We have known for years that people were getting coached on what to say to get approved for transition, to the point of being told to claim that they were suicidal.

Yes by people online etc... Here we have ideological doctors creating documents to trick providers and insurance companies to do the procedure without the patient even knowing what is going on. This person basically came in and gave very flimsy information and the doctor constructed the entire narrative to bypass any safety measures. When the "patient" questions why the dysphoria narrative was added in they flat out say that they need it to get insurance to cover the costs as the only reason.