A woman in her 70s who does not have the mental capacity to weigh up the seriousness of a foot wound which is so infected that flies and maggots can be seen in it is to be removed from her home and admitted to hospital by order of the High Court.
Doctors say unless she receives urgent medical treatment she is at risk of death from sepsis, the court heard.
Part of a slipper on her foot had fused with her skin which was eroded down to the bone and from this wound flies were going in and out and maggots were also seen on the wound, the court heard.
The president of the High Court, Mr Justice David Barniville, described it as a distressing case and one which, if ever there was a case where the intervention of the court was required, this was it.
He granted a number of orders following a one-side only represented application by Mairéd McKenna SC, for the HSE.
Like that 'for nine years'
The court heard the woman, who lives alone, was very pleasant and welcoming towards medical personnel who visited her in home. She listened to and retained what was said to her about the seriousness of her condition. She told them that her foot had "been that way for nine years" and she did not believe it was any worse than before.
However, two psychiatrists who met here said she was unable to weigh up the consequences of her decision and she appeared to be suffering from "senile squalor" or "frontal lobe syndrome" which is where a person lacks insight into gross self neglect. It is also an indication of dementia although the court heard no diagnosis of this has yet been made.
When told by one consultant psychiatrist who visited her on Thursday that she might die, she replied: "If that is God's plan, then it will be".
The psychiatrist said when she arrived at the house, the front door was wide open and there were numerous cats evident. There was a significant amount of hoarding and clutter in the hall and in the sitting room where a gas fire was lit with items of clothing around a metal guard and a lot of cigarettes on top of it, the psychiatrist said.
The woman was wearing a stained dressing gown, her hair was extremely matted and she was "almost emaciated" although her legs were quite swollen and red.
"She was at pains to reassure us she was ok and that all these people need not worry", the psychiatrist said.
Very distressing photos
The psychiatrist saw flies all around the room but they were particularly evident around her foot and there were some maggots coming out around the ankle bone. The court heard that the condition of the foot shown in photos taken last week, which the judge saw and described as very distressing, was even worse when the psychiatrist visited on Thursday.
Another psychiatrist who had visited her on Wednesday afternoon told the court a bed had been arranged for her at a local hospital but she refused to go.
The psychiatrist said the front door was also open and there were many cats, "a lot of rubbish, personal items, and furniture and empty food packets" around. "The floor was very dusty and it was hard to tell if whether it was concrete or capet", she said.
The woman talked about her [doctors'] concerns about her and she stated there was no problem and she did not think her foot was any worse. The psychiatrist said she saw part of her slipper embedded in her right foot from which fles were going in and out.
A court-appointed guardian (guardian ad litem) also visited when the case was being heard and told the judge via remote link from outside the woman's home that she believed the orders sought by the HSE were absolutely necessary. She also said contact had just been made with a brother of the woman.
Mr Justice Barniville said based on the graphic evidence presented to the court, it was clear the woman lacked the necessary capacity and he had no alternative but to intervene to vindicate her constitutional right to life, health, welfare and bodily integrity.
He ordered she be removed from her home with the assistance of gardaí if necessary, using minimal force, and that she be detained in hospital where she should receive whatever surgical and medical treatment her treating clinicians decide is necessary.
He adjourned the matter to next week.
