DN [2010] QCAT 398

CITATION: DN [2010] QCAT 398 PARTIES: DN APPLICATION NUMBER: G18822 MATTER TYPE: Guardianship and administration matters for adults HEARING DATE: 29 July 2010 HEARD AT: Brisbane DECISION OF: S Gardiner - Presiding Member E Morriss - Member M McCarthy - Member DELIVERED ON: 17 August 2010 DELIVERED AT: Brisbane ORDERS MADE: ENDURING POWER OF ATTORNEY 1. That the following Enduring Power of Attorney for DN (also known as DN) is revoked pursuant to s116(d) of the Powers of Attorney Act 1998 and s84(2) of the Guardianship and Administration Act 2000: (a) The Enduring Power of Attorney dated 4 April 2007 appointing WS as attorney for financial, personal and health matters. GUARDIANSHIP 2. That the Adult Guardian is appointed as guardian for DN (also known as DN) for decisions about the following personal matters: (a) Accommodation; (b) With whom DN (also known as DN) has contact and/or visits; (c) Health care; (d) Provision of services. 3. Unless the Tribunal orders otherwise, this appointment remains current for three (3) years. ADMINISTRATION 4. That The Public Trustee of Queensland is appointed as administrator for DN (also known as DN) for all financial matters. -- 1 of 13 -- G18822 / Page 2 of 13 5. The administrator is to provide a financial management plan to the Tribunal within four (4) months. 6. The Tribunal directs the administrator to provide accounts to the Tribunal when requested. 7. This appointment remains current until further order of the Tribunal. NOTICE OF INTEREST IN LAND 8. That the administrator shall within three (3) months: a) Identify, by way of a search of the records held by the Registrar of Titles or other means, any interest in real property registered in the name of DN) (“the adult”). b) Lodge with the Registrar of Titles a copy of this order and a notice notifying the Registrar of any interest in land held by the adult which is subject to this administration order. c) Provide to the Tribunal: (i) a copy of the search of records held by the Registrar of Titles referred to above and; (ii) a copy of the lodgement summary with the dealing number showing lodgement of the order in respect of any interests in land held by the adult which is subject to this administration order. 9. That if any change is made in an interest in land held by the adult which is the subject of this administration order or if there are any further dealings in land on behalf of the adult by the administrator, the administrator shall lodge with the Registrar of Titles within 14 days of the finalisation of such interest a copy of this order and a notice (in a form prescribed by the Registrar of Titles), concerning such changes or dealings. 10. That the administrator pay, from the adult’s funds, any fee associated with the above notices. CATCHWORDS : Capacity of Adult, Need for Guardian and Administrator, Appropriateness of appointee under power of attorney, Powers of Attorney Act 1998, Guardianship and Administration Act 2000 -- 2 of 13 -- G18822 / Page 3 of 13 APPEARANCES and REPRESENTATION (if any): Active Parties: Ms TA, daughter of DN Ms WS daughter of DN and his current attorney under an Enduring Power of Attorney A social worker at the Prince Charles Hospital A senior guardian for the Office of the Adult Guardian Interested Parties: TE (son-in-law) REASONS FOR DECISION 1. DN is 74 years of age and currently an inpatient in the Cognitive Assessment and Management (CAM) Unit at a Brisbane Hospital. Since 2009 this Tribunal and its predecessor, the Guardianship and Administration Tribunal, have received 3 applications for the appointment of a guardian and an administrator for DN. The applications have been received on 21 May 2009 from TA, daughter of DN; on 11 March 2010 from the Adult Guardian; and on 27 May 2010 from a social worker at the Hospital. 2. During the course of the hearing a Nurse Unit Manager and a Medical Registrar, gave evidence to the Tribunal. The Tribunal was informed that DM was also to attend the hearing but DM did not arrive during the course of the afternoon. 3. Written submissions were also received from MM (daughter of DN) and from her husband MW (son-in-law of DN). The issues and the legislation 4. The Guardianship and Administration Act 2000 (the Act) defines capacity as: “capacity”, for a person for a matter, means the person is capable of- (a) understanding the nature and effect of decisions about the matter; and (b) freely and voluntarily making decisions about the matter; and (c) communicating the decisions in some way. Does DN lack capacity for the matter? 