The world-renowned Boston Children’s Hospital is being denounced by leading psychologists for drastically reducing the time it allocates for mental-health professionals to determine whether children identifying as transgender should receive gender-transition treatment. Shocked and dismayed by the hospital’s policy, these experts in pediatric-gender medicine have called the shortened assessment period woefully inadequate — considering the complexity of gender-related distress in minors and the fact that these medications are life-altering and, in the case of testosterone and estrogen, cause irreversible effects.

During the second half of the 2010s, leaders at the pediatric gender clinic at Boston Children’s first cut in half, and ultimately slashed by eightfold, the time they typically scheduled for in-house psychologists to assess gender-distressed children before determining whether they should be referred to endocrinologists to begin a treatment path that includes puberty blockers and cross-sex hormones. 

By about 2018, the gender clinic’s assessment policy was to provide these minor-age patients only a one-hour appointment with a psychologist, plus one hour with that provider and their family. This is according to three staff psychologists and the clinic’s director.

“It’s shocking,” Laura Edwards-Leeper, a former Boston Children’s psychologist who helped found its gender clinic, told the Sun of the dramatic reduction in time allotted for such assessments.

This reported sea change in clinic policy came to light thanks to a lawsuit brought by a fired psychologist that is now being heard in Suffolk County Superior Court in Boston. 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. 

Speaking to the complex calculus involved in considering whether gender-distressed adolescents should receive powerful medications to alter their puberty, Dr. Tishelman continued: “There’s a lot of things to think about in the long- and short-run. It’s not like taking an aspirin. It’s a big deal.”

That it has taken so many years for these specific policies at Boston Children’s to be laid bare lends weight, critics suggested to the Sun, to the persistent allegations that pediatric gender care, a controversial medical specialty, is lacking in transparency. 

The associated political stakes are substantial. During the presidential campaign’s home stretch, President Trump has relentlessly hammered Vice President Kamala Harris for her past support of taxpayer funded gender-transition treatments for prisoners, including detainees who are undocumented migrants. His campaign has funneled tens of millions of dollars into attack ads on this issue. 

Dr. Tishelman alleged in court that her supervisor at Boston Children’s, Dr. Yee-Ming Chan, was threatened by her success and had long subjected her to sexist and ageist treatment. Dr. Chan, who denies these claims, is a pillar in the field of pediatric gender medicine in his own right. He is a co-principal investigator of an ongoing and multipronged $10 million National Institutes of Health–sponsored research endeavor of the care transgender youth, including studies of the use of puberty blockers and cross-sex hormones to treat gender-related distress. 

Republican members of Congress last week pledged to launch an investigation into the federal grant funding this study. They were inspired to do so after The New York Times reported that the research project’s leading investigator, Dr. Johanna Olson-Kennedy of Children’s Hospital Los Angeles, said that she had refrained, expressly for political reasons, from publishing the team’s study finding that puberty blockers were not tied to psychological benefits. 

The Boston trial has also shone a harsh light on a substantial blind spot in pediatric gender medicine: the crucial question of how those who medically transition as minors fare as adults. 

By stripping Dr. Tishelman of her right to see patients in the gender clinic in 2019, she and her attorney alleged in court, Boston Children’s compromised her vital research into the care of transgender children. By firing her outright two years later, she said, the hospital terminated, among other research, her effort to establish a comprehensive database of all the patients the gender clinic had ever seen and to follow up with those who had reached adulthood. 

“We were the first clinic to see transgender kids in the United States, and we don’t know whatever happened to them and how they’re doing,” Dr. Tishelman testified about the hundreds of former patients who have aged out of the clinic’s care. 

“It’s damning that an institution like that, which has all those esteemed affiliations with major universities, would put the kibosh on an area of research that’s so desperately needed and would have informed their administrative decisions had they allowed it,” Erica Anderson, a psychologist and former head of the U.S. division of the World Professional Association for Transgender Health, or WPATH, told the Sun.

Boston Children’s is most prominently affiliated with Harvard Medical School.

