The Health Service Executive has apologised at the High Court for the circumstances surrounding the discharge of an 82-year-old woman from hospital last week, which were described as substandard.
It has emerged that the woman was transferred back to her nursing home at 4am with no communication to the nursing home or her GP about her care plan.
The woman's family and GP had expressed concern that she was discharged from hospital on what they understood to be a palliative care plan which would result in her effectively starving to death.
Her GP had tried several times without success to contact hospital doctors and said she was not ethically comfortable to be part of such a plan as the woman was not "imminently terminal".
The woman, who has dementia, recently lost the ability to swallow but was otherwise reasonably healthy.
However, she was discharged from hospital on a glucose drip after hospital doctors deemed her unsuitable for tube feeding.
Her GP had objected to the treatment plan and say she should be tube fed rather than be left to "starve to death".
Lawyers for the HSE apologised for what they said was a complete failure of communication between the hospital and the woman's GP and said it was never the intention to discontinue feeding or allow her to die.
They said the plan was for the woman to resume "comfort feeding" on a liquid diet when she regained alertness.
Barrister for the HSE Sarah McKechnie apologised on behalf of the executive for the failure to bring the matter to court in the first instance, as should have been done, because the woman is a ward of court.
She also apologised for what she said the HSE accepted was a complete lack of communication.
She said the medical notes showed the intention of hospital doctors was to begin "comfort feeding" on a liquid diet as soon as the woman regained alertness and wanted to eat or drink.
She said doctors at the hospital were still of the opinion that tube feeding would be unsuitable and she asked the court for more time to prepare sworn statements on the matter.
She said there may come a time when a direction would be required from the court.
Ms McKechine explained the reason the woman was transferred back to the nursing home at 4am was because an ambulance could not be found until that time.
Doctors considered the woman would be better off in her nursing home than in an acute hospital setting, she added.
Counsel for the family Mark Connaughton told the court the matter was urgent and said they did not want a long adjournment. He said there must be urgent communication with the woman's GP who had tried several times to contact the hospital.
The woman's son also addressed the court and said they had been advised that the procedure to insert a feeding tube for his mother was risky and would cause her discomfort.
He said they had promised their mother that while she was in hospital they would not put her through any more suffering.
He said their only wish was that she be comfortable and they had accepted she would be transferred back to the nursing home.
However, he said it was then very hard to take the fact that they could not feed her and that could end her life.
"That is the hardest part," he said.
President of the High Court Mr Justice Peter Kelly described the circumstances surrounding the woman's discharge as "substandard".
He said it was regrettable that she was discharged from hospital at 4am with nothing other than a discharge summary.
He said there were a lot of failures to communicate in the case. He said it was only because the woman was a ward of court that she had access to the court and he "shuddered to think" what would have happened to an ordinary 82-year-old.
However, Ms McKechnie for the HSE said even where patients were not wards of court, the HSE would revert to the court where a patient did not have capacity to make a decision themselves.
The judge granted an adjournment to allow time for proper communication between the hospital and the GP.
He said there may come a time where a decision will have to be made as to an alternative method of feeding and if so he will seek a medical opinion.
However, he said this may not be necessary if there can be agreement on a care plan. He said the case might never have come to court if it had not been for the failure of communication and the substandard circumstances of the woman's discharge from hospital.
He also stressed that wards of court have the protection of the court and all decisions of this nature should be brought before the court for direction.
The case returns to court on Friday.