HSE apologises over communication failures in care of elderly woman

The HSE has apologised at the High Court to the family of an elderly woman over its failure to properly communicate a care plan for her which her GP had feared could involve her effectively starving to death.

The President of the High Court, Mr Justice Peter Kelly, described the breakdown in communication as "substandard" and "regrettable".

The woman, aged 82, is a ward of court since 2011. She has Alzheimer’s disease and was hospitalised about two weeks ago with aspirational pneumonia. She was diagnosed as having lost the ability to swallow after suffering a minor stroke.

She was said to be otherwise healthy and was discharged from hospital last week back to the nursing home where she was residing with a care plan. Her GP had raised concerns whether that would involve her starving to death.

The judge had been told the woman’s family was concerned the hospital discharged her after deciding she should not be fed via the PEG method, involving a tube into her stomach.

The woman’s GP had said, in a letter to the hospital she, the GP, was “not comfortable ethically” with the situation and sought clarification of matters concerning the treatment plan.

When the case came before the court ex parte (one side only represented) on Monday, Mr Justice Kelly directed an urgent hearing concerning whether the proposed care plan for her was medically justifiable.

On Tuesday, the judge heard the woman is to be fed by an alternative programme known as comfort feeding, involving getting small amounts of certain foods orally.  That programme is now in place for the woman.

In an apology to the woman’s family and the court, the HSE accepted its plan, complied by a multi-disciplinary team composed of physicians, a dietician and a speech and language therapist, was not communicated to either her GP or the nursing home.

The manner in which the woman was discharged was substandard and should not have happened, Sarah McKechnie BL, for the HSE, said. The nursing home and GP had only seen a discharge summary from the hospital, she said.

Counsel also told the court the multi-disciplinary team believed the woman was not a suitable candidate for PEG feeding and believed that view had been conveyed to the family.

The HSE also apologised for not communicating as appropriate with the Office of Wards of Court concerning the woman’s health. Ms McKechnie asked the matter be put back for a few days so the court can be updated on the woman’s situation.

Solicitor Andrew Cody, representing the concerns of the woman's daughter, who constitutes her wardship committee, had raised the situation with the court on Monday.

Mark Connaughton SC, for the committee, said on Tuesday his client wanted to see the multidisciplinary report and the care plan as soon as possible. The HSE said that would be done.

Mr Justice Kelly said there had not been proper communication between the hospital and the GP and the nursing home concerning the care plan. Noting the HSE had apologised several times for what happened, he expressed hope there would be agreement between the parties concerning the woman’s treatment.

The “urgent” situation the court found itself presented with was something he hoped “will not be repeated”, he added.

The Office of Wards of Court is there to protect those who cannot make independent decisions for themselves and it should be informed about any significant medical treatment the woman was to receive, he added.

He was also taking into account evidence from the woman’s son on behalf of the family. The son had told the court the family had no problem with the hospital and accepted they had been informed about the risks of the PEG feeding procedure. Their main concern was their mother would be comfortable and not in pain, he said.

Adjourning the matter to Friday, the judge said he hoped any remaining difficulties between the parties concerning the woman’s health are resolved. If not, the court may appoint a visiting physician to independently assess the woman on the court’s behalf, he said.