PRESS RELEASE

May 17, 2004

MONASH GENDER STATE INVESTIGATION

Dear Members of the Press

Please find attached a letter to The Hon. Steve Bracks MP, Premier of Victoria which outlines our concerns with regard to the impending review of Monash Medical Centre.

For further information or queries, please contact:

Alan Finch
giaa@optusnet.com.au

RE: State Inquiry in to the conduct of Monash Medical Centre's Gender Clinic

Dear Mr Bracks

I am writing on behalf of several individuals and our group, The Gender Identity Awareness Association (GIAA) to request a meeting with you with regard to the impending Victorian State Investigation ('the inquiry') into the operations of Monash Medical Centre's Gender Dysphoria Clinic ('the clinic') based in Clayton. The inquiry is said to be commencing in the next couple of weeks and we therefore seek conference with you as a matter of urgency. We have numerous concerns with regard to the operations of the clinic and the impending inquiry that we would like to discuss in a meeting with you and I will touch on some of them here. Most importantly, we think it is important for you to hear the first hand accounts of the patients who claim to have been mistreated by the clinic.

Firstly, I'll offer some background information to put the matter in to context. The clinic is the only one of its kind in Australia and claims to 'treat' patients from all over Australia and New Zealand who suffer with gender identity issues.

Gender Dysphoria is a medically listed mental disorder (DSM IV) and there is no evidence to remotely suggest otherwise. Obviously then, it would be unethical for a surgeon to perform surgery on a patient without the appropriate recommendation from psychiatrists and this is why they are involved. Monash claim that they only operate on about 10% of those requesting these procedures in the long run but the evidence does not support this claim.

The clinic has recently admitted that they rely heavily on what the patient tells them in order to determine whether or not they perform Sex Reassignment Surgery (SRS), yet it appears that little or no effort is made to establish any kind of psychotherapeutic relationship whereby a patients history can be adequately explored. The psychiatrists excuse their failure to discover contributing psychological factors in a patient who subsequently recovers from the identity disorder and regrets surgery by accusing the patient of having lied about their history when in fact the patient was simply unaware that such factors were significant contributors to their condition at the time. Obviously, it is the responsibility of the medically trained psychiatrist to discern what questions need to be asked to make an accurate diagnosis and not the patient himself.

It is a conundrum in itself that psychiatric patients are relied upon to make their own diagnosis and go on to prescribe their own course of therapy. One can wonder why the psychiatrist is needed. They say they are needed because only they can discern the 'true transsexual', yet they depend on the self-proclamation of the psychiatric patient to diagnose him or her self. If things go wrong later and the patient has been mis-diagnosed, these complications are not managed-the blame is placed upon the patient. It simply does not make sense.

This clinic has lost track of the number of patients they have operated on over the past 30 years, but have claimed that the number is between 500 and 600, perhaps more. The decision to operate on what are otherwise healthy Australian men and women is primarily made by two psychiatrists, Dr Herbert Bower (aged 90) and Dr Trudy Kennedy (aged 70). They work from the comfort of their own homes and bill medicare for consultations. They claim to have a 'team of specialists' that work with them: surgeons, an endocrinologist and a psychologist. Like Drs Kennedy and Bower, these medical practitioners also treat gender patients in private practise and bill medicare for part of their accounts. And like Drs Kennedy and Bower, it appears that their only real claim to expertise in the area of gender dysphoria is because they say they are and have decided to make this area a part of their practise.

We have information that indicates that a conservative minimum of $15,000,000 income has been generated to date from the patients' own funds, their private health insurance and medicare. We have strong evidence to suggest that medicare item numbers have been abused in the process of generating this income. Potentially hundreds of thousands of dollars of medicare funds may have been inappropriately claimed by SRS practitioners.

Recently it has also been alleged that the clinic has sent hundreds of Australians who cannot afford the clinic's fees to Thailand with a recommendation letter for surgery from them to their Thai counterparts. It is not known how the clinic in Melbourne is connected with clinics in Thailand or what the arrangements are between them, hopefully the inquiry will determine this.

The clinic claims that they select 'good candidates' or 'true transsexuals' from their ever-growing patient base (which has grown due to word-of-mouth, self-generated GP referrals and internet advertising etc) and put them through a gender re-assignment programme which consists of the life-long administration of opposite gender synthetic hormones and irreversible surgery. The clinic cannot scientifically explain how they actually discern who is a 'true transsexual' and who is not, though they promote their theories, or 'hunches' as they describe them, as fact to their patients who are led to believe that they are born 'a transsexual' and the only 'therapy' that will help them is SRS.