Dr. Anderson, who is transgender, said that the assessment-related testimony from multiple Boston Children’s employees in Dr. Tishelman’s trial — who gave no indication that the drastically shortened assessment time is anything but a long-standing clinic policy — suggested a “fall from grace” for the prestigious hospital. 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.

A leader in the field, a challenge to that reputation

The gender clinic housed at Boston Children’s, called the Gender Multispecialty Service, or GeMS, is a pioneer and considered to be among the pre-eminent clinics of its kind in the United States. Consequently, the news that GeMS will approve children for gender-transition treatment at a pace multiple leading gender-medicine psychologists told the Sun was alarmingly hasty will likely deal a blow not only to the hospital’s reputation, but to this controversial and besieged medical field as a whole. 

Opponents and skeptics of prescribing puberty blockers and cross-sex hormones to treat gender-related distress in minors frequently characterize the nation’s pediatric gender clinics as engaging in sloppy, rushed care. These critics, who include many Republican lawmakers as well as a few vocal insiders like Dr. Anderson, often assert that doctors routinely place vulnerable adolescents suffering from myriad mental health problems on powerful, life-altering drugs without engaging in proper due diligence. 

Given the nation’s fractured health care system and a prevailing lack of routine patient-data collection in this field, as well as an evident reticence by gender-medicine researchers to publish unflattering research findings, comprehensive information about actual assessment practices at these clinics has remained fairly elusive.

The expositions that have emerged at Dr. Tishelman’s trial consequently shed crucial light onto the practices of a medical field that has become increasingly insular and secretive as it has faced mounting political and public scrutiny, lawsuits and, for Boston Children’s in particular, even threats of violence. 

The hospital sustained waves of bomb threats in 2022 after the influential conservative social-media account LibsOfTikTok focused its criticism on the Boston gender clinic and others like it. The account, run by Chaya Raichik, circulated videos that Boston Children’s had published, and ultimately deleted, advertising its gender-transition services, including surgeries it indciated it would perform on minors. 

Evidently concerned, at least in part, by the potential for further threats of violence, attorneys for Boston Children’s have sought to keep shielded from public view allegations about GeMS’s practices that were included in exhibits Dr. Tishelman submitted for her lawsuit. In an October 2023 filing successfully requesting that the judge overseeing the case seal portions of those exhibits the attorneys wrote:

“Public disclosure of these allegations will add fuel to an already highly charged public debate over the care of gender diverse youth and could cause serious, irreversible harm to the Hospital and the practitioners who Plaintiff now, for the first time, accuses of providing substandard care to this already at-risk population.” The attorneys further asserted: “GeMS practitioners provide individualized, safe, and affirmative care.” 

A representative for Boston Children’s declined to answer questions from the Sun, saying the hospital could not comment on pending litigation.

How Boston Children’s began the U.S. pediatric gender-medicine revolution

In 2007, Boston Children’s became the first U.S. clinic to import a pediatric gender-transition treatment protocol pioneered by researchers in the Netherlands. The Dutch model, as it’s known, observed strict criteria that only prescribed puberty blockers and cross-sex hormones to minors who had consistent cross-sex identification from early childhood, supportive parents, and no major other psychiatric problems. The model also discouraged prepubescent social transitions. 

According to a 2014 paper regarding 55 of the first Dutch youths to receive gender-transition treatment and surgeries under the protocol, their outcomes by young adulthood were generally favorable. The notable exception was one participant who died from complications from a vaginoplasty.

During the transformative decade since then, diagnoses of gender dysphoria — meaning distress stemming from a misalignment between a person’s biological sex and their gender identity — in young people have soared across the Western world. In response, scores of gender clinics nationwide have opened, following Boston Children’s lead. 

Concurrently, the profile of the typical patient presenting at pediatric gender clinics has shifted profoundly from the makeup of the original Dutch cohort. Today’s gender-dysphoric minors are more likely to be natal females and to only express gender dysphoria after puberty’s onset. They also have a higher rate of other psychiatric conditions and autism.  

