In support of nurses

An update from a regular series written by Mr Robert Wheeler, director, department of clinical law, where he considers various aspects of clinical law that our nursing and medical staff rely on when caring for patients.

It is not uncommon to hear of relatives behaving in an unkindly manner towards clinical staff. Particularly nurses. Whilst relatives in hospitals may be understandably distressed by the plight of the patient they are visiting, rudeness and threatening behaviour is never acceptable. The nurse is unlikely to be able to disengage from the visitor’s onslaught.

Despite the protest of 'unacceptable', it is rare to see a court being asked by a Trust solicitor to take decisive steps to protect nurses from relatives.

In December 2021 a judge decided that it was in the best interests of G, a woman in her 20s with a profound degenerative neurological disease, who had significantly outlived her life expectancy, to be transferred to a specialist care home from a children's hospital. There she had hitherto been looked after, for the previous 13 years. For the duration of that hospital stay, the parents had devoted themselves to their daughter, having in effect given up their lives, and moved into hospital accommodation to provide 'around the clock support' for her. During the 2021 hearing, her consultant had told the court that G had been fit for discharge for more than 8 years. Differences in opinion between the parents and the clinicians had led to aspects of her care at that stage being left uncertain, seriously compromising G's welfare. It was clear that the relationship between the hospital and the father was under great strain.

Despite the court’s 2021 decision, six months later, G had still not been moved to the specialist care home, and the case was brought back to the same judge. He found that the dangers to G's welfare had been '...created entirely by the father....the tragedy of (his) behaviour is that it is generated by his love of his daughter. His decision-making has become distorted by what strikes me as a visceral panic at any change of her circumstances and particularly, his apprehension that his own day to day involvement in (her) life may be diminished'.

It would be wrong to trivialise the hostility and intimidation endured by the nursing staff in this case by a cursory summary. The judge's summation was of the creation '....of an atmosphere of stress, general unhappiness and deep mistrust on HDU'.

The evidence provided to the court is set out in NHSFT v G&LF&Ors [2022] EWCOP 25,paras 20-41.

After cursory legal argument the judge without difficulty found that the Mental Capacity Act 2005 ss 16&17 provide an 'entirely cogent' framework for a court to use injunctions to give effect to its orders or directions. These are one of a number of legal remedies available to a wronged party, in this case the hospital Trust. An ‘injunction’ might be an order of the court to prevent the parents from activities such as speaking to clinical staff in a hostile and intimidating way and questioning their competence. The court did not give details of the words used in the injunction which was placed upon father and two other individuals. However, the intention was clear ‘...to put in place clear boundaries to manage the family's behaviour. It is both justified and proportionate to regulate G's personal and nursing care, permitting the staff to operate effectively in the provision of medication, nutrition, tracheostomy care and more generally to establish her dignity as an adult’.

The court regretted that the father continued expressly to refuse to accept the placement as legitimate. 

The fact that courts are empowered to make injunctive relief in some circumstances is encouraging, since it appears that if asked, a judge may do so. In this case, it seems likely that the daughter could be discharged to the nursing home, and that the curbs on the family's behaviour would be as applicable to the staff in the nursing home as they were in the hospital.

We do, on occasion, encounter situations where over a long admission the relationship between relatives and the hospital staff have been corroded to the point of dysfunction. Intimidation of staff ultimately undermines clinical confidence. If a prolonged admission is foreseeable, and such intimidation is evident, timely recourse to a court to manage a family's behaviour may be an essential step.

Robert Wheeler
Department of clinical law