Hospital bosses criticised over pregnant woman with learning difficulties

Hospital bosses with responsibility for the treatment of a pregnant woman with learning difficulties did not launch legal proceedings quickly enough, a Court of Protection judge has said.

Managers had asked Mr Justice Baker to decide whether the woman should have a caesarean section against her wishes – and he has criticised them for not giving lawyers representing the woman enough time to consider evidence.

The judge made decisions about what treatment would be in the woman’s best interests at a hearing in the Court of Protection – where issues relating to people who might lack the mental capacity to make decisions are analysed – in London in November.

He had analysed submissions from lawyers representing the trust and from lawyers representing the woman.

The woman’s lawyers had been instructed by staff at the office of the Official Solicitor, who offer help to vulnerable people embroiled in litigation.

Mr Justice Baker, who also sits in the Family Division of the High Court, had approved a treatment plan put forward by the trust.

He ruled that doctors could perform a caesarean section – even though the woman wanted to give birth naturally at home .

The judge has outlined concerns about the approach of trust bosses in a written ruling on the case.

He said the woman, who is in her 20s and lives in the south of England, could not be identified.

Mr Justice Baker said the trust should also not be identified in reports of the litigation in case publication of its name created an information jigsaw which led to the woman’s identity being revealed.

The judge said such cases raised issues relating to the “most precious and valued human rights and freedoms” and placed an “unusually onerous responsibility” on judges.

But he said trust bosses had begun legal proceedings less than two weeks before the baby was due.

“The issues … involved a number of sensitive and difficult decisions on which (the woman) through … the Official Solicitor, had an absolute right to be heard,” said Mr Justice Baker.

“Because of the shortage of time, the Official Solicitor had very little opportunity to digest and analyse the evidence.

“As a result, there was a significant danger that issues might not have received the care and attention they deserved.”

He added: “This extremely unsatisfactory situation has been brought about by the failure of the trust to start proceedings at an early stage.”

The judge said trust bosses had “manifestly failed” to comply with guidelines.

Nevertheless, he said he was satisfied that – “thanks to the efforts of the Official Solicitor and his representatives” – all issues had been given “full consideration”.

Lawyers for the trust had said the woman was in the latter stages of pregnancy and specialists thought that she lacked the mental capacity to make decisions about care.

They said she came from Africa, might have been subjected to female genital mutilation and had scarring on her abdomen allegedly resulting from ”tribal rituals”.

The woman had a ”phobia of all medical and health professionals” and had been ”non-compliant” with staff providing antenatal care, Mr Justice Baker was told.

She wanted to give birth naturally at home, but doctors said a planned caesarean section would be in the best interests of the woman and child.

Medics said a planned caesarean section would mean that the birth could be safely managed – and stress and trauma could be reduced.

The judge was told that the woman’s parents agreed with doctors.

Staff at the office of the Official Solicitor also agreed that a caesarean section would be in the woman’s best interests.

Mr Justice Baker said he was satisfied that the woman had a mild to moderate learning disability and lacked the mental capacity to make decisions about her care.

He had approved the trust’s caesarean section plan, saying the evidence was ”one way”.

The judge had said medics could use any ”reasonable and proportionate restraint” they thought ”appropriate or necessary”.

Mr Justice Baker said the woman had subsequently given birth to a son.

He said the caesarean section had been successful and ”minimal restraint” had been required.

Barrister Nageena Khalique QC had led the trust’s legal team. Katie Gollop QC had led the woman’s legal team.

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