Sunday 27th October 2013
Now Savita Halappanavar doctor faces quiz on new complaint
Galway Mayor reports Doctor Katherine Astbury to Medical Council in a bid to ‘restore confidence’
Above Councillor Padraig Conneely and consultant obstetrician Katherine Astbury
THE consultant obstetrician responsible for the care of Savita Halappanavar has been reported to the Medical Council by the mayor of Galway.
Fine Gael councillor Padraig Conneely lodged a complaint against Dr Katherine Astbury to the doctor’s regulatory body within the past fortnight, the Sunday Independent has learnt.
Mr Conneely said he made the complaint as a public representative after reading the report from the health watchdog Hiqa, which said responsibility for Savita’s care rested with the consultant obstetrician.
The Medical Council will ultimately consider whether the complaint against Dr Astbury should be heard by its fitness-to-practise committee.
The Hiqa inquiry was the third into the death of the 31-year-old dentist from blood poisoning at University Hospital Galway last year and went further than the others in its findings.
Savita was admitted to hospital when she was 17 weeks pregnant and suffering a miscarriage but died days later after developing an infection.
The health watchdog identified 13 “missed opportunities” for intervention that could have altered the outcome for her. Savita’s medical team was criticised for failing to ensure she got the right care at the right time. But the health watchdog found that “ultimate responsibility” rested with her consultant, whom it did not name.
Mr Conneely, a longstanding Galway councillor who is also chairman of the local HSE’s regional health forum in the West, has repeatedly called for accountability for Savita’s death.
After the Hiqa report was published, he called for Dr Astbury and the clinical director of the hospital to be “stood down”.
He told the Sunday Independent this weekend that he sat through six days of evidence at the inquest into Savita’s death and read the report of the HSE’s clinical review team and the Hiqa report which was published earlier this month.
“It is quite plain, after the coroner’s inquest, after the clinical review, and above all, after the Hiqa report, it was quite clear to me that someone had to make a move,” he said.
“In the interests of accountability and to restore public confidence in the maternity unit at UHG, I decided to make this formal complaint to the Medical Council. I believe it has to be done.
“The air must be cleared. These three reports have shattered confidence in UHG.”
He said he did not consult with Savita’s husband, Praveen Halappanavar, beforehand.
The reports on Savita’s death have already been forwarded to the Medical Council and the nurses regulatory body, An Bord Altranais. But as the Medical Council does not comment publicly on complaints, it is not clear what, if any, action it is taking on foot of those reports.
Under its own guidelines, however, Mr Conneely’s complaint will be assessed by a Preliminary Proceedings Committee, which will decide what, if any further, action should be taken. The options include referring the complaint to the council’s fitness to practise committee, which hears cases in public.
University Hospital Galway’s announcement last week that up to 30 staff involved in Savita’s care will face a disciplinary process was greeted with disappointment by Savita’s husband, Praveen.
His solicitor, Gerard O’Donnell has said his client was disappointed that the process would be conducted internally by hospital staff.
The president of the Irish Hospital Consultants Association, Dr Denis McEvoy, said recently that the death of Savita Halappanavar was a great disaster, not only for her family, but the consultant obstetrician who treated her.
“It’s a great tragedy. We’re all fearful of ending up at the Medical Council, your life is destroyed. It’s a great disaster for the family but it’s also a great disaster for that poor obstetrician. Her grief pales into insignificance compared to that of the family but you say a prayer that it’s not you,” he said.
Women’s lives are much happier if they don’t get married
‘Eat, Pray, Love’
It’s a Sunday afternoon and Elizabeth Gilbert is walking her dog along a river in New Jersey. What kind of a dog does she have? “I wish I knew!” she laughs, and it is a clean and pure laugh, like burbling water rising from an inexhaustible source.
Gilbert, who will be in Dublin for a reading tomorrow evening, seems carefree, happy, open and generous, exactly the kind of person you would hope comes out the other end of the catharsis of a book like Eat, Pray, Love.
When Gilbert set out to travel the world after the traumatic break-up of her first marriage and to write about it in her memoir Eat, Pray, Love, she couldn’t have guessed at the success that awaited. The book sold 10 million copies, was made into a film starring Julia Roberts and Gilbert became a kind of self-help guru for middle-aged women adrift in their own lives.
She followed the book up with another memoir, Committed, a kind of what-happened-next crossed with a treatise on the institution of marriage. When Gilbert’s Brazilian partner Jose Nunes (better known to readers of Eat, Pray, Love as Felipe) was deported, marriage was the only way the two could be together. Despite Gilbert’s aversion to the institution, she remarried and the pair now live in a small town in New Jersey, and run a furniture store called Two Buttons.