5. A number of health professional reports were provided to the Tribunal concerning DN. The first was a report dated 13 October 2009 from the Resident Medical Officer of the treating team of a Brisbane Hospital. The doctor reports as follows: ƒ DN had a Right Pontine Infarct on 4 September 2009. ƒ In July 2009 he recorded a score of 21 from a possible 30 on the MMSE and 17 from 30 on the RUDAS tests. ƒ The doctor postulated that it was likely that DN had Alzheimer’s dementia and that he had no ability to make simple or complex decisions. -- 3 of 13 -- G18822 / Page 4 of 13 6. The second report is a report from the ACAT team dated 16 November 2009. This report approved residential respite care for DN. The report recorded DN had: ƒ Regular short term memory problems ƒ Regular confusion ƒ Occasional verbal/physical aggression, inappropriate behaviour and non- compliance ƒ Occasional long term memory problems ƒ Occasional at risk behaviours ƒ Occasional disorientation It also recorded that a CAT scan showed that DN had previously multiple infarcts. 7. A third report dated 12 January 2010 was received from the General Manager of the Residential Aged Care section of a Caring Centre. The General Manager records that DN has type 2 diabetes, CVA, hypertension and memory disturbance. She opines that DN can make simple personal health care decisions only. 8. On 15 January 2010 in a letter to WS as Attorney for DN, the General Manager also records that DN requires a high level of nursing care, with 2 people to assist with most activities of daily living (showering, toileting, walking etc) and that he did not appear to demonstrate the capacity to have an understanding of what is required to be cared for at home. 9. On 4 February 2010 a community service provider, through its Nurse Manager, forwarded a letter to the Tribunal. This letter recorded as follows: • The community service provider commenced HACC funded services to DN on 20 January 2010 following a referral for assistance from his daughter WS. • At the date of the letter the community service provider were providing morning and evening assistance with medications and insulin administration • The community service provider had a number of concerns regarding the safety and wellbeing of DN in his then residential living situation. 10. The community service provider also recorded that due to behaviours relating to DN’s cognitive deficits including inappropriate touching and groping of female staff, the community service provider was unable to provide assistance with showering. This letter recorded that DN, at that time, was incontinent of urine and that his personal hygiene needs were not being met, placing him at risk of further infections. This letter further recorded that a vital requirement of adequate nutrition to maintain the appropriate blood sugar levels for an insulin dependant diabetic was not being consistently met and that on some days, DN had not eaten at all during the day. 11. The community service provider also recorded that DN had numerous falls since returning to his home and that the nature of the falls were most closely related to insufficient supervision rather than the types of walking aides used by DN. The community service provider noted that although the falls had (at that stage) had not resulted in serious injury, the risk of further falls and injury were high. In the community service provider’s observation, DN family support appeared to be DM as his main carer. The community service provider had concerns relating to her ability -- 4 of 13 -- G18822 / Page 5 of 13 to provide regular meals and essential supervision and assistance to DN’s mobilisation. The community service provider noted that their communication with his Attorney, WS, had been limited due to her other commitments and that her physical support and the support on a daily basis from other family members was also limited. The community service provider noted that DN’s GP at that time, had stated to the provider that she felt DN would be more appropriately cared for in a residential setting. 12. On 15 February 2010 a call was received into the registry of this Tribunal from a medical registrar at a Brisbane Hospital advising that DN had been admitted on 13 February 2010 after a fall at his home. She stated DN’s family had not seen him since that admission and that none of the family contact numbers were answering and her calls were not being returned. At that point the hospital doctor and DN’s own doctor were of the belief that DN should be placed in residential care because of the unsafe environment of his home. 13. On 25 February 2010 the Hospital discharged DN to the extended care unit of the hospital until permanent placement could be obtained in a residential facility. 14. On 21 July 2010 a report was received from a social worker of the Cognitive Assessment and Management Unit of the Hospital. It recorded that DN was an inpatient of that unit and that the medical team was of the view that DN would benefit from residential care placement as his care needs were too high and too complex to be managed in his home. The social worker noted that DM was very devoted to her husband and visited DN regularly. 