Two hats

Neurologist Christine Kilpatrick has dual roles highly relevant to the gender clinic controversy

Photo by Raphael Renter | @raphi_rawr on Unsplash

Comment | Professor Christine Kilpatrick, who trained in neurology, occupies two positions that might make any thoughtful person somewhat nervous.

Since 2024, she has chaired the board of the Australian Commission on Safety and Quality in Health Care. And she became chair of the board at the Royal Children’s Hospital (RCH) Melbourne on July 1 last year.

The Commission is a health sector watchdog agency. RCH Melbourne gives minors puberty blockers and cross-sex hormones, and sometimes enables a referral to a private surgeon willing to perform a mastectomy on a teenage girl’s healthy breasts. All this in the name of gender. How can it be reconciled with safety and quality?

Do Professor Kilpatrick’s two hats give rise to a conflict of interest? Asking via RCH’s media handlers produced no answer. The Commission cited its policy on disclosure of interests, and told me that Professor Kilpatrick’s RCH role “has been declared”.

I’m not suggesting any wrongdoing, but there are questions and perceptions that warrant discussion.

Professor Kilpatrick has a history with RCH, having served as chief executive officer of the hospital from 2008-17.¹ In 2012, when paediatrician Dr Michelle Telfer took charge at the RCH gender clinic, there were 18 new referrals. In 2017, Professor Kilpatrick’s last year as CEO, the gender clinic had 253 new referrals. That’s an increase of 1,305 per cent.

On the hospital’s website, you can find a 2018 talk by Dr Telfer on “Legal reform in transgender adolescents”. Hers is a story of children in distress, clinicians championing their cause, the obstacle to reform represented by Prime Minister Tony Abbott and others from the “dominant right faction”, “clever” lawyers nudging the Family Court to wind back its supervision of gender dysphoria treatment for minors, and the ultimate humiliation of those who did not see all this as progress.

At the time, Dr Telfer told her audience of RCH alumni, she “was being targeted personally online”.

The health professional regulator AHPRA had “received a letter from an unnamed group, notifying them that I was a child abuser due to the nature of my work”.

“As instructed by AHPRA I made an appointment with [CEO] Christine Kilpatrick to inform her of the notification. Christine said, ‘Show me that letter’ and then went [on] to say she’d been sent the same one, but had thrown it in the bin. Fortunately, the Medical Board also dismissed it as being politically motivated.”²

More reason to fear a conflict of interest for Professor Kilpatrick? I cannot know if that letter of complaint was accurately characterised by RCH, but it’s a hallmark of the “gender-affirming” worldview to dismiss even evidence-based criticism as right-wing politics or religious conservatism.

Not our problem

The gender-affirming treatment model has been the subject of heightened scrutiny for several years now. Citing weak evidence and the risk of harm, health authorities in the UK, Finland, Sweden, New Zealand and Australia’s state of Queensland have adopted policies to restrict the hormonal interventions still given as routine at most public children’s hospitals in Australia.

Any role in this for Professor Kilpatrick’s Commission? I was told it “has not undertaken work, or been asked to conduct any work, on the issue of youth gender dysphoria”.

I asked if the commission had a duty or power to inquire into the safety or quality of the gender dysphoria/incongruence interventions offered by providers such as state children’s hospital gender clinics, other public health services or providers in receipt of public funds such as Orygen/headspace or ACON?

The response: “The Commission is a national co-ordinating body for improvements in the delivery of safe and high-quality health care. It is not a regulatory agency or complaints body, and does not directly regulate healthcare facilities.

“The Commission’s planned activities are shaped by our strategic priorities and align with the functions of the Commission set out in the National Health Reform Act (2011).”

One of its four key priorities is “Strong outcome-focused clinical governance, [because] clinical governance, integrated standards and accreditation drive better patient outcomes.”

A recent letter to Australia’s federal Health Minister Mark Butler disputes the Commission’s self-characterisation as simply a co-ordinator with no obvious role in the gender clinic controversy.

“A body that approves agencies to accredit health service organisations on its behalf, the accreditations of which it is responsible for then authorising and listing on its website, is not merely a coordinator,” says the June 1 letter from Emeritus Professor Bronwyn Winter as Co-Convenor of Australian Feminists for Women’s Rights.

The letter alerts Minister Butler to the statutory functions of the Commission under the 2011 Act, including its role in “the formulation of model national schemes to accredit health service organisations”.

