University College London Hospitals NHS Foundation Trust vs HER and SR

This case concerned a dispute over the medical treatment and best interests of a patient, HER, involving complex issues of capacity, medical diagnosis, and family objections.

TLDR:

• HER's medical treatment plan proposed by the Trust was disputed by her sister, SR.
• The court had to determine HER's best interests regarding the proposed treatment.
• The court found in favor of the Trust's treatment plan, emphasizing HER's best interests and medical expert opinions.

The claimant, University College London Hospitals NHS Foundation Trust, sought authorization from the Court of Protection to implement a medical treatment plan for HER, a 53-year-old patient with learning difficulties and epilepsy. HER's sister, SR, opposed the treatment plan, disputing the diagnosis and proposed medical interventions.

HER had a history of medical issues stemming from a stroke-like episode in early childhood, resulting in significant brain damage. She was diagnosed with ornithine transcarbamylase deficiency (OTC), a rare metabolic disorder causing intermittent episodes of acute encephalopathy and seizures. HER was under a 24-hour care package at a supported living placement since 2017.

The Trust's clinicians, including Dr. Murphy and Professor Walker, proposed transitioning HER from sodium benzoate to glycerol phenylbutyrate to better manage her ammonia levels and reduce seizure frequency. SR, however, challenged the diagnosis and treatment plan, suggesting alternative treatments and raising concerns about the medications' side effects.

The court had to consider whether SR's evidence, which included her observations and opinions on HER's condition, was admissible. Senior Judge Hilder determined that SR's evidence, while valuable in describing HER's reactions to treatment, could not be considered expert medical evidence.

In evaluating HER's best interests, the court relied on the medical expertise of Dr. Murphy and Professor Walker, who provided detailed explanations of HER's condition and the proposed treatment's benefits. The court found that the Trust's treatment plan aligned with national and international guidelines and had been effective so far.

Additionally, the court addressed SR's participation in HER's medical appointments. Given SR's disruptive behavior during consultations, the court concluded that it was in HER's best interests for SR not to attend appointments related to OTC and epilepsy. Instead, HER's experienced carers were recommended to accompany her.

The court ultimately ruled that the Trust's treatment plan was in HER's best interests, emphasizing the importance of medical expertise and HER's quality of life. The court also decided against issuing injunctive orders, giving SR an opportunity to abide by the court's decision voluntarily.

This case highlights the complexities involved in determining the best interests of patients with intricate medical conditions and the weight given to expert medical opinions in such decisions.

Legal representatives: Conrad Hallin (instructed by Hempsons LLP) for the Applicant, Alex Cisneros (instructed by Irwin Mitchell LLP) for the First Respondent, The Second Respondent appeared in person.

Judicial Panel: Senior Judge Hilder

Case Citation Reference: [2024] EWCOP 25