15. After her interactions with DM, the social worker opined that DM proved to be a poor historian who got confused very easily and displayed memory deficits which in her view impinged on her ability to care for her husband adequately. The social worker concluded by saying that it was her belief that DN’s family loved him dearly and was genuinely concerned for his safety and well being but were having extreme difficulties coming to terms with his diagnosis of dementia and therefore failing to understand all the implications that came with that diagnosis. 16. Also dated 21 July 2010 was a letter received from the nurse unit manager of the CAM Unit of the Hospital. The nurse unit manager reported as follows: ƒ DN had been a patient of the unit since 27 May 2010 ƒ He has vascular dementia complicated by unstable diabetes and previous strokes ƒ He was referred to the CAM unit because of his challenging behaviours and high personal care needs. ƒ The information that was received from the community service providers to the CAM unit indicated that the home situation had failed due to the inability of DM to manage DN’s care needs despite the service providers support ƒ The service providers also identified that the practical support from extended family failed to eventuate. 17. The nurse unit manager noted the challenging behaviours of DN as including: ƒ Poor impulse control -- 5 of 13 -- G18822 / Page 6 of 13 ƒ Verbal and physical aggression ƒ Inappropriate behaviours towards female staff and patients ƒ A lack of motivation ƒ Poor executive judgement 18. The nurse unit manager noted that these behaviours were being managed with a behaviour management strategy plan and the use of appropriate medications. She noted that these inappropriate behaviours had almost ceased completely and that the aggressive behaviours had much reduced. The nurse unit manager further advised that DN nursing care needs remained high and that he was: ƒ Doubly incontinent and unable to attend to his hygiene ƒ Nearly bed and chair bound due to his lack of motivation and tendency to refuse to mobilize requiring the use of mobility aides and a mechanical hoist to transfer him and ƒ Identified as being at high risk of falls. 19. The nurse unit manager opined that the unit had found that DN’s family all seemed to have a genuine concern for his wellbeing but that they all demonstrated a consistent lack of understanding of his dementia disease, the management required for his diabetes and/or the high level of care that he requires. She also opined that DN’s family seemed to demonstrate a reluctance to receive information about his condition either by being out of contact or by not being willing to listen to information being required. In her view DN’s family had consistently denied that he had dementia at all. The nurse unit manager opined that in her professional opinion due to the high level of nursing care required and the demonstrated inability of DN’s family to provide this care, DN would not be able to be safely managed at home by his family even with the maximum community care input and that he needed to be discharged to an appropriate aged care facility offering dementia specific care that will accept his ongoing management and care provision. 20. The information from the community service providers referred to by the nurse unit manager in her letter to the Tribunal dated 21 July 2010 was information provided in a letter from a clinical nurse with a community service provider dated 3 June 2010. In this report the nurse records as follows: ƒ DM has significant memory deficits and these deficits greatly affect her ability to care for DN resulting in dietary non compliance and inability to ensure DN was at home for the provider visits. Although the provider was supporting DN Monday to Friday with twice daily visits, at week-ends there was only random reception by DN of his medication including his twice a day (at that point) insulin needle. 21. The community service provider further advised that DN was grossly doubly incontinent and despite repeated requests for copies of DN’s pension card to apply for continence products, this was not provided. 22. The community service provider also advised that for DN admission to the community service provider it had been suggested that DN was to stay at home and the EACH D package would be most suitable. DN was referred by the community service provider -- 6 of 13 -- G18822 / Page 7 of 13 to ACAT to review his high care status in light of an EACH D. WS was contacted by ACAT to book a time for DN’s review and that WS had made and cancelled numerous appointments eventually declining an ACAT review. The community service provider recorded that WS had eventually recontacted ACAT and received paperwork regarding the EACH D and that DN was currently approved for high care residential. 23. The final health professional report received by the Tribunal was a report from a Physician/Geriatrician at the Hospital. This report is dated 25 May 2010. In this report the doctor recorded two cognitive assessments undertaken by DN being a RUDAS test performed on 25 May 2010 (DN scored 13 out of 30) and a MSQ test performed on 19 May 2010 (DN scored 4 out of 8). 