Queensland gender therapy pause and review terms revealed after unauthorised delivery at Cairns Sexual Health clinic
The Health Minister explained why pausing gender therapy meds for children was in their best interests as new details emerge of how “apparently unauthorised” services were delivered in Cairns.
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The temporary ban on new prescriptions of puberty blockers and hormone therapies to gender dysphoric children across the state is in their best interest, according to Queensland’s Health Minister.
Tim Nicholls was in Cairns on Wednesday to discuss how three reviews – a Part 6 clinical review and Part 9 health service investigation into pediatric gender health services provided in Cairns, as well as a broader statewide review of the evidence for hormone therapy treatment for pediatric gender services – would progress.
The state LNP government – which last year voted to ban puberty blockers at its annual national party conference – initiated the reviews in the wake of a Public Interest Disclosure over the “apparently unauthorised” provision of pediatric gender therapy services through the Cairns Sexual Health Service at Cairns North.
He said the temporary ban on prescribing puberty blockers – used to delay the onset of puberty in a child – would remain in place until the statewide review was completed.
“The health and wellbeing of children is our prime concern,” he said.
“Children need care and respect and the responsibility of the state is to ensure they are not put in harm’s way and that the services that are provided to them are based on the best available evidence and are applied with caution.
“And that is the calm and methodical approach that we are taking to both the reviews that are under way, and the ongoing delivery of pediatric gender services here in Queensland.”
Mr Nicholls confirmed the estimated 450-500 children on the Queensland Children’s Gender Service wait list would continue to receive a “suite of care,” involving psychiatrists, psychologists, fertility specialists, paediatricians, social workers and GPs, but they would not be able to access Stage 1 and Stage 2 hormone therapies.
“The pause on the delivery of those services is on anyone who has not yet been prescribed those therapies,” Mr Nicholls said.
“I want to emphasise that children experiencing gender dysphoria should still present, they will still be offered all of the services, only about a third of the children who present to the Queensland Children’s Gender Service actually then progress onto hormone therapies.”
Mr Nicholls announced the Part 6 clinical review would be conducted by former director general of the Health Department and expert in emergency medicine, Dr Michael Cleary.
And former Epworth Health chief medical officer Dr Luis Prado would undertake the part 9 health system investigation.
“Dr Prado’s report will provide information in relation to the governance issues about how this was allowed to occur, and they will inform the delivery of services across the health system,” Mr Nicholls said.
The clinical review will investigate the health services provided to all children and young people by including the whether there was appropriate clinical documentation of the health services provided to, and overall management of, the patient cohort. It will also review compliance with policies such as informed consent, and whether there was multi-disciplinary input into the health services provided.
The health service investigation will investigate matters relating to the administration, management and delivery of public sector paediatric gender health services to children and young people at the Cairns Sexual Health Service.
Mr Nicholls said the “genesis” of the issue of “apparently unauthorised gender services” was a lack of availability of consult services in the lead up to a prescription being offered to a child, but the Cairns and Hinterland Hospital and Health Service had engaged with the Brisbane Children’s Hospital to provide additional services and resources “that were not previously being provided”.
When asked if he was comfortable with the potential trauma the government’s decision could have on gender diverse children waiting to access puberty blockers, Mr Nicholls said the issue was a “very highly contested area” and their were “substantial question marks in relation to the delivery of this type of therapy” in places like Finland, Norway, Denmark, France, and the United Kingdom.
“So yes we are aware of the impact,” he said.
“It is a considered decision – to ensure that in the long term we provide services that are in the best interest of children as a whole, because that is one of the fundamental obligations of a state, of a community, of parents, to make sure that service is delivered based on solid evidence and the best evidence available and that we act with caution.
“There is a very significant concern about children going down that pathway and the long-term effects, and that being done without an understanding of those long-term effects.”
Mr Nicholls said the concerns raised by a public interest disclosure in Cairns were received by his office around December 6, after they been escalated through the local health service.
He said since revelations of unauthorised services, staff at Cairns Sexual Health Service were being “unfairly” assaulted through phone calls and emails.
“Those staff were not involved in the circumstances that have led to the current investigations, they are innocent of that respect.”
Cairns and Hinterland Hospital and Health Service chief executive Leena Singh said she could not detail which staff were responsible for the unauthorised services, but that would form part of the review.
She said she could not say if those staff were still employed, but noted “we have had a bit of staff turnover in that area in the last six months”.
Ms Singh said there were 25 patients under the care of Cairns Sexual Health and 17 of them were “on a medical pathway”.
She said internal reviews over the past four months had found issues around documentation and the wraparound services for children, in relation to gender services.
“From that review and from some of the conversations with a few of the patients and parents who felt that we were not as engaging as we should have been to help them through that journey as well, because it was quite a stressful time for families as much as it is for the patients,” Ms Singh said.
“There were a number of areas that we looked into over those four months to warrant me to be concerned with some of the documentation and the management of the patients and their processes, for me to refer that up to the Director General.”
Mr Nicholls said experts and people with lived experience of gender dysphoria would be invited to make submissions to the statewide review of puberty blockers.
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