Princess Grace Hospital scandal BS debunked

A friend credulous about claims from opponents of trans liberation passed me a Twitter thread about the story that Princess Grace Hospital in the UK denied a survivor of sexual assault necessary healthcare because of her belief that trans women are men. It had me going for a minute. Maybe she had been done wrong.

If you do not know what I am talking about, jump ahead to my transcript of the twitter thread, then follow the link to jump back up here. If you have heard the story already, then let us take a closer look.

Of course the thread was bullshit. I know this not because I found a source debunking the story, but because I read the screencaps of the email exchanges between the woman and the hospital which were included in the Twitter thread, and discovered so many misrepresentations that it is hard to avoid concluding that the thread was deliberate deception, offering the screencaps as a theatre of rigor with the assumption that few would actually squint over them, given that they look like this:

Reading the emails screencapped in the widely-shared Twitter thread which got me interested, this seems to be what actually happened:

Four days before her surgery was scheduled, the patient went in for a pre-surgical exam and was troubled that a person whom she read as a trans woman looked at her while she was in the exam room. This inspired her to write a vigorously transphobic email to the hospital, saying that with narrow exceptions — her personal doctor’s team, “certified” doctors, and specific exceptions she deigned to allow — no one assigned male at birth should be permitted any contact with her during her care, underlining that she would insult any trans people she encountered. The hospital then contacted her doctor, and when the hospital had confirmed that doing so would not put the patient at risk, they day after the patient sent her email, the hospital replied with curt email telling her that her surgery appointment was cancelled because they could not meet her demands. An email exchange followed in which she insisted that she had done nothing wrong, while threatening legal action.

Advocates for trans liberation sound unhinged when we describe the bad faith which we have learned to expect from our opponents. This is why. Opponents of trans liberation reliably and shamelessly misrepresent events and outright lie. One must never trust them on a point of fact.

Since the Twitter thread misrepresents the emails it presents, offering them with confusing context, I have put together a clarifying summary timeline. Then below that I have the entire Twitter thread and the email screencaps it offered, transcribed for legibility, so you can see the details for yourself.

Email timeline

Teresa, the patient, was scheduled for surgery on Monday the 10^th.

Th 6^th — Teresa’s initial complaint

• During my initial assessment I told you how transphobic I was, with my demands for single-sex accomodations and my refusal to use trans people’s pronouns or to otherwise “engage” with “gender ideology”
• I am using a private hospital like yours because the are so many rapes at NHS facilities
• In just the last few years men have started watching so much gross porn that I am frightened that someone will snap kinky porn of me with their cellphone camera
• When I came in for a pre-surgical exam today, a creepy man in drag came into my exam room for a moment, uninvited, and looked at me
• This demonstrates that you do not take care to protect women
• Therefore I request that
  • no males other than doctors or my doctor’s team may have direct contact with me unless I give permission
  • I get a private room and bathroom
  • you log that person coming into the room as a Patient Dignity Lapse
• Really you ought to offer a single-sex care team like this to all women

Fr 7^th — the hospital (CEO?) cancels the surgery

• We do not share your beliefs
• We cannot do what you asked
• Your surgery is cancelled
• We told your doctor
• We did this because we have an obligation not only to protect you but to protect our staff

Sat 8^th — Teresa threateningly asks to keep her appointment

• I did not get the medication you promised me for prepping for the surgery
• I am not a bigot, there is nothing wrong with anything I said
• You are illegally discriminating against me, and I am a lawyer
• I really need the surgery
• I want to keep the appointment

Mon 10^th — The CEO explains cancelling the surgery

• The incident with someone coming into the room during your exam does sound bad; we are already investigating
• After surgery you would spend some time in the ICU, where we are just not equipped to give you your own bathroom or to ensure that you will not come in contact with male people
• You can believe what you want, but given your comment about not using pronouns, I also have to protect my staff from you harassing them
• Before we cancelled your surgery, we checked with your doctor; your health is not endangered by our decision, as there are plenty of other places where you could get this surgery
• If you still want to get the surgery here, I stand ready to discuss it with you

Later — Teresa complains

• How dare you pick up my implication that the uninvited visitor showed up during the most awkward part of my exam; it was at a different time in the exam room
• I do not believe that you are not equipped to give me what I want
• I am a good person; how dare you suggest that I might “harass” someone or “discriminate” against anyone
• It is you who are discriminating against me
• You should have called me to talk this out, rather than talking to my doctor behind my back
• I am going to make legal trouble for you

The Twitter thread

Here is the deceptive Twitter thread from @ripx4nutmeg, with the text of the attached screenshots of emails transcribed. I put the original thread, formatted with individual tweets as paragraphs, in yellow boxes. The email transcripts appear in white boxes in the yellow boxes where @ripx4nutmeg put them; I have added the titles of my summaries above to those, so you can connect summary to source. I add a few interjections in regular text like this, to point to disjoints between what @ripx4nutmeg says and what the email screencaps in the thread say.

