News

Clayton's Clinic

The clinic you have when you don't have a clinic

When is a clinic not a clinic? When it’s the Monash Medical Centre Gender Dysphoria Clinic located on Southern Health Clayton’s campus. Once proudly listed amongst the hospital’s public health care services, the Monash gender clinic was widely promoted as the only government funded multi-disciplinary clinic for the treatment of patients with gender dysphoria in Australia. Referrals of patients within the Monash gender team of doctors were made on Monash Medical Centre letterhead and those deemed suitable candidates for ongoing treatment were presented with a Monash Medical Centre patient-clinic contract.

If patients of the clinic therefore imparted the credibility associated with the public hospital to their treatment, however, they were sadly mistaken - at least according to Southern Health. Whereas Monash used to claim that they had a clinic for the diagnosis and treatment of gender dysphoria they now claim that Monash merely "coordinates the activities of a group of private specialists involved in the treatment of gender dysphoria."

As it turns out, the clinic is little more than a desk in Clayton, manned by a clinical secretary every Tuesday from 10 til 4. All consultations with the doctors of the clinic are held in their private practice and billed through Medicare. Dr. Kennedy, Director of the Monash Clinic puts it this way:

"The Clinic is not a medical clinic as that expression is commonly understood. Rather, the Clinic is simply a convenient name for an administrative headquarters."

Dr. Kennedy maintains that the doctors responsible for treating patients of the clinic do not do so as employees of the hospital nor on behalf of the hospital or as doctors of the Clinic, stating "They are not ‘part of’ and do not ‘belong to’ the Clinic"

As far as Southern Health are concerned, The Monash Medical Centre Gender Dysphoria Clinic really is the clinic you have when you don’t have a clinic.

Unfortunately, it seems that disgruntled former patients who submitted to radical sex change procedures in the belief that their treatment was under the direction and control of the public hospital just don’t get the joke. After discovering that the removal of their sexual organs did nothing to address their gender confusion, these patients now have no way back to their former selves. Faced with the prospect of living an isolated and lonely life on the outskirts of society without any real possibility of marriage and family, too many may have found suicide their only remaining option.

Clayton's Review

The review you have when you're not having a review

In October 2001 the Chief Psychiatrist's office received the Preliminary Report on the Monash Medical Centre Gender Dysphoria Clinic. The report expressed a number of concerns about the assessment and treatment of patients at the clinic and raised a number of questions about the funding and operation of the clinic that the government has so far been unwilling or unable to answer.

Following the release of the report, a number of former patients of the clinic have come forward with complaints of inadequate assessment and inappropriate treatment with sex modification procedures.

In November of 2003 the mental health branch of the Department of Human Services, in conjunction with the Office of the Chief Psychiatrist finally agreed to conduct a review of the functioning of the clinic, the process of assessment and any treatment and care provided. Assurance was given that the findings of that review would be made available. The review was to be undertaken early in 2004.

In April 2004 the DHS confirmed that the review of the clinic had yet to take place, this time stating that "the review will be conducted under strict confidentiality", adding that that the findings of the review would only be made available "in broad terms".

Within the powers of the Chief psychiatrist to inquire into the care and treatment of persons receiving care of a mental illness, Professor Graham Burrows was appointed to undertake the review. He was allocated a mere day and a half to conduct the review and his report was to be provided in confidence to the Director of Psychiatry, the Chief Executive of the health service and the Director of Mental Health of the DHS.

The Clinic was founded in 1975 by Dr. Herbert Bower, who is one of the two psychiatrists on the team responsible for the assessment and treatment of patients. With respect to the appointment of Professor Graham Burrows to conduct the review, Dr. Bower comments:

"I know Graeme Burrows extremely well. He is a very good friend of mine."

The DHS refused to consult with misdiagnosed patients of the clinic, limiting the inquiry to "a specific complaint against the assessment and referral process adopted by the clinic" and later confirming that the review was conducted in response to the preliminary report submitted in 2001.

Although the review has now been completed, the results of the review have yet to be made available and the concerns raised in the preliminary report on the clinic have yet to be answered.

Regret to Forget

Lies, damn lies and statistics

Since 1975 the Monash Gender Dysphoria Clinic have been providing sex reassignment for those patients considered by the Monash gender team to be "genuine" or "true" transsexuals. These patients are started on sex-change hormones for a period of one and a half to two years followed by surgical "reassignment" of the genitalia.

The Monash Clinic has lost track of the number of patients who have been referred to them over the years and are unsure of the number of patients they have operated on or about the number of patients who they have misdiagnosed or mistreated with sex modification procedures.

It is estimated that approximately 5,000 patients have been referred to the clinic over the years and that this continues at a rate of about 2-3 new patients every week. The percentage of referred patients who are approved for the clinic’s sex change program has increased over the years from about 50% when the clinic first stated seeing patients to about 85% at the present time.

