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Sex Change Doctor Guilty Of Misconduct

http://www.guardian.co.uk/medicine/story/0,,2088274,00.html


 David Batty

Friday May 25, 2007

Guardian Unlimited

 

Dr Russell Reid leaves the GMC, accompanied by some of his transgender supporters, after being found guilty of serious professional misconduct. Photograph: Stefan Rousseau/PA

 

The UK's best-known expert on transsexualism was today found guilty of serious professional misconduct for rushing five patients into sex-changing treatments, but avoided being struck off.

The General Medical Council ruled that Russell Reid, who retired last year, could only return to work under strict conditions imposed for the next 12 months that mean he can only work under strict supervision.

He must provide the GMC with a record of his treatments of any patients with gender identity disorders such as transsexualism every three months.

The disciplinary panel ruled that Dr Reid must no longer prescribe patients with sex-changing hormones at the first appointment, nor without a firm diagnosis that they are transsexual or a proper psychiatric assessment.

The panel determined that the consultant psychiatrist was too quick to provide patients with hormones and to refer them for genital surgery.

"The panel considers that the seriousness of your misconduct lies in your lack of caution in initiating hormonal and surgical gender reassignment treatment in these patients without more careful and through investigation and assessment," said John Shaw, the panel chairman.

"The panel therefore determined that your misconduct was serious, and that you are guilty of serious professional misconduct."

Mr Shaw said Patient D, who mistakenly believed she was transsexual as a result of suffering from manic depression, only narrowly avoid an "unnecessary mastectomy" as a result of Dr Reid ignoring the second opinion of another psychiatrist that treatment should proceed with caution.

The panel chairman added that Patient C, a convicted paedophile, was still uncertain about his gender identity after having a sex change. The male-to-female transsexual has returned to living as a man and wants surgery to try to reverse his gender reassignment.

Mr Shaw said that although patients B, E and F remained in their reassigned gender roles and appeared not to have suffered harm, Dr Reid's treatment of them "fell well short of the standard of care to which [they] were entitled."

But the panel decided against striking Dr Reid off or suspending him because it did not consider "it would be in the public interest to deprive the [transsexual community] of an experienced and otherwise well-respected doctor."

Mr Shaw said: "[The panel] determined that it would be proportionate and sufficient, in the public interest as well as your own interest if you were to return to practice under strict conditions."

Speaking afterwards, Dr James Barrett, one of four NHS psychiatrists who brought the complaints against Dr Reid, said: "I'm pleased that it was felt that it amounted to serious professional misconduct. And I'm pleased that conditions to his practice were imposed for a year that mean he will operate in line with good practice."

Patient D said: "I think he's got off quite lightly, but at least he can't continue to rush people through treatment as he has in the past."

Another former patient of Dr Reid, not involved in the GMC case, said she was "disgusted" with the verdict.

Claudia, who regrets changing sex, is one of six former patients bringing a separate legal claim for damages against Dr Reid. She said the decision not to strike Dr Reid off was "absolutely scandalous".

"I'm deeply disappointed with the GMC ruling," she said. "If this had been about another group of people - not transsexuals - I think there would have been a much tougher sentence. Everything that has been taken from me - both physically and in the broadest human sense - can never be recovered."

However, Charles Kane, another former patient of Dr Reid, said he was glad the "kind-hearted" psychiatrist was not struck off.

Mr Kane, who complained to the GMC about Dr Reid but did not participate in the hearing, said: "I am happy with the verdict because with these conditions he cannot really treat anybody else the way he treated me."

Mr Kane had surgery to reverse his sex change in 2004. "I really believe that Dr Reid and the general public should view gender reassignment and sex change very seriously and this is a warning to doctors and patients not to rush into it," he said.

However, he added: "I think generally he [Dr Reid] is a kind-hearted doctor and he didn't really mean to be malicious to the patient. Most of the patients came here to support him because of this quality in him. He is a caring, almost father-figure."

Terry Reed, of the Gender Identity Research and Education Society, condemned the GMC inquiry.

She said: "This was a wholly inappropriate way of dealing with an individual whose approach to treatment is extremely successful and potentially far less damaging than the approach of some other doctors in the UK. He is more interested in caring for his patients than managing them."

The ruling came after a three-year investigation into Dr Reid, who the GMC earlier this week said had treated the five patients inappropriately, against their best interests and contrary to international ‘guidelines’ on the treatment of transsexuals.

