Tavistock faces potential class action lawsuit

Claims of medical negligence include reckless dispensing of puberty blocker drugs to vulnerable children

Photo by David Marcu on Unsplash

UPDATED: The U.K. Tavistock gender clinic faces potential litigation with as many as 1000 families of former patients expected to join a class action lawsuit alleging medical negligence, according to The Times newspaper.

The national clinic, which is to close next year following an independent review by paediatrician Dr Hilary Cass review, will reportedly be accused of adopting an unquestioning gender-affirmative approach, misdiagnosing vulnerable minors and putting them on a harmful medical pathway.

“These children have suffered life-changing and, in some cases, irreversible effects of the treatment they received . . . We anticipate that at least 1,000 clients will join this action,” Tom Goodhead, chief executive of law firm Pogust Goodhead, told The Times.

The law firm is seeking a group litigation order, which enables a number of similar claims to be managed collectively; papers are expected to be lodged at the High Court within six months.

A spokesperson for the Tavistock clinic told The Times that the service was “committed to patient safety” with no expectation of the treatment path for any given patient.

Paul Conrathe of SinclairsLaw, who acted as solicitor for detransitioner Keira Bell in her 2019-22 judicial review action against the Tavistock, said it was “not surprising” that the clinic now faced compensation claims for clinical negligence.

“Keira Bell's case exposed serious concerns about the treatment of children with gender dysphoria,” Conrathe told GCN.

“Those concerns have been amplified by subsequent independent investigations from both the regulator [the Care Quality Commission] and the independent investigation led by Dr Hilary Cass. 

“These compensation claims should sound a warning note to clinics that prescribe life-changing medication to vulnerable children.

“Ideologically driven medical approaches to treating gender dysphoria, which lack a rigorous evidence base, expose children to a significant risk of harm and doctors to risk of litigation.”

Any class action against the Tavistock, the world’s largest youth gender clinic, is likely to be watched closely by other clinics internationally using the same “child-led” gender-affirming approach and the “Dutch protocol” treatment of puberty blocker drugs to stop normal development, followed by hormone drugs to make the body appear more like the opposite sex, and then surgery such as mastectomy.

In other developments, the U.S. state of Texas is conducting a deceptive trade practices investigation into the drug companies Endo Pharmaceuticals Inc & AbbVie for alleged promotion of puberty blocker drugs for children without disclosing potential risks and without regulatory approval. (The same hormone suppression drugs are approved for the medical conditions of central precocious puberty and prostate cancer.)

Bernard Lane @Bernard_Lane

"[I'm here] to talk about these very young kids getting 'gender affirming care'. They don't tell you what that is ... they are actually giving very young girls double mastectomies, they want to castrate these young boys -- that's wrong." @GovRonDeSantis #AusPol #Health 1/

Florida’s Voice @FLVoiceNews

#BREAKING: Gov. Ron DeSantis calls for doctors to be sued for providing children suffering from gender dysphoria double mastectomies and castrations "They wanna castrate these young boys - that's wrong ... I think these doctors need to get sued for what's happening." https://t.co/aKwsHIlzXF

Earlier this month, Florida’s Medical Board met to begin consideration of a proposed rule that would prohibit medicalised gender change for minors. Florida’s Agency for Health Care Administration has advised against Medicaid subsidies for paediatric transition, following a comprehensive scientific critique of gender-affirming treatment for children and adolescents.

The Times said the medical negligence claims against the Tavistock clinic were based on February’s interim report from Dr Cass, and the alleged failures in care included reckless prescribing of puberty blocker drugs with harmful side-effects.

In her report, Dr Cass said that from the point of entry to the Tavistock, “there appears to be predominantly an affirmative, non-exploratory approach, often driven by child and parent expectations and the extent of social transition [living as if the opposite sex] that has developed due to the delay in service provision”.

Judging by documents given to the Multi-Professional Review Group — set up to supervise treatment decisions after detransitioner Keira Bell’s initial success in her judicial review case against the Tavistock — Dr Cass found “there does not appear to be a standardised approach to assessment or progression through the process [at the clinic]”.

“There is limited evidence of mental health or neurodevelopmental assessments [for children with autism, for example] being routinely documented, or of a discipline of formal diagnostic or psychological formulation.

“There do not appear to be consistent processes in place to work with other agencies to identify children and young people and families who may be vulnerable, at risk and require safeguarding.”

Joseph A. Ladapo, MD, PhD @FLSurgeonGen

Florida doesn’t support the medicalization of minors with GD because the benefits are unproven, and the risks are extraordinarily high. Chloe was treated with puberty blockers and testosterone at the age of 13. @ChoooCole was courageous enough to share her story with us.

In September 2021, the English Court of Appeal set aside the verdict in Keira Bell’s favour for technical legal reasons, but reminded gender clinicians of their responsibilities and the possibility of medical negligence suits against them.

“Clinicians will inevitably take great care before recommending treatment to a child and be astute to ensure that the consent obtained from both child and parents is properly informed by the advantages and disadvantages of the proposed course of treatment and in the light of evolving research and understanding of the implications and long-term consequences of such treatment,” the judges said.

“Great care is needed to ensure that the necessary consents are properly obtained ... clinicians will be alive to the possibility of regulatory or civil action where, in individual cases, the issue can be tested.”

In her interim report Dr Cass raised concerns about “diagnostic overshadowing”, noting that “many of the children and young people presenting [at the Tavistock clinic] have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be subsumed by the label of gender dysphoria.

“This issue is compounded by the waiting list, which means that there can be a significant period of time without appropriate assessment, treatment or care.”

In line with advice from Dr Cass, England’s National Health Service is to replace the stand-alone Tavistock clinic with regional centres more safely anchored in the mainstream mental health system and less likely to be influenced by gender-affirming groupthink.

Trans rights activists have falsely claimed that the proposed reforms endorse the Tavistock’s treatment approach and that the only reason for the shift to regional centres is to reduce waiting time.

In her July 19 letter to NHS England, Dr Cass said “the most significant knowledge gaps are in relation to treatment with puberty blockers, and the lack of clarity about whether the rationale for prescription is as an initial part of a transition pathway or as a ‘pause’ to allow more time for decision making”.

In her interim report, Dr Cass said a patient’s clinical notes should make clear “the stated purpose of puberty blockers as explained to the child or young person and parent.

“Any child or young person being considered for hormone treatment should have a formal diagnosis and formulation, which addresses the full range of factors affecting their physical, mental, developmental and psychosocial wellbeing. This formulation should then inform what options for support and intervention might be helpful for that child or young person.

“Currently paediatric endocrinologists have sole responsibility for [hormonal] treatment, but where a life-changing intervention is given there should also be additional medical responsibility for the differential diagnosis leading up to the treatment decision.”

Consistent with multiple systematic reviews of the medical literature internationally, Dr Cass has highlighted the weak evidence base for medicalised gender change with minors, especially today’s group of atypical cases of gender dysphoria diagnosed in teenage girls.

Historically, this distressful conflict between biology and identity affected a minuscule number of preschool boys, with most of them growing out of it without medical intervention, and many of these once dysphoric patients emerging as gay or bisexual adults.