Three-page document behind LNP government’s gender therapy crackdown

New details have emerged about the allegations in Cairns that prompted Health Minister Tim Nicholls to “pause,” on safety grounds, the provision of hormone therapy to new young patients with gender dysphoria.

In January, Nicholls declared the Cairns Sexual Health Service had delivered “apparently unauthorised” services to 42 paediatric patients, 17 of whom were prescribed stage 1 or stage 2 hormone therapy, leaving unresolved questions about parental consent and regulatory requirements.

Declaring the allegations serious enough to warrant an immediate ban on hormone therapy for new patients in the public sector, Nicholls also announced a review of the evidence base that he said would take 10 months to complete once a reviewer had been appointed.

Queensland Health Minister Tim Nicholls, centre, in parliament.Credit: Jamila Filippone

However, Nicholls has yet to appoint a reviewer, or consult on the final terms of reference. His office has declined to answer questions about the timing.

That makes the “pause” indefinite, particularly as Queensland has insisted on doing its own review despite the federal government asking the National Health and Medical Research Council to use its remit to conduct a review.

When he made the announcement in January, Nicholls referred to a briefing he received in early December about a preliminary review of the allegations in Cairns.

Brisbane Times applied for access to the preliminary review under the Right to Information Act. The only document identified, and partly released, was an undated three-page risk assessment.

The assessment focused on the 17 patients who were receiving hormone therapy at the time. It found the health service had consent forms from both parents for each of six patients, from one parent for each of seven patients, and medical records indicating “parental awareness and consent” for two patients where forms could not be located.

For the remaining two patients, there was “no indication of parental awareness or consent” and, the assessment noted separately, “a complaint involving two families … regarding parental engagement in the consent process”.

The assessment also highlighted a lack of documentation around steps taken in Cairns to prove patient competence, under the Gillick principle, and noted that the overarching Queensland Children’s Gender Service did not require parental consent for all patients.

“At QCGS the consent process with estranged parents is determined on a case-by-case basis,” the assessment noted.

“If [a] parent is estranged and the young person doesn’t want them involved, e.g. in cases of domestic violence, and they are Gillick competent, [the QCGS] will only get one or no signatures.

“Where puberty suppression is to be commenced and patients are too young for Gillick competence, then both parental signatures are required.”

Some details in the assessment, including patient ages, were redacted on patient privacy grounds. However, all 17 were put under the care of a Multi Disciplinary Team (MDT), with continued oversight from the QCGS, while the service sought to improve its procedures.

Outside that patient group, the assessment warned that, in Cairns alone, if services were discontinued, there were limited private options and “potential for less regulated environment with limited specialist expertise and MDT, and therefore may be more risk for children”.

Nicholls’ office has declined to say whether a risk assessment was completed before new paediatric patients lost the option of hormone therapy in the public sector throughout Queensland. More than 400 were on the QCGS waiting list at the time of the announcement, and the LNP government had already halted a planned expansion of the service.

Questions sent to Nicholls’ office were referred to the department, which said the preliminary review was “consistent with the complaints made by clinicians and families, which is why a clinical review and separate health service investigation have been commissioned”.

The clinical review is due to report by April 30, and the investigation by June 30.

Asked in a question on notice from the Labor opposition how the review of the evidence base would differ from a previous independent evaluation of the QCGS, Nicholls last week told parliament “Queensland has not yet undertaken its own review of the evidence for Stage 1 and Stage 2 hormone therapy”.

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