A High Court judge has been asked to decide a dispute over the future care of a woman who has been in a vegetative state for about a decade.
Her family want the woman, who is in her 40s, to remain in her home under a care regime designed by her GP and a consultant, but the HSE says that is clinically inappropriate and too expensive. It wants the woman to be moved to a nursing home unit.
While there had been some disagreement between the family and HSE over the circumstances in which a ‘Do Not Resuscitate’ notice should apply to the woman, that matter has since been agreed.
The woman is a ward of court and the dispute over future care has arisen because a €2.5 million settlement obtained by her in 2013 ran out last September. She has exceeded the life expectancy on which the settlement was based.
The settlement was made against the HSE without admission of liability and arose from a claim of delay and negligence in diagnosis of a brain tumour. The settlement had funded her home care since 2015 at costs ranging from €420,000 to more than €500,000 annually.
Before 2015, the woman was in a hospital intensive care unit, a private hospital room, a six-bed hospital ward and also in the nursing home that the HSE wants her to be returned to.
Dissatisfaction
Her family had taken her out of the nursing unit due to their dissatisfaction with the level of care there. A specially adapted home was obtained for her where she is subject to a care regime, designed by her GP and consultants and described by medical experts as “excellent ”.
The family employed a total of four carers and two nurses in providing 24-hour care funded via the wards of court office.
Pending Mr Justice Denis McDonald’s decision on future care, the HSE is funding the continuing home care. The judge heard evidence this week from the woman’s father, medical experts and also from funding and care provision witnesses. He will hear legal submissions later this month before giving his decision.
The woman’s father told the judge he would hand his daughter over to the HSE if it could find a place that would look after her as well as the family had. His daughter has limited time left and he wanted to ensure she is treated with dignity.
The father said that when his daughter was in hospital, a surgeon had told staff to train him in suctioning because it did not have the staff to go to her when necessary. She also experienced bed sores there but experienced none at home, he added.
Adequate
The HSE maintains it would be better clinically and financially to have the future care provided in the nursing home setting. If home care is decided on, it has proposed a “comfort care” package involving less carer and nursing supports than the woman currently has. It says that package is adequate and in line with medical reports.
It also says it cannot approve the family’s proposal that the HSE directly employ carers and nurses at lower rates than would otherwise be payable.
A witness for the HSE who is responsible for provision of home care supports in the woman’s area said home care support is not intended to provide a “hospital within a home” and she is unaware of any other person in a vegetative state being cared for at home via a HSE-funded package.
The HSE is obliged to provide appropriate services to the woman but must also ensure appropriate use of public funds, she said. There are implications for home support waiting lists and the trolley crisis by spending such a large sum as is proposed in this case, she said.