The disciplinary panel said he had provided the patients with hormones and referred them for genital surgery without an adequate assessment of their health or proof that they were transsexuals.

He was found to have repeatedly breached ‘guidelines’ set by the Harry Benjamin International Gender Dysphoria Association, regarded as the minimum standards for the treatment of transsexuals.

Despite the verdict, Dr Reid continues to command wide support in the transsexual community, many of whom regard him as their saviour. A blog set up by his supporters attracted more than 250 messages in his defence.

Dr Reid has a month to appeal against the verdict. The GMC will review the restrictions on his practice in a year.


Regrets - But Only a Few - About Gender Reassignment

http://www.guardian.co.uk/gender/story/0,,2087700,00.html

Friday May 25, 2007

The Guardian

Many in the UK trans community have been watching the Russell Reid case closely (Mistaken identity, May 23-Below) and are tired of the media fascination with a tiny minority who have undergone gender transition and then regretted it. The nine or 10 cases in the glare of the media need to be seen in the context of the 2,100 people who have successfully applied for legal recognition in their acquired gender in the UK. Few clinical processes could better a negative outcome rate of five in every 1,000. Indeed, a review of over 70 clinical studies on sex reassignment from over 2,000 patients in 13 countries and spanning 30 years concluded that gender reassignment reaps considerable benefits in terms of quality of life for people with gender dysphoria, with 1.7% regretting the decision (Pflafflin and Junge, 1998).

The attention given to these cases says more about the anxieties that some people have about the idea of people moving from one gender to another than the success of gender reassignment. If only journalists would write about the discrimination that trans people in the UK face, as highlighted by the recent report in Equalities Review.

Dr Lewis Turner

Morecambe, Lancashire

 

As a psychotherapist who has worked closely with patients like Claudia, I thought your article ducked a couple of crucial issues. The first concerns the mechanics of sex. When Claudia was asked what she most missed about not being a man she talked coyly about not being able to pee standing up. Far more serious for my patients has been their inability to experience a proper orgasm with their genitals surgically mutilated.

The second question is ethical. As Bindel makes clear, the failure to identify with male role models is a major driving force behind male-to-female gender-reassigment surgery. And presumably equivalent factors apply in the opposite direction. So can it ever be appropriate or effective to try to address such psycho-social issues surgically, or is this a mad project that stems from the confusion of the physical with the real? As an ex-patient of mine put it: "Would the NHS have provided me with a pouch if I had convinced a psychiatrist I was a kangaroo trapped in a human body?"

Bob Withers

Brighton, East Sussex

 

Trans community advocates have common ground with Julie Bindel on the importance of people being able to be themselves and not feel pressured into genital or other surgery to make others more comfortable - that's why we fought and won the principle that such surgery was not essential for legal recognition of gender changes. But the claim that "a growing number of male-to-female transsexuals" regret their surgery simply doesn't concur with the facts - hence the recycling of the same handful of tales for as long as I can remember.

Christine Burns

Trans rights campaigner, Manchester

 


Q&A: Russell Reid inquiry

David Batty explains the background to the General Medical Council disciplinary hearing into the conduct of one of Britain's best-known gender psychiatrists

 

Friday May 25, 2007

Guardian Unlimited

What was the inquiry about?

The UK's best-known expert on transsexualism, Russell Reid, faced a General Medical Council disciplinary hearing into allegations that, between October 1984 and August 2003, he breached standards of care by prescribing patients with sex-changing hormones and referring them for genital surgery without adequately assessing them. Two of the patients told the inquiry they regretted changing sex.

Who is Russell Reid?

Dr Reid is a consultant psychiatrist who specialises in the treatment of gender identity disorders, particularly transsexualism, in which a person possesses a strong and enduring desire to live and be accepted as a member of the opposite sex.

A member of the parliamentary forum on transsexualism, Dr Reid has campaigned for equal rights for transsexuals and is very popular with some sections of the transgender community who affectionately refer to him as "Uncle Russell".

He has worked for the NHS, including the main gender clinic at Charing Cross hospital, in west London, and in private practice. However, he retired from his NHS post at Hillingdon hospital, north London, in April 2005, and in February 2006 handed over his private practice in Earls Court, west London, to Richard Curtis, a transsexual GP.

What were the charges?

Dr Reid was charged with serious professional misconduct relating to his treatment of five former patients, referred to as B, C, D, E and F. The patients complained that he rushed them into taking sex-changing hormones and, in some cases, undergoing surgery, thereby breaching guidelines for the treatment of gender identity disorders.

