A severely anorexic young woman who unsuccessfully pleaded some 10 days ago for her hospital discharge because she feared she would contract Covid-19 and die will now be discharged.
The discharge order was made on Friday after the High Court heard her risk of contracting the virus in hospital has “significantly” increased.
Should the 19-year-old woman contract the virus, the medical view is it could prove fatal given her weakened state, Mr Justice David Keane was told.
The woman is a ward of court and the hospital, in an emergency application, sought orders for discharge arising from what its counsel Sarah McKechnie described as an “alarming” increase in Covid-19 cases, posing an increased risk to the woman of contracting the virus.
This was a “finely-balanced” and difficult decision by a multi-disciplinary team at the hospital because the woman’s discharge to her brother’s home with a community care plan also carries risk, including whether she will comply with it, counsel said.
The hospital favoured discharge because it now considers there is a probability she will contract Covid-19 if she stays in hospital but she is is at “much less risk” from Covid-19 at home.
Ms McKechnie agreed with Mr Justice David Keane the hospital had told the court on March 24th, when it opposed the woman’s bid for discharge with a community care plan, it considered that could only be for palliative, end of life, care for reasons including it could not, for example, continue naso-gastric feeding in a community setting.
Counsel said the hospital is no longer saying discharge would be only for palliative care for reasons including the nature of the community care plan. In the absence of naso-gastric tube feeding, the plan is aimed at weight maintenance and its success depends on the woman’s co-operation with it, counsel said.
It provided for face-to-face meetings and monitoring of the woman with several professionals, including her GP, psychiatrist and a dietician. This is not an optimum situation and, if there were no Covid-19 concerns, the hospital would not be seeking discharge, she added.
David Leahy BL, for the general solicitor for wards of court, representing the woman’s interests, said, given the changed situation, his side was supporting discharge.
The HSE is involved in the case because it had hoped to secure a specialised placement in a UK eating disorders unit for the woman but the Covid-19 crisis means such a placement is not available, its counsel said.
Mr Justice Keane said the situation had changed in two key respects since March 24th, when the High Court refused to discharge the woman.
The first was that the hospital was no longer saying discharge would be only for palliative care only. The second was that the hospital is saying, despite having put in place necessary precautions, the woman now has a high likelihood of contracting Covid-19 there but was at much less risk of that in the home placement.
Other difficulties included the general pressures on the hospital in dealing with Covid-19, providing the necessary levels of nursing care and monitoring for an anorexic patient and because the woman is struggling with protocols requiring her to stay in her room and comply with other risk reduction measures.
The hospital had said, if her condition deteriorates or she contracts Covid-19 at home, she would be assessed and readmitted, he noted. In light of the changed situation, the judge made orders for the woman’s discharge and various other orders, including requiring her to comply with the treatment plan.
