A young woman with a long history of anorexia nervosa who was re-admitted to hospital in a severely malnourished state is to remain there pending further High Court order.
In an email to High Court president Mr Justice Peter Kelly, the woman, a ward of court aged in her 20s, said this was “my worst relapse in 10 years battling the illness”.
When her case was reviewed by the judge this week, Sarah McKechnie, for the HSE, said the medical view is, as a result of her illness, the woman’s cognitive ability remains impaired to the extent she does not understand the consequences of her illness and she should remain in wardship.
The judge heard Aileen Curry, a solicitor who, on behalf of Patricia Hickey, general solicitor for wards of court, visited the woman early last week to ascertain her views, had said the woman had disputed the benefits of wardship.
The woman later last week sent the judge an email which he read to the court.
In that, the woman described herself as in a “very difficult” position. Her medical health had declined and she was again in hospital in an effort to have that stabilised, she said.
She was not seeking to “negotiate” or “make pleas” but rather to acknowledge the necessity for her current care plan.
She hoped, when reviewing her case, the court would consider there were “precipitating factors” that assisted and crystallised her relapse. Irrespective of all that has gone before, she is not a “treatment resistant anorexic” and has “every intention to get well”, she added.
David Leahy BL, for the general solicitor, said the woman did not wish to return to the family home or the community care team that had been dealing with her.
Her treating doctor believed she may need to be transferred elsewhere. Her doctor had said the woman had a particular view as to the circumstances that crystallised her relapse and there were particular family circumstances.
In his ruling, the judge said the woman was previously admitted to hospital and improved to the extent she could be discharged home and to receive community health care for her illness.
For whatever reason, and he was not adjudicating why, that seemed not to have worked out and she was readmitted to hospital for acute medical care in a severely malnourished state with difficulties including abnormal liver function and had a critically ill health status.
She has been compliant with the hospital treatment, has expressed “a sense of relief” to be there and has spoken more openly about a difficult home environment.
While she had expressed stress over the one-to-one supervision, the judge was satisfied, for reasons including concerns she may be interfering with her nutritional intake, that level of supervision was necessary.
He said multi-disciplinary meetings aimed at ensuring progress is made have been held and contact made with a UK unit which might have a bed in April at the earliest.
Her doctors considered she should remain in hospital and he was satisfied to continue the orders for that and the relevant treatment orders with the matter to return in four weeks.
The woman’s email showed she had some insight into the seriousness of her condition, he said.
She had “very strong views” as to what is to happen when she recovers, which hopefully she would, from this “very serious illness with a mortality rate of 20%”.
She was agreeable to stay in hospital and did not want to go to the UK unless absolutely necessary.
A UK placement may be necessary but that issue would be decided later, he said.
He directed the woman be told in general about the contents of the medical reports and told the reports had been read and her concerns had been listened to by the court.