Severely anorexic girl at ‘acute and chronic’ risk, court told

A judge has made orders allowing for the transfer to hospital of a teenage girl with severe anorexia nervosa due to mounting concerns her health is at “acute and chronic” risk.

The 15-year-old girl appears to be obsessively "competing" with another girl, who also has anorexia, in an effort to be the "better" of the two at achieving weight loss, the president of the High Court, Mr Justice Peter Kelly, was told. Both girls are in the same residential placement and there is concern the 15-year-old's behaviour will cause the other girl to relapse, he noted.

The 15-year-old has had three hospital admissions in the past eight months as a result of her anorexia and her acute weight loss. She now weighs about 33.4kilogrammes, has a Body Mass Index of 14 and has lost weight in recent days.

Her consultant psychiatrist told the judge the girl has very poor insight into the severity of her disease and lacks capacity to make decisions in the best interests of her health and welfare. The girl had a recent 10-day hospital admission for acute weight loss during which she was fed by naso-gastric tube, the court heard.

While the girl is back in the residential facility, she is taking in only between 400-600 calories daily and is not complying with her meal plan, the psychiatrist said.

Before her most recent hospitalisation, an earlier hospital admission was required for a skin infection due to deliberate self-harm and a third admission was required for monitoring and treatment of low weight and blood pressure.

The facility where the girl is resident cannot provide naso-gastric feeding and that is among the reasons the orders permitting her transfer from the unit to a hospital were being sought by the HSE, the court was told.

The girl refused to eat after 7pm last Wednesday or the following day and had to be restrained after she refused to get into an ambulance, the court also heard. She then agreed to take some food and fluids.

While presently medically stable in the residential facility, the concern is she may become very agitated again and would require urgent hospital treatment but might refuse that, the psychiatrist said. There was an element of “paranoid thinking” in her attitude to the other girl with anorexia.

Paul Brady BL, for the HSE, said the hospital transfer orders were sought in anticipation of an application to have the girl made a ward of court. Her parents supported the application, the court heard. Mr Justice Kelly said, having read the reports and heard the evidence, including the concern of “acute and chronic” risk to the girl’s health, he was satisfied to make the transfer orders.

The orders allow the hospital detain the girl and administer such treatment as it considers necessary, including naso-gastric feeding. They also permit the girl to be restrained but the judge said he hoped that would not be necessary.