A man with severe life long epilepsy and organic brain disease has, during the first ever High Court hearing in a nursing home, appealed to a judge to let him leave there and return home.
Aged in his sixties and in the nursing home for several months, he said he would prefer to be at home.
He previously told doctors he wanted to be at home so he could walk to his mother’s grave.
The man, who has no family supports in Ireland and whose condition was said to have seriously deteriorated since his mother died in 2012, is opposing a HSE application to have him made a ward of court. His objections are supported by SAGE, the advocacy group for older people.
Doctors have clashed about whether he has the necessary mental capacity to make decisions affecting his health and finances.
Two doctors, his treating consultant geriatrician since 2013 and a court appointed medical visitor who is a consultant psychiatrist with a background in neurology, say he lacks capacity.
His treating doctor said she believed a return home could result in his death. He had not accessed meals and other supports made available to him and was admitted to hospital multiple times, including in a state of “abject malnutrition”, she said.
Seizures
Two consultant geriatricians who assessed him last May for the court proceedings disagreed, and said their view is he has capacity. One said there are daily risks in discharging people but he believed the man understood seizures can kill and was able to reason “what was the point of being safe if he was not happy”.
On Thursday, the president of the High Court, Mr Justice Peter Kelly, held the first ever court hearing in a nursing home.
That “unusual” situation arose because the man’s treating doctor considered the stress of court proceedings in a formal court setting could trigger a seizure, the judge said.
The judge, who heard detailed evidence last month from the treating doctor and the two dissenting geriatricians, heard evidence on Thursday from the man, the court medical visitor, his treating doctor and legal submissions.
After the two hour hearing in a meeting room in the modern nursing home, the judge said he would rule on the case in the Four Courts next Tuesday.
In his evidence, the man told his counsel Lewis Mooney BL, he had lived with his parents and remained on in the family home after they died.
‘Annoyed’
He was discharged to the nursing home early this year following a hospital admission and was “annoyed” because he believed he was going home from the hospital. Before he went to the nursing home, he said: “I coped with everything, I paid the bills and anything else”.
He said he cannot use a cooker because it was dangerous due to his seizures and ate take out meals which he microwaved. He said he took his medication and would take any assistance. He follows football and is a Spurs fan.“I would just prefer to be at home.”
In response to Maria Dillon, solicitor for the HSE, he said he rarely has a seizure now and when he does, he wakes up on the floor and had not been in hospital in recent years. When Ms Dillon said he has had 25 hospital inpatient admissions, including one for 56 days, and 11 emergency admissions, he said he was "surprised". Asked would he wear a panic button for people with epilepsy, he said there was "no use" pressing a button after a seizure because he would recover but he would wear one if it was a condition of going home. He had hurt himself plenty of times but had not had to get medical attention, he said.
Asked about his doctors concerns at his having been admitted to hospital in a malnourished state at stages in recent years, he said he had “always been skinny and had been trying to put on weight for years”.
Seizures could be dangerous but once they are over, “I am back to normal”, he said.
‘Torn apart’
In her evidence, the court appointed medical visitor said, based on her assessment of the man and collateral history from his treating doctors and medical records, she considered he lacks abstract thought processes and cannot act on advice. He has damage to both sides of his brain and underwent “uncommon” brain surgery when young which had helped alleviate multiple seizures he was then experiencing, she said.
His collateral history indicated his mother managed his condition well but, since her death, his life had been “torn apart” . His number of hospital and emergency admissions was “alarming” and she considered organic brain damage, “not fecklessness or foolishness”, was the problem.
Her “fairly certain conclusion” is he is incapable of managing his affairs without assistance because of bilateral organic brain disease. She agreed he had lived independently since his mother’s death but said he had not done so well.
The man’s treating doctor told the judge he has had 18 seizures since being admitted to the nursing home, those were managed in a supported environment and he has “thrived” in the nursing home. The ideal is for him to be home with round the clock care but the HSE does not provide that, she said. She did not believe he has capacity to manage outside a supported environment.
When told issues were raised in written legal submissions presented by Mr Mooney opposing wardship concerning arbitrary detention and lifelong nursing home care, the judge said detention in wardship is regularly reviewed and all care options are considered.
In her submissions, Ms Dillon argued the evidence, including the number of hospital admissions for conditions including malnutrition, sepsis and protracted delirium, supported wardship application and the judge should prefer the views of the treating doctor and the medical visitor.
The evidence of the two dissenting doctors was qualified because neither took collateral history, she argued. One had said he believed the man was entitled to take his discharge, even if that resulted in his death and that was a “cavalier approach” to discharge without reference to collateral information or clinical notes.
