Irish Fucking Health Service Once Again

The state of the Irish health service and the incompetence of its staff can be illustrated by this tragic story:

http://www.irishtimes.com/newspaper/ireland/2009/0103/1230842386932.html

THE FAMILY of a woman who collapsed and died while
waiting for a bed in the accident and emergency department of the Mater hospital has engaged the services of a pathologist, an inquest heard yesterday Beverly Seville-Doyle (39) of Priory Walk, Manor Grove, Whitehall Road, Dublin, left her chair in the AE department of the Mater on the morning of January 15th, 2008, to use the toilet.

Minutes later she collapsed and medical staff, who rushed to her aid, found the woman, who had diabetes, in a deeply unconscious state. Efforts to resuscitate the mother of three continued for an hour but, despite all efforts, she was pronounced dead.

Yesterday, the solicitor for Mrs Seville-Doyle's family, Damien Tansey, told Dublin City Coroner's court the family had instructed his firm to engage the services of a pathologist.

He told the inquest the pathologist commissioned by
the Coroner's Office to carry out an independent autopsy was an employee of the Mater hospital and was not "an independent witness".

Dublin city coroner Dr Brian Farrell disputed this and said a pathologist carrying out coroners' autopsies is required to be independent, give evidence under oath and give true evidence.

When the inquest opened in December, pathologist Dr Michelle Harrison, who supervised a postmortem on the deceased, said Mrs Seville-Doyle had suffered a sudden cardiac death secondary to enlargement of the heart muscle tissue in a patient with diabetes and high blood pressure. This is disputed by the family.

She also found the deceased had small clots in her lungs, which were not large enough to cause death. Mrs Seville-Doyle presented at the Mater two weeks before her death with severe chest pain.

Giving evidence yesterday, Dr Kate Douglas said Mrs Seville-Doyle presented at the AE department of the Mater at 11.21am on December 29th, 2007, complaining of left-sided chest pain. She said the deceased described this as intermittent, dull, non-pleuritic pain with no associated featured such as shortness of breath, coughing or sputum production.

She also complained of nausea and general lethargy for
two days prior to her presentation, she said.

Mrs Seville-Doyle underwent a number of investigations at the facility, including a chest X-ray, an electrocardiogram, full blood count and arterial blood gas reading, all of which were unremarkable.

Tests revealed she had a urinary tract infection, for which Mrs Seville-Doyle was prescribed antibiotics.

A D-dimer test, which if elevated can indicate clotting problems such as a deep vein thrombosis, was mildly elevated at 313, but Dr Douglas said swelling at the injection site where Mrs Seville-Doyle injected insulin and her infection could also account for the increase.

Questioned by Mr Tansey, Dr Douglas agreed yesterday that
Mrs Seville-Doyle was overall a patient at high risk of a pulmonary embolism (a blood clot in the lungs), but that when she saw her on December 29th, she was not concerned about a cardiac event or a pulmonary embolism, and felt that, clinically, Mrs Seville-Doyle's chest pain was most likely musculoskeletal in origin. Dr Douglas said Mrs Seville-Doyle was at low risk of a pulmonary embolism when she saw her in December.

Dr Douglas said there were no objective findings that supported a diagnosis of a pulmonary embolism, such as changes in the electrocardiogram.

Mrs Seville-Doyle was discharged with antibiotics and pain medication and advised to return if she experienced further pain.

The coroner said he would need to make sure all the facts were before the inquest before "we can assume whether the D-dimer test is as significant as you believe it to be". He adjourned the inquest until a date in January.

A further two days have been set aside in February.

From this, we see that the relevant symptomatic and diagnostic information relating to Mrs Seville-Doyle’s symptoms were:

• left-sided chest pain
• nausea
• general lethargy
• female
• age 39
• diabetes
• high blood pressure
  

So I decided to check the diagnosis given by the not so competent Dr Kate Douglas against some online diagnostic tools. A fair test? Why not? Why should doctors arrogate to themselves the right to diagnose medical conditions but not accompany this with the requisite competence and effectiveness? Why should the opinions of doctors not be questioned?