Patient B told the inquiry she regretted changing sex and now feels stuck in gender limbo. Patient C, a convicted paedophile, said he wanted his sex change reversed. Patient D said she decided she needed to have a sex change after watching a TV documentary about transsexuals while suffering from depression.

She told the inquiry that her illness led her to believe she was turning into Jesus and a sex change would help her achieve that transformation. After being treated for manic depression, she no longer has any desire to change sex.

Who brought the complaints?

Four doctors from the Charing Cross gender clinic - James Barrett, Richard Green, Donald Montgomery and Stuart Lorimer - forwarded complaints on behalf on patients B, C, D and E.

Dr Barrett and Dr Green are members of a Royal College of Psychiatrists' expert committee, which is devising new UK standards of care for the treatment of gender identity disorder. Dr Reid was also a member of the committee until he was asked to step down because of the ongoing GMC inquiry.

Another of his former patients, patient F, filed a separate complaint, although her case was considered along with the other four.

What do the guidelines say?

The guidelines, set by the Harry Benjamin International Gender Dysphoria Association, are "flexible directions", not legally binding, and may be modified to suit individual patients.

However, they are widely regarded by doctors as the minimum standards of care patients should receive. The guidance states that patients should have been living in their desired gender role for at least three months before being 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.

Were the charges proved?

The most serious charges against Dr Reid were found proved (pdf).

The GMC said he gave the patients hormones too soon and referred them for genital surgery without an adequate assessment or proof they were transsexual. The disciplinary panel declared his treatment was inappropriate, not in the patients' best interests and in breach of the Harry Benjamin guidelines.

What was the final verdict?

Dr Reid was found guilty of serious professional misconduct, and the panel rebuked him for his "lack of caution in initiating hormonal and surgical gender reassignment treatment in these patients without more careful and through investigation and assessment".

It noted that patient D had narrowly avoided an "unnecessary mastectomy" and that patient C remained uncertain of their gender identity.

Although the panel said patients B, E and F remain in their reassigned gender role and appear not to have suffered harm, it decided Dr Reid's care "fell well short of the standard of care to which [they] were entitled". The full verdict can be found here (pdf).

What penalty was imposed?

Dr Reid avoided being struck off or suspended, but had strict conditions imposed on his practice.

If he decides to come out of retirement, he can only work under supervision and must provide the GMC with a record of any patients he treats for gender identity disorder every three months.

He is barred from providing patients with sex changing hormones on their first appointment. Nor can he do so without a full physical and psychiatric assessment, a firm diagnosis of transsexualism, verification that a patient has gender identity disorder, or without informing the patient's GP.

What reaction has there been to the verdict?

Dr Reid has so far refused to comment, but Dr Barrett has welcomed the conditions placed on his practice, saying they would ensure he provided a good standard of care.

Claudia, an ex-patient of Dr Reid who is involved in a claim for damages against him, said it was "absolutely scandalous" that he had not been struck off.

One supporter of Dr Reid said he was not a "rogue doctor" and provided a valuable service to the transsexual community. She dismissed the case as brought by a group of doctors with a "history of bad blood" with Dr Reid.

What are the wider implications of the case?

The Department of Health says it will not have any bearing on the provision of treatment for gender identity disorders.

However, the GMC's conclusion that Dr Reid strayed too far from accepted practice are likely to shape the new UK standards of care covering this field of medicine.

The standards are currently being drawn up by the Royal College of Psychiatrists, other medical bodies and patient groups. The GMC's recognition of the Harry Benjamin guidelines is also likely to lead to a stricter adherence to its recommendations.


Mistaken Identity

http://lifeandhealth.guardian.co.uk/wellbeing/story/0,,2086087,00.html

On Monday, psychiatrist Russell Reid was censured for improperly authorising five sex changes. Claudia, whom Reid approved for gender reassignment 20 years ago, tells Julie Bindel how she was rushed into the operation - and quickly came to regret it

Wednesday May 23, 2007

The Guardian

There was a moment when Claudia, as a young gay man living with the person she describes as the love of her life, was "blissfully happy". Now, approaching 50 and medically retired from her successful career as an opera singer and performer, she is full of regrets. "I feel I was railroaded into having a sex change," she says, "when I should have been enabled to live happily in my own skin."

