Reckless: Boston Children’s Hospital Cut Time for Children to Receive

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The NY Sun published a story today about a lawsuit filed by a psychologist who was fired by Boston Children’s Hospital. The lawsuit alleges that over several years the hospital cut the phycological inquiry required to receive “gender affirming care” from around 20 hours down to two.

Amy Tishelman, 68, has accused Boston Children’s Hospital of age- and gender-based discrimination and of retaliation. The hospital terminated her in 2021, alleging she violated a patient-privacy law; she had filed her initial discrimination suit against the institution the year prior.

Dr. Tishelman, who is widely recognized as a leader in pediatric gender medicine, on Thursday testified that when she began working for Boston Children’s gender clinic in 2013, administrators allotted her 20 hours, and sometimes longer, to assess whether a child should be referred for gender treatments; this included her time to write the report on the patient.

A few years into her tenure at the gender clinic, the hospital had cut that period to 10 hours, she said. Then, by early 2018, it had slashed the time again.

“I didn’t feel like that was doable at all,” Dr. Tishelman said from the stand. She denounced as “reckless” the clinic’s policy it adopted over six years ago of allotting just two hours of assessment-appointment time and a half hour for report writing.

In 2019, Dr. Tishelman was restricted from seeing patients and two years later she was fired. She said that put an end to years of research she had been doing on the outcomes for all of the patients seen by Boston Children’s Hospital, which was the first hospital in the US to treat minor gender patients.

Dr. Erica Anderson who is trans and is also a former head of the US Professional Association for Transgender Health said the hospital’s treatment of Dr. Tishelman was a “fall from grace.”

The institution, she said, has “capitulated to the medicalization of children in a way that is reckless.”

“When people like Amy Tishelman are forced to draw a line in the sand and say, ‘no,’ and institutions come down hard on someone like her, we’re in deep trouble in America,” Dr. Anderson said.

Another doctor who helped found the gender clinic at Boston Children’s Hospital also expressed shock at the changes.

Dr. Edwards-Leeper, who was on the team that first imported the Dutch protocol to Boston Children’s, told the Sun that she only relatively recently learned that GeMS had progressively slashed its assessment time period during the late 2010s.

“When Amy first shared that with me, I was just in disbelief,” said Dr. Edwards-Leeper, expressing concern that the system of patient oversight she had helped establish at GeMS — one in which she said that, as Dr. Tishelman testified, psychologists spent about 20 hours on the assessment process all told and produced a 15- to 20-page report — had been compromised.

Officially, Dr. Tishelman was prevented from seeing patients in 2019 because she had turned in some reports late, so the time allotted for reports is relevant to her lawsuit. Ultimately, she was fired for allegedly looking at the records of other patients. Her attorney claims that was just an excuse.

Mr. Hannon said that the patient-privacy-related infraction was a “trumped up” pretext for Dr. Tishelman’s termination. Dr. Tishelman ultimately testified that the GeMS patient population was considered communal among the staff psychologists and that it was common practice to discuss one another’s cases and review related medical records at staff meetings. Dr. Tishelman said that Dr. Chan knew in mid-2019 that she had recently reviewed other clinic psychologists’ reports and that he made no objection at the time.

Incidentally, Dr. Chan, who was Dr. Tishelman’s supervisor, is a co-author of a publicly funded report which the authors have apparently been sitting on for years over concern that it might undermine their stance on the effectiveness of puberty blockers. I wrote about that story here.