Professor Winter’s letter invokes a string of health scandals—Chelmsford, Ward 10B, Newhaven, Bundaberg, Campbelltown, Oakden, and Djerriwarrh—as the founding rationale for the Commission’s creation.

“The Commission appears to have lost sight of its regulatory mandate to prevent avoidable harm by doctors,” the letter says.

“The administration of puberty-suppressing and cross-sex hormonal agents to alter the bodies of children without a valid evidence base allowing for informed consent repeats the above-mentioned pattern [of past scandals].

“This pattern is to ignore significant concerns being raised and instead to assume that a patient safety accreditation system is working. The medical profession’s own repeated failure to recognise this pattern is precisely why the Commission was established as an independent statutory body tasked with external clinical governance of health services.”³

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Detransition: Keira Bell, a former patient at the London-based Tavistock gender clinic, and other detransitioners tell their stories at a 2026 Genspect conference in Washington, DC

Strictly feedback

I asked the Commission whether it had any role in the development of new national treatment guidelines by the National Health and Medical Research Council, a project assigned by Mr Butler in January 2025. The Minister also asked the NHMRC to undertake “a comprehensive review” of the de facto national guidelines for youth gender dysphoria first issued by RCH in 2018.

“The Commission is registered to receive updates [on the NHMRC guideline project] and will contribute feedback during the public consultation,” a spokeswoman said.

Intriguingly, it seems there might have been an opportunity to run such an NHMRC review “a few years ago” on the recommendation of the Commission, according to internal documents obtained under Freedom of Information (FOI) law.

An outsider, whose identity was redacted from the FOI documents issued to GCN, had asked in May 2025 if the Commission had “ever reviewed or endorsed” the RCH gender clinic’s treatment guidelines, which have been promoted as “Australian Standards of Care”.

This led to an email exchange within the Commission, touching on the new NHMRC guideline project, with one Commission staffer saying: “… I saw there was discussion around this a few years ago with a recommendation from the Commission that the NHMRC undertake a review—which has now commenced [following Minister Butler’s intervention]”.

I asked the Commission to confirm the fact of an earlier opportunity to scrutinise gender clinics, but received no reply.

In August 2025, the month following Professor Kilpatrick’s arrival as chair of the RCH board, the hospital underwent a “short-notice assessment” for accreditation.

The benchmark is the Commission’s National Safety and Quality Health Service Standards. The assessment is undertaken not by the Commission directly but by an accrediting agency, such as the Australian Council on Healthcare Standards, in a system overseen by the Commission.

Under the rubric of clinical governance, RCH was assessed on 33 safety and quality aspects, known as “actions”. The hospital met requirements on 31 with no changes needed, and satisfied another two after necessary or recommended “improvements”.

“The Clinical Governance Standard aims to ensure that a clinical governance framework is implemented so patients and consumers receive safe and high-quality care,” the Commission website says.

Action 1.01 states that the hospital board “Endorses the organisation’s clinical governance framework”. Action 1.27 requires the hospital to provide clinicians with “ready access to best-practice guidelines”.

Under the heading “Partnering with Consumers”, Action 2.04 has the hospital ensuring “that its informed consent processes comply with legislation and best practice”.

Unreliable guide

To be sure, the gender clinic is just one centre within a large children’s hospital. But nothing at RCH rivals the gender clinic as a subject of considerable public disquiet and a potential threat to the reputation of the hospital.

How would the treatment guidelines of the RCH gender clinic qualify as best practice? This 2018 document was appraised in a peer-reviewed study of international guidelines commissioned by the distinguished UK paediatrician Dr Hilary Cass during her landmark 2020-24 review of youth gender dysphoria care.

In the systematic review of guidelines undertaken by the UK University of York, the RCH contribution to the field was rated 19/100 for the rigour of its development and 14/100 for editorial independence. The RCH gender guideline was not recommended for use. And the circular cross-referencing between the RCH document and other gender-affirming guidelines gave a false impression of consensus favouring medicalisation, despite the poor evidence, according to the Cass review.

In her 2024 final report, Dr Cass noted that the evidence for puberty blockers and cross-sex hormones—confidently recommended by the RCH guideline—was “remarkably weak”. As a consequence, clinicians, minors and their parents who rely on this RCH document cannot know whether the treatments promoted have a favourable benefit:risk ratio.

Yet this guideline, with no published expert authors outside the RCH clinic, was adopted by children’s hospitals across Australia as if it were a national standard. Clinicians using the RCH guideline were advised that not even a diagnosis of psychosis or depression was a necessary obstacle to the medical transition of a gender-distressed minor.