In one of the most shocking stories you could read, a London hospital has cancelled a woman's life-saving operation at the last minute because it doesn't 'share her values'. That 'value' she had was that she wanted the aftercare nurses to be female

Former solicitor Teresa - @XXFemaleOnly - needs urgent, rare and highly complex, colorectal surgery. She selected the private Princess Grace Hospital, which specialises in women's healthcare, for it specifically because she didn't want to be in a mixed-sex facility

A victim of sexual assaults, Teresa made it clear to the hospital how important this issue was to her, by both requesting a single-sex room and bathroom, and stating she would only answer questions on forms about her sex, not her 'gender identity'

During a pre-operation intimate procedure, a male member of staff, wearing a blonde wig and bright lipstick, opened the door uninvited, and peered in. He made eye contact with her, before leaving. Teresa wondered if she was being targeted due to her requests

Feeling frightened and vulnerable, Teresa reported the incident as a 'patient dignity breach', and issued a request that her nursing care from now on must be from females only, and not men who 'ID' as women, something that is allowed under the Equality Act

Th 6^th — Teresa’s initial complaint

Dear Staff

I attended Princess Grace Hospital today for a pre-op assessment. My surgery is due on Monday 10th October.

Before attending the assessment, I completed a questionnaire in which I explained that:

1. I wanted single sex bathroom / accommodation facilities during my stay, as per my rights under the Health and Social Care Act 2008 (Regulation 2014) as updated in 2022, and the CQC Fundamental Standards of Care relating to Dignity and Privacy, and in accordance with the Equality Act Schedule 3 Single Sex Exemption; and

2. that I would not agree to use pronouns or otherwise engage with such manifestations of gender ideology. This is in accordance with my beliefs which are deemed to be “worthy of respect in a democratic society” (as per the judgment in Forstate v CGD) and are also listed as one of the nine protected categories (Religion / Beliefs) under the Equality Act 2010.

I selected a private hospital specifically to avoid the NHS, because of the Annex B policy scandal, which has resulted in sexual assaults and rapes in mixed sex facilities, on an industrial scale, as recent FOI enquiries have made clear. I know this, because I am part of an enquiry into it. It is a fact that mixed sex hospital facilities are unsafe for women.

Only five years ago I would not have worried about this; however, the reality is that in the last few years, the use of online porn has grown exponentially. There are a myraid of porn genres (which have been monetised) and no end to the depths of depravity online. 2.8% of heterosexual men have a paraphilia of some kind. Everybody has a mobile phone. I do not wish to be exposed to risk while I am immobilised when I am in ICU following my surgery.

This matter is of sufficient importance to me that I regard the two requirements above as a condition of my contract with HCA.

The pre-op assessment which I had this afternoon at the Princess Grace Hospital included intimate procedures including [redacted]

Towards the end of my assessment, somebody knocked at and simultaneously opened the door without waiting to be invited to enter. The door opened onto a corridor. A young male in what appeared to be a blonde wig, wearing full evening make-up including bright scarlet lipstick peered at me. I am not sure wht his role was or what he was doing there. He made direct eye contact with me (which in itself was quite brazen and so disconcerting), then said something to the nurse and looked away.

I was horrified and shocked that any male member of staff would feel entitled to breach the privacy of a woman patient in such a way in these circumstances. It was especially egregious that this happened in the light of the advance notice I had given to the hospital.

All male staff should be required to knock at a door and WAIT for permission to enter before opening a door when a female patient is in a state of undress. This person obviously feels sufficiently entitled to walk in on a female patient and I find this to be very alarming. This transgression suggests that there is a lack fo discipline / training of male staff to respect the boundaries of female patients at HCA. Although this is following a societal trend (see above) I did not expect to encounter this in a central London private hospital. It makes me feel very nervous about aftercare.

None of this augurs well for women who are vulnerable following major surgery.

