Legal fees in Irish medical negligence cases are criticised by Irish Medical society
The Gravy train’ legal charges should be capped, says Medical Protection Society.
The Medical Protection Society, which provides indemnity cover for 16,000 Irish doctors, says “the gravy train” legal fees are driving up health costs for patients and forcing doctors to join the “brain drain” leaving Ireland.
Legal fees in most medical negligence cases should be capped to 20 per cent of the award and tough financial penalties imposed on lawyers who bring forward cases without merit, according to a new report.
The Medical Protection Society, which provides indemnity cover for 16,000 Irish doctors, says “gravy train” legal fees are driving up health costs for patients and forcing doctors to join the “brain drain” leaving Ireland. The society has called for new legislation to reform the way medical negligence cases are handled, including limits on the damages and costs that can be claimed and a shortening of the time period in which cases can be brought forward.
Increasing & rising claims:
The society says increases in the number of medical negligence claims and in the size of awards are threatening the sustainability of some areas of private medical practice. If this results in a shift in workload to the public sector, the pressure on public hospitals will grow.
Escalating legal costs have been blamed for a 90 per cent rise in the cost of providing indemnity cover for consultants in the past two years. This was one factor in the end of private obstetric practice at Mount Carmel Hospital in Dublin and its eventual closure last year.
“The cost of medical negligence claims is paid ultimately by patients, either through taxation or the cost of healthcare,” the society’s director of patient engagementJohn Tiernan said. “Society has to ask itself whether this is affordable or not.”
The society says the rise in the cost of indemnity cover is a result of large increases in the rate at which private hospital consultants are being sued and the average size of claims. In a report, it claims the economic downturn has led to a “compensation culture” in which claimants pursue more cases and lawyers have moved into medical negligence as an “alternative and more attractive source of income”.
The legal system?
“The lack of a speedy and transparent system leads to a pressure to settle claims in circumstances where we would not do so elsewhere in the world.”
The report says the Irish legal system does not do enough to discourage unmeritorious claims, for example when a plaintiff’s lawyers are unable to get solid expert support for a claim. It also allows cases to drag on for many years, and the courts are reluctant to strike out claims even when they have failed to progress.
The report says some lawyers even run cases without strong expert support until the last moment in the hope that the defendant will settle.
Property prices to continue to rise in Ireland for year ahead 2015
Supply and demand mismatch to drive prices in urban centres despite the mortgage challenges.
Sherry Fitzgerald said on Friday that there is “every reason to believe that prices will continue to rise at above trend levels in the short term in many locations” into 2015.
Residential property prices are expected to continue to rise into 2015, despite challenges such as the Central Bank’s proposals to restrict mortgage lending, Sherry Fitzgerald said on Friday.
Pointing to the constraints in supply allied with a recovery in demand, the estate agency group said that there is “every reason to believe that prices will continue to rise at above trend levels in the short term in many locations”, adding that the trend will be particularly evident in the urban centres where supply is most constrained. It will be “ some time” before the mismatch between demand and supply is rectified, Sherry Fitzgerald said, adding that it will therefore be some time before the market truly stabilises.
“In the interim, there is likely to be some volatility with above trend price and indeed rental inflation in urban centres.”
In 2014, house prices rose by 16.3%, with Dublin experiencing a higher growth rate at 18%. Residential property outside Dublin was up 13.9%.
And it wasn’t just property prices that rose in 2014 – activity levels increased too. With some 40,000 properties sold nationally last year, activity levels jumped by 33% according to Sherry Fitzgerald, while the growth in activity was more marked in Dublin, with a growth rate of 40%, up to about 14,000 transactions.
Marian Finnegan, chief economist Sherry FitzGerald, said that 2014 was undoubtedly “a fragmented year” for the Irish property market.
“For the Dublin market the year opened to very tight supply and pent- up demand resulting in buoyant price inflation, of 12.6% in the first six months. That said, an increase in supply and a more temperate demand outlook saw price growth rates effectively half in the latter six months with overall growth for the year coming in at 18%,” she said.
Pat Davitt, chief executive of the Institute of Professional Auctioneers & Valuers (IPAV), agreed that price growth in the latter half of the year was “more muted”.
Looing to the future, the outlook for 2015 is “challenging” Sherry Fitgerald said, pointing to the recent intervention by the Central Bank to minimise the risk of another credit driven property bubble by limiting loan to value and loan to income ratios.