The results from these online tools were:

http://www.myelectronicmd.com

Angina Pectoris
Pericarditis
Myocardial Infarction

http://symptoms.webmd.com/symptomchecker

Seek medical attention immediately

http://www.easydiagnosis.com/

Coronary Disease or Heart Attack 55%

http://www.nhsdirect.nhs.uk

Seek emergency help immediately - ring 999 and ask for an ambulance

http://familydoctor.org/online/famdocen/home/tools/symptom.html

EMERGENCY. CALL AN AMBULANCE RIGHT AWAY.

They all got it right. A valid test? I believe so.

So, we can replace Dr Kate Douglas and all the other incompetent staff with a laptop and a broadband connection. We can coattail on the medical infrastructure in other countries for free and get a better service. We can save money and get a better service.

National Consumer Agency Petrol and Diesel Price Analysis

The National Consumer Agency (“putting consumers first”) has published a report on diesel and petrol prices – see Investigation into Petrol and Diesel Price Movements 19 December 2008 http://www.nca.ie/eng/Research_Zone/Reports/Investigation_into_petrol_and_diesel_prices.html.

This turgid document has completely failed to identify and analyse the correct and relevant information to draw a correct conclusion on retail diesel and petrol prices.

The report is an example of detail used to hide an absence of relevance and a failure to grasp the details involved.

The NCA analysis was performed over a very limited four week interval and fails to take a longer term view on petrol and diesel price movements. They failed to identify trends in buy and sell prices of petrol and diesel. As a result the NCA failed to reach the correct conclusion.

There is little evidence to suggest unwarranted delays in the passing on of wholesale price changes to the consumer at the pump.

If this were correct there would be little variability in the margins being achieved by retailers. This is not the case. For a more detailed and relevant analysis, see the following Irish Diesel and Petrol Price Analysis December 2008.

For substantial intervals, buy price falls have clearly not been passed on in the form of reduced sell prices. Price increases are however passed on quickly. Price reductions are passed on slowly if at all. There have been long intervals when falls in the cost price have not been matched by falls in the price charged.

This clearly demonstrates the inadequacy of the analysis performed by the National Consumer Agency. This is an example of the quality of work of Irish civil servants.

Putting consumers first my arse.

What Ever Happened to Basel II

Basel II, the invention of the Bank for International Settlements (www.bis.org), and more correctly entitled International Convergence of Capital Measurement and Capital Standards: a Revised Framework, has so clearly and substantially failed.

And yet this has received almost no publicity. The Banks fucked up. As did the Financial Regulator and the Central Bank.

For those of you who are interested Basel II was intended to ensure that banks made provision for risks more effective and sensitive. The original report is available here. It is quite readable with a little effort, even for a non-banking person. It included a detailed frame work for all types of risk: operational risk, credit risk and market risk. It was intended to manage what is called “regulatory capital” . The capital ratio is the percentage of a bank's capital to its risk-weighted assets (RWA). Weights are defined by risk-sensitivity ratios detailed in the Basel II document. The core idea of risk-weighted assets is a move away from having a static requirement for capital adequacy. The approach is intended to be more flexible and is based on the riskiness of a bank's assets. So loans of various types have different risks. Loans secured by a letter of credit would be weighted riskier than a mortgage loan that is secured with collateral, assuming that the collateral had a realisable value. In calculating risk the assumed value of such collateral is reduced by what is called a haircut based on its volatility.

Irish financial institutions spent between €1 billion and €2 billion on implementing Basel II. The lower number is derived from the pure costs – software licences, consulting fees, additional hardware and other direct costs. The higher value would include an allowance for the time of personnel of the institutions working on its implementation.

For consulting and software companies – Accenture, BearingPoint, IBM, SAP, SAS and so on, Basel II represented a sloshing, lumbering gravy train. It was a fee-earning bonanza along the lines of the Year 2000 problem. These companies parasitised and devoured the floundering corpses of the institutions while the institutions accepted the huge costs.

And all for absolutely nothing.

Basel II is based a "three pillars" concept:

1. Minimum capital adequacy requirement to handle risk
2. Supervisory review by the appropriate regulator
3. Market disclosure and discipline

It failed in all three:

1. Not enough capital to handle actual risk
2. Incompetent regulator that could not or did not understand or act upon the inadequate information being made available
3. A market that failed to examine the incorrect information being presented and the schemes to avoid capital adequacy

At a very high level, the basic structure of Basel II is:

For example, under the Foundation Internal Rating-Based Calculation Approach for calculating Credit Risks banks are required to use regulator's prescribed LGD (Loss Given Default) parameters required for calculating the RWA (Risk Weighted Asset). Then total required capital is calculated as a fixed percentage of the estimated RWA. It is all very simple, if implemented, measured, monitored, reported on and understood correctly.