Accordingly I have to make the following requests:

1. While I naturally accept that Professor Faiz’s surgical team is mixed sex, I am again stating my wish that the nursing, auxiliary and support staff with whom I will be in immediate contact following surgery are FEMALE ONLY. Please note that trans-identifying males are NOT females.

2. I will accept male staff entering my room ONLY if they are qualified doctors unless by prior agreement with me.

3. I assume that I will have a private room with a private bathroom.

4. I insist that the above incidence is registered as a Patient Dignity Lapse on the hospital incident recording system.

Finally, in light of the above, I do feel that the hospital should follow a protocol of offering ALL women patients single-sex nursing care. Please do not make life difficult for women when they are at their most vulnerable by forcing them into uncomfortable and embarrassing situations. I cannot believe that I am the first patient to have raised this with you.

What are you doing to reassure female patients as to their privacy, comfort and dignity in accordance with the CQC Fundamental Standards in this regard. Does HCA guarantee same sex care to it women patients?

I look forward to hearing from you.

Yours faithfully
Teresa [redacted]
Solicitor (retired)

She then had to go home for three days to prepare for the operation, in which pre-op medication was to be couriered to her. Nothing arrived. She called the hospital and was told the operation had been cancelled, with no explanation given why

She then found an email had been sent to her by the CEO of the hospital saying the operation, which was due the next working day, had been cancelled due to a 'lack of shared values' and to 'protect staff from unacceptable distress'.

Fr 7^th — the hospital (CEO?) cancels the surgery

From: [redacted]
Sent: 07 October 2022 19:36
To: [redacted]
Subject: Response from the Princess Grace Hospital

Dear [redacted]

Thank you for your email dated 6^th October 2022.

We have reviewed the content of your email. We do not share yor beliefs and are not able to adhere to your requests and we have therefore decided we will not proceed with your surgery at The Princess Grace Hospital on Monday 10^th October 2022. We have shared our decision with Professor Fiaz and recommend you make alternative arrangements.

I appreciate this is not the communication you were expecting to receive, however HCA is committed to protecting our staff from unacceptable distress and we believe the cornerstone of good patient care is based on mutual respect and trust.

Notice that @ripx4nutmeg implies that Teresa received the cancellation after three days incommunicado, on the eve of her planned surgery, while the email informing her is dated the 7^th (the day immediately after Teresa’s email above) not the 9^th (the day before the planned surgery). Then @ripx4nutmeg leans on this deception about the timeline in the next tweet … which attaches a screencapped email from Teresa contradicting the implication, describing how she saw the refusal the morning of the 8^th:

The life-saving operation would have involved two leading surgeons, their clinical entourage, two surgery suites, a robot, a place in ICU and a patient bed for seven nights, and this was all cancelled at the last minute

Sat 8^th — Teresa threateningly asks to keep her appointment

Dear [Redacted]

I refer to your email of yesterday evening that I opened this morning (Saturday). It has caused me significant anxiety and concern only two days before a major surgical proceedure for my acute medical condition.

Your staff member (Ms Katie Jones), as late as 16:30 yesterday, assured me that my prophylactic prescribed medicine would be couriered to me this morning (due to widespread local unavailablitiy yesterday). I have relied on this statemenet accordingly.

It appears that you and your colleagues have completely misunderstood/misinterpreted my reasonable advance directive provided during the pre-admission session on Thursday, along with the points made in my email below.

I am a liberal left-of-centre Labour voter and do not object to anyone identifying in any way they wish. That does not mean that I must agree to nursing care from biological males while I am immobilized following major surgery. I am a former solicitor, a former biochemist, and a rationalist. My beliefs on this subject are ordinary, mainstream, and a protected belief under English law. I have always championed minority rights and all aspects and principles of diversity and inclusion. Indeed, my husband is a partner in a major law firm which is a Stonewall Diversity Champion.

My request for post-operative care is no different from the requirements of many female patients of Middle Eastern/Asian heritage, and it is not unreasonable to expect to be accomodated similarly.

As per the Equality Act 2010 and HCA Healthcare UK’s own Code of Conduct (the “Code”), which have mandatory application to this matter, my belief is one of the nine protected characteristics described by HCA. I respectfully suggest that cancelling my proceduere is a discriminatory decision, made in error and haste.

