A hospital “compromised” a brain-damaged man’s dignity by keeping him on life support for nine years, a High Court judge has said. The man, known only as JP, suffered a hypoxic brain injury following a cardiac arrest in January 2016 and was transferred to the Royal Hospital for Neuro-disability (RHN) in London in April of that year, where he remained in a prolonged disorder of consciousness with no prospect of recovery.
At a hearing earlier this year, the Court of Protection, a specialist family court, was asked to decide whether continued treatment was in JP’s best interests. Mr Justice Hayden ruled on January 24 that treatment should be discontinued, but in a second written judgment published on Wednesday the same judge said the RHN’s failure “properly to address his (JP’s) best interests, in a timely way, has compromised his dignity”.
He said: “The inherent dignity of a human being imposes an obligation on those treating him, actively to promote his dignity. I very much regret to say that the RHN has failed to meet this most fundamental of obligations.”
The judge said JP’s condition had “identifiably been the case since April 2016” and that there was “powerful and strong evidence that JP would have hated to have been in the circumstances in which he found himself”.
But he said concerns from the RHN over the views of JP’s family as to whether treatment should be continued caused the hospital to “lose focus on the central question of what is in JP’s best interests”, causing a delay which he described as “lamentable”.
He said: “There was strong and convincing evidence as to what JP would have wanted from the outset. I have struggled to understand why there was not a timely application to the court. I have not discovered any satisfactory explanation.”
He continued: “It is important to say that when there is disagreement within a family as to where (a person’s) best interests lie, that is a signal to bring the matter to court. It most certainly is not a reason to spend months or, as here, years in hand-wringing procrastination.”
The judge said that while the hospital had given a “clear and unambiguous” apology to JP’s family, the delays in the case were “entirely unacceptable”.
While he acknowledged those involved in patient care “are each highly motivated to do their professional best in what are immensely challenging circumstances”, he added the case was the third from the same hospital in just 18 months “where similar failures have emerged”.
A spokesperson for the RHN said in a statement that the site was “dedicated to the wellbeing and best interests of every individual in our care”, and acknowledged “past delays in the decision-making process” in some cases. They said: “We have since implemented significant improvements to ensure a thorough, respectful and transparent approach in all such decisions. We have apologised to JP’s family for the delays in his case, as the court acknowledged.”
They continued: “The RHN has developed a structured and comprehensive process that places patient welfare at the centre, guided by ethical standards and best practice in collaboration with clinical and legal professionals. This process has been described by Mr Justice Hayden as thought-through, robust and sensitive.
“The reason for a number of cases coming to the Court of Protection in the past year has not been because the RHN has been resistant to the lessons of the past but because it has been addressing these historic issues and not ignoring them. We remain committed to continuously reviewing and refining our processes to provide the highest quality of care.
“Respecting the privacy of the individual and family involved, we are bound by a legal transparency order and will not be commenting further on the specifics of this case. The RHN continues to prioritise compassionate and individualised care, seeking to support families and uphold our responsibility to those we serve.”