The High Court adjourned a wardship case about the care of a woman in a permanent vegetative state, asking the Health Service Executive to reconsider funding a home care plan before the court rules on its legal powers.
In a judgment delivered on 31 May 2019, Mr Justice Denis McDonald said the woman’s family had provided exceptional care at a purpose-built facility beside her parents’ home. The €2.4 million settlement of earlier proceedings, made without admission of liability, had been exhausted. The family’s Committee sought continued funding for two carers around the clock.
The HSE initially proposed residential care at a Community Nursing Unit, estimating annual costs of €315,198. It later offered an alternative home plan costing about €283,796 a year: one healthcare assistant available at all times, two hours of nursing each day, and the family taking responsibility for care when staff were absent. The Committee’s plan was estimated at €296,270 annually, including bank holiday costs.
The judge said it was premature to decide whether the HSE could be legally required to fund a court-set care plan. He asked the HSE to give serious consideration to funding the Committee’s plan through the Registrar of Wards of Court, with the family remaining the carers’ employer. He said safeguards, including audits and periodic GP attendance, could address governance concerns. He considered that plan could cost less than residential care.
If the HSE could not proceed that way, the judge said its proposed home plan would need adjustment. In his view, some care tasks, including full repositioning and personal hygiene, require two people. He said family members could assist at scheduled times and be on call for unscheduled needs, but the HSE should consider respite for them and whether daily nursing visits would be needed over the longer term.
The court did make an order on resuscitation. With the parties’ agreement and medical evidence before him, the judge declared that the proposed direction should apply: no cardiac or pulmonary resuscitation, Ambu bag use or other extraordinary measures in the event of cardiac, respiratory or cardio-pulmonary arrest, while comfort measures, including morphine as required, should continue.
The matter was adjourned for mention early the following term. The judge said he would rule on whether the HSE could be compelled to fund a care package if the parties could not resolve the issue.