Banks estimate the PD (Probability of Default) for loans.

They also calculate Exposure at Default (EAD) or the extent to which a bank may be exposed in the event of a default.

It is a wonderfully complex framework that should be flawless in its structure and execution.

For example, for some details on how AIB approached the implementation of Basel II, see here.

What about all the commercial lending so extravagantly and incontinently indulged in by backs. This is called HVCRE or High-Volatility Commercial Real Estate

Paragraphs 227 and 228 of the BIS Basel II report contains the following:

227. High-volatility commercial real estate (HVCRE) lending is the financing of commercial real estate that exhibits higher loss rate volatility (i.e. higher asset correlation) compared to other types of SL (specialised lending). HVCRE includes:

Commercial real estate exposures secured by properties of types that are categorised by the national supervisor as sharing higher volatilities in portfolio default rates;

Loans financing any of the land acquisition, development and
construction (ADC) phases for properties of those types in such jurisdictions; and

Loans financing ADC of any other properties where the source of repayment at origination of the exposure is either the future uncertain sale of the property or cash flows whose source of repayment is substantially uncertain (e.g. the property has not yet been leased to the occupancy rate prevailing in that geographic market for that type of commercial real estate), unless the borrower has substantial equity at risk. Commercial ADC loans exempted from treatment as HVCRE loans on the basis of certainty of repayment of borrower equity are, however, ineligible for the additional reductions for SL exposures described in paragraph 277.

228. Where supervisors categorise certain types of commercial real estate exposures as HVCRE in their jurisdictions, they are required to make public such determinations. Other supervisors need to ensure that such treatment is then applied equally to banks under their supervision when making such HVCRE loans in that jurisdiction.

Duh. Where was the regulator when all the HVCRE lending was taking place that has so endangered Irish banks? Where were the banks' risk departments? Will anyone take responsibility? Will they fuck?

Never Trust a Barrister

Once again, we are seeing the results of appointing a barrister to a senior ministerial role.

Barristers are sole traders. They do not operate in teams. Barristers work on highly technical and specific aspects of problems in a rareified environment. They do no see a problem from initial definition to final resolution. Once the specific problem has been resolved they move on to the next problem without having to deal with the consequences of its implementation. Barristers are also not held accountable or responsible for their failures. They get paid anyway, irrespective of whether they win or lose a case. In the case of a loss, they might get paid less but still they get paid.

In 2004, Michael the Mouth McDowell made the comment that that gangland murders were on the decline and their activities represented “the last sting of the dying wasp” and presided over a substantial increase in crime, especially murder and manslaughter:

2004 – 45 or 1.11 per 100,000 of population
2005 – 65 or 1.57 per 100,000 of population
2005 – 67 or 1.58 per 100,000 of population

Now Brian Lenihan is demonstrating his incompetence in handling major issues. He is raising taxes when the rest of the world is reducing them. He is failing to demonstrate any leadership in handling the issue of bank capitalisation.

Misoxenia

I have to say that the use of xenophobia to mean hatred of foreigners annoys me. The word means fear of strangers or foreigners. There is a need for a separate word to describe hatred of foreigners for which I propose misoxenic.

So there. Pendantic moi? Non, bien sur.

Irish Retail Petrol Price Analysis

The purpose of this analysis is an attempt to answer the question regarding how abnormally expensive Irish petrol prices are. This analysis is restricted to 95 Octane unleaded petrol. The attached document contains the detailed results of this analysis. Performing this analysis involves gathering data from multiple sources:

• Price of crude oil – normally priced in USD
• Price of unleaded petrol (called EN 228 in the industry) – normally priced in USD
• USD to EUR exchange rates
• Effective excise and VAT rates
• Average selling price per litre

This information has to be normalised across changes in currency type and dates on which the information is available.

The EN 228 standard is defined by the Committee for European Standardisation – see http://www.cen.eu/. The relevant standard is EN 228:2008 - Automotive fuels - Unleaded petrol - Requirements and test methods and EU Directive 98/70/EC.

