.
J - attachments? Seems to be more than one form? The version in the bundle is a composite form, what was actually signed?
AB - we’ve just realised that, we’re going to try and find the actual document at lunchtime
AB - we’ve just realised that, we’re going to try and find the actual document at lunchtime
J - mother was sent 2 forms.
AB - mother was asking what she was expected to sign, seems to have been sent through.
J - we need to see what she signed
AB - what’s relevant to me is the signature page. Referencing the composite form,
AB - mother was asking what she was expected to sign, seems to have been sent through.
J - we need to see what she signed
AB - what’s relevant to me is the signature page. Referencing the composite form,
Tribunal only looked at one aspect: there are 5 relevant passages.
1st ‘I want to change my body to that of the opposite sex’, PC and mother wanted to embark on that process. It’s very relevant that there were many years until PC would be offered gender affirming hormones.
1st ‘I want to change my body to that of the opposite sex’, PC and mother wanted to embark on that process. It’s very relevant that there were many years until PC would be offered gender affirming hormones.
AB - 14 or 16 there are a number of years before there are gender affirming hormones.
J - it’s a holistic pathway of treatment
AB - yes, HW said during here evidence that it’s a fluid process, the capacity of the patient and parents to understand.
J - it’s a holistic pathway of treatment
AB - yes, HW said during here evidence that it’s a fluid process, the capacity of the patient and parents to understand.
AB and the questions both might have. That passage sets out that there’s fluidity in the treatment pathway.
2nd relevant passage: may go on to testosterone, impacts on body; no periods, etc,
3rd relevant passage; explains uncertainty of treatment outcome
2nd relevant passage: may go on to testosterone, impacts on body; no periods, etc,
3rd relevant passage; explains uncertainty of treatment outcome
J - so that’s a warning
AB - it warns about various risks etc.
J - saying that it is problematic that HW was not asked any questions in her evidence about the form. Don’t assume that will win your case. Isn’t it the case that most who go on blockers go on to further treatment?
AB - it warns about various risks etc.
J - saying that it is problematic that HW was not asked any questions in her evidence about the form. Don’t assume that will win your case. Isn’t it the case that most who go on blockers go on to further treatment?
AB - yes, but the form sets that out.
J - the patient is likely to move on to Stage 2, and those risks are not explained
AB - that’s not the allegation is it?
J - maybe the point is a slightly lesser one. The patient needs to understand they are embarking on a pathway.
J - the patient is likely to move on to Stage 2, and those risks are not explained
AB - that’s not the allegation is it?
J - maybe the point is a slightly lesser one. The patient needs to understand they are embarking on a pathway.
No one is asserting that this is an inevitable pathway to surgery. But there’s no indication that it is a holistic pathway?
AB - but it is in the first paragraph of the form, of the desire to change the body. Then sets out the various risks of each stage.
AB - but it is in the first paragraph of the form, of the desire to change the body. Then sets out the various risks of each stage.
AB - it does set this out.
J - it is clear that the pathway is there. You say that. But it does discuss testosterone, and further steps including surgery.
AB - but it does discuss egg harvesting and it’s clear what the consequences are.
J - it is clear that the pathway is there. You say that. But it does discuss testosterone, and further steps including surgery.
AB - but it does discuss egg harvesting and it’s clear what the consequences are.
AB - the parents are the main conduit for consent of PC. It says on the form that PC has had the form explained to them, and understands it.
J - discussing 2 different forms. How can the signature page be the same?
AB - there are other differences. Testosterone vs pbs.
J - discussing 2 different forms. How can the signature page be the same?
AB - there are other differences. Testosterone vs pbs.
AB - this form related to consent for puberty blockers. The risks set out in relation to testosterone are impressive.
J - but this is the wrong form? Who provided the GMC with the form?
AB - I will have to take instructions.
J- was it your client ?
J - but this is the wrong form? Who provided the GMC with the form?
AB - I will have to take instructions.
J- was it your client ?
AB (taking instructions from HW)
AB - its seems that both forms were provided by HW husband to the GMC and only one made it’s way into the bundle.
J - it’s a complication.
AB - yes.
AB - its seems that both forms were provided by HW husband to the GMC and only one made it’s way into the bundle.
