A woman who was removed by court order from her home last week and transferred to hospital over her lack of capacity to recognise a wound in her foot could kill her has responded well to treatment, the High Court heard.
The woman, who is in her 70s, was found by medical staff in what the court heard were distressing conditions in her home with flies and maggots emanating from the wound into which part of her slipper had become embedded.
There were cats outside and inside her home which had its front door left open while inside the property was extremely cluttered with clothes and cigarettes around a guard at a gas fire, the court heard. Her clothes were dirty and one doctor said her hair was so matted that it was one of the worst cases she had ever seen.
The woman would not accept the wound in her foot was serious, telling doctors it had been that way for "nine years".
As a result, the HSE applied to High Court president Mr Justice David Barniville for orders allowing her transfer to hospital for appropriate treatment.
On Wednesday, the judge was provided with an update on the case.
A psychiatrist who had visited her in her home said once admitted to the local hospital, she received intravenous antibiotics and the wound in her foot was cleaned. The part of her slipper that was embedded did not have to be surgically removed and came off itself allowing for the wound cleaning.
The doctor said fortunately there was no fracture and while the wounds were extensive they had not gone into the bone and she had recovered more quickly than envisaged and did not require transfer to another hospital.
She still does not really accept the ulcers on her foot could have killed her and repeated what she had said before she was brought to hospital that she was "ready for God to take me", the doctor said.
Treatment convalescence
She was however happy to stay in hospital and to go into a nursing home temporarily for continued treatment convalescence.
The doctor hoped that she could ultimately return to assisted independent living as she was very able in many ways and had regularly texted neighbours to get her groceries. She was also very tuned in and up with the news and had a lot of friends and neighbours who visited her in hospital, the court heard.
The court heard last week she appeared to be suffering from "senile squalor" or "frontal lobe syndrome" which is where a person lacks insight into gross self neglect.
She had also been affected some years ago by the death of her father and found the pandemic lockdown extremely difficult because she was unable to go out and later simply did not want to go out, the doctor said.
There would be follow up over coming months to establish whether it is a transient or fluctuating organic condition or a more complex psychological picture which led her to get into the situation she did, the doctor said. She was very vulnerable and if the process was not managed correctly, she could end up in the same situation again, the doctor said.
Court intervention
The court appointed guardian said the court's intervention had been extremely helpful. The woman's brother, with whom she had not been in contact with for more than a year, appeared to have reconciled with her, the guardian said.
Mr Justice Barniville thanked very much those involved in the court-ordered intervention and in particular to the psychiatrist and guardian who both acted with great speed and efficiency.
He was satisfied she still lacked capacity in terms of her ability to comprehend her injury and what had led to it. it was heartening that she had come round to the fact that she did require treatment and was happy to remain in hospital on a temporary basis, he said.
He continued the order appointing the guardian and that she receive appropriate treatment in hospital or any nursing home she is moved to. It would not be appropriate to discharge her back to her home given the conditions she would return to, he said.
He will review the case next month.
