Australia's only sex-change clinic shut down

Postby Plasman » Sun May 31, 2009 2:37 am

This was on the front page of today's edition of the Age newspaper. I saw it and thought of the forum immediately:
Sex-change clinic 'got it wrong'
Jill Stark May 31, 2009

AUSTRALIA'S only sex-change clinic has been temporarily shut down and its controversial director forced to quit amid growing claims that patients with psychiatric problems have been wrongly diagnosed as transsexuals and encouraged to have radical gender reassignment surgery.
The Sunday Age has been told at least eight former patients of the Gender Dysphoria Clinic at Melbourne's Monash Medical Centre believe they may have been misdiagnosed. Some have tried to commit suicide while struggling to live as the opposite sex after the irreversible operations.
But as the clinic has limited patient follow-up, it is difficult to determine how many patients may have been adversely affected by the surgery.
Three former patients have recently taken legal action against Monash and the clinic's doctors.
Psychiatrist Dr Trudy Kennedy — who is being investigated by the state's medical board — says officials at Southern Health, which operates the service, told her she could no longer run the clinic she co-founded 34 years ago.
The 73-year-old claims she is being made a scapegoat after the recent legal action. "I have been hung out to dry. They just want to blame it all on me. I have not made one single decision here, they are all team decisions," Dr Kennedy said.
One former patient, "Andrew", who was 21 when he had his penis and testicles replaced with a false vagina, was awarded damages after claiming Dr Kennedy misdiagnosed him as a transsexual in the late 1980s.
Since the surgery, he has twice tried to take his own life and has undergone operations to reconstruct a penis and remove breast implants. He says he will never be able to have children, is unable to work and feels like a "mutilated freak".
In the past few weeks, a 66-year-old who also underwent surgery to become a woman following a diagnosis by Dr Kennedy, settled his claim out of court. The man, who was sexually abused by his mother for seven years from the age of eight, was referred for a sex-change operation in 1996 despite another psychiatrist, stating in his medical notes that "surgery would make little difference" to his life.
Dr Kennedy said Southern Health's executive director of mental health, Anne Doherty, told her on March 31 that she was no longer in charge of the clinic, which has been closed until July while an internal review is conducted.
Southern Health did not disclose who had been appointed as the new director, but said in a statement that the clinic was committed to "delivering high-quality gender assessment services".
Dr Kennedy claims the same "political forces" that tried to shut down abortion clinics are trying to close the gender dysphoria facility, which has performed sexual reassignment surgery on more than 600 people — a third of all referrals — since it was founded in 1975 by Dr Kennedy and Austrian-born Dr Herbert Bower, who died in 2006.
The temporary closure comes five years after a State Government probe found a catalogue of problems with the way the clinic diagnosed and treated people with gender-identity issues.
The 2004 review, led by Victoria's chief psychiatrist, was never made public, but a copy obtained by The Sunday Age shows the review found that countless patients were given sex changes without proper mental health checks before or after surgery.
A second review in 2006 found half of all patients had significant psychiatric conditions, such as borderline personality disorder and psychotic depression, but many were still operated on. There was no evidence that patients' underlying mental problems were treated or their risk of suicide monitored.
The reviews also found most patients had been prescribed hormones almost immediately and in some cases were referred to a plastic surgeon before being sent for psychiatric assessment.
Almost all of the clinic's staff also practise privately. While Dr Kennedy faces an informal hearing of the Medical Practitioners Board, The Sunday Age understands that no other doctors who work at the clinic are under investigation.
Consultations are Medicare-funded but surgery costs about $10,000 and is carried out in private hospitals including Masada, in St Kilda, and Beleura, in Mornington. Surgery is performed only on patients who have been diagnosed as "true transsexuals" suffering gender dysphoria, which causes feelings of being born in the wrong body and creates a deep desire to change sex.
Dr Kennedy believes that gender dysphoria is a biological condition that can be cured by surgery. But other experts say childhood abuse and underlying psychiatric conditions often cause gender confusion that can be alleviated with psychotherapy.
Another of the clinic's patients — a woman with a history of sexual abuse who had both breasts removed before putting a stop to further surgery — is now trying to have Dr Kennedy disciplined through the Medical Practitioners Board.
Anne Shortall, a lawyer from Arnold, Thomas & Becker, who represents the former patients, said the results of the surgery were psychologically devastating. "This operation is so incredibly extreme … you're changing someone's gender in a situation where if you are wrong there's virtually no recourse to put it right again. Then they're turned away when they go back to the clinic to say, 'I'm not able to live in this role, I need help'," Ms Shortall said.
The Sunday Age has been told at least five other former patients, some of whom live interstate, have contacted a Melbourne support group, fearing they have been misdiagnosed as transsexual.
Dr Kennedy insists no patient was encouraged to have surgery. She admits post-operative follow-up was limited, making it difficult to gauge how many people regretted surgery, but blames this on lack of funding and staff shortages.
Dr Kennedy insists all patients were offered psychotherapy — a claim contested by the aggrieved patients and the government reviews. She also denies that patients were diagnosed without being assessed against internationally recognised criteria for gender-identity disorder.
The Sunday Age sent 22 questions to Southern Health, whose short response did not outline what had been done to address the reviews' concerns, except to say that "substantial progress had been made towards implementing the recommendations".
Sally Goldner, of Transgender Victoria, said she was aware of some cases of misdiagnosis but believed 95 per cent of patients were happy with their treatment.
She said lives of transsexuals would be at risk if the clinic closed. "The suicide rate in our community is 40 per cent … You'd have lines of tombstones without this service," she said.