J - it’s a complication.
AB - yes.
AB - back to the email chronology. Series of emails, discussions of fertility, PC adamant that doesn’t want children, and discussions of egg harvesting, would need to return to female puberty. 2 points demonstrated: PC’s mother does understand the implications on fertility…
That these effects are reversible. And mother understands that.
Email from HW about the ongoing discussions of egg harvesting, fertility etc. Response from mother: wouldn’t that be difficult? Question never really answered by HW according GMC.
Email from HW about the ongoing discussions of egg harvesting, fertility etc. Response from mother: wouldn’t that be difficult? Question never really answered by HW according GMC.
AB - patients mother is asking about whether eggs can be harvested during puberty blockers,
J - there is a misunderstanding here HW is saying there can be egg retrieval while on blockers.
AB - it wasn’t an allegation, there was no question
J - there is a misunderstanding here HW is saying there can be egg retrieval while on blockers.
AB - it wasn’t an allegation, there was no question
J - you’re asserting he (tribunal judge) was scratching around for grounds.
AB - I would never be so indelicate
AB - back to emails in bundle that didn’t enter the tribunals deliberations.
J - info provided by the doctor to assistant for transmission to mother and patient
AB - I would never be so indelicate
AB - back to emails in bundle that didn’t enter the tribunals deliberations.
J - info provided by the doctor to assistant for transmission to mother and patient
J - one point you haven’t addressed. The mother was supposed to show the letter to PC, that is not specifically confirmed (letter from HW to GP of PC).
AB - HW’s response to her assistant, more discussion of fertility. A warning that any treatment carries risk to fertility.
AB - HW’s response to her assistant, more discussion of fertility. A warning that any treatment carries risk to fertility.
J - Tribunal should have addressed these emails.
AB - we agree
AB - goes through all the relevant documentary evidence.
Now moving on to how GMC closed its case.
AB - we agree
AB - goes through all the relevant documentary evidence.
Now moving on to how GMC closed its case.
AB - written submissions; HW accepted in her oral evidence that she didn’t discuss fertility directly with PC, all transcripts accepted by both parties.
Absence of risks from taking puberty blockers; what risks we say? As puberty blockers are fully reversible.
Absence of risks from taking puberty blockers; what risks we say? As puberty blockers are fully reversible.
AB - this is confining the case to the period of puberty blockers.
J - the risks don’t flow from the blockers but from the testosterone. The form doesn’t consider the two questions. 1. The likelihood of treatment pathway 2. the testosterone risks.
J - the risks don’t flow from the blockers but from the testosterone. The form doesn’t consider the two questions. 1. The likelihood of treatment pathway 2. the testosterone risks.
Apologies - a series of tweets have been absorbed.
J & barristers now discussing the formulation of opening and closing arguments
AB -apologies, I was looking at opening argument, I meant to be looking at closing arguments.
J & barristers now discussing the formulation of opening and closing arguments
AB -apologies, I was looking at opening argument, I meant to be looking at closing arguments.
AB - very quick summary of closing arguments, lack of informed consent.
J - I don’t think he went off piste.
AB - my apologies I was mistaken.
AB - now looking at legal advice on capacity and consent. I only take exception to the application of the advice.
J - I don’t think he went off piste.
AB - my apologies I was mistaken.
AB - now looking at legal advice on capacity and consent. I only take exception to the application of the advice.
AB - I don’t disagree but subject to the direction of who must consent. Discussion of Gillick competence and Bell case, was whether a child can consent to puberty blockers. This case is about whether the parent can consent. A gillick competent child’s consent
Cannot be trumped by parents.
J - this domain can obviously be fraught and there are many occasions when parents might override the child.
AB - yes that was different.
J - yes.
AB - moving on to another case.
J - this domain can obviously be fraught and there are many occasions when parents might override the child.
AB - yes that was different.
J - yes.
AB - moving on to another case.
AB - issue in Bell was ‘can a child consent’, and in what circumstances, should it be taken to the court. The relevant case is one that was taken to the court under Bell. The issue is not whether a child can consent but what is the status of a parental consent to blockers.