24. The doctor lists DN’s current medical conditions as type 2 diabetes mellitus, hypertension, cerebrovascular disease, chronic obstructive pulmonary disease and dementia. She lists a substantial number of medications being taken by DN to treat the various medical conditions. The doctor opines that DN lacks insight into his condition and lacks the ability to understand information and to make decisions based on the consequences of these decisions. She says he is quite physical, frequently touching others. The doctor states that DN can make simple decisions only. 25. At the hearing before the Tribunal, DN’s family gave evidence of their views about his ability to make personal and financial decisions. His current Attorney, WS and his daughter TA both agreed that DN could make personal decisions but could not make financial decisions currently. His daughters explained this by saying that they had probably “spoiled and babied” their father for the last 10 years and had managed his finances on his behalf. 26. WS and TA were of the view their father could make decisions about his accommodation and that he was clearly of the view that he wanted to live at home with his wife DM. His daughters were of the view that this was a reasonable decision and that it could be supported with their assistance and the assistance of service providers to the home. TA was also of the view that DN could decide with whom he had contact and or visits and that he was able to make decisions about his medication. 27. TE, DN’s son-in-law, was of the view that DN could make both personal and financial decisions despite his diagnosis of vascular dementia. TE was particularly of the view that because DN could identify that he owned a house, a car and a bank account and that because he had been able to be taken to the bank some months ago and withdraw some funds, this was evidence of his capacity to understand the nature and effect of financial matters both simple and complex. 28. When pressed, WS admitted that her father had difficulties with motivation and with memory but she attributed these difficulties to depression and to the environment in which he is currently living. TA said that the medication was the cause of the reported lack of motivation. TA admitted that her father had vascular dementia but refused to accept that this resulted in any cognitive disability. 29. At the hearing evidence was given by three professionals. Collectively they indicated to the Tribunal that: ƒ DN had no capacity to make any complex decisions -- 7 of 13 -- G18822 / Page 8 of 13 ƒ Specifically their evidence was that DN continued to have moderate impairment as a result of vascular dementia and that this included a lack of insight to his diagnosis and care needs ƒ He has minimal problem solving skills ƒ He had limited understanding ƒ He had moderate memory impairments for example, he could not remember what he had for breakfast ƒ DN executive functioning was lacking and he had poor judgement and he cannot make informed decisions ƒ He had no motivation or initiation abilities. 30. Two professionals informed the Tribunal that all of these things impacted on DN ability to understand his health care needs and medications and substantially affected his ability to manage his continence and his hygiene. They opined that DN was unlikely to understand his care needs, couldn’t be left unsupervised and required assistance with all activities of daily living in a 24/7 environment. DN refuses to co- operate and engage and has had significant behavioural problems noticed in the community prior to admission and in the hospital environment, for example verbal and physical aggression and sexualised behaviour. Conclusion 31. The opinions expressed by DN’s family runs squarely contrary to the medical evidence as provided overwhelmingly to the Tribunal that DN is unable to make any decisions except very simple personal decisions. DN’s family seems to confuse DN’s ability to express his wishes and his views as evidence of his ability to understand the nature and effect of the decisions that are needed to be made about his personal and financial matters. 32. Even where DN does express a view, the examples given by his family were examples of simple views and choices not complex matters for example whom he wants to see, where he wants to be and simple choices about food and clothing. TE identified these simple views and choices when speaking about his finances and again confused DN ability to identify the basic categories of his assets and a simple bank transaction with the more complex matters of understanding the nature and effect of his finances, whether his finances would be able to support any accommodation needs and to on his own, institute and maintain financial dealings. As his daughter’s evidence pointed out, he had not managed his finances for 10 years as his daughters had “spoiled and babied him”. Not only, it seemed to the Tribunal, could DN not now undertake financial transactions but the evidence from his family was that he had not done so for nearly 10 years. 