Order allows HSE to clean disabled man against his wishes

The HSE has secured court orders permitting nursing staff to regularly clean, against his wishes, a severely disabled man who is incontinent and suffering from a progressive neurological condition.

The orders were sought over concerns the middle-aged man, who refuses to wear underwear or incontinence wear and will only allow himself be cleaned once a day before going to bed about 4am, is at risk of infection and septicemia as a result of sitting in faeces for hours daily.

He now has broken skin on his buttocks, David Leahy BL, for the HSE, said.

Lawyers for the man, who has no next of kin, sought an adjournment of the HSE application to get psychiatric and other reports for use in a plenary hearing concering his capacity to make decisions affecting his life and welfare. It was argued various constitutional rights, including to refuse medical treatment, were at stake.

After it was indicated by Ciaran Craven SC, for the man, that those reports could take weeks to prepare, the President of the High Court, Mr Justice Peter Kelly, said this was a "very grave" situation involving a man sitting in his own faeces for hours on end, with all the associated health risks, including septicemia and ultimately death.

He was very concerned, unless the orders were made, that the lawyers “may have no client” for a plenary hearing as the man’s right to life was at risk. The situation was also creating psychological distress for staff caring for him, he said.

Psychiatric report

The HSE had provided reports, including from a consultant forensic psychiatrist who had assessed the man and considered his situation was of significant and urgent concern and could lead to a “grave outcome”.

That report set out the dangers of sepsis in a person whose health is already compromised. It also stated the man’s articulate presentation may give a misleading impression and he may be suffering a deterioration in cognitive functioning due to his progressive neurological condition. It was also believed his behavioural issues could reflect brain damage.

A psychiatric assessment of the man carried out in late 2014 found he would meet the criteria for a schizoid personality disorder with obsessive complusive traits, the judge noted.

On foot of the material before the court, the judge said he would make an order pemitting regular cleaning of the man pending further order. He has also directed a medical visitor assess the man within days, with a view to deciding if he should be made a ward of court, and returned the matter to next Thursday.

Earlier, the judge noted the man is an isolated person whose parents are dead and has no next of kin. He has complex needs and challenging behaviours which had lead to a number of placements for him breaking down. Care staff employed by a private company are currently caring for him in his own apartment in a HSE funded facility.

As well as refusing to allow himself be regularly cleaned, he twice refused recently to allow catheters be inserted but that situation has resolved and a catheter was recently inserted, the judge noted.