In tandem, U.S. gender-medicine practitioners have become known worldwide for their particularly eager abandonment of the Dutch model’s guardrails. In their place, clinics such as Boston Children’s have adopted a philosophy known as gender-affirming care. 

The gender-affirmative ethos has been propagated and popularized in particular by a policy statement published by the American Academy of Pediatrics in 2018. The statement encourages care providers to observe deference to a child’s self-perception of their gender and essentially let the child take much of the lead in their own care. The document is now the subject of a medical-malpractice lawsuit and a recent probing letter from Republican state attorneys general.

Recent analyses of national medical-claims data provide at least some sense of how common pediatric gender care has become. The nonprofit Do No Harm recently conservatively estimated that at least 14,000 U.S. minors received gender-transition medications, surgeries, or both between 2019 and 2023. And the Manhattan Institute estimated, also conservatively, that 5,300 to 6,300 minors—as young as 12 years old—received gender-transition mastectomies between 2017 and 2023.

Boston Children’s, Do Not Harm found, provided such services to at least 300 children, accounting for nearly half the cases that the analysis identified in Massachusetts. 

According to GeMS’s website, the clinic has cared for more than 1,000 families. The site states: “We believe in a gender-affirmative model of care, which supports transgender and gender diverse youth in the gender in which they identify. This is a standard of care grounded in scientific evidence, demonstrating its benefits to the health and well-being of transgender and gender diverse youth.”

Recent systematic literature reviews—the gold standard of scientific evidence—have cast serious doubt on assertions that the evidence base behind pediatric gender-transition treatment is robust and reliable. These reviews have all found that such medical interventions are based on shaky and uncertain research findings.

The broad adoption of the gender-affirming care method and the concurrent surge in gender-transition treatment prescriptions have helped fuel a furious backlash among state-house Republicans. Since 2021, 26 states have passed laws banning pediatric gender-transition treatment; all but two of them ban transition surgeries for minors as well. In December, the Supreme Court will hear oral arguments over whether Tennessee’s treatment ban violates the Constitution.

Gary Click, a Republican state representative from Ohio, marshaled that state’s ban into law. In an email to the Sun, he responded to news from Dr. Tishelman’s trial, specifically that Boston Children’s assesses gender-dysphoric minors in just two hours of appointment time, by criticizing the pediatric gender-transition treatment advocates with whom he has clashed. 

“While I consistently advocated for mental-health over medical interventions, I was frequently and falsely accused of denying psychological care,” Mr. Click said of such advocates. “I’ve since discovered they are usually guilty of what they accuse us of doing. Now it appears that they are in a rush to medicate children before they have a chance to heal emotionally and choose a normal life.” 

An employment lawsuit affords a rare view inside a top gender clinic

Dr. Tishelman, who is an expert in child maltreatment and trauma, worked at Boston Children’s for nearly three decades. In 2013, she was appointed the director of clinical research at GeMS. Prior to her termination, she was a senior attending psychologist at the hospital and an assistant professor at Harvard Medical School. 

In addition to her research duties, Dr. Tishelman spent a relatively small portion of her overall schedule conducting the psychological assessments of gender-dysphoric patients who were potential candidates for gender-transition treatment. 

WPATH guidelines advise that gender clinics conduct a comprehensive assessment of such pediatric patients prior to prescribing them gender-transition drugs. 

Today, Dr. Tishelman is a research associate professor in psychology at Boston College. Her 2021 amended legal complaint, filed after she was fired in March of that year, charts what it claims was a fraught relationship between her and the Boston Children’s pediatric endocrinologist Dr. Yee-Ming Chan. Her complaint states that Dr. Chan, who is over a decade her junior, became her supervisor at GeMS in 2014. 

Dr. Chan repeatedly disputed in his testimony on Monday that he was indeed her official supervisor at the gender clinic. 

The legal complaint alleges that Dr. Chan subjected Dr. Tishelman to “a ceaseless sexist and ageist campaign of denigrations, accusations and recriminations” that created a hostile work environment and was driven by his “professional jealousy.” 