33. The Tribunal concluded that his family were confusing simple expressions of his wishes, views and desires with the elements of capacity even when these elements were explained to them. The Tribunal is satisfied that: (1) DN has a diagnosis of vascular dementia resulting from a number of strokes -- 8 of 13 -- G18822 / Page 9 of 13 (2) DN has significant cognitive impairments including impairments to his executive functioning, his memory, his judgement, his ability to initiate and to be motivated and that these cognitive impairments impact on his decision making ability. (3) DN has complex health care needs which require specific management in particular these health care needs are as follows – 1. Vascular dementia 2. Type 2 diabetes 3. Cerebrovascular disease 4. Chronic obstructive pulmonary disease 5. Hypertension 6. Incontinence 34. Finally the Tribunal is satisfied that DN lacks insight and awareness into the seriousness of his physical conditions, the medication he requires and the need for close management of his medication and diet, and management of his incontinence. Further he lacks understanding and insight into the risks associated with his particular health needs. The Tribunal is satisfied therefore that the presumption contained in General Principal 1 of the schedule of the Guardianship and Administration Act 2000 that presumes that DN has capacity for personal and financial matters is rebutted. What are the outstanding decisions that need to be made for DN? 35. Section 12 of the Guardianship and Administration Act 2000 provides that before the Tribunal can appoint a guardian to make personal decisions or an administrator to make financial decisions for an adult with impaired decision making capacity the Tribunal must be satisfied that there are circumstances that establish a need for a guardian or an administrator. Need is established if the Tribunal determines that the adult is likely to do something in relation to the matter that involves, or is likely to involve, unreasonable risk to the adult’s health, welfare or property and without an appointment the adult’s needs will not be adequately met or the adult’s interests will not be adequately protected. Personal Decisions 36. The Tribunal identified a number of personal areas where decisions currently need to be made for DN. The areas identified from the material by the Tribunal were decisions about – ƒ Accommodation ƒ Provision of services ƒ Health ƒ Contact All of the parties at the hearing agreed with these identified areas as matters where decisions must be made. -- 9 of 13 -- G18822 / Page 10 of 13 Financial decisions 37. Decisions also need to be made concerning DN’s finances to support an accommodation decision in the near future and to ensure that his wife, DM is supported and that all his activities of daily living are financially supported into the future. All active parties to the hearing agreed with the need for a substitute decision maker for financial decisions. Is there an appropriate current decision maker? 38. DN entered into an Enduring Power of Attorney (“EPA”) dated 4 April 2007 appointing his daughter WS as his Attorney for financial, personal and health matters. This Enduring Power was to begin immediately in relation to financial matters. There is no evidence before the Tribunal to suggest that this enduring power was not a validly created document. 39. Section 76 of the Powers of Attorney Act 1998 requires that an attorney when exercising powers under an enduring document must comply with the principles set out in schedule 1 to the Powers of Attorney Act being the general principles, and for a health care matter, the health care principle. 40. In particular general principle 7(5) requires that an Attorney, in performing a function or exercising a power under this Act or an enduring document, must do so in a way consistent with the adult’s proper care and protection. The health care principle in section 12(2) of Schedule 1 provides that an Attorney when exercising a power must to the greatest extent practicable take into account the information given by the adult’s health care provider. 