“If the Central Bank is tempted to follow through on its original proposal insisting on 20 per cent deposits for the majority of buyers it would be an unmitigated disaster,” Mr Davitt said, adding that “joined-up thinking” was needed.
A week in my Sligo job as an anaesthetist at the General Hospital
Eileen Forrestal says 'My work is all about paying attention at all times to everything’
Eileen Forrestal, who works as an anaesthetist in Sligo Regional Hospital and also produced the Get Up And Go Diary.
Sleeping, waking I often say that in my “day job” as an anaesthetist, I put people to sleep, and in my other job, with Get Up and Go Publications, I wake people up. What I want is for all people to be as healthy as possible, both mentally and physically, so we can enjoy the best life possible. A healthy mind in a healthy body is truly the recipe for a wealthy life.
My interest in medicine grew partly out of a family story that was a favourite of our dinner-table conversation for many years. My dad had TB as a young man and was in hospital for three years before he enrolled in the first streptomycin drug trial.
Unlike his father and two young brothers, who sadly succumbed to the disease when my father was an infant, Dad had survived long enough for a cure to be found. My mother was his nurse in hospital, and after he recovered, they met again on a bus. The rest is history.
I qualified from University College Dublin in 1982 and have since practised medicine in the UK, Africa, Canada and Ireland. All this developed my passion for travelling, and I have managed to experience (albeit very briefly at times) life and living conditions in more than 60 countries, giving me a fairly unique perspective on the world. It is an aspect of my education for which I will be forever grateful.
Although I have been a specialist anaesthetist since 1991, I have also worked in other areas of medicine, including general practice, psychiatry, geriatrics and obstetrics, in a career of more than 30 years.
My work as an anaesthetist at Sligo Regional Hospitalbegan in 1995. I fell in love with Sligo and, after completing a two-year advanced fellowship in Toronto, I returned as a permanent consultant on a half-time contract in 2004. My weekly commitment at the hospital consists of two and a half days per week, plus an on-call commitment of 24 hours, once every 14 days.
In my practice I cover all general theatre specialities, from general surgery, orthopaedics, ear nose and throat, gynaecology and obstetrics, paediatrics, opthalmology, intensive care, A&E, and my own area of special interest, the pre-anaesthesia assessment clinic. As an anaesthetist I work closely with all the other specialities and, of course, the nursing staff. A collaborative team approach and good communication are essential to achieving the best outcome for patients.
A Vigilance:
People often joke that an anaesthetist can take a break once the patient is asleep, but I can guarantee that the only person “sleeping” in theatre is the patient. My job is all about vigilance and paying attention at all times to everything that is happening throughout a surgical procedure. In an extended operation, this includes monitoring blood loss and replacing fluids and electrolytes.
The machinery and monitors are now very technologically advanced, and the medications we use tend to be a mixture of anaesthetic vapours, intravenous sedatives, strong painkillers, muscle relaxants and anti-nausea drugs.
Our job is to ensure that patients are safe throughout their operations, that they do not feel sick or in pain when they wake up, and we provide optimal operating conditions for the surgeon.
I have always loved my work and take great satisfaction in guiding my patients, often with multiple complicating conditions and medications, safely through their operation and immediate post-operative care, often in the intensive care unit.
I also really enjoy meeting patients in the pre-assessment clinic, where I can educate them on perioperative risk reduction, which often involves weight loss, smoking cessation, medication management, and lifestyle choices to do with nutrition and exercise, so that they come for their surgery in the best possible condition.
80% of Irish houses expected to have a brown bin within three years
Up to 80% of all houses are expected to have a brown bin by 2018 as Ireland becomes more environmentally friendly.
More of us than ever before are recycling our leftover Christmas turkeys with an extra 150,000 brown recycling bins being rolled out.
According to the Irish Waste Management Association, nearly half of all homes with a collection service now separate their organic waste.
“Householders in Ireland have played a big part in the success of recycling,” said IWMA Secretary, Conor Walsh.
“So it’s a joint effort – it’s driven by legislation, it’s implemented by the waste industry and we have to roll out another, probably 200,000 households over the next couple of years, the IWMA members.
“So I think 75-80% of houses in Ireland will have a brown bin within the next two or three years.”
The ordinary’ nature of mental health issues in Ireland
Music, poetry, theatre, art, film and dance part of the line up for First Fortnight festival.
