You would think that in a field of real experts operating with integrity, that you would be able to achieve a reasonable scientific certainty as to what the heck was actually going on. But here, as in many other cases, instead of scientific certainty we have keystone psychiatrists. I am starting to think that we might as well employ astrologers in the court system instead. They otherwise do a tragic dis-service to people saddled with real problems and situation.
Seen Here
A psychiatrist testifying as an expert witness for the Internal Revenue Service (IRS) questioned the judgment of his colleagues who recommended sex-reassignment surgery for Rhiannon O’Donnabhain, who is suing the IRS for the right to deduct the cost of the surgery from her taxes. But one of O’Donnabhain’s lawyers, Bennett Klein of Gay and Lesbian Advocates and Defenders (GLAD), questioned the psychiatrist’s qualifications to determine O’Donnabhain’s treatment needs, as U.S. Tax Court Judge Joseph H. Gale heard a third day of testimony in the case on July 26.
Dr. Chester Schmidt, Jr., a psychiatry professor at John Hopkins University and co-founder of the university hospital’s Sexual Behaviors Consultation Unit (SBCU), stated that gender identity disorder (GID) specialists Diane Ellaborn, a licensed clinical social worker, and psychologist Dr. Alex Coleman recommended O’Donnabhain for sex-reassignment surgery without knowledge of her history of attention deficit-hyperactivity disorder (ADHD) and her history of depression, for which O’Donnabhain was treated with anti-depressants. Schmidt learned of the conditions after reviewing the notes of Dr. Judith Robinson, a psychiatrist who also treated O’Donnabhain, and those of Ellaborn and Coleman, who both previously testified at the trial (See "Experts at tax trial explain gender identity disorder," July 26).
Asked by IRS attorney John Mikalchus whether or not he agreed with Ellaborn’s and Coleman’s individual assessments that O’Donnabhain was in good shape from a psychological and psychiatric point of view prior to her sex-reassignment surgery, Schmidt replied that the fact that neither seemed to know of her history of other disorders posed a dilemma. "I don’t want to be critical," Schmidt replied. "... It’s difficult for me to not to take that into consideration when weighing the accuracy of [Ellaborn’s and Coleman’s] notes." Schmidt went on to say that the fact that O’Donnabhain was being treated with anti-depressants prior to her surgery should have been known to Ellaborn, who testified that she treated O’Donnabhain for about five years, and Coleman, who stated he did a two-hour consultation with O’Donnabhain to specifically evaluate her fitness for sex-reassignment surgery. It may not have impacted their decisions to recommend the surgery, said Schmidt. But he added, "We’ll never know that." Schmidt explained that knowledge of "co-morbidity" - the coexistence of two or more diagnosable conditions or diseases in an individual - is important because the treatment of one condition can worsen the symptoms of another condition. "The clinical challenge is to be able to parse out how they affect each other."
Schmidt took the stand in the IRS’s effort to bolster its contention that O’Donnabhain’s sex-reassignment surgery was a cosmetic rather than a medically necessary treatment, therefore is not tax deductible. O’Donnabhain, a 63-year-old South Shore resident, underwent sex-reassignment surgery in October 2001 and deducted the $26, 000 cost on her 2001 tax return, receiving a $ 5,679.00 deduction. Months later she received noticed that she would be audited by the IRS, which resulted in the deduction being denied. She was ordered to pay back the money. With GLAD’s help, she filed the lawsuit, known as O’Donnabhain v. Commissioner of Internal Revenue, instead. Klein and fellow GLAD attorneys Karen Loewy and Jennifer Levi assert that GID is a disorder recognized by the medical community and that it is included in the Diagnostic Statistical Manual of Mental Disorders (DSM), a standard handbooks of mental health practitioners. Witnesses have testified that O’Donnabhain’s treatment, including her surgery, was well within the norms of treatment for GID and that the surgery was medically necessary.
O’Donnabhain was diagnosed with GID in 1996, after struggling since childhood with feeling as though her physical body did not match her female gender identity. In testimony occasionally punctuated by tears on July 24, O’Donnabhain recounted her long struggle with GID, which included thoughts of suicide and self-castration.
