The president of the High Court will rule later whether a man with severe life long epilepsy who has been in a nursing home since early this year has the necessary mental capacity to decide to return home.
The man, aged in his sixties, objects to the HSE's application to have him made a ward of court, which would mean the court decides what is in his best interests. His objections are supported by SAGE, the advocacy group for older people.
A consultant geriatrician involved in treating him over years disputes he has the necessary capacity, says he is of unsound mind with impaired self-awareness and judgment, and supports wardship and told Mr Justice Peter Kelly on Friday she believes a return home could result in his death.
Two other consultant geriatricians who assessed the man three times this year at the request of SAGE said they believe he has the necessary capacity.
He told one of them he understood a seizure could kill him but would rather be happy at home, where he could visit his mother’s grave, than safe in the nursing home.
The judge heard the man wants to attend court to give evidence but his treating geriatrician feared the stress of that could trigger a seizure.
Alan Brady, for the man, said they would explore whether video link evidence was an option.
The judge has adjourned the case to July to facilitate that and to hear evidence from two doctors asked by the court to assess capacity.
‘Malnutrition’
On Friday, the man’s treating geriatrician said a supported environment has maximised his function and she strongly disagreed with the views of the other geriatricians, based on “one off assessments”, on his capacity.
The man’s condition deteriorated since his mother died in 2012, his father having predeceased her, and he has no other family supports here.
He has had 25 hospital admissions in the last five years as a result of no warning seizures, suffered third degree burns after one seizure and is at risk if not in a supervised environment, she said.
After a visit home, he returned to the nursing home in a state of "abject malnutrition", she said. He refuses to engage with community supports and while able to "talk the talk", lacks understanding of the complexity of his condition and the importance of compliance with measures necessary for his safety. He refused, for example, to have a panic button he could press in the event of a seizure or to engage with Epilepsy Ireland.
The other two geriatricians said they believe he has capacity to decide where he will live and understands how to manage his finances. They believed he understands the nature of his condition and the need to take medication even if he does not always do so and understands there are risks involved in going home.
‘Unwise’
One said a scan carried out on the man suggested an Alzheimer’s Disease process but both said that was not a factor affecting his current capacity.
Both accepted they had not sought any collateral history about him from his treating geriatrician and accepted her account of his previous admissions.
Both said their briefs when they saw him in January, April and May was to assess his current capacity and they believed he was able to balance the pros and cons of various options.
One doctor believed the man’s decision to return home was “unwise” but said many people make unwise decisions.
Both said they have discharged home other patients who had had multiple admissions even if they believed the patient’s decision was unwise and said the primary issue was capacity to decide.
One said there are “risky” discharges daily and while a small number of people discharged by him had died, more did well and others had mixed results.
He also said the HSE can sometimes be "frustrating" in terms of providing community supports but private agencies were an option and it was sometimes necessary to look to good samaritans who will call in and befriend a lonely person.
The man needs less supports than some people and the fact he may be safer in the nursing home was true of many situations where people with chronic illness are at home, he added.
