About this case:

• Citation:
  [2024] IEHC 698
• Judgment:
  External link
• Court:
  High Court
• Judge:
  Mr Justice David Nolan

Delivering judgment for the High Court, Mr Justice David Nolan emphasised: “The purpose of this judgement is not to punish the Mater hospital, but to ensure that all other applicants in these types of proceedings understand their importance and ensure that they put in place appropriate systems in order that court orders are abided by.”

Background

The applicant secured orders pursuant to the inherent jurisdiction of the High Court to protect the respondent, a young woman suffering with anorexia whose body mass index was falling dramatically, leaving her close to death. 

Mr Justice Nolan ordered inter alia that the respondent would be detained at the applicant hospital and that certain doctors would be responsible for her care. 

Those orders, which also included an anonymity order pursuant to s.27(1) of the Civil Law (Miscellaneous Provisions) Act 2008 and an order appointing a guardian ad litem, were later continued at a further hearing.

In breach of the High Court’s orders, the respondent was discharged from the Mater hospital and was transferred to another hospital. It became apparent that none of the medical staff charged with her care were aware of the orders.

The High Court

Mr Justice Nolan heard from the applicant’s solicitor who he described as being “one of the most experienced and diligent solicitors” appearing in his list and found that it was “clear that she was very distressed at what had taken place”.

The court also noted that it was clear that “nobody in the hospital had been listening to her about the importance of abiding by the court orders up until the matter was back before the court”.

The court received an affidavit of Dr C, upon whose evidence the original order had been granted, which explained that he had been on leave for a week but prior to his departure had spoken to a consultant in a different hospital in which the respondent had previously been admitted, to see if they were happy to resume care.

During DrC’s leave, another doctor, Dr B, contacted a member of Dr C’s team to say that the respondent was medically stable and no longer needed admission.

Mr Justice Nolan opined: “Neither Dr B, nor Dr C’s team, nor anybody in administration, indeed nobody other than Dr C himself seemed to be aware of the existence of the court orders. On that basis, the respondent was transferred.”

The judge also pointed out that “nothing had been done between her transfer to the other hospital and the court being informed of what had happened. It was not until I directed that Dr C come before me to explain what happened, that a flurry of activity took place.”

The court deemed the situation “a disgrace” where the orders were made at the instigation of the applicant hospital and where “nobody was aware” that they had occurred.

It heard evidence from Dr C as to the steps that would be taken in future to ensure that a similar situation would not arise again, including the placing of an alert on the hospital’s bed management system and inclusion of information in daily nursing safety meetings and an operation team’s weekly update meetings.

Mr Justice Nolan remarked: “I, rather foolishly, had assumed all of that was already in place. I had assumed that in the 21st century one of the leading hospitals in the State would have systems in place to be able to communicate to doctors and nurses the legal status of their patients.”

The judge recalled mentioning the placing of a sticker on the respondent’s folder, noting that “surprise, surprise a supplemental affidavit has been sworn saying that, at the suggestion of the court a warning sticker system has been created with a sticker placed on the front of all files pertaining to patients the subject of High Court orders”.

Finding that to place the preponderance of blame upon Dr C would be a mistake as this was a “fundamental systems break down, the responsibility of which rests with the management of the hospital”, Mr Justice Nolan highlighted: “The effect of this illegal movement of the respondent… has been detrimental. Firstly, she was not made aware until the day before of her move. She has lost trust, she has become nervous and crucially her BMI has been affected. She deserves better.”

The High Court was offered a personal undertaking from the CEO of the applicant hospital that no breach of a court order would ever occur again in relation to anyone falling under the inherent jurisdiction of the court.

Mr Justice Nolan observed: “If there is a breach of a court order, the next step would be an application for attachment and committal of the Chief Executive Officer to explain why she is in contempt of court and/or an application for the sequestration of the hospital’s assets.”

Conclusion

The High Court accepted the undertaking given by the CEO on her own behalf and on behalf of the applicant hospital.

Mater Misericordiae University Hospital v CBA [2024] IEHC 698