Judge ruled that homeless man had to have legs amputated against his wishes to save his life

A high court judge has ruled that a homeless man found collapsed in a Manchester bus shelter must have both of his legs amputated against his wishes to save his life.

The man, believed to be 42 years old, was admitted to hospital in December but insisted to staff that he would get better without treatment.

He had acute limb ischaemia – a sudden lack of blood flow – caused by severely frostbitten feet, as well as kidney damage.

With his condition deteriorating, medics argued that if he went untreated he would develop sepsis and suffer ‘life-threatening renal and cardiac failure’.

Mr Justice Hayden, vice president of the Court of Protection said the man – referred to as TM – lacked the capacity to make decisions about treatment and that it would be in his best interests if both legs were amputated below the knee.

At a hearing on January 21, the judge said: “I have found it deeply shocking to hear how it is possible, in modern Britain, for a relatively young man, living on the streets of a major city, in the enhanced visibility of our present public health crisis, to have suffered in the way that he obviously has.”

Pennine Acute Hospitals NHS Trust confirmed that TM’s surgery has been carried out and was successful.

In early January the trust, which manages hospitals across Greater Manchester, had applied for permission to carry out a below-the-knee bilateral amputation to avoid an ‘imminent death’.

The Court of Protection decides whether a person has the mental capacity to make a decision on their physical welfare or financial matters, and if the decision itself needs to be made for them.

Parishil Patel QC, acting on behalf of the trust, told the court that if TM was found to lack capacity then it would be in his best interests to get the medical treatment advised.

TM, who is believed to be from Zimbabwe originally, was found to be ‘manifestly confused and strongly resistant to any kind of care or assistance’ when admitted to hospital.

Subsequent tests showed that TM had acute limb ischaemia, prompting concerns that he could develop sepsis. 

He was also found to be HIV positive but had not been taking his medication for some time.

TM was judged by doctors to lack the capacity to make a decision to proceed with treatment on January 3.

Two days later a vascular surgeon concluded that neither foot could be saved.

But when confronted with this ‘tragic diagnosis’, TM immediately declined treatment and continued to resist, forcing the trust to apply to the Court of Protection.

Mr Justice Hayden had spoken to TM over a video call and learned that he was a fan of football and nature, and had a young daughter who he had not seen for a long time.

When asked about his condition, TM was ‘reluctant to engage’ but the judge was left ‘with a very strong sense that he wanted to get better’.

Katie Gollop QC, on behalf of the Official Solicitor’s office which represents vulnerable people caught up in legal proceedings, argued that TM had capacity as he was able to understand some aspects of his medical treatment.

The court also heard that TM was an ‘overstayer’ having arrived in the UK years ago, and concerns were raised that would be ineligible for prosthetics due to his ‘insecure’ immigration status, meaning he would be in a wheelchair for the rest of his life.

But in his judgement Mr Justice Hayden said that the emergency operation was in the best interests of TM, who he described as being a ‘man of courage and strength of character’.

He said: “I am satisfied that TM lacks the capacity to take medical decisions concerning the treatment of his necrotic legs and his failing kidneys for himself.

“I had little doubt, when assessing his evidence, that he was keen to see his daughter.

"His enthusiasm for his football team and for nature also signalled to me a man who was interested in and engaged with life.

"In short, a man who wanted to live.

“It is at least a little consolation that notwithstanding the pressures on the NHS generally and ICU in particular, TM has received highly skilled, consummately professional and manifestly thoughtful care.”

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