AB - the matter was IF the child was Gillick competent, a path applied, If the child was not Gillick competent then a path applied. But in either case, parental consent is sufficient.
J - the child appeared to be consenting. This was in the interregnum between Bell in High Court
J - the child appeared to be consenting. This was in the interregnum between Bell in High Court
And Bell in court of appeals.
J & AB discussing Bell.
AB - parents were seeking a declaration, granted of the legal ability of parents to consent to puberty blockers among other forms of medical treatment.
(All discussions of relevance of precedent)
J & AB discussing Bell.
AB - parents were seeking a declaration, granted of the legal ability of parents to consent to puberty blockers among other forms of medical treatment.
(All discussions of relevance of precedent)
AB - in this case, does the parents ability to consent disappear when the child is Gillick competent? And this judgement is relevant.
AB - the GMC asserts that PC was assessed as to competence therefore discussions needed to be with PC not with the parents.
AB - the GMC asserts that PC was assessed as to competence therefore discussions needed to be with PC not with the parents.
AB - reading out sections of judgement of precedent case. If PC was
gillick competent then it’s still okay for the parents to consent if the child has consented. Parents have given permission, agreeing with treatment request. So not a ‘trumping’ case.
AB - a Gillick competent
gillick competent then it’s still okay for the parents to consent if the child has consented. Parents have given permission, agreeing with treatment request. So not a ‘trumping’ case.
AB - a Gillick competent
Child has given the right to consent to the parents.
AB - I’m going to canter through all of this (law, UN convention etc), the parent’s rights are consent rights. The idea that parents retain the right to consent is enshrined in the Children Act
AB - I’m going to canter through all of this (law, UN convention etc), the parent’s rights are consent rights. The idea that parents retain the right to consent is enshrined in the Children Act
Various other authorities.
AB - refers to Bell again and why it doesn’t apply. More discussion of documents in bundle and authorities cited in closing arguments.
Key passages: the very essence of Gillick is that you can’t trump a Gillick competent child. But this is different
AB - refers to Bell again and why it doesn’t apply. More discussion of documents in bundle and authorities cited in closing arguments.
Key passages: the very essence of Gillick is that you can’t trump a Gillick competent child. But this is different
Because parents and child agree. Discussing situations where the parents have rights to make decisions for a Gillick competent child. |Where the child is unable, or has not made a decision. Or declines to make a decision. And leaves the decision to her parents.
AB - the idea that PC at 11 should have these discussions with the doctor, risk of physical consequences, etc is ludicrous. The common sense idea that the parents discuss this with the doctor and then the parents discuss with the child.
J - the rights don’t disappear do they?
AB - 2 options, a child that is Gillick competent can ask her parents to consent to the treatment,
J - now we’re looking at the signed version of the consent form which takes on even more importance.
AB - 2 options, a child that is Gillick competent can ask her parents to consent to the treatment,
J - now we’re looking at the signed version of the consent form which takes on even more importance.
J - room for two parental signatures, what does it mean when the child is saying ‘the form has been explained to me’ and ‘agree’ to the treatment.
AB - it means that this isn’t a trumping situation. The child is still consenting to the treatment. It is wrong for the GMC to say
AB - it means that this isn’t a trumping situation. The child is still consenting to the treatment. It is wrong for the GMC to say
That because the child is competent the child must discuss the risk face to face.
J - there are two parts to your argument; the consent form and the Gillick question.
AB - I think the case in question directly applies.
J - now discussing the consent form;
J - there are two parts to your argument; the consent form and the Gillick question.
AB - I think the case in question directly applies.
J - now discussing the consent form;
J - are you saying that there is a deference (child has given right to consent to parents)
AB - yes that is what we are saying.
J - this submission is a trump of a different form. If the child has deferred to the parent, then there doesn’t have to be a face to face consultation
AB - yes that is what we are saying.
J - this submission is a trump of a different form. If the child has deferred to the parent, then there doesn’t have to be a face to face consultation
AB - we are yet to find any precedent etc that requires that face to face discussion between patient and doctor when parents have consented or when patient hasn’t consented.
J - your two limbs of argument don’t have a bridge between them.
Whether it was required with the parent
J - your two limbs of argument don’t have a bridge between them.