Despite popular belief that a suspected 'true transsexual' would have to have 2 years counselling before SRS could be contemplated, the clinic have unashamedly recently admitted that they offer no counselling to attempt to guide the person in the direction of reconciling with their birth gender or investigate the patients past. In recent media they have said that counselling only comes in to the scenario as a coaching to 'transition'. If a patient has been severely abused (in some cases that we know of, sexually) and this is what has contributed to their confusion, then they say that it is up to the patient to tell them that. In other words, the potentially abused and confused patient is expected to understand the origins of his/her own confusion and explain this to the psychiatrist. In most instances of psychiatric practise, it is normally the other way around.

It must be emphasised that the said clinic practise SRS on healthy, biologically and anatomically perfect males and females who have nothing more than a belief, a delusion or some other mental condition. The clinic may attempt to baffle its inquirers with smoke and mirror tactics, but this is a fact that they cannot argue with, if the question is pressed. A large number of SRS candidates have even been married previously and mothered/fathered children.

This clinic at Monash claims to transform males in to fully functional females and females in to fully functional males. Part of the problem surrounding this 'therapy' is that the patients (and the community) are sold this idea as a truth. A more accurate description of this surgery would be 'sex-organ amputation and modification surgery' as outlined in the brief explanation below.

In females, a synopsis of the SRS programme includes; the administration of synthetic male hormones (testosterone), amputation of the breasts, full hysterectomy, surgical (partial) closure of the vagina, labia surgically stitched together to form a 'housing' for two artificial testicles, a 5cm by 10cm by 1cm deep piece of flesh removed from the forearm and rolled to make a sausage like phallus (dysfunctional and aesthetically poor) which is then surgically stitched to where the clitoris is located, a skin graft from the leg then taken to cover the donor site on the arm.

In males, a similar synopsis can be described; the administration of synthetic female hormones (oestrogen), the permanent removal of male hair with electrolysis, breast implants, castration, total and radical amputation of the penis, a hole is excavated in the groin and lined with the skin of the scrotum, part of the bowel used to make a 'neo-vagina'.

Both males and females need to be placed on opposite-gender synthetic hormones for the rest of their lives to prevent characteristics of their birth gender from manifesting.

It is also worth noting that it is the only area of psychiatry that uses surgery as a therapy (the frontal lobotomy was abandoned years ago). It also appears to be not only the only area of psychiatry that is married to surgical practise but one where the practitioners are not accountable to any medical body, have no peer review, have no duty of care to patients and are not required to manage complications. We are calling for this issue especially to be looked at by the State Government. If this type of surgery is to be done at all, then it simply must be as regulated and monitored as any other area of medical practise.

Obviously, SRS is extreme by any measure. It is regarded as unethical by the majority of the medical community for many reasons, including that, not only does it permanently mutilate an otherwise healthy individual, but also SRS does not resolve underlying psychological issues. In other words, the opponents to SRS say that it mutilates a healthy body to suit an unwell mind, creates a mutilated, infertile facsimile of man or woman from an anatomically healthy, fertile one. If the mind then becomes well at a later stage, the results are catastrophic. The suicide rate in these cases is rumoured to be high, but no-one really knows the truth of the matter because no follow-up has ever been done, yet the clinic is said to have claimed government funding for this purpose.

The clinic has been getting away with operating on lies and misconduct for many years. We have evidence to prove that the clinic has lied about the numbers of misdiagnosed cases, instances of children being 'treated', falsification of medicare claims, falsification of health insurance claims, misleading patients and their families, wrecking family units by recommending divorce and other measures, refused to assist those whom it has misdiagnosed to name but some concerns.

Before closing until our expected meeting with you, I'd like to explain how and why it has come about that this matter has been escalated to your office.

I am an ex-patient of the clinic and my story was aired last September on the ABC as an episode of their 'Australian Story' series. At that time I assumed that I was an isolated case. After the programme, I was contacted by other ex-patients and their families who have been adversely affected by this clinic.

I learned that Mr Ken McGuire, whose wife had been misdiagnosed by this clinic, had been trying to get something done about this for several years and that he had even attempted to make his own investigation in the clinic after being fobbed off by every politician and bureaucrat that he contacted. Mr McGuire wrote a preliminary report (attached) from evidence that he had been able to secure through the FOI act and having taken matters to VCAT and the Ombudsman countless times because the clinic attempted to withhold information.

Since I met Mr McGuire and the others, I realised that there was much more to this than just a few isolated cases and I decided that it was my duty to do what I could contribute to something being done on this issue.

