A doctor treating transgender children denied her clinical judgment was clouded when prescribing puberty blockers, a medical tribunal heard.
Dr Helen Webberley, the founder of website GenderGP, has been accused of failing to provide good clinical care in 2016 to three patients, identified only as A, B and C, aged 12, 17 and 11, who were transitioning from female to male.
Patient A was distressed because puberty was not progressing as a male, patient B because he was being mis-gendered because he looked like a girl, his sex assigned at birth, instead of a boy, and patient C was distressed because his body began growing breasts, Dr Webberley said.
At a Medical Practitioners Tribunal Service (MPTS) hearing on Tuesday, Simon Jackson QC, representing the General Medical Council (GMC), said experts, instructed by the GMC, criticised the inadequate assessment and lack of follow-up care given to the patient.
Dr Webberley is accused of 21 charges including compromising patients’ safety and putting them at risk.
The hearing, which started in July, heard for the first time from Dr Webberley on Tuesday.
The tribunal heard normal practice was that transgender patients were dealt with by a multi-disciplinary medical team and given psychiatric or psychological assessment by specialists before any medical intervention.
Dr Webberley said she would “triage” her own patients when she made her assessments.
Mr Jackson said: “Rather than it being triage, you are coming to a conclusion prematurely and being led in that process by the patient saying, ‘What I want is hormone treatment’ the family saying, ‘hormone treatment’.
“Your acceptance of the patient as being the person who knows best is obscuring your judgment, rather than going through the hoops?”.
Dr Webberley replied: “I don’t agree.
“I don’t think I came to a conclusion prematurely.
“The right medical treatment was extremely delayed certainly for patient B such that fortunately he did not succeed in taking his own life at 16.
“With patient A I did not give it prematurely, he was at risk of it being extremely delayed for another four years.”
Dr Webberley said, with regards to patient C, her assessment concluded he needed to see an experienced psychologist.
Mr Jackson continued: “Your approach is derived from your empathy for the patient in terms of the patient saying, ‘This is what I want, this is what I need’, and you seek to provide that to them?”
Dr Webberley replied: “As a doctor, every single time a patient comes to us we have a very careful balancing job to do.
“Balancing giving intervention and not giving intervention.
“My role is how best to help that person.
“The function of my assessment is to ensure the patient fulfils the criteria for a medical intervention.”
Dr Webberley said, from 2015, there was an increase in “visibility” of transgender patients and more patients coming forward looking for help but the NHS was “not really 100% accommodating to their perceived needs”.
She took her working guidelines for treating transgender patients from the University of California San Francisco, she told the tribunal.
Dr Webberley, from Abergavenny in Monmouthshire, Wales, was convicted in 2018 of running an independent medical agency without being registered.
But Dr Webberley said there was a “significant deficit” in this field of medicine, a lack of structured training and guidelines.
She added: “At the time I was learning and reading and educating myself and patients started to come through saying, ‘Can you help me?’
“And you had to treat each one on their merits.
“It evolved quite quickly.”
Rather than rushing into prescribing puberty blockers, she told the hearing her initial response was, “I’m not sure this is right” but after gaining confidence and knowledge she began prescribing the drugs.
But Mr Jackson said while she was on this “learning curve” her competence to prescribe such drugs was based on her own self-assessment, not that of her peers and her learning was not formal or subject to objective appraisal.
Dr Webberley said: “Unfortunately there’s a paucity of experienced clinicians but there was a rising number of patients that needed help.
“I understood this was a contentious area of medicine and I was likely to attract attention from NHS colleagues.
“My instinct is to do my best for my patients.”