Claudia, who does not wish to reveal her surname, is one of a growing number of male-to-female transsexuals who regret undergoing gender-reassignment surgery. In 1985, after a consultation with psychiatrist Russell Reid that she says lasted only 45 minutes, she was diagnosed as transsexual and referred for surgery. Reid, until his retirement last year, was the UK's best-known expert in gender identity disorders (GIDs). During more than 20 years of practice, Reid was responsible for assessing whether those wishing to change sex fitted the criteria for treatment. On Monday, after a case lasting three years, the General Medical Council's disciplinary committee ruled that Reid had prescribed hormones to five of his patients too soon, and referred them for genital surgery without properly assessing their mental and physical suitability.

The complaints were made by four doctors at the gender clinic at Charing Cross hospital based on the cases of five male-to-female transsexuals. Claudia was keen to be a complainant, but the GMC ruled that due to minor inconsistencies in her recollection of the consultation with Reid 20 years previously, and because they had sufficient witnesses with similar complaints, she would not be included in the disciplinary case against Reid. She is, however, currently pursuing a civil claim for damages against him.

Growing up in a tough working-class neighbourhood in the east end of Glasgow, Claudia was, she says, constantly reminded of the worst aspects of manhood, and had no desire to become like the men she encountered every day.

"The women wore the trousers in my family," she says, "with my mother and grandmother keeping things together." The men in the neighbourhood, meanwhile, "battered each other, got drunk, and molested children". Anything less than macho and violent, recalls Claudia, and you were not considered a "real man".

From primary school onwards, Claudia was bullied for being effeminate, and called a "he/she". "I grew up believing I could never live my life as a 'real' man. I never for one moment thought I was a little girl trapped in a boy's body; I just did not want to be the sort of boy I was expected to be."

Claudia was "terrible at all sports", had no friends and felt totally segregated. "I was battered every single day at primary school, and it only got worse at secondary school," she says. "I learned all about the rage of young men, and the last thing I wanted to do was become one."

By the time Claudia had her first real relationship, she was 18 years old and very sexually inexperienced. She met Martin (not his real name) in 1976 when she was at hairdressing college and he at Strathclyde University.

"He was beautiful," Claudia recalls, "like a cross between Jesus and George Best." They soon became lovers and moved in together in Glasgow. Martin, however, insisted he was heterosexual and referred to Claudia as "a woman with a penis."

Claudia had begun to dress as a woman in order to stop the homophobic bullying she endured on a daily basis. "I looked so androgynous," she says, "I had two choices. One was to butch up, the other to dress as a woman."

With Martin as her manager (he was from a family of musicians), Claudia's love of singing and performing became a lucrative career for them both. In her early 20s Claudia began touring abroad with her show. She soon found that her days of being bullied for her appearance were not over. On her way from Paris to the Hague, a border guard took exception to Claudia dressing in a feminine manner when her passport confirmed she was male. "He had a wobbly, and really battered me," says Claudia. "When I got home Martin said we had to 'fix it' once and for all."

Under increasing pressure from Martin, who insisted Claudia was "really a woman", she decided to undergo hormone treatment as a first step in the direction of a complete sex change.

Having been prescribed hormones by a psychiatrist in Glasgow, Claudia began to live as a woman, just before moving to London with Martin in 1985. Hearing from friends in the close-knit transsexual community that one of the only surgeons who carried out gender-reassignment surgery was about to retire, she made an appointment with a psychiatrist to whom many of her friends referred as "Uncle Russell" - Reid - who was then based at Charing Cross.

Claudia says that during the 45-minute consultation, Reid asked her how she was earning her living; how long she had been taking hormones; and whether she had played with dolls as a child. Claudia explained that her life was bound up with her boyfriend, who was also her manager. She told him she wanted to change sex because she was living with a man who was not gay and that he was having affairs with women.

"Warning bells should have been ringing for him there and then," says Claudia. "Even I was aware at the time that those reasons weren't good enough." However, Claudia was convinced her troubles - with bullying, and her relationship with Martin - would be over if she changed sex.

"Martin slept with women the whole time I was with him," says Claudia, "and would say, 'If you were a girl, this wouldn't be happening,' and of course I believed him." A year after the surgery, Martin left Claudia.

"If I had been properly assessed, it would have been obvious that sex-change surgery was inappropriate for me," says Claudia. "I was desperately unhappy and was going for a sex change because I felt under pressure from my boyfriend." No searching questions were asked about her background and no warning or preparation were given as to the impact of such life-changing surgery. That surgery took place just three months after her consultation with Reid.