*Names have been changed.
For help go to, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.

It's hard to tell exactly what's happened here, but it seems to me that some people have not done their jobs properly. Why on earth was there no follow-up on the outpatients of the clinic?! It is awful that there are people who regret having the surgery - aren't there protocols to prevent this sort of thing from happening?
What's most interesting is that the majority of the former patients who claim to have been misdiagnosed were victims of abuse, which suggests - to me at least - that they might have fared better with other forms of therapy than a major and irreversible surgical procedure. (Which is why there's supposed to be a transitional period, in case the patient decides not to follow through... I think. Isn't there?)
If this last post seems ridiculous, please disregard it. Thank you. ;)
By the way I made two level packs for Boppin' in case anyone is interested... :oops:
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Re: Australia's only sex-change clinic shut down

Postby Jennifer Diane Reitz » Sun May 31, 2009 4:15 am

Under the rules laid down by Harry Benjamin, a transsexual should have the permission of not less than two qualified psychiatric professionals and one psychologist before being allowed to have final, irreversible sex reassignment surgery.

A candidate should have the surgery only when no other treatment or solution is considered viable.

So, it seems that perhaps -perhaps- this clinic was not being careful enough, and was giving people what they demanded without fighting them over it enough.

Then again, there is the argument that a person is responsible for their own choices, good or bad.

I have personally met several cases of really... self concerned.... people who were willing to sue their SRS surgeons for invented 'tragedies' even though they were utterly grateful to them - just to get money. They had no remorse; their attitude was that the world owed them a living, and doctors have money.

I have also met one case of a person who truly regretted their surgery. That person was miserable, yes, but they blamed no one but themselves - they had worked very, very hard to convince all the guards at the gate to let them through. They did not blame the guards, or the surgeon.

I know far more people than either of these that are just grateful beyond words for being able to have surgery, to transition. This group vastly outnumbers the tragedies, and the scam artists, in my experience.

And as for followup... it is difficult to do, especially with transsexuals who are eager to vanish and get on with their lives, and it truly would take a lot of money and staff to even try to do followup work.

From my view, this clinic could probably have been a little less permissive, but the patients should be a little more responsible about their own lives as well.

No one ever forces you to get on that table. There is no force that makes a patient save up the 10K (or more) they need, except themselves. And nothing forces anyone to claim they are transsexual, push hard for treatment, and constantly work towards surgery. There is a robust element of self-responsibility in this matter.

Then again, we do seem to have a common culture where people are encouraged to be as helpless children before the almighty righteous wisdom of presumed authority which should surely protect people from themselves. Who needs to be responsible for their own decisions when there is a substitute parent for every need or wish?

Without question there is a strong element that would get rid of any help for transsexuals whatsoever.

Perhaps this clinic is a trannie-mill. Perhaps.

Or perhaps they were just over willing to trust people at their word, and provide services demanded.
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Re: Australia's only sex-change clinic shut down

Postby Coda » Sun May 31, 2009 6:59 am

I don't think you can point the finger at the recipients of the operations in the cases that prompted the shutdown. We're talking about cases of abuse -- physical, emotional, sexual -- who have developed delusional rationalizations to cope with the trauma and are desperate for help. It seems that it's not the actual surgeries that are the crime here, but the terrible malpractice on the parts of the psychologists who were following the wrong course of treatment for the WRONG PROBLEM. The allegations are that they made vulnerable people BELIEVE that's what they wanted and then helped them do it. The power of suggestion is incredible -- if they WERE following the rules here as far as having the multiple diagnoses, but not the requisite rigor, then you suddenly have this poor abused soul thinking "wow, something's wrong with me, and three well-educated and experienced people think that this surgery will fix me."

I'm trying to put myself in the position of these patients; it's not much of a stretch. I'm not dysphoric, in that I'm comfortable operating in my biological gender (male), but I don't really feel that I identify with it. (I use it as my gender online, by default, simply out of habit.) It's not far to envision a situation where instead of simply not identifying with my biological gender I could, through abuse or trauma, deeply desire to NOT be what I am physically. I don't know if I'd want to go to a clinic where there's such a history of post-op remorse; could I trust that I would receive the right advice? And then I try to envision myself being desperate to deal with these emotions and impulses to the point of being too close to the issue to make a detached, objective decision, so I went to get help... How suggestible would I be in that condition?

On the other hand, I am greatly aggrieved for those who DO need reassignment surgery who now can't receive it. Sloppy practice on the part of a few psychiatrists/psychologists has shut down the only way they can get the help they need without leaving the country -- and that means you're far away from home, and probably won't be able to have the necessary follow-ups.
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Re: Australia's only sex-change clinic shut down

Postby draque » Sun May 31, 2009 7:25 am

Yeesh... what an awful mess that is. I'm typically very much in favor of temporary shutdowns of medical facilities for investigations involving systemic malpractice, but this is a unique situation. Given that it's the only clinic in the entire country where TG folk can receive treatment, and that there's probably significant pressure from conservative elements out there to shut it down for good, it might be better to come to some sort of compromise, allowing limited function in the clinic while investigations continued.
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