As per the Code a patient has a right to request advance directives regarding treatment. The Code states that they “are honoured within the limits of the law, and our organisation‘s missions, philosophy, values and capabilties”. There is nothing in my own values and beliefs that run contrary to the foregoing. Denying my scheduled treatment without discussion because I have made a complaint about a transgression of boundaries by a member of staff is totally unethical, and contrary to HCA's stated values.

I am greatly concerned that my reasonable request and points in my email below that reflect my legally protected belief have been misrepresentated as unlawful or unreasonable both within HCA and externally to my clinician and his staff. I fully agree that all staff must always be protected from unacceptable distress. However, there is nothing in my request that in any way could be reasonably construed as a cause, or as an intention to cause, such distress. Nothing could be further from my stated intentions.

Futhermore, your decision is breaching the Code under the heading of Patients’ Rights by dismissing my Patient Dignity complaint and request for same sex care:

‘In the promotion and protection of each patient’s rights, each patient and his or her representatives are accorded appropriate confidentiality, privacy, security, advocacy and safeguarding services, opportunity for resolution of complaints and pastoral care or spiritual care.’

Your response is evidently based on an incorrect understanding of the facts of the matter, and has resulted in a rushed and disproportionately harmful denial of my urgent clinical needs. You have not given me an opportunity to discuss the matter or attempt to resolve this misunderstanding. That is a breach of the Code and is unreasonable by any objective standard.

The cancellation of a critical proceedure on Friday evening, when I am due to take medicine tomorrow for a procedure scheduled for Monday, if not reversed (i.e. re-scheduled in the very near future) may have significant implications for my clinical outcome. I have already had one emergency admission with a perforated intestine recently. A delay at this stage increases the risk of a further emergency and so is creating an unnecessary risk to my health. My procedure is particularly complex and requires a robot and two surgeons. I am unwell and the condition is life-threatening.

Accordingly, I would respectfully but strongly urge you to re-consider your decision. I can assure you that I am a wholly reasonable person who appreciates the absolute need to treat everybody in all circumstances with mutual respect and trust.

I look forward to hearing from you as soon as practicable in light of this urgent situation.

I reserve all my rights in this matter.

Yours sincerely
Teresa [Redacted]

The hospital CEO also, in contravention of healthcare regulations, failed to confirm that she would register the patient dignity breach and did not offer to investigate it

@ripx4nutmeg attaches to this last tweet another screencapped email which directly contradicts its claim, since in their email the CEO recognizes the “dignity breech” as wrong and says they are already investigating it.

The hospital CEO also, in contravention of healthcare regulations, failed to confirm that she would register the patient dignity breach and did not offer to investigate it

Mon 10^th — The CEO explains cancelling the surgery

Dear Ms [Redacted]

Thank you for your email which I read this morning on my return to the hospital.

Your email of 6 October, timed at 23:51 that night, expressed concerns over an incident which occurred earlier that day and included a number of ‘requests’ and ‘requirements’ relating to the surgery which was scheudled for the following Monday (today, 10 October). The incident you described in that email - where an individual entered into the room whilst you were [redacted] in advance of your planned surgery - should not have happened and is under investigation. We will come back to you once that investigation is complete.

Your email also advised (my words):

• you wanted a private room with a private bathroom
• you wanted all nursing, auxillary and support staff with whom you would be in immediate contact following surgery to be female only, with male stafff only entering your room if they were qualified doctors or you had previously agreed

You also noted that you would not agree to use pronouns or otherwise engage with “such manifestations of gender ideology”.

Our hospital wards comprise single rooms with ensuite facilities, and you would be admitted into one of these rooms once assessed as ‘fit’ to return to the ward, would be nursed in such a room until your discharge from the hospital. However, our intensive care facility does not comprise single rooms with ensuite facilities and we do not have single sex intensive care facilities at the hospital. We would not therefore be able to meet your request always for a private room with a private bathroom.

I would also note that the Hospital’s staffing is mixed sex. This includes the doctors that work here, as well as our nursing staff, radiotherapists, pharmacists and phisiotherapists and we would not therefore be able to meet your request that you be cared for only by female members of staff or ‘prior agreement’ as to specific male members of staff.

As regards your comment around pronouns, whilst I acknowldge your belief, I have a responsibility to protect our staff from discrimination and harassment.

I should note that before making our decision to cancel the surgery that was planned for today, our team liased with your Consultant to confirm that there would be no risk to your physical health. I also understand that it would be possible for you to have the surgery elsewhere. Having said that, I note from your emails that you would pefer to have your procedure in the private sector, so noting my comment above, I wonder if you might find it helpful to meet with me to discuss how (and if) we might be able to work together to accomodate an admission for you under mutually accepted terms? If you would like to do that, then I will ask my assistant to let you have some dates where I, as well as some of my senior nursing team and your Consultant could meet.

