Sending an anorexic woman from Northern Ireland for specialist treatment in England against her wishes could cost up to £200,000, the High Court heard today.
A judge was also told that a consultant from the eating disorder unit did not travel over to assess her before the decision was taken to authorise the transfer.
The patient, who cannot be identified, is taking legal action in a bid to block the move.
Now aged in her forties, she has suffered from anorexia nervosa for more than 20 years and is currently being detained under mental health legislation.
The court heard her condition is so serious that efforts are centred on improving her quality of life and reducing the risk of sudden death.
Her lawyers claim Department of Health officials took the decision in July after carrying out an unlawful "tick box exercise".
Any transfer would also be in conflict with her human rights, it was contended.
Counsel also set out how treatment in England could take months and potentially involve a bill of up to £200,000.
During the second day of the judicial review challenge Mr Justice Maguire questioned whether the Department complied with relevant guidelines.
The general rule is that the consultant from the receiving clinic visits the patient - a situation which did not take place in this case.
Counsel for the Department accepted there was no explanation for the non-attendance, but argued that exceptions applied.
But the judge responded: "An institution that might have £200,000 spent by the Northern Ireland authorities, could somebody not have said 'We would like you to come and tell us what you can do'."
Although he stressed that no decision has been reached in the case, Mr Justice Maguire added: "I don't know why he didn't come. That's a mystery that hasn't been unravelled."
He also stressed the need to know the potential benefits and prospects of success in sending the woman for the specialist treatment.
"This is a very serious matter, there's such a thing still extant as civil liberties," the judge said.
"In the extreme circumstances of a case like this people are entitled to have fair process and a court is entitled in a challenge like this to be satisfied that the decision maker has considered this matter thoroughly.
"The tick box would clearly be unsatisfactory."
The case continues