High Court discharges ward of court from facility in UK, returns girl to parents’ care – 2019vol2#9

The President of the High Court ordered the discharge of a ward of court from a facility in the United Kingdom, where she was being treated for an eating disorder, when the court heard the doctors were satisfied that it was in the young girl’s best interests. It was ordered that the young girl was to be brought home and given into the care and custody of her parents and to reside in the family home.

It was noted that a whole series of services were to be provided and that there was an undertaking from the Health Service Executive to make a referral to the Youth Advocacy Programme and that this referral would be facilitated by the Child and Family Agency. If the young girl was to abscond the President of the High Court directed An Garda Síochána to immediately search for the young girl and to arrest her without a warrant.

The President of the High Court made an order under section 27 of the Civil Law (Miscellaneous Provisions) Act 2008 prohibiting the identification of the young girl as a person suffering with a medical condition.

The barrister for the Health Service Executive (HSE) told the court that the matter was last before the court in October and was listed for further review and an update on the plans to discharge the young girl home. The doctor was in court to give oral evidence for discharge planning.

There was an affidavit before the court that exhibited minutes of a meeting and a nursing report. The affidavit set out recent interactions and recommended that the young girl be discharged home as soon as reasonably possible. The court was told that the only outstanding piece was what community supports the Child and Family Agency (CFA) would offer. The court asked for an affidavit on behalf of CFA setting out why it was not in a position to supply family support services.

The affidavit on behalf of the HSE set out the latest position as to the discharge plan and stated the clinical opinion was that the young girl was ready clinically for discharge and she was otherwise at risk of institutionalisation. The recommendation was that discharge should take place, along with recommendations for her care plan.

A report provided to the court recommended discharge within two weeks and supported the clinical view and the plan for a follow-up appointment and a discharge date. The young girl would be weighed weekly but twice at certain times. It was recommended that individual therapy with a psychologist and family therapy should start straight away and a meal plan was to be sent by the dietitian.

The court heard evidence that the young person was to return to hospital if she dropped below a certain weight. If she became acutely medically unwell an assessment at an acute medical unit was required to assess whether she needed to be admitted. The court was told that as the young person came into her later teenage years it would become an equivalent adult medical team.

Judge: “If she does have to be admitted does it have to be through A&E?

Doctor: “During the working week can arrange with the unit directly. Otherwise through A&E.”

Judge: “I wouldn’t wish on anyone to have to go through the A&E department of any of our hospitals particularly for someone acutely unwell.”

The court was told that they would be tracking the young girl’s condition as sometimes with eating disorders they can deteriorate quickly but they would set up a communication system and “will act as fast as we can”.

The doctor said that the consultants had an hour-long meeting with a unit in Ireland and the referral would be kept on hold to be activated when needed. The court was told that the plan was for the young girl to have two appointments a week that would be scheduled in advance so the family could plan work and family life around them. The therapy would also involve support around food and exercising and at the start of each session the young girl would be weighed.

The court was told that following discussions it was thought that a Youth Advocate Programme (YAP) worker would be the best support in managing the home placement and the risk of absconding and would provide a scaffold for the next six months after coming out of an institution for a long time.

Judge: “The CFA want nothing to do with it?”

The barrister for the CFA told the court that he had instructions in respect of a YAP.

In relation to education for the young person the court was told that she would require appropriate special needs assistance and a gradual transition as “mainstream school might be very overwhelming, particularly meals and the social aspects”. It was suggested that the life centre could be a “stepping stone” back into mainstream education.

The court was told that the draft order was to discharge the young girl back into the custody of her parents and upon discharge to reside with her parents at home. The order had the possibility of approved residential admission with nasal gastric feedings and reasonable force and restraint with outings as the discretion of the treating consultant.

Judge: “Are those terms and conditions what you would regard as optimal treatment and in accordance with the doctor?”

Witness: “Yes.”

The barrister for the general solicitor asked what was to occur in the event she absconded from her parents’ care and whether there was an agreed procedure. The court was told that the standard procedure was that the Gardaí would be informed. The barrister for the general solicitor said that it was her understanding that normally the CFA would be involved as if she absconded a child care issue arose. The court was told that there is sometimes a delay if this is activated and if there was an order form the court directing the Gardaí to arrest the young girl if she was to abscond this could be avoided.

The judge directed the following question to the barrister for the CFA.

Judge: “Your client wants nothing to do with case?”

CFA barrister: “The view is that a family support worker is insufficiently specialised for a case this complex. [There is] no difficulty facilitating a YAP worker.”

Judge: “It is not in her best interest to stay there longer than necessary.”

If the court was to make the order for discharge it was necessary to make sure everything was in place in accordance with the recommendations, subject to the clinical decision of the doctor to ensure her best interest were looked after. There was agreement that the sooner the better but that it was best that everything was in place.

Judge: “The sooner she is brought home the better but I don’t want to bring her home purely for the sake of it unless all the safeguards are in place.”

It was said that it was “not going to be plain sailing” for a young girl with her condition and there was a need for the legal structure in place if she needed to go into hospital or for psychiatric treatment. There was a need for specific authority if she was absent without permission that the police be ordered to look for her.

There was discussion between the court and the barrister for the CFA and the barrister for the HSE as to who was going to make a referral for the YAP worker to be appointed for the young girl.

Judge: “I will not get into the bureaucracy of the CFA and HSE. A child needs it. I don’t care who gives it. I don’t want them to be in a bureaucratic war between two state agencies. Who is taking responsibility? We have heard evidence of the best interests and welfare of the child.”

CFA barrister: “The CFA are not a party to the proceedings and never sought orders. The CFA is here at the request of the general solicitor but happy to facilitate.”

Judge: “Any objection to the order recording happy to facilitate?”

HSE barrister: “YAP won’t take instruction from the HSE, it has to be a referral from the CFA.”

Judge: “So happy to facilitate it… That they are going to accede to it. Written into the High Court Order, happy to facilitate it so to take the necessary steps.”

CFA barrister: “To facilitate the HSE.”

Judge: “You would think that the CFA, as the name implies, that it has some concern… We need some clarity if it is to be provided and I am told the CFA are the only people to invoke it… Have someone from senior management here this afternoon. I am not letting this go until clarified.”

The matter was adjourned to clarify the issue of the referral for a YAP worker and then the matter resumed after lunch.

Judge: “I hope some sense has now come into the picture.”

HSE barrister: “The HSE are going to initiate the referral themselves. YAP have agreed that they will accept the referral.”

Judge: “Thank goodness someone has some common sense.”

The judge said that the referral was to be directly between the HSE and YAP and that it was going to be provided for in the court order so as “to concentrate minds so not left high and dry.”

A draft order was handed into the court. The judge said that it should not be in a permissive form and it should be that An Garda Síochána “do immediately search for and arrest without warrant” so that the order was not permissive bur rather directive and mandatory.

The court said that the order should also contain the detail that the HSE was undertaking to apply for the provision of a Youth Advocacy Programme Worker to assist the ward and that the CFA would facilitate this referral. The court was told that the revised draft order was acceptable by the general solicitor and the father of the young girl.

The judge ordered the discharge of the young girl from the facility in the United Kingdom when the doctors were satisfied that it was in her best interests. It was ordered that the young girl was to be brought home and given into the care and custody of her parents and to reside in the family home. It was noted that the other parts of the order were agreed and accorded with the recommendations from the doctor of what should be provided when she was discharged from the facility in the United Kingdom with a whole series of services to be provided.