Judge says hospital's transfer of patient in breach of court order a 'disgrace'

Ann O'Loughlin

A hospital’s transfer of an anorexic patient to another medical setting in breach of a court order had been called a “disgrace” by a High Court judge.

Mr Justice David Nolan said there was a “fundamental systems breakdown” at the Mater Misericordiae University Hospital in Dublin, the responsibility for which “rests with the management of the hospital”.

The woman’s case had earlier come before the court’s “inherent jurisdiction” list as she was found to lack capacity due to anorexia nervosa. Orders made in this list are done to vindicate the constitutional rights of people who cannot make decisions in their interest due to a lack of capacity.

The judge said some time ago he made orders for her detention and treatment at the Mater after hearing her body mass index (BMI) was falling dramatically and she was “very close to death”.

The orders had been sought by the Mater, but it seems only one doctor was aware of their existence, the judge said. When that doctor went on leave for a week the woman was assessed as medically stable and ready for a transfer to another medical setting.

The ensuing “illegal movement” has had a “detrimental” effect on the woman, as she became nervous and, “crucially”, her BMI level was affected, said the judge, adding: “she deserves better”. The court discovered the move only after it occurred.

He said the situation is “quite frankly” a “disgrace”. He said he “foolishly” assumed that leading hospitals would have a system in place to communicate to doctors and nurses the legal status of their patients.

He noted the hospital has now put in place new safeguarding steps to ensure an event such as this does not happen again. He said steps such as putting a sticker on a folder would be “taken in a gym” and it is “shocking” that it has taken this case for the hospital to implement such a “simple basic procedure”.

He accepted an undertaking from the hospital’s chief executive officer ensuring that no breach of a court order will ever occur again in relation to someone who falls under the inherent jurisdiction of the court.

“If there is a breach of a court order, the next step would be an application for attachment and committal of the Chief Executive Officer to explain why she is in contempt of court and/or an application for the sequestration of the hospital’s assets,” the judge said.

He said it is perhaps worthwhile reminding the medical community of the implication of orders made under the High Court’s inherent jurisdiction.

Applications to this list are not “box ticking exercises” but are “very serious constitutional applications to deprive somebody of their liberty for the specific purpose of vindicating their constitutional right to bodily integrity in circumstances where they themselves lack the capacity to make such decisions”, he said