Dawn Solowey, an attorney for Boston Children’s of the law firm Seyfarth Shaw, asserted during her opening statement on Oct. 21 that Dr. Chan sought to foster a productive and copacetic working relationship with Dr. Tishelman. During his testimony, he denied Dr. Tishelman’s accusations of mistreatment. 

Both Psychologist Kerry McGregor, who is now the associate director of GeMS, and Francie Mandel, a senior clinical social worker supervisor at the clinic, testified favorably about Dr. Chan’s character and professionalism and cast those qualities of Dr. Tishelman in a negative light.

There remain several days of additional testimony in the trial that might flesh out the details of all the contrasting accounts.

Dr. Tishelman testified that other GeMS employees reacted with jealousy to the news in late 2017 of her appointment by WPATH as the lead author of the revision to its guidelines on care for prepubescent children with gender dysphoria. However, many professionals throughout the national field congratulated her, she said.

Soon after the WPATH appointment, Dr. Tishelman testified, GeMS doubled her clinical work, demanding that she see far more gender dysphoric patients than her schedule permitted. Others testified that this shift was unrelated to the news regarding WPATH.

“When I started, there were 20 hours,” Dr. Tishelman said of the time allotted for patient assessments. “And now they were asking me to do them in two-and-a-half hours.”

The assessments, she said, were meant to address a litany of complex needs and concerns. The original 20 hours included the time for Dr. Tishelman to speak with a gender-distressed child and their family; conduct scoring of major mental-health and neurodivergence markers; assess for suicidality; and determine the family’s concerns about infertility, which is a major risk of pediatric gender-transition treatment. Additionally, she might secure permission to confer with the patient’s outside therapist or school counselor. The time allotted also factored in her effort to write a detailed report on whether the child was a proper gender-transition treatment candidate and what other types of support they might need.

“Kids can be confused about what they want to do,” she said on the stand. “It’s a collaborative process to try to work with kids and their families to try to figure out what’s best for them, knowing the benefits and risks—being informed about the choices.”

Dr. Tishelman testified that by early 2018, GeMS administrators eliminated from the assessments a screening measure for autism. She alleged that despite what she characterized as the degradation of the assessments’ quality by that time, GeMS would include in various reports about the clinic’s work that its staffers followed WPATH’s trans-care guidelines.

“Shortening evaluations” at GeMS “eventually became a big concern” among her research collaborators nationwide, Dr. Tishelman testified. “People would complain to me about my protocol from outside,” she said in reference to those national colleagues. 

Dr. Tishelman specified that Dr. Robert Garofalo, a leading pediatrician at the gender clinic at Lurie Children’s Hospital in Chicago, expressed a concern to her at around this time regarding GeMS excluding from the assessments a measure of family acceptance and support of transgender patients. Along with Dr. Chan, Dr. Garofalo is a co-principal investigator on the long-running NIH-funded study of which Dr. Olson-Kennedy is the research lead.  

“I would try to tell people that I was not in charge of the protocol,” Dr. Tishelman testified.

Dr. Garofalo responded to an email seeking comment by asserting that the Sun’s initial characterization of Dr. Tishelman’s testimony about him was incorrect. But after the Sun then clarified her words about him, he did not respond further.  

Dr. Edwards-Leeper was a coauthor under Dr. Tishelman of the WPATH guidelines chapter revision on prepubescent children and also co wrote the accompanying adolescent chapter. Having left GeMS in 2011, Dr. Edwards-Leeper now practices in Ohio. She reported that she faced similar pressure to assess patients faster from an employer in the interim. 

She refused.

“There was no possible way I could cut corners,” she said. Today, in private practice, she directly assesses gender-dysphoric adolescents and their parents for at least 10 hours and ultimately writes a 20- to 30-page report on them.

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. 

On Tuesday, Dr. McGregor testified that the clinic had allotted four hours of “face-to-face time” with patients for assessments when she started at GeMS in 2016 and ultimately cut this to two hours. The day prior, Dr. Jeremi Carswell, director of GeMS, also testified that the assessment appointment time had been cut from four hours to two hours. 

