Royal Borough of Greenwich v CDM [2018] EWCOP 15 (29 June 2018)

P was a 63 year-old lady who had multiple health conditions. She suffered from type 2 diabetes which required insulin, administered by district nurses twice a day and a controlled diet. However, P had a history of refusing insulin or claimed she had already had it when she hadn’t. Her condition was therefore unstable and complex. Although she now complied with her insulin administration, she was non-compliant in other forms of mediation that she required. She was hyper-tensive and also suffered from COPD although she was a smoker and as a result of her unstable diabetes, P had her small right toe amputated. Following further non-compliance with health professionals and self-neglect the wound on her foot became infected and then became gangrenous and this led to the amputation of her lower right leg in May 2017.

Various concerns were raised about P following her return from hospital in June 2017 by a variety of professionals including the London Ambulance Service. Records from them on 29/07/17 noted that P was lacking in capacity and had been found sitting in vomit and faeces with the floor covered in faeces (P had 3 dogs and a cat) and she was non-compliant with her medication.

P’s social worker carried out an assessment and at a best interests meeting on 12/09/17 she concluded P lacked capacity. She was in hospital at the time but she wished to return home on discharge. However, it was concluded at the meeting that it was not in her best interests to return home. P was discharged from hospital on 23/10/17 to a nursing home.

COP proceedings were then issued and a Consultant Old Age Psychiatrist was instructed to assess P’s capacity. An urgent authorised deprivation of P’s liberty was made on 04/04/18 and she was moved to a CC care home where she remained. A standard authorisation for 6 months was granted on 11/04/18. Two of her dogs remained with her in the care home.

P was adamant that she wanted to return to her own home, however the Court concluded that P lacked capacity with regards to the question whether or not she should be accommodated in the relevant hospital or care home for the purpose of being given the relevant care or treatment and therefore authorised her continued detention and deprivation of liberty in that home.

A further hearing would be required to establish a mechanism under which the local authority could operate when capacity fluctuated and also to consider best interests. P’s strongly held wishes remained important factors to weigh in the future assessment of her best interests.

The full judgment can be read here.

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