Regards
Yours sincerely
[Redacted]

With this all gone, probably the only alternative available to her at this, now, late stage, is open surgery, something her surgeon did not recommend as the best option

@ripx4nutmeg attaches to the last tweet there a screencap of Teresa’s email to the CEO which does not demonstrate the medical consequences the tweet names; it does not even make the assertion. It says instead that the CEO’s email has her feeling disrespected, so she threatens legal action.

With this all gone, probably the only alternative available to her at this, now, late stage, is open surgery, something her surgeon did not recommend as the best option

Later — Teresa complains

Dear [Redacted]

Thank you for your email below.

First, there is an inaccuracy that I feel compelled to correct right now before any investigation takes place, which is that you appear to have misread my Patient Breach complaint. I never said that it took place while intimate swabbing was occurring. I said that it took place during an assessment which included intimate swabbing. That is not the same thing. We must ensure that your trans-identified male employee will not be exposed to ‘unnecessary distress’ by a false claim. Please do not inadvertantly lend the lie to my honest account.

There is no point in going around in circles on the minutiae of the hospital layout and facilities regarding my requests, suffice to say that I don't agree with your analysis below. You have further muddied the water by using your own words and not mine.

Most importantly, I am of good character and particularly resent being portrayed as some kind of hazard to staff. You don’t appear to understand the meaning of the very loaded words that you employ. ‘Harassment’ is an example. It’s a criminal offense. Obviously, as a sex-realist and a lawyer, I have checked the legal position on engaging with pronouns or otherwise. Not using pronouns, or identifying a third-party male, as a male, for example, is not tantamount to harassment. I know exactly where the line lies and never cross it. Kindly refrain from stating, expressly or impliedly, that such a word applies to me.

Neither is expecting same sex care ‘discrimination’ against anyone, and I don’t understand why you consider it to be so. In fact I am the party who has been discriminated against. Your bias in this matter is very telling. There are nine protected categories under the Equality Act 2010, and that there is no hierarchy of rights. Gender reassignment does not take priority over the eight other protected categories. I have three protected characteristics, Sex, Religion / Belief, and Age. Proportionality is key.

Obviously, in the light of the patient dignity breech, I found myself in an invidious position where I had to set my own boundaries as PGH did not appear to have adequate ones in place. Hence the updated request for single sex care. For example, if staff are allowed to chat around the door of the assessment suite straight off a corridor, why not have a screen around the patient? That would have been fine with me.

All these issues could have been resolved if you had followed the mandatory HCA Code and rang me on Friday for a conversation before making a final decision about my proceedure. The correct first step would have been to apologize for any upset for the breech and promise an investigation. If you had said that the person was sorry and it was a genuine error, I may well have let it go. The second step would have been to explain the hospital’s position regarding my requests. I am sure we would have found some form of compromise, it would have been in my interest to do so.

Instead, you appear to have discussed the cancellation of my procedure with everyone except me; I merely received a thoroughly unpleasant emailed notification at 7:30pm. You ensured that no reply to the email could get through over the weekend as you switched on your auto-response facility (as you were no doubt entitled to do); however, you did not supply any alternative contact details for a member of staff that I could talk to over the weekend. I feel that I was dismissed and treated like some kind of pariah, with utter contempt.

I did not pick up your email until Saturday. I was still expecting my prescription and was chasing PGH. That saga was another incredibly stressful PGH service failure. In the course of chasing, I was horrified to be notified that my procedure had been cancelled - by a PGH receptionist. I asked for a senior member of staff at PGH to return my call, but nobody did, which was callous and unprofessional. I was extremely distressed and upset; it made me ill over the weekend.

I can honestly say that I have never encountered such a lack of professionalism and failure to follow due process or protocol as I have experienced while trying to arrange the proceedure. Aside from the total disregard of my interests, I cannot believe that any reasonable person would think it proportionate to lay off two of the UK's leading surgeons and their clinial entourage without notice and leave a robotic suite redundant along with a patient bed for seven ights, on such a ridculous premise as you did. The wasted costs must have been astronomical.

All of this sends a very clear message to women who are concerned about their privacy and dignity, about the priorities and values of PGH. On the basis of my experience, I am certain that I am most unlikely to receive fair or reasonable treatment from you.