Mental health issues are a “normal experience rather than something extraordinary”, JP Swaine says as he takes a break from the last minute preparations for this year’s First Fortnight festival.
The festival which runs through January aims to challenge mental health prejudice through the creative arts with a series of events, most of which are Dublin based.
In 2009 Mr Swaine, a mental health social work manager and cognitive psychotherapist, and arts professional David Keegan decided to “test out” an idea they had to use the arts as an aid in opening up discussion around mental health.
“We decided to take our passion and our experience of the arts and see if we could do something different,” he said.
The idea of the “ordinariness” of mental health issues is one that he, and the other organisers and volunteers who are the driving force behind the fortnight’s events, are very close to.
“For many generations there was a very heavy veil of silence that surrounded mental health and where there is a veil of silence people imagine that it’s something to be ashamed of. That’s a cocktail for a problem that will never get solved,” he said.
Mr Swaine had his own experience of mental health issues: when he was 16 his older brother David died by suicide. The idea for the festival began as a way of honouring David’s memory while also aiming to be beneficial to others.
“I think it’s valuable that when bad things happen we don’t try and undo the pain that is caused but that we integrate that experience into something that could be useful for someone else,” Mr Swaine said.
In 2010 the first event took place and has grown ever since. Now in its fifth year the festival line up encompasses music, poetry, theatre, art, film and dance and a tongue-in-cheek National Therapy project which is “compulsory on a voluntary basis” for all occupants of Ireland.
Sport is also represented in the line up with a panel discussion entitled Over the Bar which sees figures from the sports world explore mental health issues.
An event unique to the festival is Co-Motion, which takes place on Sunday January 4th in St Stephen’s Green at 2pm, where participants are asked to load their MP3 players with music which they then share with others using headphone splitters:
“It’s like a silent disco except you are walking with a stranger and listening to the music that gets them through,” Mr Swaine explains.
More information about the festival can be found at firstfortnight.ie.
Scientists describe a protein capable of modifying other proteins
Findings from a recent study reveal that, contrary to the previously held understanding of protein synthesis, proteins can be assembled without instruction from mRNA. In the study, published in Science, researchers describe how a protein is capable of adding amino acids to other partially formed proteins.
During protein synthesis, amino acids are linked together according to messages received by messenger RNA (mRNA) with the assistance of ribosomes– a process called translation. In the process, defective ribosomes or faulty messages can lead to translational “stalling”.
In response to the translational stalling, the incomplete proteins (polypeptides) are degraded by a ribosome-bound quality control complex (RQC) which triggers the destruction. Researchers from the University of California, San Francisco and the University of Utah first documented this complex in 2012.
RQC is a multi-protein complex, and one of those proteins, Rqc2, was found to be capable of directing the addition of amino acids. “We caught Rqc2 in the act,” said senior author Adam Frost, M.D., Ph.D., in a statement. “But the idea was so far-fetched. The onus was on us to prove it.”
In the present study, the team used cryo–electron microscopy to show Rqc2 bound to transfer RNA with either of two amino acids, alanine or threonine. Using mass spectrometry, the team also showed that the stalled proteins had chains of alanines and threonines on them.
Remarkably, the protein was playing the role of mRNA by directing the ribosome to add either alanine or threonine. “This surprising discovery reflects how incomplete our understanding of biology is,” said first author Peter Shen, Ph.D., a postdoctoral fellow in biochemistry at the University of Utah.
“Nature is capable of more than we can imagine.”
The resulting protein contained anywhere from 5 to 19 alanine or threonine residues. The authors conclude that the purpose of Rqc2 is to add “carboxy-terminal Ala and Thr extensions” or “CAT tails.”
These “CAT tails” can serve as a signal to initiate the destruction of faulty proteins, or part of a test to check how the ribosome is functioning, the authors explain.
The implications of this work are broad as recent evidence suggests that either of these functions are faulty in neurodegenerative diseases (such as Alzheimer’s).
“There are many interesting implications of this work and none of them would have been possible if we didn’t follow our curiosity,” said co-author Onn Brandman.
Proteins perform numerous functions in the body from their role as antibodies, to maintaining structural integrity to catalyzing essential reactions. This latest finding adds one more function and illustrates the beauty of scientific discovery.
“The primary driver of discovery has been exploring what you see, and that’s what we did. There will never be a substitute for that,” says Brandman.
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