Wardship orders continued for teenage boy with eating disorder- 2022vol2#53

The President of the High Court has continued orders sought by the Child and Family Agency (CFA) and the guardian ad litem (GAL) to keep a teenage boy [B] in wardship who had initially been admitted to a hospital after a continued period of declining food in his residential placement.

The teenage boy was initially taken into wardship in October 2022 on the application of the CFA and the boy was admitted to hospital for nasal gastric feeding. Later in the same month, the solicitor for the GAL had sought an extension of those orders, as B had continued to decline oral nutrition. The order was granted based on the social worker’s report and written evidence from B’s psychiatric consultant. At the end of the following month, the solicitor for the GAL sought another continuation of the wardship orders for B, who was close to reaching his majority. The ward was now in a residential placement and taking food orally without medical intervention.

As well as the report from the GAL, there were two sets of reports and minutes from the CAMHS in-patient unit. His doctor was recommending the orders remain in place up until the young man’s 18th birthday. An adult psychiatric report was awaited and the solicitor advised that the GAL was suggesting a slightly amended version of the current wardship order which would allow for his readmission to a centre, if so required, on the opinion of a consultant psychiatrist.

The solicitor for the GAL noted that the GAL had the view that adult wardship proceedings might be necessary and there was the option that day for the judge to direct the medical visitor to be sent out [to assess B’s capacity] or to wait until he reached his majority to assess him. “Justice O’Malley was clear that the sending out of a medical visitor [prior to majority] invokes the HSE jurisdiction in the matter for his majority,” added the solicitor. She noted that there was a level of vulnerability in terms of the young man’s 18th birthday and a continued suite of orders would allow for readmission to services post 18.

The court also heard there was a concern from the GAL that the young man’s “preference is to be fed by nasal gastric tube, it may be his choice that he’s looking to go back to [hospital], for that reason the continuation of the orders is required, if he decides to cease eating once again and to be fed by way of nasal gastric feed,” stated the barrister for the CFA.

The solicitor for the HSE told the court that she supported the application being made by the CFA. She advised the court that an affidavit had been sworn on route, in the first exhibit the young man “had made a disclosure to the nursing team in [the CAMHS inpatient unit], that he wants to be readmitted to [hospital].” The affidavit included the minutes of the professionals’ meeting. It was the view of the staff from his care placement as well as that of the clinicians “that he is planning to engineer a return to [hospital], the concern is that this may the start of a restrictive plan of food intake, he is eating and drinking, there is a benefit to his welfare for this order being made by the court.”

The judge extended the wardship orders. He noted that the case had “been before the court on several occasions in the last few months and before that for the purpose of orders designed to save his life and protect his health.” The teenager had had “an urgent admission” to a Dublin hospital for “urgent treatment for severe weight loss and restrictive eating practices which has led to severe risks to his health, he is almost 18, he has a working diagnosis of ASD [Autistic Spectrum Disorder],” stated the judge.

The judge also noted that B, having been admitted to the hospital in October on foot of an urgent application, was discharged from there to an inpatient CAMHS unit the following month and subsequently discharged back to his care placement. A lot of concern remained around the young man however, “in particular about his eating, whilst at the moment, the evidence discloses that he is eating three meals and fluids per day, he is refusing to take snacks, which form part of his meal plan”. The judge also noted that there was evidence that he had told the staff there that he likes being fed by the nasal gastric tube and there is a concern that he will refuse to eat so that he can go back to hospital, which he described as “like heaven.”

The judge said he felt at this point having regard to the concerns relating to his capacity that he would “send the medical visitor to assess his capacity, bearing in mind his imminent 18th birthday, so that this is in train and there can be some continuity in the court’s oversight of this case.” He also stated that whilst a report on the assessment of the young man’s capacity was being awaited, informally the psychiatric consultant had advised that B was not capable of living independently.

The existing orders were therefore continued on the basis that they were necessary and appropriate and the least restrictive, due to the real risk of relapse.