Ten years on from the journey that started in Eat, Pray, Love, Gilbert appears content and has just written what could be her best book yet.
“A large part of what I was striving to do on Eat, Pray, Love was to get myself in order so I could get out of my own way,” she says.
“I’ve always stood up against the idea that if you’re not suffering for your art, you’re not an artist. I’m profoundly against that. I think the more you clear yourself out of that stuff, the better you can be creatively. Depression takes so much energy, and shame and despair burn so much of your life and that is one of the biggest motivations to just clear that stuff out.”
The Signature Of All Things is only Gilbert’s second work of fiction in 13 years. Set in the 1800s, it tells the story of Alma, a gifted botanist and towering intellect in an era when intelligent women were considered unmarriageable. Alma finds fulfilment in her work investigating the behaviour of mosses. While this is historical fiction, fans of Gilbert’s memoirs will find her central theme of self-discovery runs through this book too.
“I wanted to write about a woman who loved her work, or her vocation,” says Gilbert. “And I say that as a woman whose vocation has saved her life more than once. When women don’t get everything they want in their emotional lives, when their relationships may falter, the work itself is the meaning that ties their lives together and I feel that way about my own work.”
Like Gilbert, Alma doesn’t follow the traditional female trajectory of marriage and children. At one point in the novel, Alma’s childhood nanny tells her not marrying and having children is not the worst thing that could happen to a woman. Gilbert agrees.
“We live surrounded by the romantic message that the story ends at marriage. It’s still how most books and movies end but the studies show unmarried women have happier, longer lives and the reverse is true for men. If you are a woman and you want to have a happy, healthy, contented, non-depressed life, your best chance is not to be married.”
The Signature Of All Things also functions as a kind of cautionary tale. When Alma’s research of mosses leads her to the same conclusions as Charles Darwin, she holds off on publishing her paper as she feels it is not quite perfect.
“We live in a culture that tells us we’re supposed to be perfect. Perfect doesn’t exist. Throwing ideas and products into the world that are not quite perfect never stops men from putting ideas forward and it doesn’t stop them raising their hands in meetings and it doesn’t stop them demanding attention or asking for raises.
“I was lucky enough to be raised by a mother who said, ‘done is better than good’. It doesn’t have to be perfect, it just has to be done.”
If Gilbert’s 34-year-old self could see her now – financially independent, critically and commercially successful, happily married – what would she think?
“It’s exactly what my 34-year-old self wanted to be doing but was unable to then because she was such a mess. This book is a great celebration of where I’ve come to. It’s a gesture of gratitude to Eat, Pray, love because it financed this book. It’s the only way to honour how lucky I am.”
Gilbert hasn’t started work on her next book yet but she has two competing ideas in mind.
“One idea is for a novel and one is for a non-fiction book. When I settle down, I’ll have to have a strong word with them both but they’re just growing in my head at the moment.”
Meanwhile, she is looking forward to being back in Ireland. “It’s one of the mossiest countries in the world so hopefully I will see some moss!”
Work begins on turbines as energy companies predict an ill wind
Construction has begun on a 40-megawatt wind farm at Bruckhana in Tipperary, which will help the country move closer to its renewable energy targets.
Ireland must generate 40% of electricity from renewable sources by 2020 under European Commission rules.
Last year it reached just half of this target, with wind energy contributing more than any other form of renewable energy.
This is a global trend; the world will have enough wind turbines to generate more than 300 gigawatts of power – the equivalent of 114 nuclear power plants – by the end of the year, industry figures show.
Growth in the last year has come mainly from turbines added in Brazil,China, Mexico and South Africa.
Europe, which has led the world on wind, still represents around one-third of all capacity, with more than 100 gigawatts, but its growth has been stalled because of abrupt changes to subsidy regimes, thanks to the financial crisis.
The EUs current renewable energy policy stretches out to 2020 with a set of goals to encourage a sustainable, secure and affordable energy supply.
They aim to increase use of renewables to 20pc and cut carbon emissions by 20pc.
Policymakers are expected to announce proposals for 2030 goals by the year’s end .
Environmentalists say targets for renewables, energy savings and the climate are all essential and have been proved to work .
But energy suppliers argue that generous subsidies for renewable sources have distorted the market, while they have had to close down gas-fired power plants because they cannot compete.
