Brandon report: ‘Rights-based’ approach still absent at HSE centre

Residents at a HSE-run disability centre in Co Donegal, where upwards of 108 incidents of sexual assaults were perpetrated on intellectually disabled adults over a 13-year period, still do "not live in a rights-based environment", an independent investigation has found.

The report, from the National Independent Review Panel (NIRP), found 18 intellectually disabled residents of the Ard Gréine Court complex in Stranorlar were subjected to "sustained sexual abuse" by another resident between 2003 and 2016.

The perpetrator, given the pseudonym Brandon in the report, was moved to a private nursing home in Convoy in 2016 and died there last year.

NIRP was commissioned by the Health Service Executive (HSE) to investigate the management of Brandon, following publication of a "look-back" review of files in 2016. It had been commissioned after Independent TD Thomas Pringle raised concerns after he was approached by a whistleblower in October 2016.

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The abuse, which included sexual touching and attempted touching of other residents inside and outside their clothing, entering the bedrooms at night of residents whom he had previously targeted, and exposing himself and masturbating in the presence of others, continued “with the full knowledge of staff and management of the facility at that time”, the report said.

“Evidence available on file would suggest that Brandon regularly targeted particular individuals and was able to identify particularly vulnerable residents whom he pursued relentlessly.”

The common strategy to manage him was to move him around the wards, which happened nine times from 2003.

“While each of these moves provided some respite to the staff and residents from the ward Brandon was vacating, unfortunately they also gave him access to other residents, many of whom became new victims of his abusive behaviour,” the report said.

The “only successful strategy” to stop the abuse was “short-term”. In December 2011 Brandon was moved out of the house he shared with other residents. However, “unfortunately, on 5th September 2013 he was moved back again . . . to live with the residents he had previously assaulted”.

Though the review’s terms of reference were confined to incidents between 2003 and 2018, records reviewed “suggest this sexualised behaviour had been ongoing and known to managers of the service prior to 2003”. And while there were no records of Brandon assaulting named individuals from November 2011, there were reports suggesting Brandon continued to engage in inappropriate behaviour “including sexual touching of other residents, publicly exposing his genitals or masturbating in public” until he moved to a nursing home.

‘Lack of leadership’

The report found “no evidence that any of the families of these residents were informed at the time of these assaults”. All have been informed since.

Gardaí were informed of the abuse on four occasions, the report said, in June 2011, March 2017, December 2018 and April 2019. The March 2017 report is undocumented, however, and based on recollection.

Nursing staff “regularly reported incidents to the director of nursing at that time, in the expectation that something would change which it never did”, and they experienced a sense of “powerlessness”.

The report said: “Many of the staff . . . did their best to manage a very difficult but ultimately unmanageable situation.”

It found “a lack of external management oversight and leadership from the HSE also allowed this situation to worsen over time”.

Among the contributing factors to the abuse continuing for so long was the “outdated” medical model of care, where residents are treated as patients in need of treatment, where they have a “lack of control or choice” and are “rendered powerless”.

“The fact that each resident . . . does not live in a rights-based environment, where they can make real decisions about where they live and who they live with, means residents are completely dependent on staff in the service to protect them.”

Of Brandon, the report said he was “a gentleman with a diagnosis of mild-moderate intellectual disability and bipolar affective disorder”. He had “an additional diagnosis of frontal lobe syndrome to which a senior forensic clinical psychologist directly attributed Brandon’s sexually inappropriate behaviour”.

“Unfortunately at no time during Brandon’s 20 years in this service was a holistic assessment of his needs conducted or an alternative, more specialised placement considered for him.”