United
Kingdom — The UK's best known expert in
transsexualism is being investigated by the General
Medical Council <http://www.gmc-uk.org/>
after claims he repeatedly put his patients' health at
risk, the Guardian has learned.
Consultant psychiatrist
Russell Reid, a specialist in gender identity disorders
(GID), allegedly breached standards of care by
prescribing patients with sex-changing hormones and
referring them for genital surgery without adequately
assessing them.
Twelve cases in which Dr
Reid, a member of the Royal College of Psychiatrist's
committee on gender identity disorder
<http://www.rcpsych.ac.uk/>,
allegedly broke the guidelines "to the detriment of the
patients concerned" have been submitted to the GMC. It is
alleged some people later regretted changing
sex.
The complaint was filed
by three of the UK's most senior psychiatrists in GID,
who work at the Charing Cross hospital's gender identity
clinic in west London: Donald Montgomery, James Barratt,
and Richard Green, another member of the college's
committee.
Together with Stuart
Lorimer, a senior registrar at the clinic, they allege Dr
Reid has repeatedly breached guidelines set by the Harry
Benjamin International Gender Dysphoria Association
<http://www.hbigda.org/>,
based in Minneapolis.
The guidelines lay down
"flexible directions" for the treatment of people with
GID, which are not legally binding and may be modified to
suit individual patients. The standards are "generally
supported" by the college, though it does not formally
recognise them.
The psychiatrists claim
Dr Reid has not adhered to the guidelines' minimum
eligibility requirements for the prescription of hormones
and referrals for genital surgery.
The guidance states
patients should have been living in their desired gender
role for at least three months before prescribed
hormones, or had at least three months of
psychotherapy.
Patients should also
undergo a minimum of 12 months hormone therapy and live
in their desired gender role for the same period before
referral for gender change surgery.
Dr Barratt
said:
"I felt that Dr
Reid seemed more often than not to prescribe hormones
to patients in a manner contrary to published
guidelines.
"He seemed too rapidly
to refer patients for gender reassignment surgery,
sometimes seemingly without the appropriate second
opinions which would be required by the
guidelines.
"Some of the patients
would seem to have been inappropriately referred, and
some to have later been unhappy with what had
happened."
But some of Dr Reid's
patients have defended him. Daphne Neal, an NHS nurse
treated by him, said he had prescribed her with hormones
earlier than the guidelines advise, but stressed she
believed this was the best course of action.
She said:
"It is fair to
say Dr Reid prescribed me hormones earlier than the
Harry Benjamin guidelines recommend, I was in fact
prescribed hormones on my first visit.
"I felt that this was
appropriate in my case. If I had not been prescribed
hormones at that time I may have been forced to look
for other sources, something I don't really agree
with, as the consequences can be dire."
The guidelines state that
it can be acceptable to provide drugs to patients earlier
"as an alternative to black market or unsupervised
hormone use".
A GMC spokeswoman
confirmed Dr Reid is under investigation.
He is due to appear today
before the GMC's interim orders committee, which could
suspend him or restrict the work he can perform. These
hearings are held when the council wishes to consider
whether patients, the public or the doctor under
investigation would be put at risk if they continue
practising prior to a full investigation.
Regardless of the
hearing's outcome, Dr Reid will then appear before the
preliminary practice committee on January 26-27. This
will decide whether there should be a full inquiry by the
professional conduct committee, which has the power to
strike a doctor off the medical register.
There is disagreement
among psychiatrists and the transsexual community over
the period patients should spend living as their desired
sex prior to treatment.
But Brian Ferguson,
another member of the royal college committee, said in
his view hormones should only be administered to a
patient after "at least two or three"
appointments.
Dr Ferguson, a consultant
psychiatrist at the Nottingham Gender Clinic, said many
psychiatrists would consider it "reasonable" for patients
to live in their desired gender role for two years before
surgery. He said he had seen a number of people who
changed their minds quite late in this period.
News of the investigation
has been greeted with dismay by many in the 5,000-strong
transsexual community. Several support groups have
launched a website backing Dr Reid.
Some fear the GMC inquiry
could bolster opposition to the gender recognition bill,
which is currently before parliament. The bill would
allow transsexuals to gain the rights of their acquired
gender. But it has been opposed in the Lords.
A spokeswoman for the
Medical Defence Union <http://www.the-mdu.com/>,
which is representing Dr Reid, said he did not wish to
comment on the investigation at this stage.