Based on these figures, approximately 4,000 patients have been approved for the clinic’s sex change program and started on sex-change hormones and the clinic continues to place more than 100 patients per year on the path to gender reassignment.

The estimates of the number of patients who complete the gender reassignment process by undergoing sex-reassignment surgery, however is only about 500 to 600 patients and this continues at a rate of approximately 30 patients per year.

These figures raise the question as to what happens to the thousands of patients who are started on sex-change hormones but dont go through with sex-change surgery. There are only two possibilities. (1) They continue to live in the opposite gender role without surgery or (2) They have gone back to living in their biological gender again.

When Dr. Kennedy, the director of the clinic, was asked how many patients who are started on their sex change program decide that a sex change is not right for them, stop taking hormones and go back to their original situation she replied:

"A lot of people do that. Quite a significant number of people do that."

Yet when Dr. Herbert Bower, the other psychiatrist on the Monash team, was asked about the assessment process prior to starting patients on hormones he comments:

"if I or the other psychiatrist have any in the slightest doubts we don’t start hormones. Both of us must agree totally that this is a true transsexual."

The fact that "quite a significant number" (up to 75%) of the patients who both Dr. Kennedy and Dr. Bower "agree totally" are "true transsexuals" without even "the slightest doubts" stop taking hormones and "go back to their original situation" should raise some serious concerns about the patient assessment process, which Dr. Bower describes in the following terms:

"We arrive at a diagnosis simply by interviewing the patient quite a number of times and literally using our own experience, our brain as a computer, feeding what information the patient gives us to our brain and coming to the conclusion, not lightly, that this is or is not a transsexual"

All these facts raise the question as to how many of the 500 - 600 patients operated on over the years have lived to regret the sex change and wanted to go back to living in their biological gender again.

Dr. Bower claims that they had made just two mistakes in their first 200 patients. By 1999 they had operated on 350 patients and Dr. Bower claims that they added just one further mistake, a total of three biological males came back after the operation wanting to be men again.

Dr. Bower failed to include a biological female who, in 1995, came back after the operation wanting to be a woman again, so that makes four cases of regret. Another male has recently expressed regret so that makes five cases.

Yet, according to recent reports by the psychiatrists on the Monash team, the number of cases of regret is actually going backwards again. On the 7:30 report recently aired, Dr. Bower said that their clinic was wrong in only two cases out of 600 surgeries. Dr. Kennedy recently stated that she, too, was only aware of two cases of regret.

Trick or Treatment

Patient assessment at the Monash Gender Clinic

Hundreds of Monash sex clinic patients could be entitled to millions of dollars in compensation if a pending governmental review of the clinic determines that their assessment program falls below minimal standards of care. According to Elizabeth Riley, the General Manager of the Gender Centre in NSW:

"The Harry Benjamin Standards are the controlling guidelines for access to SRS. The main reason that the standards of care are so rigidly followed is to avoid the risk of litigation. Any surgeon who failed to abide by the standards would have no defence in the event of litigation from a dissatisfied client"

A 1995 document released under Freedom of Information stated that patients were merely given a "series of interviews" before the initiation of sex-change hormones and then "reviewed on a 3 monthly basis for two years" prior to surgery. The prevailing standards of care at that time, however, required that the treating psychiatrist know the patient in a psychotherapeutic relationship for at least three months before recommending hormone treatment and at least six months before recommending surgery. Psychotherapy generally entails weekly consultations that are regular and ongoing. From this it does not appear that the Monash Medical Centre Gender Dysphoria Clinic has been providing patients with adequate psychotherapy before carrying out sex modification procedures.

According to a recent news article in the Sunday Herald Sun, the two psychiatrists responsible for patient assessment at the clinic believe that the condition is biological and irreversible and they strongly dismiss any suggestion that psychotherapy could offer assistance in its treatment. But then how do they explain the fact that a significant number of the patients placed on their sex-change program decide against surgery, stop taking sex-change hormones and go back to living in their biological gender again? Since it the condition is obviously not biological and irreversible for such patients it begs the question as to why they were started on the clinic’s sex change program in the first place. Is it because the psychiatrists at the clinic aren’t able to tell the difference between a mentally healthy individual (who they claim has simply been born in the wrong body) and a person suffering from a delusion of psychotic proportions? Or is it because they simply failed to provide their patients with adequate psychotherapy before recommending hormones and surgery?

Concerns

Gender Menders has been approached with questions of what the parents or relatives of patients undergoing sex reassignment can do if they have questions or concerns.

Because the condition being treated is classified as a mental illness, there is a question as to whether or not the patient has given informed consent to the procedures. Individuals concerned about the treatment of any patient should therefore address complaints in writing to the following governmental agencies:

The Registrar

Medical Practitioners Board of Victoria

GPO Box 773H

Melbourne Vic 3001

Fax: 9655-0580

Health Services Commissioner

30th Floor

570 Bourke Street

Melbourne Vic 3000

FAX: 8601-5219