Similarly, diesel is defined by standard EN 590 EN 590:2004 Automotive fuels - Diesel - Requirements and test methods and EU Directive 93/38/EEC.

EN228 is priced in USD per tonne. A tonne of petrol is about 1,335 litres. (This can vary because the specific gravity of EN228 can vary from 720-775 Kg/cubic metre. A cubic metre is 1,000 litres so 1 tonne or 1,000 Kg represents from 1,389 to 1,290 litres. I have used a value of 1,335 litres of petrol per tonne.)

Excise duty increase in increments over the analysed interval. The Oct 2008 budget increased duty (before VAT) to €0.5088 per litre. Prior to that it was €0.4427 per litre for about three years. And so on.

The price of petrol consists of the following elements:

1. Buy price of litre of petrol
2. Excise duty
3. National Oil Reserves Agency levy of €0.01 per litre
4. Margin added by from retailer and supplier
5. VAT

according to (1 + 2 + 3 + 4 ) x 5. However, the public buy price of petrol is not necessarily the price at which it is bought by retailers. Many retail petrol companies are part of larger entities that have direct access to the raw material and refining resources. But the calculated buy price is still a valid index against which sell prices can be compared. This is the price you and I would buy bulk refined fuel for resale at. Having stated this, the difference between the actual sell price of a litre of petrol at petrol stations and the derived buy price based on the public price of bulk refined petrol should be roughly constant. This is not the case as shown in the following chart (Click on the chart to see a larger version):

The left-hand scale shows the sell price. The right hand scale shows the buy price.

There have been long intervals when falls in the cost price have not been matched by falls in the price charged. Price increases are however passed on quickly. Price reductions are passed on slowly if at all.

So, the answer to the question “Are Irish motorists being ripped off?” is a fairly certain yes. The answer to the question “Are the Government doing anything to question retail petrol prices and ensure savings are passed to motorists?” is a definite no.

20th Century … The Century of …

The 20th century was the century of many greats. The largest population, the largest economic growth, greatest wealth, greatest advances in the sciences and in technology, the development of real medicine, the largest population, the largest number of wars with the greatest losses of life. But in the midst of these firsts and greatests is one that is so overpoweringly depressing and represents such a immensity of unjustified suffering. The 20th century was the century of genocide, mass civilian murder and racial, cultural, national and tribal purgings. The attached list shows just the largest of these events. It is also far from complete.

Starting with what is called the most forgotten mass extinction event of the 20th century – the systematic officially sanctioned casual murder of millions of citizens of the Congo Free State, an event that we should all remember given that it was exposed by our own Roger Casement – the number of mass murder events and the numbers killed increased unremittingly throughout the century.

This lists excludes deaths from events such as famines that were not explicitly man made - so the Ethiopian famine of the 1980s is not listed here – and events such as pandemics and combatants in wars. This list represents the larger events of the murder of civilians purely for their own sake, where even the feeble context of external justification has been removed.

The Turks feature three times: once for the well-known and now much denied Armenian genocide, recalled only because of the probably apocryphal statement by Hitler questioning who remembers the Armenians, to the less known and now long-forgotten Assyrian and Pontic Greek massacres.

Stalin ordered millions to their deaths just to fill quotas with the reasoning that because there must be a certain number of traitors in a given area, that number must be found and killed.

You’d think it would be hard to kill hundreds of thousands of people in circumstances where you are not using military and mechanistic tools and insulated by distance but evidently it is far from difficult. Statements such as “it is inconceivable that …” fall away to irrelevance in the face of the unstoppable sequence of mass slaughter events. The Croatians brutally and physically murdered hundreds of thousands of Serbs from 1941 to 1944. The Serbs then revisited this brutality on the Bosnians 50 years later.

It is so hard to tolerate the thought of the accumulated personal pain that these deaths represent.

Critics may decry the world standing idly by as the Rwandan and Bosnian massacres took place. But the world has stood idly by and continues to remain disinterested and uninvolved as these events continue.

The ease with which a society turns from apparent civilisation to gorging on mass murder may seem extraordinary but the reality demonstrates it is so ordinary and routine. The frail restraints of civilisation are so simply snapped and what is then unleashed is appalling. I was going to write unimaginable but again history demonstrates that it can be both imagined and then effected so very easily.