Bosses from 10 utility companies, representing half of Europe’s power-generating capacity, urged EU leaders this month to adopt reforms to prevent black-outs.
RISK
The chief executives, who call themselves the Magritte Group, say EU energy and environment policy objectives are failing and raise the risk of the lights going out.
They argued that Europe’s electricity bills are around double those in America because suppliers are burdened by subsidies for renewables, whereas shale gas has lowered US costs.
According to the Magritte Group, European utility companies have closed 51 gigawatts of increasingly unprofitable gas-fired assets – the equivalent of the combined energy capacity of Belgium, the Czech Republic and Portugal – and the risk is that more will be shut.
This, they said, makes energy supplies more vulnerable.
“We cannot have a renewables society without security of supply,” said Peter Terium, chief executive of German power company RWE.
Without action, the CEOs said the sector would remain unworthy of investment and reliable power would be a thing of the past.
“The risk of black-outs has never been higher,” GDF Suez chief executive Gerard Mestrallet said, who added that high electricity bills were damaging Europe’s international competitiveness.
Can you afford to keep your health insurance cover after Irish budget tax hit?
The hundreds of thousands of medical card holders who could lose their cards in the Budget clampdown face a grim choice – cough up for private health insurance or find some way to pay their medical bills.
As healthcare bills could run into hundreds of thousands of euro if you have a serious illness that requires a lengthy stay in hospital, many of those who are about to lose their card will have no option but to buy private health insurance – if they can afford it.
“Most people who have been relying on a medical card have probably been priced out of private health insurance, ” said Dermot Goode, general manager with the Cornmarket Group’s healthcare division. “Unfortunately for them, they’ve nowhere to turn. They’ll either have to forgo essential treatment or find the money to pay for those bills.”
Those who could face losing their medical cards aren’t the only ones who will be affected by healthcare changes announced in this month’s Budget. The cap on medical insurance tax relief and the free GP for under fives also mean it’s time for the 2.1 million people who have private health insurance to rethink their cover.
Private health insurance is not cheap. The premiums could run into thousands of euro a year for an individual – or several thousand if you’re a family of six.
Rarely a year goes by without a price hike in private health insurance. So does it make sense to hold on to private health cover if you already have it – or to sign up to it if you’re about to lose your medical card?
THE HOSPITAL GOER
If you have a medical card and have been in and out of hospital over the last year, your card covered the €75 daily charge every time you visited a public hospital. If you lose that card, you’ll be hit with that charge – up to a maximum of €750 a year. So if you’re in hospital for 10 nights, you’ll face a €750 bill.
This is one reason why it could make sense to sign up to private health insurance – as long as your premium is cheaper than the maximum €750 public hospital charge. “You can buy basic health insurance plans from €495 and these plans will cover the public hospital charge,” said Goode. “If you take out insurance, you could end up paying less in premium than in levy.”
The cover for the public hospital levy is a basic benefit in private health insurance policies – so it isn’t the only reason private cover could be useful to someone who has just lost their medical card.
However, if the levy is one of the reasons you’re considering buying insurance, there’s an important caveat – if you’re signing up to private health cover for the first time, you will usually have to serve a waiting period before you’re covered for the public hospital charge.
If you’re joining VHI Healthcare, you’ll have to wait eight weeks before you’re covered for the levy; if joining Aviva or Glo Health, you must wait at least six months – longer if you’re over a certain age or have a pre-existing illness.
Laya Healthcare is the only insurer that immediately covers you for the public hospital levy – unless you have a pre-existing illness or are pregnant.
“Laya Healthcare waives the initial waiting period of 26 weeks for all new customers joining, therefore the €75 levy is covered for all new customers immediately,” said a spokeswoman for Laya. “Pre-existing and maternity waiting periods for new joiners still apply.”
Remember if you’re admitted to a public hospital after an accident or emergency, you’re automatically covered for the public hospital levy.
THE CHRONICALLY ILL
If you have a major illness or medical condition and you’ve just lost your medical card, it may not be worth your while taking out private health insurance – as you could be facing a 10-year wait for cover.
For example, if you’re aged 60 or more and you’re buying private health insurance for the first time, you’ll have to wait 10 years before you’re covered for any illness or medical condition you had before you bought the cover. Furthermore, unless you’re with VHI, you’ll have to wait 10 years before you’re covered for the public hospital levy – a very basic benefit.
If you’re between 55 and 59 years of age, you must wait seven years before you’re covered for pre-existing illnesses; if younger than 55, you must wait five years.