It became quite evident from several misdiagnosed former patients that the clinic has turned them away, treated them with hostility and contempt and made them feel to be the architect of their own fate when they have returned to them for help. The misdiagnosed patient is left with no-where to go and many have suicided or retreated to a life of seclusion from fear of humiliation. We therefore formed a self-help support group for people who have been affected (details at www.gendermenders.org). We have had contact (in some cases meetings) with Senator Lyn Allison MP, David Davies MP, Bronwyn Pike MP, Fran Bailey MP and others in an effort to get some action taken on this. We have made complaints to the medical board and have attempted to be included in the advisory committees of the State Attorney General and the State Health Minister.

At times we felt that much of our efforts had been in vain. The most promising indication that something would be done was the promise from Bronwyn Pike that she would order a 'review' of the clinic after she read the attached report. This appeared to be a loose promise and nothing happened. It seems to be that it was only after media attention on the issue that Ms Pike conceded to her duty as our Health Minister and ordered an inquiry.

What we have learned in recent days is almost laughable. Ms Pike has appointed the Chief Psychiatrist, Professor Amjad Tanaghow to conduct the 'independent review'. I had a conversation with Professor Tanaghow and requested that, since the investigation had come about because of serious allegations and complaints from ex-patients of the clinic, we wanted to be given the opportunity to give evidence. Professor Tanaghow indicated that this could not be promised because of time restrictions-the investigation is to last one and a half days. I expressed our concerns about this in an email (attached).

If this did not seem enough to be token-gesture-like, then the 7.30 report aired last Thursday evening would confirm the suspicion. Here is a closing excerpt from the transcript of the programme which clearly demonstrates that the inquiry is not an independent one as the DHS had previously claimed:

Mary Gearin: "Meanwhile, his work (referring to Dr Bower), along with that of his colleagues, is now subject to an independent review by eminent psychiatrist Professor Graeme Burrows, but Dr Bower is confident".

Dr Herbert Bower: "Well, I know Graeme Burrows extremely well. He is a very good friend of mine. I think he is an excellent psychiatrist and I have complete confidence in him. But I would say, quite open, that I know more about transsexuals than Graeme Burrows".

If the allegations made against this clinic are founded, then they could be deemed to be not only inappropriate medical conduct, but also criminal acts. We therefore implore you, Mr Bracks that you seriously consider this letter and our request for a meeting with you and that as our Premier, you use your authority to order that a truly independent inquiry is conducted by medical investigators under the supervision of the Victoria Police, not by a long-time personal friend of the people whose conduct is in question.

Finally, we re-iterate the importance for any responsible government authority considering a review of the clinic to hear first hand from the patients who claim to have been mistreated by the clinic and we look forward to hearing from you as soon as possible.

Yours sincerely

Alan Finch
giaa@optusnet.com.au

Re: Investigation in to Monash Medical Centre Gender Dysphoria Clinic under the direction of The Honourable Brownwyn Pike, MP, State Minister for Health

Dear Associate Professor Tanaghow, Chief Psychiatrist for the State of Victoria

Thank you for the time on the phone yesterday to briefly discuss the investigation in to Monash Medical Centre Gender Dysphoria Clinic. I am sorry that you had to finish the conversation to go to a lecture but I am sure we can continue a discussion soon.

I understand from our conversation that the investigation will be led by Professor Graham Burrows and the investigation will be one that will last one and a half days. I also understand that you will not be looking at all the files but a cross section of files of an undisclosed number and variety. One and a half days does not seem like much time to look at allegations, which could potentially affect 600 patients and their families, and from which a minimum estimated figure of $12,000,000 of revenue has been generated.

We would still like to have a meeting with you and your investigative team regarding the inquiry in to the MMCGDC as soon as possible. We have some very grave concerns regarding the conduct of the clinic and how this investigation is to be administered and we would like an opportunity to discuss these with you.

We also have important evidence that may not be made available to you from the clinic; an example of this is information that the clinic has in the past inducted children on to their program although recently in the media they have denied this.

Since the whole reason that the investigation has come about is because of complaints and allegations from former patients who have been misdiagnosed as 'true transsexuals' and then, as they see it, forever mutilated, I am sure that you would therefore agree that to consult with those people is of paramount importance if the investigation is to be a sincere one.

Since the clinic says that part of their diagnosis process is to meet with family members of the gender confused, we also think that it is important that you have the input from these people as well. I can put you in touch with the ones that I know of who have expressed to me that they have also been adversely affected by the clinic.

I look forward to hearing from you at your earliest convenience so that a meeting can be arranged with the aforementioned patients and their families.
Yours sincerely

Alan Finch
giaa@optusnet.com.au