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Inflated property prices linked to offshore trusts

Positive response to major new programme but fears that implementation will be privatised and community sector organisations sidelined

Pathways to Work effects are unclear though it forces people to take work and join schemes, and assails their morale

The compromised ‘party of conscience’ merits continuing scrutiny

suggestion that Patrick Bruel, a Jewish singer, should be “put in an oven” was a “serious political mistake”

Dublin Coroner returns verdict of medical misadventure in Mater Hospital case. By Rónán Lynch.   The inquest into the death of Dublin woman Maureen Desmond has indentified a number of ways to improve the early diagnosis of, and continuity of care for, women’s cancers. Dublin Coroner Dr Brian Farrell returned a verdict of medical misadventure in the case of the death of Ms Desmond from complications related to uterine cancer at the Mater Hospital in 2011. Stephen Desmond, son of the late Mrs. Desmond has indicated that he intends to take a civil action against the Mater Hospital. The coroner delivered his verdict on September 26, a year after the first hearing of the inquest, and raised issues about lack of clarity in communications between staff and the patient, and missed opportunities for an earlier diagnosis of the cancer that led to Ms Desmond’s death. Ms Desmond’s son Stephen told the inquest of the difficulty he had experienced in gathering his mother’s medical records, and the inquest found that there was no clarity about the hospital’s claims to have made several appointments with Ms Desmond which she did not attend. Ms Desmond’s son Stephen said that they had received no notification of these appointments. The coroner said that a verdict of medical misadventure had no implications of misconduct or negligence, but that his remit included making findings where he could identify what he called “risk factors” that may have altered the outcome of the case. Evidence presented to the inquest showed that there were opportunities for earlier intervention in Ms Desmond’s care – including an opportunity to review her case following the emergence of discrepancies between scans in 2007 and a hysteroscopy in 2008, and an opportunity to diagnose cancer on a CT colonogram in 2009. The coroner’s expert witness told the inquest that it was likely that Ms Desmond already had early-stage endometrial cancer when she first presented to the Mater Hospital in 2008. Despite several tests, the cancer was not identified until the summer of 2010, by which stage it was inoperable stage-three cancer. Evidence presented during the year-long inquest, which the coroner described as very complex, highlighted the problem with accurate and early diagnosis of uterine cancer in postmenopausal women. The inquest, which began in September 2013, heard that in 2007 Ms Desmond began experiencing abdominal pains and cramps and a vaginal discharge and was sent for an ultrasound scan and a CT scan at the Charter Medical Centre later that year. The scans showed a thickened endometrium (or lining of the uterus) of 14mm. In postmenopausal women, a thickened endometrium is a risk factor in the development of cancer, and Ms Desmond was immediately referred to the gynaecological clinic at the Mater Hospital, where Dr William Boyd arranged for her to undergo a hysteroscopy. The inquest heard that nine months elapsed after the 2007 scans before Ms Desmond received the hysteroscopy and biopsy as an outpatient at the Mater Hospital’s Gynaecological clinic. Her son Stephen, who regularly accompanied his mother to the hospital for tests, told the inquest that he had called the Mater a number of times to request the test, which was performed by Dr Moses Abe, a fourth-year specialist registrar under the supervision of consultant gynaecologist Dr William Boyd. Dr Abe was unable to obtain a sample of tissue for biopsy. His medical notes indicated that he found the endometrium (or lining of the uterus) to be atrophic, and he discharged Ms Desmond from the gynaecological clinic. The inquest heard that Dr Abe’s finding of an ultra-thin endometrium did not correspond to the finding of the 2007 scans showing a thickening of the endometrium, though Dr Abe and Dr Boyd both told the inquest that the hysteroscopy was the “gold standard” which overrode the results of the scans. Following the hysteroscopy, there was no further communication between the consultant and his junior doctor. Dr Boyd told the coroner it was not Dr Abe’s duty to report to him, and that any further interaction with Dr Abe would have been unnecessary, as Dr Abe was an experienced doctor and was required to be allowed to work on occasion without supervision. Coroner Dr Brian Farrell called his own expert witnesses, including consultant radiologist Dr Arthur Grey and consultant gynaecologist Dr John Price of Belfast’s Musgrave Park Hospital. Dr Price told the inquest that negative findings from a hysteroscopy did not exclude cancer and that there were other options for dealing with tests that produced conflicting results, as in Ms Desmond’s case. One option was to conduct a review of the results with the medical team. Another was to proceed from an outpatient pipelle hysteroscopy to a D&C hysteroscopy under general anaesthetic to try to obtain a tissue sample for a biopsy. If a D&C hysteroscopy provided no tissue sample, the hospital could continue to an MRI scan, which Dr Price described as the gold standard. Following her discharge from the Mater’s Gynaecological clinic, Ms Desmond continued to experience the same symptoms, and was referred to the Gastroenterology clinic, where she received a CT Colonogram in June 2009. The Mater Hospital found the scan to be normal, and Ms Desmond was diagnosed with Irritable Bowel Syndrome. Dr Price told the court that he had asked Dr Gray to re-examine the 2007 scans and the 2009 CT Colonogram. Dr Gray said that the 2007 scans showed evidence of organ-confined pathology of unknown nature, and that the 2009 CT Colonogram showed evidence of small amounts of metastatic disease in the uterine region. Dr Price told the court it was likely that Ms Desmond already had early-stage endometrial cancer when she first presented at the Mater Hospital. Questioned about the 2009 scan, Mater radiologist Dr Michelle McNicolas told the court that she did not dispute that the 2009 CT scan showed evidence of cancer in the uterine region. She said her concern at the time was to check the scan for colon-related problems. She told the court that