Whether it was required with the parent
(Face to face discussion of risks). And your common sense argument that primary school age child doesn’t need to have all of these risks etc explained to them by the doctor.
AB - there is some merit to the doctor discussing these things with the patient because it helps the
AB - there is some merit to the doctor discussing these things with the patient because it helps the
Doctor understand the child’s competence.
J - your submission is really that the child couldn’t consent, they want the treatment without the ability to understand the treatment.
AB - fortunately, you don’t have to decide that. The tribunal says that the face to face discussion
J - your submission is really that the child couldn’t consent, they want the treatment without the ability to understand the treatment.
AB - fortunately, you don’t have to decide that. The tribunal says that the face to face discussion
Would have involved substantial involvement of the parents. We are a hair’s breadth away from what actually happened in these circumstances and HW is facing a suspension.
AB - final line from relevant case, where the parents have given consent no need to establish
Gillick
AB - final line from relevant case, where the parents have given consent no need to establish
Gillick
Competence. That’s the final nail in the coffin to GMC’s argument that the child should have given consent.
J - there’s a tension; it suggests that discontinuance of child’s decision in case of unconsciousness or overwhelmed. That doesn’t do away with the parent’s ability to
J - there’s a tension; it suggests that discontinuance of child’s decision in case of unconsciousness or overwhelmed. That doesn’t do away with the parent’s ability to
Consent.
J - in this case was the child being asked,
AB - the child was being asked if the parents had consented on their behalf
J - that’s a very fine point
AB - the case says ‘the parents are able to consent to puberty blockers’. This advice not addressed by the GMC.
J - in this case was the child being asked,
AB - the child was being asked if the parents had consented on their behalf
J - that’s a very fine point
AB - the case says ‘the parents are able to consent to puberty blockers’. This advice not addressed by the GMC.
J - well that’s because HW barrister didn’t bring this up either.
I think I hadn’t understood the high water point of your argument. I think there’s a slightly easier argument to make. And it’s about expert opinion.
AB - the expert hadn’t seen all the notes etc (Dr K)
I think I hadn’t understood the high water point of your argument. I think there’s a slightly easier argument to make. And it’s about expert opinion.
AB - the expert hadn’t seen all the notes etc (Dr K)
J - what was the expert saying?
AB - that there is a narrow window for say egg harvesting etc and so the discussions cannot be left to the last minute. However, her patients were broadly all adolescents and are time sensitive because patients are older.
AB - that there is a narrow window for say egg harvesting etc and so the discussions cannot be left to the last minute. However, her patients were broadly all adolescents and are time sensitive because patients are older.
J - but also the holistic pathway, and the consequences of taking testosterone.
AB - not relevant.
J - wondering what the doctor’s obligation is when the child is so young. At the initial appointment to consider the inevitable progression to testosterone etc.
AB - not relevant.
J - wondering what the doctor’s obligation is when the child is so young. At the initial appointment to consider the inevitable progression to testosterone etc.
J - How do you explain this to a child so young?
AB - there has to be an element of judgement left to the doctor. If you say to a cancer child the risk of treatment are X, they may turn around and decline treatment.
J - but you do need to talk to the child about that
AB - there has to be an element of judgement left to the doctor. If you say to a cancer child the risk of treatment are X, they may turn around and decline treatment.
J - but you do need to talk to the child about that
J - I understand the element of judgement. Where was it applied in this case?
AB - the judgement is the communications with the parent.
The lengthy informed consent form, parent is in the best position to make the explanations, etc.
J - how far did the family have to travel?
AB - the judgement is the communications with the parent.
The lengthy informed consent form, parent is in the best position to make the explanations, etc.
J - how far did the family have to travel?
AB - 200 miles
J - DrK doesn’t say ‘pathway’, but should to doctor explain the testosterone? Was it made sufficiently clear?
AB - we say it was made sufficiently clear.
J - let’s look at the finding of fact. We have the consent form, not sure it’s the right form.
J - DrK doesn’t say ‘pathway’, but should to doctor explain the testosterone? Was it made sufficiently clear?
AB - we say it was made sufficiently clear.
J - let’s look at the finding of fact. We have the consent form, not sure it’s the right form.