ALREADY INSURED GOLDEN OLDIES
If you’re over 55 and have private health insurance as well as a medical card, it could be a bad move to cancel your cover.
“There are a lot of older people who have a medical card who also choose to have health insurance as they feel there’s always a risk they’ll lose the card,” said Goode. “If you’re over 55, we’d advise you not to cancel your private health insurance – even if you have a medical card.
“If you ever get on a waiting list, you’ll get seen earlier if you have insurance. For example, if you have chronic hip pain, you could be waiting between six months and two years to get an appointment with a specialist in a public hospital – and you could be waiting between three and four years for the procedure publicly.
“With private health insurance you’ll get the procedure much earlier.”
If you cancel your private health insurance but then lose your medical card, you’ll have to wait at least two years for cover if taking out a new health insurance policy from the age of 65. The only occasion that you won’t have to serve the waiting period is if you renew your cover within 13 weeks of cancelling it.
THE TAX TARGETS
Your health insurance could increase by up to 20 per cent because of the cap in tax relief introduced in Budget 2014, according to Goode.
Before this month’s Budget, you could have claimed back one-fifth of your private health insurance premiums in tax relief – regardless of the cost of your policy. However, since October 16, anyone who renews or buys private health insurance will only get tax relief on the first €1,000 of an adult’s premium, and the first €500 of a child’s premium.
So if you’re paying more than €800 a year (after tax relief) for an adult’s premium, and more than €400 for a child’s premium, you’ll be caught by the new cap.
“Most plans for adults are priced at between €1,200 and €1,500 a year,” said Aongus Loughlin, head of healthcare and risk with Towers Watson. “Most children’s plans will be covered by the €500 limit.”
To avoid getting hit by the cap in tax relief, consider moving to a plan that costs no more than €800 a year per adult once the tax relief has been deducted from the cost of the plan.
Loughlin said it was hard for an adult to find good private health cover for less than €800 a year. However, some plans he recommended that are just below the €800 mark are VHI’s Company Plan Starter, Aviva’s Health Level 1, Laya’s Essential Choice and Glo’s Good Plan.
“These are all plans aimed at the public hospital access side of things but a number of them will provide some access to private hospitals,” said Loughlin.
Remember if you’re moving to a cheaper plan, you will usually be losing some benefits in doing so.
“You’re probably going to lose access to semi-private and private hospitals – and if you need hospitalisation, you’ll pay more of the bill than you did previously,” said Loughlin.
THE LITTLE TERRORS
If you’ve children under the age of five, the free GP care, which is expected to kick in next year, could save you a small fortune.
If you’ve got private health insurance for your family, the free GP care for under fives could make any cover you have for your children’s everyday medical expenses redundant – if they’re all under five. You’ll save money by stripping out the cover for day-to-day expenses and moving to a plan that only covers hospital care.
For example, a family of two adults and two children could save as much as €325 a year by stripping out their children’s cover for everyday medical expenses, depending on the policy, according to Goode.
Before stripping out day-to-day medical cover for your child, remember the free GP care covers just that – visits to your child’s GP.
If most of your child’s everyday medical expenses don’t arise from GP visits, it could be a mistake to strip out their day-to-day cover from your private health insurance.
Nova/UCD start-up adds nearly €37m to the Irish economy
Days after the launch of the first of seven State-backed scientific research centres, new findings have demonstrated the value of commercialising university research.
UCD start-up incubator Nova has supported 1,000 Irish jobs and contributed nearly €37m to the economy, according to a new study.
It provides support for hi-tech start-up companies and commercialises research from UCD academics. The release of findings on its contribution to the economy coincides with Nova-UCD’s 10th anniversary.
Since 2003, UCD has agreed 81 licensing deals with Irish and international businesses and filed 318 patent applications.
Some 30 new spin-off companies have been directly created from this research, while another 126 start-ups have used Nova’s incubation services.
Today these companies have a combined annual turnover of €71.2m and have raised €91m in equity funding. They expect to create 851 new jobs over the next three years, with 630 of these to be based in Ireland.
New Alzheimer’s study reveals eleven new genes implicated in disease
Researchers from Wales have helped uncover 11 new genes linked with Alzheimer’s in a major breakthrough into the causes of the disease.
Scientists from Cardiff University jointly led an international collaboration gathering data from more than 74,000 people – the largest ever study of its kind – as part of a two-year project, the findings of which are published today.
The academic group, headed by Merthyr Tydfil-born professor Julie Williams, has helped discover a record 11 new susceptibility genes linked with Alzheimer’s disease.
