Malnourished woman appears to have refused to leave bed for four years

A woman appears to have remained in bed for almost four years before presenting to hospital malnourished and “on the brink of death”, the president of the High Court has heard.

“Even by the standards of awfulness I have to deal with on a daily basis, this is one of the worst cases I have ever encountered,” Mr Justice Peter Kelly said.

The woman, aged in her 30s, was living at home with her mother in “horrendous conditions”, the court heard. She seemed to have been spoon fed by her mother and to have refused to leave the bed from late 2015, even for bodily functions and she used a cloth in the bed for urine and bowel motions.

He said that what was “truly distressing” were suggestions that a GP had provided certificates of her sickness at her mother’s request without having seen her during that time. It also appeared there were prescriptions for medications.

He said those matters, if true, would be for investigation by the Medical Council.

Mr Justice Kelly made the comments after being updated on the situation of the woman, who remains in hospital in a precarious state of health including being at continuing risk of cardiac failure.

On the application of the HSE, the High Court granted emergency orders on September 23rd allowing doctors, in the context of an intended wardship application, to treat the woman in circumstances where she was refusing to allow various tests and treatments.

When the case returned before Mr Justice Kelly on Friday, Donal McGuinness, for the HSE, noted that when the woman was first admitted, she was on the brink of death with a haemoglobin level of 1.5 and in renal failure.

‘Incredibly low’

Her weight was 28kg and she had an “incredibly low” Body Mass Index of 10.4. A bowel blockage was later detected, requiring emergency surgical treatment which was successful. Since admission, her weight has risen by 5kgs but her BMI, despite rising to 11.9, remains critical.

She remains at risk, including from refeeding syndrome, and counsel said he wanted orders for various continuing treatments.

The limited history available for the woman seemed to suggest an underlying psychotic disorder and the medical view was she lacks capacity to consent to treatment, he said.

A doctor who discussed with her the risks if she did not eat had said she “did not believe any of it”.

She had said: “Maybe I am a little gaunt” but did not accept she was close to death.

The woman’s court appointed guardian had obtained some information including that the woman had been living at home with her mother, seemingly in “very dire” circumstances, and apparently with limited intervention by her GP.

It seemed the woman was “tricked” by her mother into going to see the GP in 2011 when both women gave different accounts to him concerning the daughter’s condition, counsel said.

Untreated

Michael Ramsey, for the guardian, said the woman seems to have a psychiatric condition that has been untreated for some years. The last time she seemed to have come to the HSE’s attention in relaiton to psychiatric issues appeared to be in 2011 and issues arose as to how she “fell through the cracks” of the services and reached the point of being on the brink of death.

It would be appropriate for the issues relating to the GP to be investigated through a social worker now appointed by the HSE, he added.

In his ruling, Mr Justice Kelly said, while the woman’s awful physical condition has improved, she remains at high risk of cardiac arrest. Her psychiatric condition was “doubtful” and the medical evidence suggests she lacks capacity.

The woman will be in hospital for months but, sadly, she does not believe her physical condition poses a threat to her life and wishes to go home, he said.

There was “no question of that” given her current physical and psychiatric condition and he would make the orders for continuing treatment, he said.