J - the tribunal makes a mess of several issues, but then comes to the important point of consenting to fertility. This is a reference to the need for a face to face discussion. It is a complete mess.
There’s another thundering bad point on timing that HW loses either way.
There’s another thundering bad point on timing that HW loses either way.
But there is a very good point towards the end. It is not fixating on the lost opportunity on day1; but that it is focused on the lost opportunities throughout the process. And HW has not accepted that gender dysphoria treatment is a process and better communication and
Explanation would be very helpful. Demonstrates a lack of insight and resistance to learning that is concerning.
AB - citing another legal case.
J - particular judge was prone to making up his own mind on medical cases and giving extempore judgements. Which he did in this case
AB - citing another legal case.
J - particular judge was prone to making up his own mind on medical cases and giving extempore judgements. Which he did in this case
AB - no further discussion on that case.
Goes on to a different point. Talking about the reversibility of risks.
J - but that’s a different case.
AB - fully reversible, partially reversible effects of hormone treatment. Expert witness describes puberty blockers are fully
Goes on to a different point. Talking about the reversibility of risks.
J - but that’s a different case.
AB - fully reversible, partially reversible effects of hormone treatment. Expert witness describes puberty blockers are fully
Reversible. ‘The probable permanent suppression of fertility’ saying that the decision elevated the consequences of one treatment to that of another.
J - expert witness does say that it should be discussed with the patient, ‘probable permanent suppression’ they don’t really
J - expert witness does say that it should be discussed with the patient, ‘probable permanent suppression’ they don’t really
Need the ‘probable’.
J - they then say it doesn’t need to be the initial consultation.
AB - I’ve described the case as irreconcilable conflicts in the GMCs case. From start to finish this was a difficult case to follow. The allegation was allowed to morph
J - they then say it doesn’t need to be the initial consultation.
AB - I’ve described the case as irreconcilable conflicts in the GMCs case. From start to finish this was a difficult case to follow. The allegation was allowed to morph
During the case.
J - the consultation on 9 Nov was via telephone, the face to face was in December.
AB - yes
J - the query in assessing seriousness (misconduct) they are not considering what the reality was. There was a discussion of fertility and testosterone in the emails.
J - the consultation on 9 Nov was via telephone, the face to face was in December.
AB - yes
J - the query in assessing seriousness (misconduct) they are not considering what the reality was. There was a discussion of fertility and testosterone in the emails.
J - there wasn’t the express language.
AB - there was no express language, but there was no express requirement.
AB - can I move on finally to the point you’ve made. The issue seems to be insight as you’ve mentioned. HW did not say it would be her practice to discuss
AB - there was no express language, but there was no express requirement.
AB - can I move on finally to the point you’ve made. The issue seems to be insight as you’ve mentioned. HW did not say it would be her practice to discuss
Fertility with all patients at the first appointment. That misunderstands the doctors role. A discussion with a 10 year is going to be different to a discussion with a 15 year old.
J - by the time you get to insight we’re not talking about first meeting. The judgement
J - by the time you get to insight we’re not talking about first meeting. The judgement
Is then looking over the breadth of the case.
AB - nowhere in their determination was this consent issues discussed. They are ignoring their own finding of fact. The point on sanctions - considering what sanctions to impose - many mitigating features
AB - nowhere in their determination was this consent issues discussed. They are ignoring their own finding of fact. The point on sanctions - considering what sanctions to impose - many mitigating features
A discussion on phone or in person would have had substantial input from mother. And in this case it did as documented by the emails.
So it all comes back to ‘insight’. It is difficult to understand the reasons for this judgement. What were they expecting? Look at this in
So it all comes back to ‘insight’. It is difficult to understand the reasons for this judgement. What were they expecting? Look at this in
Context, there is nothing to demonstrate what insight she should have demonstrated.
<<proceedings slightly disrupted by tannoy announcement>>
J - we will hear from the other side after lunch, I assume that will take most of the afternoon.
Court rises.
End of morning session.
<<proceedings slightly disrupted by tannoy announcement>>
J - we will hear from the other side after lunch, I assume that will take most of the afternoon.
Court rises.
End of morning session.
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