Since the case against Reid began, many in the transsexual community have spoken in support of him. Websites serving the gay and transgender communities are full of comments about how Reid has shown phenomenal support to numerous transsexuals. He "has saved the lives of many trans people, treated them with respect and left them with the dignity they deserve," reads one post. Many others wrote in, agreeing.

Claudia's world, however, began to crumble soon after the surgery. "My body was not my own any more," she says, "and it turned out not to be the success I had been led to believe it would be, in more ways than one." She found sex difficult, as the surgery had not been entirely successful. In pain and discomfort, her confidence was at rock bottom and her desire for sex nonexistent.

Soon after her change, Claudia became sucked into the world of transvestism and transsexualism, even though it felt "alien" to her. "I was by then a very successful opera singer and drag performer," she says, "but as soon as I had my surgery I lost all confidence. Rather than going on stage in character, I was there as this thing. There is a huge leap from being a cross-dresser to being a transsexual."

When Claudia's relationship with Martin broke down, so did her professional and home life. Soon afterwards, she suffered a breakdown. Claudia moved in with her mother in Glasgow, and it was then that she first sought help for depression. "Before the breakdown I was in total denial that the cause of the problems was the sex-change operation and its consequences."

In 1995 Claudia suffered a sexual assault, an event she found deeply traumatising. At first police, not realising Claudia was a transsexual, were sympathetic. When the forensic examiner realised, however, everything changed. "Policemen would come into the room I was in, just to have a look at me. Some would laugh. It was then that they stopped taking the attack seriously. "It was during her recovery that Claudia had the opportunity to reflect further on how drastic a mistake it had been to have sex-change surgery to correct her psychological problems.

After reading the novel The Silence of the Lambs, which includes an account of a man who wanted to have a sex-change operation but was not referred for one because he did not meet all the criteria, Claudia realised that she had not met them either. "It was only on reading that book that I realised that there were any criteria in place for assessing patients for sex change," she says, "and that psychiatrists had to take account of these before referring somebody for such a drastic life-changing operation."

Before being prescribed hormones, patients seeking to undergo gender-reassignment surgery should be able to display demonstrable knowledge of the effects of hormones on the mind and body, and their benefits and risks. Three months before taking hormones, patients should be advised to undergo a period of psychotherapy. Before surgery is considered, the general guidelines stipulate that patients should live full time in their desired gender role for at least a year to see how they cope with work, family, friends and relationships. "I neither lived properly as a woman," says Claudia, "or had counselling to prepare me for what was coming." In 2004 another of Reid's former patients, the businessman Charles Kane, complained that he had been referred for gender-reassignment surgery after living as a woman for only a month.

Despite being an optimistic person, Claudia is dreading growing old alone. "I'll never have a relationship. Who's going to want me when they could get a real woman?" she says. "I am not a woman, I am a sex change, and men know that." For Claudia to live as a woman with a partner, she believes she would have to reinvent her past life and pretend she grew up as a woman, something she is not prepared to do. "It is not possible to integrate and 'pass' in the same way that it used to be, because of all the raised awareness. People know what to look out for."

Claudia is not bitter about her experiences, but would like an apology from Reid, and some financial compensation to reflect that fact that her sex change ruined her career and personal life. She would also like to help prevent other troubled young men going through the same traumatic experiences.

"I fundamentally regret having had surgery. I could have lived as a woman without mutilating my body, but no one talked to me about the possibility," she says. "I could have been enabled to live happily as a gay man. Instead I was put in this box - transsexual - simply because I did not conform to what psychiatrists think a real man should be."

What does Claudia miss about being a man? "Standing up to pee for convenience. Not waiting for the double take when an admirer first clocks me. And I miss having the newly acquired acceptance of my male body. I had just found some when I had the surgery."

As gender-reassignment surgery becomes more commonplace in the UK, with more than 400 operations carried out each year, and since the recent implementation of the gender recognition bill, which allows those who have had reassignment surgery to change their passports and birth certificates to reflect their new sex, society seems to be becoming more accepting of a person's right to decide to change their gender. For Claudia and others who regret having surgery, this is not good news.

"If we allowed people to be as they wish, whether that is a man being camp and feminine or a woman butch and unadorned," says Claudia, "then the need to chop up healthy bodies to achieve that acceptance would diminish".



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