It is said the breakthrough will significantly increase knowledge of the disease and lead to a better understanding of its disordered functional processes while throwing open new research avenues.
The work gives researchers an unprecedented view of the biological pathways that drive the neurodegenerative disorder, and raises the prospect of a test that could determine a person’s susceptibility to the disease. Such a test could be helpful in the future if preventative drugs become available.
The scientists found many genes already implicated in the disease, including APOE4, which is strongly linked to late-onset Alzheimer’s. But 11 of the gene regions had never before been linked to the disorder.
Alzheimer’s disease is the most common form of dementia and affects around 500,000 people in Britain. An irreversible degenerative disorder, the condition takes hold when areas of damage and tangles form in the brain that cause nerve cells to die off. The disease causes memory loss and confusion and ultimately leaves patients needing full-time care. One in 14 people over the age of 65 are affected.
The findings reveal a complex disease that is driven by changes in inflammatory responses, the immune system, the way proteins are handled in the brain and how neurons talk to one another.
Among the most intriguing results from the study published in Nature Genetics is the discovery of a risk-raising gene involved in the immune system which is already thought to put people at greater risk of multiple sclerosis and Parkinson’s disease. “This helps us understand the pathophysiology of the disease,” said Amouyel.
“If we are able to develop preventative treatments for Alzheimer’s disease, they would need to be used very early on,” said Amouyel. “This could help us identify people who are more prone to the disease by estimating their individual risk.”
James Pickett, the head of research at the Alzheimer’s Society, said the work opened up new avenues to explore in the search for treatments for the condition.
“This truly global effort has doubled the number of genes linked to Alzheimer’s and showed what can be achieved when researchers collaborate. We now need continued global investment into dementia research to understand exactly how these genes affect the disease process,” he said.
New light shed on how our genes can shape the development of our face
Thousands of small regions of DNA influence the way facial features develop
Scientists are starting to understand why one person’s face can look so different from another’s.
Working on mice, researchers have identified thousands of small regions of DNA that influence the way facial features develop.
The study also shows that tweaks to genetic material can subtly alter face shape.
The findings, published in Science, could also help researchers to learn how facial birth defects arise.
The researchers said that although the work was carried out on animals, the human face was likely to develop in the same way.
Professor Axel Visel, from the Joint Genome Institute at the Lawrence Berkeley National Laboratory in California, told BBC News: “We’re trying to find out how these instructions for building the human face are embedded in human DNA.
“Somewhere in there there must be that blueprint that defines what our face looks like.”
Switch off: the international team has found more than 4,000 “enhancers” in the mouse genome that appear to play a role in facial appearance.
These short stretches of DNA act like switches, turning genes on and off. And for 200 of these, the researchers have identified how and where theywork in developing mice.
Prof Visel said: “In the mouse embryos we can see where exactly, as the face develops, this switch turns on the gene that it controls.”
Transgenic mice revealed how genes affected the face during development
The scientists also looked at what happened when three of these genetic switches were removed from mice.
“These mice looked pretty normal, but it is really hard for humans to see differences in the face of mice,” explained Prof Visel.
“The way we can get around this is to use CT scans to study the shapes of the skulls of these mice. We take them and scan their heads. then we can measure the shape of the skull of these mice and we can do this in a very precise way.”
By comparing the transgenic mice with unmodified mice, the researchers found that the changes were very subtle. However some mice developed longer or shorter skulls, while others have wider or narrower faces.
“What this really tells us is that this particular switch also plays a role in development of the skull and can affect what exactly the skull looks like,” he explained.
Designer babies?
Understanding this could also help to reveal why and how things can go wrong as embryos develop in the womb, leading to facial birth defects.
Prof Visel said: “There are many kinds of craniofacial birth defects; cleft of the lip and palate are the most common ones.
“And they have severe implications for the kids that are affected. They affect feeding, speech, breathing, they can require extensive surgery and they have psychological implications.”
While some of these are caused by genetic mutations, the researchers want to understand how the genetic switches interact.
Professor Visel added that scientists were just at the beginning of understanding the processes that shape the face, but their early results suggested it was an extremely complex process.
He said it was unlikely in the near future that DNA could be used to predict someone’s exact appearance, or that parents could alter genetic material to change the way a baby looks.
Schools were called on to:
The number of wild royal Bengal tigers in Nepal has increased to 198, a 63.6 per cent rise in five years, a survey of the big Cats shows.
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