This week, the High Court granted leave to two leading medical experts, Prof Donal O’Shea and Dr Paul Moran, to seek a judicial review of HIQA’s alleged failure to review the HSE’s care of children with gender dysphoria.
Prof O’Shea is a consultant endocrinologist at the National Gender Service (NGS), and Dr Moran is a consultant psychiatrist at same – and both have been outspoken regarding the possible risks to children in the HSE’s referrals to the disgraced Tavistock clinic in London where former patients (who were children and young people when they went to the clinic) said they were rushed to change gender without the necessary mental health assessments.
On Monday, Ms Justice Mary Rose Gearty granted permission to Joe Jeffers SC and Brendan Hennessy BL, for the two doctors, to have a hearing of the case.
Prof O’Shea and Dr Moran have challenged the HSE’s referral of young people for assessment abroad, saying it poses a possible risk to children.
Serious questions had been raised about Tavistock long before the clinic was finally closed down in 2022, after the UK’s health watchdog, the Care Quality Commission, gave it the lowest possible rating of ‘inadequate’ and found “significant concerns” with how it was operating.
It fact, in 2019, an internal report by a Tavistock board member effectively turned whistleblower, Dr David Bell, revealed how patients – again, these were children and adolescents – were suffering ‘long term damage’ because the clinic’s treatment was being shaped by what he saw as highly politicised’ campaigners and families. He felt children were being “rushed through” the gender service and set on a medical pathway to address gender confusion while other issues such as anxiety and depression were not addressed.
Bell’s report should have set alarm bells ringing in the HSE. But this was in a climate when activists and extreme views on gender identity held sway to the point where it felt like any caution would only be met with extreme public hostility.
In fact, even when Tavistock was described as putting children at “considerable risk” in 2022, and when their treatment of kids with gender dysphoria had become a major public scandal in England, the HSE said it would continue to send Irish children to the clinic as they had found no evidence it was unsafe.
It is to the credit of Drs O’Shea and Moran that they persisted in putting the welfare of their patients first, ahead of any concerns they must surely have felt about the inevitable backlash for speaking out on their concerns about what was happening to children – a backlash they were subject to even though they were the medical experts and those making demands on them were activists.
In March 2019, Dr Moran wrote to the HSE, copying Prof O’Shea urging that children no longer be referred to Tavistock, saying it should be a priority that the Tavistock service being facilitated by the HSE be terminated as quickly as possible. Their concerns were ignored, the doctors have said, and the email was not acted on.
Both doctors then conducted an audit of the patient files of 17 teenagers who had been to Tavistock as children before they had subsequently been referred to the National Gender Service in Ireland. What they found was shocking:
In seven of the cases, the audit found no record of a proper assessment, which should have included detailed patient histories and reasons for treatment decisions.
Nine of the teens had been prescribed puberty blockers or cross-sex hormones, but in eight of the cases it was unclear from the documentation whether they had been prescribed medication at all.
“What that audit told us was that… we were sending our young people to a very inadequate service. We wanted that data to go and show the HSE why we had to stop the Tavistock,” Prof O’Shea said.
Dr Moran emailed the audit to a senior doctor within the HSE and says his email was ignored until two years later.
In fact, the HSE tried to move against Dr Moran saying he had breached data regulations by sharing an audit. The charge was investigated, and that investigation found “Dr Moran had a legal and ethical obligation to share this information” with the HSE, but the action of the health service clearly had purpose. It is deeply troubling that Dr Moran’s audit and his concerns were treated in such a fashion.
Around the same time, Prof O’Shea spoke publicly about a new gender identity panel set up by the HSE when Simon Harris was Minister for Health. He pointed out that the panel did not include any clinicians experienced in treating transgender patients – and added that he had to decline a position on that panel because the Ministerial nominee was an advocate “who has frequently trashed our services”.
A committee “with no clinical experience” in the management of gender issues “isn’t going anywhere”, he added at the time.
The response of transgender activists was to attack Dr O’Shea. The above-mentioned ministerial nominee, Noah Halpin described the doctor of using “fear-mongering statistics of which there are no record of”, and accused him of making a “bizarre and extremely unprofessional attack on TENI – for seemingly no reason at all.” The GCN article was headed: “Professor Donal O’Shea made multiple uninformed and disparaging comments surrounding transgender people and trans healthcare”.
Gay Community News later wrote that: “the time has come for the wider LGBTQ+ community to use their campaigning expertise and resources to assist their Trans brethren and put pressure on the HSE to engage with the Trans community and TENI to address this crisis immediately by implementing an informed consent model of care and end the pathologising of Trans people”.
The “informed consent model of care” is gender affirming care, which has caused so much damage. In 2023, O’Shea said that groups like TENI were “shaping, if not brainwashing political thinking in Ireland” at the time, and that the thinking of senior management in the HSE was always to “say activist view is correct when it’s not correct”.
It is mind-boggling that these medical experts – both with long track records of excellent care for patients – were put in a position where they felt the HSE was listening, not to the medical expertise of their employees, but to crackpots.
And the impact of that HSE decision is potentially devastating: Dr Paul Moran told Newstalk Breakfast that “We’ve been seeing the children, who the Tavistock have recommended starting on hormones, be very unwell and not ready to start hormones.”
“It has led to further harm. We’ve seen their mental health being very poor, dropping out of school, self-harming and have substance problems.
“Clearly the assessments done were completely inadequate”.
Further, he he suggested that any problems for patients may not have emerged just yet.
“If there are going to be problems, we would not see them yet. These children are still quite young, and it’s too early for them to realise that they will never be able to have families and the health problems that can be linked with these treatments”.
That is horrendous. Little wonder that the doctors were left with no option but to ask Hiqa “to consider whether there were reasonable grounds to believe that there may be a serious risk to the health or welfare of the children receiving the relevant services.”
But as the court heard this week: “There is no evidence, or no sufficient evidence, in the decision letter whether Hiqa did in fact consider whether there were reasonable grounds to believe that there may be a serious risk to the health or welfare of the children receiving the relevant services.”
The judge in the High Court this week granted a judicial review which would also seek to look at the “a care pathway established by the HSE, whereby Irish children are now being referred to a private clinic in Antwerp, Belgium, by a non-medically trained “trans-activist”.
“The clinic in question is located in ZNA Hospital, Antwerp and is operated by an endocrinologist by the name of Dr Klink. The complainants allege the clinic had no “model of care” or discernible operational guidelines, Mr Jeffers has submitted to the court.
Mr Jeffers told the court the applicants have concerns about “proper” care in Antwerp and over alleged lack of “regulatory oversight” by health authorities in Ireland.
The matter under review is really an appalling can of worms that the court action by Drs Moran and O’Shea may now open, reflecting their determination to do the best for children with gender dysphoria in the teeth of trans activism. They’ve had to speak publicly, fight against the national health service, and now initiate court proceedings in order to protect their patients and to protect children experiencing gender confusion.
We owe them a debt of gratitude. And the HSE – and the politicians who facilitated this terrible situation – owe the public answers.