In March 2023, the RCH document was declared untrustworthy by a pioneer of evidence-based medicine, Professor Gordon Guyatt.

The RCH guideline and its contradictions figured in an important 2025 Family Court case known as “re Devin”, involving disagreement about the care of a gender non-conforming boy aged 12 who had been a patient at the RCH gender clinic for almost four years. The clinic and Devin’s mother favoured puberty blockers; Justice Andrew Strum agreed with the father that the child should be protected from blockers and the clinic.

During the hearing, Dr Telfer, who served as the clinic’s director from 2012 to 2022, gave evidence that the RCH treatment guideline was “best practice”. She was the lead author of the document.

In cross-examination, Dr Telfer conceded that her rating the document as best practice “was essentially tantamount to her agreeing with herself,” Justice Strum said in his April 2025 decision. He regarded the guideline as “oddly binary” in its advice “to affirm unreservedly those who present with concerns regarding their gender, brooking no questioning thereof”.

The judge was critical of Dr Telfer for failing in her duty to give impartial evidence as an expert witness in the case; instead, she presented herself as an “advocate for trans rights”.

He also rebuked the RCH gender clinic for persisting in its over-confident claim that puberty blockers are “fully reversible and relatively risk-free” when, in court, Dr Telfer and Devin’s treating psychologist, Dr N, had “to concede the lack of evidence to support that position”. Justice Strum found Dr Telfer unable to cogently defend her belief that very young children had an “immutable” gender identity, without which medical intervention would be hard to justify.

Sometime in late 2024, without explanation or announcement, RCH watered down its online promotion of puberty blockers. Where its webpage had made the unqualified assertion that blockers were “reversible” in their effects, now they were said to be “largely reversible”. According to the RCH guideline, now badged as Version 1.4, 2023, puberty blockers remain simply “reversible”.

Is this good clinical governance?

Professor Kilpatrick’s Commission has launched a new National Model for Clinical Governance. She is quoted as declaring: “When board members, executives and clinical leaders champion clinical governance as fundamental to achieving high-quality care, it sets the tone for the rest of the organisation.”

The new model document says: “Public inquiries into suboptimal care show that weak clinical governance can result in normalisation of poor care, ignored patient concerns, a culture of blame, a disengaged workforce, and overemphasis on legal and financial matters at the expense of care quality and patient outcomes.”

What of the accreditation tick given RCH for informed consent? In re Devin, Justice Strum noted the opinion of a consultant psychiatrist, Dr O, that the boy and his parents were not likely to get from RCH gender clinic staff the “accurate and comprehensive” answers “necessary for true informed consent”. The judge found Dr O to be an “impressive, considered and unbiased expert”.

Is the Commission satisfied that the accreditation of RCH was thorough and rigorous? Does a hospital with such a gender clinic truly meet the National Safety and Quality Health Service Standards of the Commission? Is it in line with the new National Model for Clinical Governance?

No surrender

On 5 June 2025, Justice Strum allowed the identification of Dr Telfer and the RCH gender clinic in the otherwise anonymised case of re Devin. In response, the hospital issued a defiant statement, saying it was “proud to lead a gender service that delivers a world-leading, multi-disciplinary model of care with a strong emphasis on supporting the mental health and wellbeing of the children and young people referred to our service. Our gender service is underpinned by both national and international research methodology.”

On July 1 last year, when Professor Kilpatrick began her term as chair of the RCH board, did she bring some much-needed realism to the analysis of the gender clinic’s record and its clinical governance? There is no outward sign of it.

In November last year, when Professor Kilpatrick presided over an annual general meeting of the RCH board, two mothers challenged her about the gender clinic: they spoke of the reputational damage to the hospital; the re Devin case; the Cass review’s sobering verdict on the evidence; the negative appraisal of the RCH treatment guidelines; the inability of a child to consent to lifelong hormonal treatment; and the international shift to more cautious psychological interventions.

In reply, Professor Kilpatrick acknowledged that “the board has overall responsibility for ensuring the clinical governance”. Within this clinical governance framework, she said, “there are many elements of the treatment which are carefully thought about to make sure there is evidence for that treatment, that they’re monitored carefully, that the staff are educated and trained in that particular area”.

She said clinical governance ensured “that the quality of care is appropriate at this hospital, and we monitor it very carefully through our quality committee and also through the board itself and also within my meetings with the CEO as well”.

