The 73-year-old claims she is being made a scapegoat after the recent legal action. "I have been hung out to dry. They just want to blame it all on me. I have not made one single decision here, they are all team decisions," Dr Kennedy said. One former patient, "Andrew", who was 21 when he had his penis and testicles replaced with a false vagina, was awarded damages after claiming Dr Kennedy misdiagnosed him as a transsexual in the late 1980s. Since the surgery, he has twice tried to take his own life and has undergone operations to reconstruct a penis and remove breast implants. He says he will never be able to have children, is unable to work and feels like a "mutilated freak". In the past few weeks, a 66-year-old who also underwent surgery to become a woman following a diagnosis by Dr Kennedy, settled his claim out of court. The man, who was sexually abused by his mother for seven years from the age of eight, was referred for a sex-change operation in 1996 despite another psychiatrist, stating in his medical notes that "surgery would make little difference" to his life. Dr Kennedy said Southern Health's executive director of mental health, Anne Doherty, told her on March 31 that she was no longer in charge of the clinic, which has been closed until July while an internal review is conducted.

Southern Health did not disclose who had been appointed as the new director, but said in a statement that the clinic was committed to "delivering high-quality gender assessment services". Dr Kennedy claims the same "political forces" that tried to shut down abortion clinics are trying to close the gender dysphoria facility, which has performed sexual reassignment surgery on more than 600 people  a third of all referrals  since it was founded in 1975 by Dr Kennedy and Austrian-born Dr Herbert Bower, who died in 2006. The temporary closure comes five years after a State Government probe found a catalogue of problems with the way the clinic diagnosed and treated people with gender-identity issues. The 2004 review, led by Victoria's chief psychiatrist, was never made public, but a copy obtained by The Sunday Age shows the review found that countless patients were given sex changes without proper mental health checks before or after surgery. A second review in 2006 found half of all patients had significant psychiatric conditions, such as borderline personality disorder and psychotic depression, but many were still operated on. There was no evidence that patients' underlying mental problems were treated or their risk of suicide monitored.

The reviews also found most patients had been prescribed hormones almost immediately and in some cases were referred to a plastic surgeon before being sent for psychiatric assessment. Almost all of the clinic's staff also practise privately. While Dr Kennedy faces an informal hearing of the Medical Practitioners Board, The Sunday Age understands that no other doctors who work at the clinic are under investigation. Consultations are Medicare-funded but surgery costs about $10,000 and is carried out in private hospitals including Masada, in St Kilda, and Beleura, in Mornington. Surgery is performed only on patients who have been diagnosed as "true transsexuals" suffering gender dysphoria, which causes feelings of being born in the wrong body and creates a deep desire to change sex. Dr Kennedy believes that gender dysphoria is a biological condition that can be cured by surgery. But other experts say childhood abuse and underlying psychiatric conditions often cause gender confusion that can be alleviated with psychotherapy. Another of the clinic's patients  a woman with a history of sexual abuse who had both breasts removed before putting a stop to further surgery  is now trying to have Dr Kennedy disciplined through the Medical Practitioners Board.

Anne Shortall, a lawyer from Arnold, Thomas & Becker, who represents the former patients, said the results of the surgery were psychologically devastating. "This operation is so incredibly extreme you're changing someone's gender in a situation where if you are wrong there's virtually no recourse to put it right again. Then they're turned away when they go back to the clinic to say, 'I'm not able to live in this role, I need help'," Ms Shortall said. The Sunday Age has been told at least five other former patients, some of whom live interstate, have contacted a Melbourne support group, fearing they have been misdiagnosed as transsexual. Dr Kennedy insists no patient was encouraged to have surgery. She admits post-operative follow-up was limited, making it difficult to gauge how many people regretted surgery, but blames this on lack of funding and staff shortages. Dr Kennedy insists all patients were offered psychotherapy  a claim contested by the aggrieved patients and the government reviews. She also denies that patients were diagnosed without being assessed against internationally recognised criteria for gender-identity disorder. The Sunday Age sent 22 questions to Southern Health, whose short response did not outline what had been done to address the reviews' concerns, except to say that "substantial progress had been made towards implementing the recommendations".

Sally Goldner, of Transgender Victoria, said she was aware of some cases of misdiagnosis but believed 95 per cent of patients were happy with their treatment. She said lives of transsexuals would be at risk if the clinic closed. "The suicide rate in our community is 40 per cent You'd have lines of tombstones without this service," she said. Loading *Names have been changed. For help go to www.beyondblue.org.au, call Suicide Helpline Victoria on 1300 651 251, or Lifeline on 131 114.