Accordingly, I am escalating this matter as a next stage complaint to HCA.

Yours sincerely
Teresa [Redacted]

Just four days after the operation was due to take place, last week, her condition began to deteriorate and Teresa ended up in A&E, in considerable pain. She has rapidly lost weight and may now be too weak to have the open surgery

As she says: "The material reality of my serious illness is being totally disregarded by Princess Grace Hospital in order to protect the feelings of a male member of staff who committed a breach of patient dignity". Read the story here:

Daily Mail
EXCLUSIVE: Hospital refuses to operate on sex attack victim after she requests all-female care because she fears mixed sex facilities are unsafe for women

• The patient - a sex assault victim - had requested all-female facilities due to concerns over mixed areas
• She was stunned when someone she believed to be a transgender male opened door in pre-op assessment
• It prompted her to complain and make a request for all-female nursing care at Princess Grace Hospital
• The hospital then cancelled the surgery, claiming it was ‘protecting staff from discrimination and harassment’
• Women's rights campaigners have savaged the hospital’s act, branding it ‘a movement of misogyny in heels’
• Hospital said requests for ‘single sex care’ were particularly challenging, citing the 'diversity of colleagues’

Inviting misreadings

Is the thread really an argument in bad faith? Am I just quibbling over small particulars?

I submit that it is designed to support over-readings of what it says and what it demonstrates. The thread has been re-shared thousands of times, seen by countless more. At the time that I write the addendum, four days after the thread was initially shared, there are just shy of two thousand quote-tweets of the first tweet alone, many of them saying things which are simply not true. From the first six dozen QTs which Twitter offered me, I found these offering statements of fact contradicting the evidence of the thread:

The CEO of the Princess Grace Hospital is ignoring the single sex provisions of the EqualityAct, and, in effect is sentencing this woman to death by refusing allow robotic surgery to a person who no longer has the option of general surgery somewhere else.

The burgeoning practice of providing medical care only to the ideologically acceptable is unimaginably dangerous. #RespectMySex

London hospital will let a rape victim die unless she agrees to be touched by male staff.

Tells her it is so offensive to tell a man no that they cancel her operation instead.

Did I get this right?

Gilead hospital imposes possible death sentence to rape victim for crime of wrongthink.

We are now at a point where life saving care is being refused by a hospital because the patient's protected beliefs don't align with those they say they hold.

Principles

Same-sex care

An unfriendly interlocutor on Twitter asked whether I consider access to a same-sex care a reasonable request at all. I have to grant that this is an important question. So for the record:

As a matter of care for the comfort and psychological safety for patients, I vigorously support ensuring that as many medical facilities as possible have the capacity to offer same-sex exams to conscious patients, and to have facilities actively invite that request.

My support for trans liberation has me fundamentally skeptical about allowing requests specifically for care from a cis person, but I think the need for psychological safety for traumatized people trumps that skepticism. This makes facilities exclusively staffed by and in service of cis women an intriguing idea. I would criticize the theory — a staff of cis women is not the right way to ensure actual safety — but that does not mean that I would oppose their creation. And for obvious reasons not every facility could provide that level of exclusivity.

So if we set aside intensive care, a patient at a facility with mixed-sex staff requesting that the facility arrange to only have cis women enter their room? That is an even stronger request than requiring only cis women present for examinations. Again, the cultural politics of it make me uneasy, but I hesitate to call it morally wrong to ask. But it should be evident why this is logistically a heavy lift, not simply impractical for that particular hospital (as the CEO said) but impractical, period.

In her email, the patient suggests that this accommodation is a protected and routine right which she has been denied. Given just the logistics, I would be very surprised if that were true. So part of my objection to how this story has been told is that the hospital has been portrayed as refusing a reasonable expectation of a same-sex exam for a conscious patient — which I vigorously support! — when she has made a far more expansive set of demands.

Rights to care

As for a patient’s right to medical care whatever her behavior, the question of stakes and urgency is important. Even if a patient is making the worst insults or threats possible to their caregivers, the Hippocratic principle obligates those caregivers to deliver care preserving life & limb when urgently necessary. I take a universal right to medical care very seriously.

But without life & limb urgency, I do not see how medical caregivers are obligated to endure insults from patients.