One mother pressed her, saying: “To put children on puberty blockers, [when] almost invariably they will go on to cross-sex hormones, [means] they will be sterile, they will have no sexual function. A child cannot give informed consent for that and yet the hospital still seems to defend your position on this [treatment] and I think that is absolutely untenable.”

In a more accommodating tone, Professor Kilpatrick replied: “I’m not a paediatrician, and I’m certainly not an expert in gender dysphoria. And I can understand that the treatment of this condition is for some—for many people, I’m sure, challenging. And the concept of the condition is challenging.”

She mentioned the NHMRC guidelines project, itself a study in conflicts of interest, and said: “I certainly welcome that [project], and I’m sure we all welcome that.”

The Cairns connection

As for the role of her Commission, the recent investigation of a paediatric gender service in the regional city of Cairns suggests some awkward parallels with the RCH clinic. There are 34 references to the Commission in the Cairns report issued in January 2026. The inquiry was triggered by concerns about “treatment adherence with clinical standards”.

The Cairns service had been operating for 20-plus years, but it was “never formally established” and its clinical risks were not monitored or controlled at an executive or board level, according to the report from the investigation.

Although it was supposed to be following the (low-quality) RCH guidelines, the Cairns service showed a “high level of variability with respect to initial assessment, and the documentation of a client’s decision-making capacity”.

There were “deficiencies in the quality of care”. The clinical setup was “not reliably safe for paediatric clients, with mixed adult-child settings, unsecured medications, and incomplete risk assessment for high-risk adolescents”.

In a significant number of cases, there were “gaps in timely and clinically appropriate assessment, treatment, follow up, referral and escalation”. Informed consent was “not consistent with best practice”. The service “did not have adequate clinical governance systems in place” and failed to align with the Commission’s (now superseded) National Model Clinical Governance Framework.

The Cairns area health service, part of the public system in the state of Queensland, had no governance framework “to identify, approve, monitor and report on new clinical products and procedures”. This is significant because the puberty blocker-driven affirmative model is arguably experimental, yet it is offered as routine treatment within Australian public health.

A recently improved system for the Cairns health area, the report noted, was “broadly in line” with the Commission’s guidance document “Introduction of New Interventional Procedures and Clinical Practice Innovations”.

That guidance, the Cairns report said, “calls for a structured governance process, including a dedicated New Interventional Procedures Committee reporting to the organisation’s clinical governance body, to assess proposals, monitor implementation, and determine when innovations can transition to routine care”.

Which brings us back to the RCH gender clinic. There are serious questions about clinical governance at the hospital and how the gender-affirming innovation—as represented in the clinic’s 2018 treatment guideline—became routine.

It is now public knowledge that in September 2019 the RCH gender clinic applied within the hospital for retrospective approval of the new treatment approach it was already using as routine.

The accompanying letter from the gender clinic to the chair of the RCH New Technology and Clinical Practice Committee (NTCP) said: “It is important to highlight that controversy surrounds the management of gender dysphoria, which has recently been replayed in the public media.”⁴

The letter attributed the controversy to “religious beliefs about sexuality”, potentially irreversible effects of the medical interventions, and the “paucity” of evidence on treatment outcomes.

The gender clinic’s application relied on low-quality evidence to claim a high risk of attempted suicide in untreated minors, a doubtful “reversible” status for puberty blockers given to children as young as 10 to 12 years old, and a supposedly low incidence of regret after treatment.

The application was refused in October 2019 by the majority on the hospital’s NTCP committee, whose job is to scrutinise new treatment proposals or medical devices to ensure they are safe and effective.

The committee, which reportedly felt it lacked authority to review an established clinical service, referred the matter to the hospital’s executive team, with the result not captured in FOI documents obtained in 2025.

Psychiatrist and researcher Dr Alison Clayton, who had submitted the FOI request, asked: “Was the RCH treatment protocol approved by the executive? And if so, what was the official and legal basis of this clinical governance process, which appears to have bypassed usual channels?”

I reported Dr Clayton’s analysis for The Australian newspaper on 3 May 2025, two months before Professor Kilpatrick became board chair. We know the Commission is aware of this clinical governance issue. On 28 May 2025, an internal email, obtained under FOI law, cited my news report. The Commission staffer also referred to my commentary on the re Devin case for The Australian on 10 April 2025.

