The President of the High Court has made orders permitting the Health Service Executive (HSE) to take “all necessary and appropriate steps” to bring a woman with various disabilities and epilepsy to her next neurology appointment.
The orders include allowing gardaí to be engaged and to use “such minimal and proportionate force as may be reasonably necessary” to gain access to and enter the home the woman shares with her mother.
Making the orders on Thursday, Mr Justice David Barniville said they are “unusual” but “necessary and proportionate” when considering the woman’s medical needs and that she no longer has a prescription for her anti-seizure medication.
The woman (aged in her 40s) has been diagnosed with cerebral palsy, a severe intellectual disability and epilepsy. She is fully dependent in all her activities of daily living.
Jen Hogan: Maybe my kids will look back and think their childhood was grand (in spite of dropped balls)
She was declared a ward of the court in 2020 due to serious concerns about her mother’s lack of engagement with medically recommended epilepsy treatment.
A person can be made a ward of court if the High Court President is satisfied on the basis of medical evidence that they lack capacity and are incapable of managing their own affairs.
The woman’s mother gave various undertakings to the court last March, including that she would permit a home support worker to observe the administration of anti-convulsion medication twice per day, seven days per week. She also agreed to attend monthly meetings with the HSE and to notify the HSE if bringing the woman away for a few days.
On Thursday, the court was informed the mother did not attend some of the monthly meetings and, while she permitted administration of medication under observation, she did not allow it in the house, permitting it instead to occur in her car.
She told the HSE last summer that she intended to stop co-operating with the service and, according to a social worker, home service personnel ceased attending at the house to monitor administration of the medication.
Barrister Paul Brady, for the HSE, said there has been a “clear breach” of the court undertakings. He said efforts to reach the mother, including visiting the home, were unsuccessful and the daughter did not attend her last neurology appointment.
The woman’s court-appointed guardian was supportive of the HSE’s application, which he acknowledged was brought in her best interests as a “last resort”.
In documents before the court, a social worker said the mother has provided a “high level of personal care” to the woman. The mother felt her daughter’s seizures did not cause her significant difficulties and she believed the anti-convulsion medication carried significant side effects, the worker said.
Doctors had concerns that not taking the medication carries serious risks, including increased frequency of seizures, physical injury and death, she added.
The mother agreed in June 2020 to co-operate with her daughter’s care plan, but the HSE noted gradual and increasing disengagement towards the end of 2021, the worker said.
Making the orders, Mr Justice Barniville said there was nothing before him to suggest there was a prospect the mother would voluntarily co-operate with the HSE.
He had “no doubt” the HSE’s request was made as a “last resort” and he was satisfied it was appropriate to grant the orders in these “exceptional circumstances”.
The orders permit the HSE and the assisted admissions team to take all necessary and appropriate steps to bring the woman to her next neurology appointment.
The judge made another order compelling the woman’s mother to attend for the next court hearing scheduled for a date next month.