“My understanding is that some were unhappy about it,” Dr. McGregor said about the time reduction, specifying Dr. Tishelman and GeMS psychologist Peter Hunt in particular. “I thought it was appropriate. But some people wished they’d had that time.”  

Further asked by a Boston Children’s attorney about why the assessment time was reduced, Dr. McGregor said: “I think that four hours was too much time. If you ever try and get an adolescent to pay attention to you for four hours straight, it’s a little bit difficult. And also we were able to get all the information in much less time. So, in order to see our growing patient population, it made sense to make that time more efficient.”

Dr. McGregor, who said she spent about 15 to 45 minutes writing her assessment reports, with the aid of a template she created, continued: “And we also could always ask for more time if we needed to. So I’ve met for a second session with patients. It’s pretty rare, but I do it if I need it.” 

Asked if two hours was typically sufficient to perform what the attorney called “a hormone-readiness assessment,” Dr. McGregor replied that it was. And asked for greater specifics about occasions when she said this was not sufficient time, she said, “Very rarely, but usually if someone has extreme social anxiety, they don’t want to talk, it takes a while to warm them up, maybe they’re on the autism spectrum, things like that, it might make sense to have a second session.”

Dr. Tishelman’s attorney, Patrick Hannon, of Hartley Michon Robb Hannon, asked Dr. McGregor about the videos that GeMS put out advertising their services. She referred to one in which she suggested that, as she recalled in her testimony, “a lot of parents share that some of their children seem to know seemingly from the womb as if they come out kind of knowing who they are,” meaning transgender. 

“There’s no scientific research that would support the assertion that kids know whether they’re transgender as soon as they come out of the womb, right?” Mr. Hannon asked Dr. McGregor.

“I don’t know how we would do that scientific research, so no,” she replied.

What is typical practice in this field?

It is evident that many of the nation’s pediatric gender clinics do engage in lengthy and circumspect assessments of gender-dysphoric minors seeking puberty blockers. But WPATH’s recommendation on this measure notwithstanding, it is also apparent that there is no uniformly upheld standard across this medical field and that assessment times and thoroughness vary dramatically. 

Some American mental-health providers, for example, advertise that they will write a letter recommending a gender-dysphoric child for puberty blockers after only a single visit. 

Dr. Edwards-Leeper has defended the value of robust assessments in the face of a burgeoning movement across the pediatric gender medicine field to question their utility.

The most comprehensive data set detailing assessment times comes not from America, but from Britain. A major analysis of pediatric gender medicine, called the Cass Review, that was published in April included information from an audit of discharge data regarding some 3,300 patients cared for by England’s pediatric gender clinic, known as GIDS. 

The children from this cohort who were ultimately referred to endocrinology received the go-ahead after an average of just under seven assessment appointments. However, a substantial proportion of these children were referred after only three or four assessment appointments.

Anna Hutchison, a psychologist who worked for GIDS between 2013 and 2017, reflected on the prospect of being asked to assess a child and their family in only two appointments, as became the practice at GeMS in 2018. “What can you realistically achieve in that time?” Dr. Hutchinson said.

Dr. Hutchinson ultimately publicly protested policies at GIDS that she said resulted in incautious, unethical care. In an interview, she conjectured that the Boston clinic might have been under mounting demands similar to those that, across the Atlantic, caused the inadequately resourced GIDS to buckle. As the population of gender-dysphoric British children seeking care swelled, Dr. Hutchinson recalled, systemic pressure pushed her and her colleagues to spend less time assessing each child — even as the rate of other psychiatric conditions among the patients steadily increased.

“There are risks in changing what we do clinically based only on resources,” said Dr. Hutchinson. Referring to the increasing demand for services from increasingly troubled children, she said, “Because numbers are going up, complexity is going up, and the amount of time per patient her family goes down.”

“We essentially became an assessment and medication service,” she said of GIDS during her tenure.

Ms. Solowey, the attorney for Boston Children’s, suggested in court last week that GeMS also could not keep up with demand, saying that the clinic “had a really long waiting list.” 

