Des Houghton: Ethical worries raised over Palaszczuk govt gender clinic

A leading psychiatrist has raised concerns over the establishment of Brisbane’s child and adolescent clinic, saying she has been unable to find evidence of an ethics review before was launched to offer “novel” gender-affirming care.

Dr Catherine Llewellyn Picture: Des Houghton

A leading psychiatrist has questioned why the Queensland Health ethics committee did not vet Brisbane’s child and adolescent gender clinic before it was opened by the Palaszczuk government in 2017.

Dr Catherine Llewellyn said there was no record that the Queensland Children’s Hospital obtained an ethical clearance before offering “novel” gender-affirming care.

“The usual processes of medicine have not been followed,” said Llewellyn, who operates a private practice at Spring Hill, where she is
a child, adolescent, adult and addiction psychiatrist.

“I have not found any evidence the ethics committee was involved in the establishment of the clinical pathway.”

A psychiatrist who worked at the clinic at the beginning confirmed to me there was no independent ethical assessment.

Health Minister, Tim Nicholls, and Health Director-General, Dr David Rosengren, declined interviews and did not respond to written questions.

Dr Llewellyn said her efforts to find out how the clinic was set up and what research was done beforehand were “actively resisted”.

“I have significant worries that puberty blockers and cross-sex hormones are associated with irreversible effects and there is insufficient evidence to justify their use,” Llewellyn said.

Minister for Health and Ambulance Services Tim Nicholls. Picture: David Clark

Around the world gender affirming clinics have been shut and their treatments discredited.

Llewellyn joins a growing number of skilled specialists who have come out in support of Dr Jillian Spencer, the Queensland Health psychiatrist who was suspended for raising concerns about transgender activism at the clinic.

“I believe she was treated unfairly,” Llewellyn said. She called for Spencer’s reinstatement.

“If you are going to give a treatment to a child with irreversible effects the usual process is that you first examine that within clinical trials,’’ she said.

“In medicine in general, if you introduce a treatment that is associated with irreversible effects, and you provide it to children, the usual practice would be to do it in strictly controlled conditions.”

Any treatments would need to be offered “inside an ethical standards framework”, she said. And it would require a long clinical trial before it was “rolled out”.

“If you are going to do something novel that has significant, long- lasting effects you are going to go to the ethics committee with that particular child so you can have a framework around making sure that the treatment is necessary (and) that there are no other less-invasive options available to the child that will alleviate their symptoms.’’

Dr Jillian Spencer was suspended for raising concerns about transgender activism at the clinic. Picture: Lyndon Mechielsen/The Australian

The ethics committee involvement was vital to ensure the evidence was robust enough and that outcomes were monitored.

“I think there is a significant risk some will experience irreversible harm,” she says.

Llewellyn, who was born in Wales and studied medicine at the University of Cambridge, said it appeared no one was monitoring the outcomes in the public or private sector. Llewellyn is a modern-day polymath; an opera singer who plays four musical instruments.

When she became disenchanted with the NHS in Britain she considered ditching medicine to study law; but changed her mind after visiting Australia and working here.

Llewellyn has just published a research paper on gender-related healthcare for children in Queensland as a guide for her peers.

It is subtitled “Clinical concepts and questions”.

And there are many questions, such as:

“Has Queensland Health reviewed the standard of consent proforma used by the Queensland Children’s Gender Service?

Queensland Health Director-General Dr David Rosengren. Picture: NCA NewsWire / Dan Peled

“Does the current consent form make it clear that a range of complicationsthat may occur to minors assessing treatment, include infertility and permanent sterility?’

She told me: “We are unaware of the magnitude of potential harms that may have been sustained (in the past).

“I don’t understand how it ever came to this. I don’t understand how we have a service rolling out irreversible treatments for children without any framework for clinical governance.

“I suspect the clinic was established with the best of intentions, but it has become an area of practice that is not openly discussed and where there is a lack of transparency regarding outcomes.

“The treatment has been misrepresented in the media as lifesaving, and vulnerable families are frightened and may be unaware of the broader evidence-based reviews that have called
for caution.’’