In the Matter of [A], and In the Matter of the Inherent Jurisdiction of the High Court and In the Matter of a Transfer Application Contrary to the View of Family (Approved)

Factual and Procedural Background

An application was made ex parte by Company A (a hospital) resulting in orders appointing a guardian ad litem for the Respondent and permitting sharing of her records with potential care providers. These orders were continued after a hearing attended by the guardian and the Respondent’s daughter. Company A now seeks permission to transfer the Respondent, a lady in her seventies with extensive care needs, to a specialist care facility (Company B) against the wishes of her family. The Respondent was admitted to the hospital in April 2024 and is considered by her treating team, multidisciplinary staff, and family to require full-time nursing care unsuitable to be provided at home. Medical evidence indicates the Respondent lacks capacity to decide on her care due to irreversible cognitive and physical impairments. The family opposes the transfer primarily on geographical grounds, as the proposed placement is approximately 50 km from the family home, creating a significant visitation burden. Extensive efforts were made to find alternative placements closer to the family, but no suitable nursing home capable of meeting the Respondent’s complex needs was identified. The Respondent’s medical condition poses a continuing risk if she remains in the acute hospital setting once medically fit for discharge. The hospital supports transfer to the specialist unit, which offers dementia-specific care and has been inspected positively by the relevant health authority. The family’s concerns regarding timing and suitability were addressed by medical evidence confirming transfer will only occur once the Respondent is medically fit.

Legal Issues Presented

1. Whether the court should grant permission to transfer the Respondent to the proposed care facility against the family’s wishes.
2. Whether it is necessary and proportionate to make an order detaining the Respondent in the new care placement.

Arguments of the Parties

Applicant's Arguments

• The Respondent requires 24-hour nursing care that cannot be provided at home or in the acute hospital setting.
• The proposed placement at Company B is the only facility able to meet the Respondent’s complex care needs, including specialist dementia care and management of laryngectomy/tracheostomy patients.
• Remaining in an acute hospital beyond medical fitness for discharge poses significant and continuing risks, including hospital-acquired infections.
• Extensive efforts to find alternative nursing homes closer to the family have failed, with over 30 nursing homes contacted and only Company B able to accept the Respondent.
• The transfer is necessary to vindicate the Respondent’s fundamental rights, including the right to life, bodily integrity, and equal access to care.
• The Respondent’s family may continue to seek alternative placements closer to home after the transfer.
• Detention orders are not necessary or proportionate; transfer and placement orders suffice to protect the Respondent’s rights without undue interference with autonomy.

Family's Arguments

• The family opposes the transfer primarily due to the geographical distance to the proposed placement, which would impose a significant visitation burden.
• The family expressed that the Respondent should not be transferred until she is medically fit, fearing that a nursing home is unsuitable while medical issues remain unresolved.
• There was hope for a closer placement at another nursing home (Company F), but this was unavailable due to capacity limitations.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The court carefully considered the competing interests: the inconvenience and burden on the family caused by the geographical distance of the proposed placement versus the significant and continuing risk to the Respondent’s health and wellbeing if she remains in the acute hospital setting beyond medical fitness for discharge. The medical evidence was uncontroverted and demonstrated both harm already suffered (hospital-acquired infections) and the benefit of transfer to a specialist long-term care facility. The court acknowledged the extensive efforts made to identify alternative placements closer to the family, which were unsuccessful. The court emphasized that the primary concern must be the welfare and fundamental rights of the vulnerable Respondent who lacks capacity to make decisions about her care. The court held that granting the transfer is necessary and proportionate to vindicate these rights. Regarding detention orders, the court found no evidential basis that detaining the Respondent in the new care placement is necessary or proportionate, given the significant interference such an order would entail with her autonomy. Transfer and placement orders were deemed sufficient to protect her personal rights.

Holding and Implications

The court’s final decision is TO GRANT PERMISSION FOR THE TRANSFER of the Respondent to the proposed care facility (Company B).

The direct effect of this decision is that the Respondent will be moved to a specialist care setting that can meet her extensive medical and nursing needs, thereby reducing the risk to her health posed by prolonged hospitalization. The family’s opposition based on geographical inconvenience was acknowledged but found insufficient to outweigh the Respondent’s welfare and rights. The decision does not prevent the family from continuing to seek an alternative placement closer to them. No detention order was granted, preserving the Respondent’s autonomy to the extent possible. The ruling does not establish new legal precedent but applies established principles regarding the protection of vulnerable persons lacking capacity within the court’s inherent jurisdiction.