Under questioning by Klein, Schmidt testified that he has not personally evaluated O’Donnabhain - as he did when offering expert testimony in the case of Michelle Kosilek, an imprisoned murderer who is seeking sex-reassignment surgery - nor has he ever encountered her beyond listening to her July 24 testimony in court. Though he co-founded the SBCU, which does consultation and evaluation on gender identity issues, Schmidt also said he has not personally treated a patient with GID since the 1980s. He also testified that since 1992, much of his work has focused on "current procedural terminology," a complex system of evaluation and management codes used by mental health professionals for billing and other purposes; in recent years he has published a handbook on the codes and chaired an American Psychiatric Association committee on the subject. Schmidt said that overall, 75 percent of his work is administrative, as opposed to being in a clinical environment. He said he keeps current on the literature regarding GID through his teaching duties and through "rubbing shoulders regularly" with some of the most prominent practioners in the field of human sexuality and GID, who are also on staff at Johns Hopkins, which Schmidt noted has topped U.S. News and World Report’s list of Best Hospitals for the past 17 years.
Klein also asked Schmidt a number of questions relating to the diagnosis and treatment of GID. Schmidt testified that people who appear to be ambiguously gendered could suffer psychological damage as a result of their appearance. He also stated his belief that the physical changes brought about by taking cross-gender hormones can provide a sense of psychological well-being to a patient with GID and that sex-reassignment surgery can provide important psychological benefits as well.
But under questioning by both Klein and Mikalchus, Schmidt several times emphasized his belief that the Harry Benjamin Standards of Care - a set of widely recognized and accepted standards for the treatment of GID set out by the World Professional Association for Transgender Health (WPATH) - are simply guidelines for physicians treating GID patients rather than mandatory treatment protocols. "These are what is considered at the moment the ’best practices’," said Schmidt of the standards. "But they do not say any practitioner has to follow them."
The Harry Benjamin Standards recommend sex-reassignment surgery after successful hormone treatments and at least one year of living in the gender with which the patient identifies. Ellaborn testified previously that she treated O’Donnabhain in accordance with standards.
Though Schmidt testified that he does not disagree with the substance of the standards as far as their use as guidelines, he stated he does not ever recommend sex-reassignment surgery as a treatment for GID, a position he described as a "significant point of departure" between himself and WPATH and Dr. George Brown, a WPATH board member who was called to testify as an expert witness by GLAD on July 25. "I firmly believe that the decision to take hormones and have surgery should be the patient’s decision," said Schmidt.
Asked by Mikalchus if he would recommend sex-reassignment surgery if he felt it was medically necessary, Schmidt replied that he could not think of such a situation. "It’s certainly medically helpful," he said. "It’s not necessary in terms I understand."
Earlier in the day, Gale queried Brown, who finished his testimony that morning, on how consensus on standards of care is reached by doctors for any type of medical condition. Brown replied that most often professional organizations with an interest in a given field would conduct research and/or review existing research on a particular condition and create standards of care based on their findings. They will then issue an opinion based on their knowledge and research, said Brown, even if the research is inconclusive at that point in time.
Dr. Toby Meltzer, the Oregon plastic surgeon who performed O’Donnobain’s sex-reassignment surgery, also testified in the case. Under questioning by Loewy, Meltzer who performed genital surgery, breast surgery and facial feminization procedures on O’Donnobhain, said that the purpose of the procedures was to treat O’Donnabhain’s GID. Meltzer said that for patients with GID, sex-reassignment surgery "is a validation of their being in many ways," because it allows their external appearance to align with their internal gender identity. "It allows them to move on with their life in the way they always wanted to but were not allowed to," said Meltzer.
Under questioning by Mikalchus, Meltzer said he was not aware that O’Donnabhain was being treated for "severe depression" at the time of her surgery. He also said it would not have impacted his decision to perform the surgery.
Testimony in the case is scheduled to continue on Aug. 23, when the IRS’s second and final expert witness will take the stand, followed by closing statements by lawyers for both parties in the case.
No comments:
Post a Comment