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X Health Authority v D [2019] EWHC 2311 (Fam)

The matter came before Mr Justice Hayden and concerned an application by a Health Authority to place ā€˜Dā€™, a 12 year old girl, in a special unit which would better address her medical and mental needs.

D had a longstanding problem regarding her consumption of food. She had been admitted as an inpatient at Y Hospital on 9th July 2019, and during her time in hospital refused to take any food. As a result, her condition deteriorated, such that it was considered to be a threat to her life. In response to this, the Applicant Health Authority issued an application seeking to implement a feeding regime which required reasonable and proportionate restraint to prevent D from obstructing staff administering food to her. Mrs Justice Theis authorised this regime on 9th August 2019.

Upon approval by Mrs Justice Theis, the regime was implemented for over 2 weeks, and although D's condition stabilised, she continued to lose weight. Whilst her current condition did not pose an immediate risk of failure to her vital organs, the situation nonetheless was very grave. Further to the concerns regarding D's physical health, it was also evident that D was also suffering psychologically and emotionally.

A number of experts with differing paediatric specialities had been involved in D's care. However, the Judge considered that the input into D's healthcare thus far had been neither consistent nor focussed, due to the clinical anxiety and confusion that surrounded her condition, and the inability to identify any organic cause of the condition to date. Mr Justice Hayden took the clear view that D's hospital had now found itself to be beyond the parameters of its expertise.

An alternative placement had been identified which specialised in eating disorders and offered physical, medical and mental health care which could meet D's multiplicity of needs. The court therefore authorised D's immediate move to this new placement, as this would be in D's best interests. In addition, the court endorsed a detailed plan of care which would involve a very significant interference with the autonomy of D. As a result, Mr Justice Hayden made clear that D would enter the placement "with the direct authority of the Court", however, he stopped short of making her a ward of court, due to the need for a collaborative approach in this circumstance.

Finally, the Judge noted that the law framing his decision is "easy to state, though frequently difficult to apply." Nevertheless, the guiding principle within every decision such as this, remains "the best interests of the child".

Summary by Mavis Amonoo-Acquah, barrister, Harcourt Chambers

You can read the full judgment of X Health Authority v D [2019] EWHC 2311 (Fam) on BAILII