HSE agrees to fund home care for woman in vegetative state

The HSE has agreed to fund a home care package for a woman who has been in a vegetative state for more than 10 years, the High Court has heard. 

 

The agreement, which involves the HSE funding care similar to what the woman would receive in a community nursing unit (CNU), was reached in the context of the woman being in a vegetative state and is not regarded as a precedent. 

 

The woman, aged in her 40s, is a ward of court and her family, as the committee representing her interests, wanted her to remain in her home under a care regime designed by her GP and a consultant. This would see two care assistants being present at all times (which would involve four care assistants working two 12-hour shifts) and her parents, under GP guidance, assuming certain nursing duties. 

 

The HSE argued that regime was clinically inappropriate and too expensive and wanted the woman moved to a CNU. The case raised what Mr Justice Denis McDonald described as “very important” issues concerning whether a court can make orders compelling a State entity to allocate a specific amount of limited public resources to a ward of court. 

 

In a judgment last May, the judge said he would only decide the legal issues if the sides cannot resolve the matter after considering his views on the evidence and he adjourned the case to allow for that. 

 

The HSE subsequently agreed to fund home care for the woman at the same level as she would get in the CNU, not at the level sought by the family. The case returned before the judge on Monday to deal with outstanding issues. 

Fundraising 

The judge was told the family wanted to raise additional funds, via social media and other avenues, to fund extra respite care. 

 

Peter Finlay SC, for the HSE, said it had concerns about the impact of that on legal provisions preventing publication of any matter which might identify a ward of court. That issue has importance for other cases, he said. While the HSE was not opposed to fund-raising, it wanted an adjournment to allow the sides address the issue, he said. 

 

Counsel for the family said there had been earlier fundraising which did not appear to raise a difficulty but they would consult with the HSE. 

 

The judge adjourned the case to next month on that basis and to allow the sides prepare submissions concerning legal costs. 

 

Last May, the judge had said the HSE should reconsider funding home care. If the family adjusted their proposals, he believed the home care costs could be less than the estimated annual €315,000 cost of maintaining the woman in the CNU. 

 

He appreciated the HSE had various concerns, including about governance and control, but regarded the circumstances of this case as “unique”, including the woman’s life expectancy is likely to be short. 

 

The dispute over future care arose because a €2.5 million settlement the woman obtained in 2013 ran out in September of last year after she exceeded the life expectancy on which it was based. 

 

Tumour 

That settlement was against the HSE without admission of liability and arose from a claim of delay and negligence in diagnosis of a brain tumour. The settlement funded home care from 2015 at annual costs ranging from €420,000 to more than €500,000. 

 

Before 2015, the woman was cared for in hospital facilities and the CNU but her family took her out of the CNU because they were dissatisfied with the level of care there. 

 

A specially adapted home was obtained for her involving a care regime described by the judge as “exemplary”. That regime was funded from the wards of court office until the settlement ran out and the HSE has funded it since. 

 

The HSE said the level of homecare sought was on a scale its Home Support Service was never designed to meet. It would cost more than €2 million a year to address the needs of 321 people on the waiting list for services in the woman’s home region, it said.