And this discussion plug into much bigger questions about the ways in which we (if as a Yank I can include the UK in “we”) fail to support survivors of sexual assault, and people emotionally traumatized in general. One of my Twitter refrains is “we need a politics which is supportive of people who been traumatized and recognizes how people have incentives to exaggerate their trauma and recognizes how people have incentives to ignore and diminish trauma”.

All of this patient’s behavior reflects how that she has not received the support she deserves. We are seeing how a hospital simply cannot accommodate that need by itself; it requires a full-spectrum set of supports.

I vigorously resent the way that opponents of trans liberation have turned this broad-spectrum failure into a club with which to beat trans women. That does a disservice not only to trans people ... it is also a distraction from discussions of broader needs for support for the traumatized.

Shouldn’t they have just called her?

Many commentators suggest that the hospital should have phoned her to discuss after her first provocative email. They have a point: the hospital’s reply is unnervingly curt.

I strongly suspect that there are other elements under the water line here. I imagine them receiving that first email with its crackpottish particulars and not-so-veiled threats of legal action and talking over what they knew. Did they look at the initial intake assessment questionnaire she alludes to? Talk about other encounters the staff had already had with her? Ask people who were there about what actually happened in the exam room?

I imagine them dreading the risk of might happen once she was actually in the hospital for several days, the ways she would find to escalate. And given how the email exchange we can see proceeded, it seems that they called it right.

What of the patient’s legal rights?

I do not claim any expertise in law in general, in the UK legal system, or the particulars of this incident ... but Teresa’s legal argument in her emails sounds screwy to me.

She rests a great deal on her “legally protected belief”, but she then claims that this protects not just her beliefs but her latitude to make demands and to insult trans people. The bit where she says “Not using pronouns, or identifying a third-party male, as a male, for example, is not tantamount to harassment. I know exactly where the line lies and never cross it.” — is some chilling stuff. She is saying that she has premeditated plans to engage in as much harassment-in-the-colloquial-sense as she believes she can legally get away with.

Just the tweets

For folks new to this story, it helps to start by reading just the Twitter thread without the attached emails, the way I did at first:

In one of the most shocking stories you could read, a London hospital has cancelled a woman's life-saving operation at the last minute because it doesn't 'share her values'. That 'value' she had was that she wanted the aftercare nurses to be female

Former solicitor Teresa - @XXFemaleOnly - needs urgent, rare and highly complex, colorectal surgery. She selected the private Princess Grace Hospital, which specialises in women's healthcare, for it specifically because she didn't want to be in a mixed-sex facility

A victim of sexual assaults, Teresa made it clear to the hospital how important this issue was to her, by both requesting a single-sex room and bathroom, and stating she would only answer questions on forms about her sex, not her 'gender identity'

During a pre-operation intimate procedure, a male member of staff, wearing a blonde wig and bright lipstick, opened the door uninvited, and peered in. He made eye contact with her, before leaving. Teresa wondered if she was being targeted due to her requests

Feeling frightened and vulnerable, Teresa reported the incident as a 'patient dignity breach', and issued a request that her nursing care from now on must be from females only, and not men who 'ID' as women, something that is allowed under the Equality Act

She then had to go home for three days to prepare for the operation, in which pre-op medication was to be couriered to her. Nothing arrived. She called the hospital and was told the operation had been cancelled, with no explanation given why

She then found an email had been sent to her by the CEO of the hospital saying the operation, which was due the next working day, had been cancelled due to a 'lack of shared values' and to 'protect staff from unacceptable distress'.

The life-saving operation would have involved two leading surgeons, their clinical entourage, two surgery suites, a robot, a place in ICU and a patient bed for seven nights, and this was all cancelled at the last minute

The hospital CEO also, in contravention of healthcare regulations, failed to confirm that she would register the patient dignity breach and did not offer to investigate it

With this all gone, probably the only alternative available to her at this, now, late stage, is open surgery, something her surgeon did not recommend as the best option

Just four days after the operation was due to take place, last week, her condition began to deteriorate and Teresa ended up in A&E, in considerable pain. She has rapidly lost weight and may now be too weak to have the open surgery

As she says: "The material reality of my serious illness is being totally disregarded by Princess Grace Hospital in order to protect the feelings of a male member of staff who committed a breach of patient dignity". Read the story here: Daily Mail

Wow, she was done wrong, yes? That was how I felt when I read this. Spend a moment securing that thought in your mind.

Then jump back to the top of this post to learn what I found when I looked at the screencapped emails attached to those tweets.