MDO denies transphobia over gender-affirming care

4 minute read

MDA National’s president says he doesn’t want doctors exposed in the ‘difficult and risky’ area of gender care for young teens.

Dr Michael Gannon, the president of medical defence organisation MDA National, has denied the company’s move to restrict coverage for gender-affirming care for adolescents is transphobic, saying it was “a very difficult and risky area” for GPs.

“As an indemnity provider we have no desire to walk away from any area of medicine that is legal and necessary,” Dr Gannon told TMR.

“I am concerned about doctors exposing themselves in this very difficult and risky area, making complex decisions without the help of a multidisciplinary team.”

MDA National said on Monday it would no longer cover private practitioners prescribing gender-affirming care to adolescents, not for moral or ethical reasons but because “we don’t think we can accurately and fairly price the risk of regret”.

Dr Michael Gannon was quoted as saying young people experiencing gender dysphoria should be initially assessed by multidisciplinary teams in hospital – not by GPs: “It’s simply not fair to ask individual GPs in the suburbs or the bush to be making these complex decisions on their own.”

An official position statement from MDA National clarified the details of what would and would not be excluded from cover:

“It is important to reiterate that we have not excluded cover for GPs providing care for patients with gender dysphoria,” the statement read.

“We have been deliberately targeted in the areas of exclusion to ensure that we are focusing on those areas of practice that we believe are the greatest risk of future claims.

“This is an insurance risk decision. The exclusions don’t relate to the treatment of gender dysphoria broadly but rather the initial assessment that a patient under 18 is suitable for gender transition or initiating prescribing of gender affirming hormones for any patient under the age of 18 years. 

“For example, a practitioner is still covered for:

  • ongoing repeat prescribing of gender affirming hormones (based on the medication regime initiated by a non-GP Specialist as part of a multi-disciplinary team);
  • prescription of puberty blockers with the expectation that the Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents are complied with at all times when treating children and/or adolescents with gender dysphoria;
  • where a practitioner is indemnified by their employer for their work in the area of gender transition, the MDANI policy will continue to provide cover for the legal costs of investigations and inquiries arising from this work; and,
  • Counselling and general healthcare involving a patient with gender dysphoria.”

Dr Gannon said MDA National was aware it would be disappointing “some members and advocates” with the decision.

“There is no move away from coverage for GPs who are writing repeat prescriptions for treatment plans that are already underway,” he said. “There is no move away from coverage for initiating treatment in adults. “There is no move away from coverage for doctors working in hospitals in multidisciplinary teams.

“This was an insurance risk decision,” he said.

“The work came from our clinical underwriting committee about the emerging risks in this area. At its heart is a decision that we have thought about for a long period of time.

“We have considered the evidence from the medical literature, the medical media, and the broader media as well. We don’t think we can accurately or fairly price coverage in this area.”

Dr Gannon declined to detail the evidence used to make the decision, saying the information was commercial in confidence.

When asked if MDA National could not just charge a higher premium to doctors undertaking the kind of work they are now refusing to cover, Dr Gannon said the company did not want to “put further pressure on GPs” after increasing premiums “over the last two years”.

“It might be something we look at in the future,” he said.

On Monday Dr Clara Tuck Meng Soo, a transgender GP and gender-affirming care provider, told TMR MDA National’s decision was “transphobic, frankly”. She said there was much more risk in cosmetic surgery than in gender-affirming care and that MDA was “acting on supposition and not evidence”.

“We make complex decisions all the time. And we create multidisciplinary teams all the time as well. This decision is all about pushing the risk on to hospital insurers.”

RACGP president Dr Nicole Higgins said she was “deeply concerned” about MDA National’s decision and the signal it sent to doctors, patients and their families.

AMA president Professor Steve Robson said he was concerned about an MDO inserting itself into the care process.

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