Ms. Mandel testified that the reduction, six years back, in appointment hours allotted for individual patient assessments at GeMS was driven not by clinical factors but by billing-related concerns. 

As for insights into American practices, in October 2022, Reuters published an investigation of pediatric gender clinics in which it reported: “Seven of the clinics said that if they don’t see any red flags and the child and parents are in agreement, they are comfortable prescribing puberty blockers or hormones based on the first visit, depending on the age of the child.” 

Nearly two dozen medical-malpractice lawsuits have been filed by detransitioners –  people who medically transitioned and then regretted it, stopping treatment and reverting to identifying as their birth sex – against health and mental health providers over the past two years. Central to many of those suits are claims that minors or young adults suffering from multiple other psychiatric conditions were prescribed gender-transition treatment for dysphoria after only a cursory assessment that failed to meet the WPATH standard.

Jordan Campbell, a partner at Campbell Miller Payne, a Dallas firm that represents many of these plaintiffs, told the Sun: “Dr. Tishelman’s testimony squares with what we see and hear from every single one of our clients: a general sense to rush patients into life-altering medicalization with very little — frequently even less than two hours — assessment, if any.”

In Feb. 2023, Jamie Reed famously blew the whistle on her employer, The Washington University Transgender Center at St. Louis Children’s Hospital, where she had been a case manager. Ms. Reed has accused the since-shuttered clinic of shirking its responsibility to provide comprehensive aid to a population of vulnerable children with very complex needs. (An internal university investigation found the clinic followed “appropriate policies and procedures according to the accepted standards of care.”)

“I long suspected that the sloppy care Wash U. provided would be found across the country,” Ms. Reed told the Sun. During her time at the St. Louis clinic, she said, “I was often unable to refer patients to high-quality psychological assessment, and our clinicians were also limited to scheduling only two sessions to complete an assessment—matching Dr. Tishelman’s account.”

Dr. Tishelman’s downfall

Attorneys for Boston Children’s have asserted in court that the hospital stripped Dr. Tishelman of permission to see GeMS patients in 2019 as a consequence of her chronic delinquency in turning in her patient reports; Ms. Mandel confirmed in her testimony that some reports were late. At that time five years ago, Dr. Tishelman testified, she had six delinquent reports. 

The hospital claims that it fired Dr. Tishelman outright in 2021 for violating federal patient privacy laws by viewing, without authorization, records of hundreds of patients not under her care. The hospital alleged that she secretly accessed those files in 2019 in hopes of defending herself by identifying other delinquent psychologist colleagues. 

Dr. Tishelman testified that the deadlines for her reports were deliberately unreasonable, given how GeMS administrators had burdened her with an excessive workload. She asserted that the clinic singled her out and “set me up to fail.” 

Dr. Edwards-Leeper and Erica Anderson were among the dozens of major figures in pediatric gender medicine who signed a letter of protest to Boston Children’s over Dr. Tishelman’s firing.

In his opening statement, 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.

Dr. Tishelman said Dr. Chan confirmed to her during that meeting that the other psychologist at GeMS she had identified as delinquent – Kerry McGregor –was making recommendations regarding gender-transition treatment for children despite omitting key information meant to be in the reports.

“You can’t really write the report without using all the information we’re gathering to put together to understand these people,” Dr. Tishelman testified. “Otherwise why would we even collect that information in the first place?” 

Dr. McGregor testified that records indicated her reports were not actually delinquent. She said that at that time there were “​​some addended scores that I had not placed for the assessment report” – an oversight that she said she quickly rectified.

She further testified that she was alarmed when she learned in 2019 that Dr. Tishelman had accessed her patient records; the following year, she determined that this included files pertaining to over 200 children. Dr. McGregor recalled that Dr. Carswell relayed to her in mid-2019 that the legal department at Boston Children’s found there were some legitimate reasons for Dr. Tishelman to have accessed those records and that her having done so was not cause for concern. 

Two years later, however, Dr. Tishelman was terminated from the clinic.