41. In the letter to the registrar of human rights division of the Queensland Civil and Administrative Tribunal dated 27 May 2010 the Adult Guardian notified 1 that she had exercised her power to make a health care decision in relation to the health care for DN. The Adult Guardian advised that she considered that DN’s attorney refused to make a decision or was making decisions contrary to the health care principle contained in schedule 1 of the Act. 42. In this letter, the Adult Guardian recorded that on 25 May 2010 the Adult Guardian was advised by a doctor that DN had been admitted to a Brisbane Hospital for medical treatment for elevated blood sugar levels and behaviours associated with dementia and severe cognitive impairment. On admission, DN presented with hypoglycaemia and acute and chronic dehydration. The doctor’s concern was that some of these medical issues had arisen as a result of DN’s care being neglected in his home. 43. The doctor advised the Adult Guardian that she had found it difficult to contact WS and that when she had contacted WS she considered WS was acting contrary to the health care principle. The doctor considered that DN required continued admission to the Hospital for further treatment of his diabetes and appropriate care for the moderate to severe cognitive impairments. She further advised that WS as Attorney would not consent to DN continued admission and could not guarantee that DN would receive his required medication if outside the hospital. The doctor indicated 1 Pursuant to section 43 of the Guardianship and Administration Act 2000 -- 10 of 13 -- G18822 / Page 11 of 13 that she clearly articulated her concerns to the family however they advised they continued to make the decision to discharge DN to his home. The doctor also advised that the community service provider had informed her that they had attended DN in his home on a number of occasions and he was in a neglectful state, including sitting in his own urine and without being showered or moved since their last visit. His double incontinence was not being managed appropriately at home. 44. On 25 May 2010 the Adult Guardian consented to DN continuing to be admitted to the Hospital and receiving appropriate medical treatment2 . At the hearing of this matter, WS advised that she told the doctor that she must discuss these matters with her sisters before she could give an answer and that before she was able to have these discussions, the Adult Guardian had made her decision. WS also indicated that for the last one and a half weeks, WS had disrupted phone contact because she had changed service providers and some messages had not reached her. 45. The Tribunal accepts that WS may have experienced phone contact difficulties for the previous one and a half weeks. However, the Tribunal was not satisfied that this constituted an adequate explanation of the difficulties service providers and the hospital had experienced in seeking to contact WS in periods prior to that as the allegations about such contact problems predate the period referred to by WS by a number of months. 46. WS did confirm that she finally consented to her father undertaking an ACAT assessment. 47. In relation to the exercise by WS of her power as a financial attorney, a nurse unit manager in her letter to the Tribunal dated 21 July records that WS, who initially visited her father regularly, had not visited for over 3 weeks and had not returned phone calls at that time. The nurse unit manager attempted to discuss with WS the importance of changing DN’s financial care category from assessment to maintenance while he awaited discharge to a care facility as a fee was attached to maintenance care. She was unable to contact WS. 48. WS at the hearing countered that again she had telephone difficulties and that for a recent period of time she had been ill and had not visited her father because she did not want to spread infection. 49. When the Tribunal questioned WS on her view if an appointed guardian made an accommodation decision with which she disagreed as a financial attorney for her father, WS replied that she would decline to pay for any accommodation or for any residential care facility with which she did not agree. 50. Section 79 of the Powers of Attorney Act 1998 requires that an attorney must consult with other appointees or attorneys on a regular basis. It is not open to a financial attorney to thwart the decisions of a validly appointed attorney for personal matters or a guardian simply because he or she does not agree with those decisions. 51. The Tribunal is satisfied that WS is no longer appropriate or competent as a financial or personal attorney for her father. The Tribunal is satisfied that despite overwhelming evidence that DN proper care cannot be managed in his home, WS 2 Under section 43 of the Guardianship and Administration Act 2000 -- 11 of 13 -- G18822 / Page 12 of 13 and indeed her whole family are of the view that is where DN should be discharged to from the hospital. WS has also made it clear that she would refuse, in circumstances where she does not agree with the decision of a guardian, to fund any accommodation decisions with which she does not agree. 52. The Tribunal therefore revokes the enduring power of attorney to WS as it is no longer appropriate in the circumstances. Who should be appointed as guardian and administrator for DN 53. At the hearing TA nominated herself and WS as guardians and administrators if the Tribunal saw the need to make such appointments. All other applications request the Tribunal to consider the appointment of the Adult Guardian and The Public Trustee of Queensland for these roles. 