Agents of influence

Professor Kilpatrick is not the only link between the Commission and the RCH gender clinic. Both have ties to radical trans organisations.

The gender clinic website links to MINUS18. Its website tells minors: “Puberty blockers can stop your body developing things like breasts or an ‘Adam’s apple’, and basically give you a bit more time to figure things out. It’s also a reversible treatment.” No mention of international data showing the vast majority of minors begun on blockers proceed to cross-sex hormones, meant to be taken lifelong.

In its 2024-25 annual report, the Commission proudly declared the renewal of its membership with the Pride in Health + Wellbeing program of ACON, the former AIDS council which is now a national trans activist lobby as well as a provider of paediatric medical transition at its Sydney Kaleido clinic.

The Commission’s National Safety and Quality Primary and Community Healthcare Standards Guide for Healthcare Services promotes ACON’s Pride Training. For a Trans & Gender-Diverse Inclusive Practice for GPs course, the fee pocketed by ACON is $3,685. Learning outcomes include the ability to “Outline gender‑affirming healthcare, including options and considerations for social, legal, and medical gender affirmation.”

Does such a course acknowledge the weak evidence for paediatric medical transition as well as its risks and uncertainties? ACON has a track record of playing down the risks and encouraging minors to seek gender medicalisation without telling parents.

ACON’s influence in the health sector seems so pervasive that it would be more newsworthy to find an agency not affiliated with it.

Take the Australian Council on Healthcare Standards, which assesses hospitals such as RCH for accreditation within the Commission’s system. It promotes Pride Month with alarming but low-quality suicide statistics.

When an accrediting agency engages in fast-and-loose “LGBTQI+” activism, its capacity to rigorously assess a hospital with a high-profile gender clinic must be in doubt.

Would the public have confidence in the Commission exerting a corrective influence from above?

At the recent Australian Pride in Health + Wellbeing Awards—a lavish event staged by ACON—Anna Flynn, Director for Partnering with Consumers at the Commission, delivered a keynote address titled “Person-centred care in practice: Every experience matters”.

I asked the Commission if this created a conflict of interest. No direct answer, but a spokeswoman said Ms Flynn’s “presentation focused on the importance of empowering patients, carers and communities through strong and representative clinical governance and a person-centred approach to care”.

When lobby groups are dignified as “communities” and “consumers”, when they exert gender ideological influence, who protects the public interest for Australians?

GCN does not dispute that gender-affirming clinicians believe their interventions to benefit vulnerable minors.

1. It would be interesting to hear the thoughts of RCH Melbourne’s current CEO, Dr Peter Steer. He also sits on the board of Western Australia’s Child and Adolescent Health Service, responsible for a Perth-based gender clinic. And he served as CEO of Children’s Health Queensland, home to a Brisbane-based gender clinic. London’s Great Ormond Street Hospital for Children—where Dr Steer was CEO—hosts one of the post-Cass Review gender clinics.

2. I asked the Commission and RCH to confirm Dr Telfer’s account, but there was no reply.

3. On July 2, a response to Professor Winter’s letter came; not from Minister Butler but from the Commission itself. Professor Anne Duggan, chief executive officer of the Commission, noted that RCH Melbourne had accreditation until April 2029. “Where assessors identify safety and quality failures or significant risks during an assessment, the Commission has mechanisms for reporting to state and territory health departments for further action,” Professor Duggan wrote.

Her response makes no mention of the 2025 re Devin case which, according to the Winter letter, had “documented systemic clinical governance failures at the RCH”. In that case, Family Court Justice Andrew Strum made adverse findings against the RCH gender clinic, its former director Dr Michelle Telfer, and its treatment guidelines.

4. Disclosure: This is a reference to my early coverage of gender clinics for The Australian newspaper. In 2021, Dr Telfer, who has steadfastly ignored my requests for comment over the years, made a complaint about my reporting. This was partly upheld by the Australian Press Council (APC) in 2021.

Two years before, the APC had adopted an activist-influenced guideline to do with “Reporting on persons with diverse sexual orientation, gender identity, and sex characteristics”. The guideline uses inaccurate and ideological terms such as “sex/gender assigned at birth”.

In 2019, before any complaint against me, I reported on the new APC guideline, predicting it would make normal journalistic scrutiny of trans-related issues even more difficult. Back then, I asked the APC which lobbies had been invited to shape the new reporting guideline, but the council refused to say, citing “privacy”. ACON, the most successful trans activist lobby in Australia, has boasted of its involvement.