HSE must pay €1m legal costs in case of vulnerable woman

The Health Services Executive (HSE) must pay a legal costs bill estimated at some €1m over multiple applications and hearings concerning the appropriate care of a vulnerable young woman with a personality disorder, the High Court has directed.

Most of the High Court proceedings arose from the HSE's application, initiated last May and effectively abandoned last July, to keep the 18-year-old woman in a specialised psychiatric unit in Northampton, England, against her wishes, and at an annual cost of €400,000.

The HSE application raised what Mr Justice Seamus Noonan described as “profound” legal issues because Irish law, unlike English law, does not permit involuntary detention of adults with personality disorders. Those issues remain undecided because the HSE did not proceed with its application.

At one stage, Mr Justice Noonan remarked the legal costs of the proceedings — involving five senior counsel and as many junior counsel and solicitors — would have funded the costs of a purpose built unit here.

When the case came back before the judge today to address costs issues, he was told the HSE would pay the costs of the woman’s legal team.

Tim O’Leary SC, for the HSE, said it was for the judge to decide liability for costs of the notice parties to the case — the girl’s mother, father and her court-appointed guardian, all of whom were separately represented.

Noting other judicial colleagues who had dealt with the case had invited the notice parties to get or stay involved in the proceedings, the judge ruled the HSE should also pay their costs.

He was pleased to hear the woman is doing well here in a private unit made available for her some months after she was returned to Ireland last July from the unit in Northhampton, the judge added.

The woman has a borderline personality disorder making her prone to unpredictable episodes of self-harm including trying to take her own life. She has spent almost all of the last four years in psychiatric units in Ireland and England.

The High Court last March directed an arrangement be put in place for her return to Ireland by June 12th last but the HSE in May brought further proceedings arguing her circumstances had changed since the March order. Some doctors believed she could not be kept safe in the Irish services and should remain in the UK unit where high levels of security could be put in place, it said.

The matter then came before Mr Justice Noonan more than 20 times. The HSE later accepted that the woman, who had personally appealed to the judge to allow her return here, has capacity to make decisions about her treatment and it no longer sought her further detention in England.

The case raised complex legal issues related to the Irish High Court’s jurisdiction to order involuntary detention in a psychiatric unit in England of an Irish adult with a personality disorder.

The Oireachtas’s view that personality disorder should not be subject to involuntary detention is shared by other jurisdictions, including Scotland and Wales, Mr Justice Noonan previously noted.

The medical evidence, including from doctors who assessed the woman on behalf of her court-appointed guardian and the HSE, was of great assistance, he said.

The doctor acting on behalf of the guardian had said he believed long term detention of persons with personality disorders is not appropriate and may inhibit the woman’s recovery.