54. The Tribunal when considering the appointment of a guardian or an administrator must be satisfied not only as to the need for appointment as set out in section 12 of the Guardianship and Administration Act 2000 but also as to appropriateness of a proposed appointee as set out in sections 14, 15 and 16 of that Act. 55. The Tribunal has recorded earlier the attitude of DN’s daughters and son-in-law towards the medical evidence and the advice given to them concerning DN care. Both TA and WS (as with all family members) refuse to accept the medical advice regarding management of his health care needs, including his diabetes, incontinence, and vascular dementia. They do not accept that DN has cognitive impairments or that he is not capable of living in his home. 56. WS and TA have demonstrated at the hearing of this matter a profound lack of insight into the risks associated with placing the adult in anything other than full residential care. 57. The Tribunal is satisfied that neither of these parties understands or accepts the implications of his diagnosis and the high level of care that he now requires. If either TA or WS were appointed as guardian or administrator it is very clear to the Tribunal that they would be likely to discharge DN to his home in the care of his wife who is herself failing in her health and potentially in her cognitive abilities. With all family members leading very busy lives it is also clear that they have been unable to provide anything other than limited support for DN at home to support their mother. The inevitable conclusion of this would be in the Tribunal’s view that DN’s health and wellbeing would be substantially at risk. 58. There also exists between TA in particular and all service providers and hospital staff, ongoing and substantial allegations of difficulties with communication, verbal aggression and threats where the advice from service providers and medical staff differs from TA’s view. There is independent evidence to support this. The Tribunal relies on the evidence of the social worker in her letter to the Tribunal dated 21 July 2010 concerning conversations she has had with mainstream residential facilities in Brisbane about the possibility of placement of DN and the case conference notes dated 25 May 2010 of a meeting at the Hospital on that day. Numerous allegations were made by the staff present at that meeting about the conduct of TA and the aggressive attitude she took when information was provided with which she did not agree. -- 12 of 13 -- G18822 / Page 13 of 13 59. There is also evidence from the Adult Guardian concerning the conflictual communication style of TA. That office will now only communicate with TA in writing. There is a letter from the Caring Centre dated 12 January 2010 recording that on Monday 11 January DN was visited by his daughter TA and son-in-law and that they became very agitated and were threatening and were aggressive to staff. This has resulted in that facility indicating to the social worker (as recorded in a letter to the Tribunal dated 21 July 2010) that the facility would only accept an application from the family for DN to be placed in this culturally and linguistically diverse facility if a restraining order was put in place against TA. 60. At the hearing, TA denied all allegations of aggressive behaviour at the Hospital in particular on the date of the case conference discussed above and herself made allegations regarding her treatment at the hospital and of an assault on her by security staff. Despite these denials by TA, what this evidence does indicate is an ongoing pattern of confrontational behaviour by TA when decisions are made or information given with which she does not agree. 61. The Tribunal is satisfied that all of this evidence indicates a high level of conflict between the family and all medical staff and residential care staff as well as ongoing communication and potentially decision-making difficulties arising between TA, service providers and medical staff where there is disagreement. 62. The Tribunal is not satisfied in the circumstances that TA or WS could satisfy the requirements of an appointed guardian or administrator to consult with other appointees on behalf of the adult 3 and to apply the general principles and the health care principle as required by the Act. 63. The Tribunal is satisfied that the appropriate appointments in relation to DN are those of the statutory appointees being the Adult Guardian and The Public Trustee of Queensland, who are independent of family conflict, able to deal professionally with service providers and medical staff and able to consult free of conflict with all members of DN’s family. 64. The Tribunal will appoint the Adult Guardian for accommodation, service provision, health and contact for DN for a period of 3 years. 65. The Tribunal will also appoint The Public Trustee of Queensland as administrator for DN for all financial matters until further order of the Tribunal. 3 Section 40 of the Guardianship and Administration Act 2000 -- 13 of 13 --