By John Gormley. Labour’s W****loo: political luck comes and goes on the grandest scale. Eventually a tabloid sub-editor will  come up with a headline to sum up the imminent demise of the parliamentary Labour Party. It will involve  some bad puns on water, loos and the party’s final Napoleonic election battle.. Older Labour heads are not giving up the fight and are  standing their ground with a series of statements on the water issue. Pat Rabbitte dismissed the idea of  water  privatisation as a “red herring”; and another Labour grandee, Fergus Finlay, tweeted that the proposal for a referendum was “daft”. Such is the credibility of the Labour party  hierarchy that these statements have been interpreted by a sceptical public in the following way: (a) that privatisation must definitely be on the cards and (b) that a constitutional change to prevent the privatisation of water is eminently sensible. So sensible, in fact, that Labour party senators  broke ranks in the Senate to support a Fianna Fáil motion. The Labour leadership was reported to be “relaxed” about this minor revolt, but the signs are ominous. Many of Labour’s top people are now privately conceding that the game is up. When I asked a Labour Party Minister of Sate last week how the Christmas cards were going, he observed ruefully that he had no supporters left to send cards to. He also gave a brutally bleak assessment of their electoral chances: they’d be lucky to come back with two to five seats, he said. I know the feeling. Let’s call it the Homestore political effect: when you’re electoral luck is gone, it’s definitely gone. Just look at Obama, a president with charisma and  a recovering economy, yet an ungrateful American electorate still gave the Democrats the heave-ho. But, the converse also applies. When you’re electoral luck is in, you can do no wrong in the eyes of the electorate, as evidenced by the spectacular poll results of Sinn Fein. Fine Gael, Fianna Fáil and Labour had all expected that the sustained attacks on Sinn Féin in recent weeks would cause their poll ratings to tumble. But the Shinners have once again confounded their critics. Their continued climb in the opinion polls has shocked their opponents. One Fianna Fáil TD, with whom I spoke, just shook his head in disbelief. They are perplexed and deeply frustrated. I stated in my previous column that the Shinners would learn quickly from the defeat in the Dublin South west by- election. And they certainly have. Both Gerry Adams and Mary Lou McDonald are now standing with the people, declaring that neither will pay the water charge. They must be very  relieved that Alan Kelly won’t be cutting off their water supply or turning down their water pressure. The new minister is desperately trying to present himself as the good cop, as opposed to Big Phil’s bad cop.  The Labour Party media handlers  have also opted for the  set-piece media appearance. We used to call these a ‘standy uppy’. It means you stand before the microphones and cameras of the assembled hacks, deliver a few key messages and make a swift exit. There’s no real probing or scrutiny by journalists allowed. That’s the theory, but there is a downside. If government ministers constantly refuse to do more in depth, sit-down  interviews, frustrated broadcasters on RTE, Newstalk or Today FM have no real choice but to hand over the space to your political opponents. Paul Murphy et al will only be too happy to oblige. They have long understood that water is the defining issue for the people. It’s visible, ever-present and visceral. Every time you make a cup of tea or flush the loo or have a shower, or anytime it rains, the people are reminded of the injustice, as they see it. Capping the cost of the bills may help a little but essentially it’s not the amount but simply the idea of charging for water that angers many voters. The water issue has altered  Irish political landscape in ways that were unimaginable a few short years ago. If the opinion polls are to be believed Fianna Fáil and Fine Gael combined won’t have the numbers to form a government without the assistance of some independents. This would leave Sinn Féin as the main opposition party. It reflects too a European trend as voters’ distrust of and disenchantment  with mainstream parties has seen the rise of AfD in Germany, UKIP in England and host of other anti-establishment parties throughout the EU. Dealing a heavy blow to  Labour party TDs may seem like an attractive proposition to weary and cynical  voters right now, but they could be replacing them with a politics they had not bargained for. Unfortunately, for the Labour Party this is a line of reasoning that seldom works with the electorate.