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A profoundly disabled 37 yr old female, prone to self-harm and occasional violence towards others, was cared for by a local authority, although her mother was very much involved in her care. She was accommodated in a property acquired by the authority and had 24 hour care, along with another resident. In 1995 the mother had successfully judicially reviewed the LA’s failure to provide a lawful care plan in accordance with her assessment. The LA put together a care package but the mother complained relentlessly about the arrangements, and the LA was critical of the conduct of the mother and step-father towards the client. The mother had in the past given undertakings as to conduct during visits from the daughter, which were promises to the Court, but had failed to observe them. There was a specific incident when the mother procured the digital vaginal examination of the client by a retired doctor who was a personal friend, rather than the client’s GP, when she feared that her daughter was suffering from a vaginal infection. As relations became more strained between the authority, the provider and the mother, the mother kept the client at home instead of returning her to the premises where she was accommodated. Even when proceedings were started the mother failed to co-operate with the court’s order for an assessment, but committal to prison was avoided. The Court concluded that the client was plainly mentally incapacitated (despite expressing preferences from time to time), to make her own decisions as to where she should live, or who should care for her, or what contact she should enjoy with her family. He found that the mother found it difficult to accept that anybody other than she herself could have a constructive or correct view relating to the welfare of the client. The judge concluded that the service the LA had commissioned was of a high standard in general terms, with lapses from time to time, which the judge regarded as inevitable. He concluded, although the health authority were not represented before him, that the failure to provide the client with an adequate hearing aid for several months was unsatisfactory and unkind. He found that the constant complaints from the mother paralysed or even detracted to the service provided to the daughter because dealing with them took so much energy and time and led to excessive monitoring of the care package. The judge approved of the appointment of an independent non-legal advocate for the client as a channel for concerns which would inevitably arise in the future. The judge recommended that complaints be channelled through the independent advocate. He was not satisfied that the digital vaginal examination had been intentionally abusive, nor that the fact that the step-father had observed the client in a hot-tub was motivated by any salacious intent. But he made a declaration that it was not lawful for the mother herself, or through her instruction, anyone else, to arrange for the daughter to be medically or psychologically examined without the consent of the general practitioner with whom the woman was registered, or another clinician involved in her care. He made some other very detailed declarations about what would be in her best interests (not on the face of the report) for the greater assistance of all concerned in relation to disputes. The family was injuncted from visiting contact, save as was agreed in writing by the authority, but it was also declared that staying contact should be considered if visiting contact proceeded in a satisfactory manner. A penal notice was attached to some of the court’s orders because of the previous regrettable, albeit understandable, breaches of undertakings. |
