PIAB

Modern people, sportsmen/women excepted, are most at risk of serious injury when travelling on the road. The energy bundled in a motor car, or other vehicle, is considerable. If that energy is suddenly blocked, which is what happens in a typical car accident, it must go somewhere and, unfortunately, it sometimes goes into us. Then you are injured and the nature and extent of that injury is determined by chance.

Make no mistake; as a society, we have planned these accidents. Otherwise we would prohibit such forms of travel. Instead, we build lots of roads and we promote the use and sale of motor cars.

In this sense, it is a misnomer, to call these events “accidents”.

Take a circus, or theatre, knife-thrower.  If the knife thrower “accidentally” throws the knife and stabs his (typically) lovely assistant in the heart, we expect that the police will arrest him and that he will be convicted of a crime. We reject the idea that this is an accident. His implied position, that his only fault lies in that last unintended lapse in his wrist, is rejected.

We know that he arranged everything and we are reasonable in considering that, perhaps, or even probably, he had no lapse whatever in his wrist and intended the injury/death.

It is, among other things, this knowledge of a social responsibility for road traffic accidents that we see expressed in the fact of a Government “4^th Road Safety Strategy” or that the EU is holding a “Road Transport Safety Conference on Serious Injuries” in Dublin.

It is a fact, and we should know it, that, as a society, we can suffer mental aberration on these matters. (“Mental aberration” is a polite term for madness).

I do not just mean politicians’ proposals for Irish farmers to be permitted to drink and drive.

I do not just mean politicians claiming that workers allegedly neglecting road safety be allowed to get on with the job and be freed from “red tape”.

I mean it is a form of mental illness, hypocrisy certainly, to plan for injuries to happen and to claim, in the Constitution, that the State will vindicate the person (meaning bodily integrity) of citizens (and others) and then to establish a statutory body (the Injuries Board, a.k.a., the Personal Injuries Assessment Board) (and maintain it) that seeks to ensure the lowest possible level of success in delivering compensation to those injured persons, and to go further; to shrink the window of opportunity for the injured person to effectively make a claim for that compensation to the inadequate time of two years.

In fact, to term all of this “madness” is politeness.

We should remember that we were not always as “mad” as we currently are. We have a “legal system” that includes a cohort of persons intent on overcoming the State’s lunacy.When it comes to car accidents solicitors (and barristers) are those working for the common good. The persons who intentionally hobbled them in doing what they try to do, namely, vindicate the bodily integrity of road accident and other personal injury victims, cannot be categorised as mad. They are simply working against the common good.

The Injuries Board is also called the Personal Injuries Assessment Board. It was established by statute in 2003.

Every person wishing to recover compensation for a personal injury inflicted by wrongdoers must first apply to the Injuries Board for an assessment of the value of the claim.

The Board has issued an article today (26^th March 2013) and Patricia Byron, Chief Executive, went on Morning Ireland for an interview.

The upshot of the article and the interview is this; personal injury claims are increasing and this is bad.

This sounds like the resurrection of the jibe about “Compo Culture”. That jibe was the cry of persons who wished to deny to injured persons their rightful compensation when they were injured by the wrongful acts of others.

Those persons were successful in their campaigning because they had political friends in high places. The establishment of the Personal Injuries Assessment Board was one of their achievements.

Another was the shortening of the time within which an injured person had to issue proceedings before becoming statue barred from doing so. The time was shortened from three years to two years. (One politician wanted to drop it to one year).

Now the Injuries Board is asserting something is happening that it says is undesirable; that people are being educated to make claims for personal injury.

This is a surprising development. The Personal Injuries Assessment Board has a budget for advertising. Any reasonable person would think that it was part of the job of the Personal Injuries Assessment Board to educate injured persons to make claims for personal injury and to do so to the Board. Clearly, the Board does not think so. It fully approves of the restrictions on solicitors to advertise about personal injury claims. It wants that extended to others; it says those others are “claims agencies”.

Here are some facts:

1. PIAB are precluded from examining liability, but do get information on the facts of accidents. if those facts are not credible or reliable, PIAB can decline assessment;
2. In addition, respondents can and do decline assessment of false claims;
3. Consequently, piab assessments are of valid claims;

What public official can claim to be reasonable when decrying a claimed increase in PIAB claims? These claimants have been injured and want and deserve compensation.

The explanation is this; PIAB is biased against injured claimants.

1. It wishes to leave those persons in ignorance of their rights. (Patricia Byron; RTE’s “Morning Ireland” – 26/3/2013). Ms. Byron specifically complained in that interview that “the thought is being put in their mind”.
2. PIAB charges claimants for an assessment, but can, and does, relieve respondents (wrongdoers) of their obligation to pay, or even to submit to the PIAB system, before making an assessment (or, as should happen, giving the claimant an authorisation to go to court). (See Section 14 (b) of The Personal Injuries Assessment Board Act 2003).

Every six months or so, the Injuries Board issues a press release. These follow a fairly standard formula. The board praises itself for saving notional sums of fantasy money. It castigates dastardly solicitors for representing clients, even though the Constitution guarantees clients that right. It darkly suggests- without providing any evidence- that only its constant vigilance prevents dishonest claims from running riot.

And then, because it probably knows that this sort of thing isn’t much of a hook on which to hang a news report, it lets drop one or two statistics.

But yesterday, without apparently understanding the significance of what it was saying, the Injuries Board let slip a number which suggests that hundreds of people who have been injured because they were fitted with faulty (and now recalled) hip implants made by DePuy are at risk of their claim going statute barred.

Year to date, Injuries Board has received 605 claims in respect of the De Puy hip replacement recall. As a total of 3,500 implants are understood to have been fitted, further claims are likely to arise.

The Press Release goes on to say

The average time taken by InjuriesBoard.ie to make an assessment is seven months.

The reason every one of those 605 people should be concerned is that the Injuries Board has no role in a claim for compensation arising from the DuPuy hip cases.

Section 3 (d) of the Personal Injuries Assessment Act 2004 is very clear that the Act is not applicable to civil claims;

arising out of the provision of any health service to a person, the carrying out of a medical or surgical procedure in relation to a person or the provision of any medical advice or treatment to a person.

If somebody opens up your body, replaces one of your major joints and then sews you up again, we can be fairly confident future claims about what they put in there are going to fall under this exemption.

And, as these sorts of claims are exempted from the entire Act, the provisions of the Act that stop the clock from running against an injured person after they have made an application to the Injuries Board also do not apply.

That clock only lasts two years. After that, the injured recipients of these recalled hips will be prevented from suing those responsible for their injuries. They will be what is known as Statute Barred.

Here’s the description from the NHS of the sorts of injuries those people would be stuck with, without any right to redress:

• pain in the groin, hip or leg
• swelling at or near the hip joint
• a limp or problems walking
• tissue damage from Metal ions (Chrome and/or Cobalt)

The same document confirms a risk of secondary systemic poisoning by the build up of those metal ions

There has been no definitive link between ions from MoM implants and illness, although there has been a small number of cases in which high levels of metal ions in the bloodstream have been associated with symptoms or illnesses elsewhere in the body, including effects on the heart, nervous system and thyroid gland.

The first set of claims in the US settled in August for approximately $200,000 each. These are significant injuries which will result in claims estimated to cost the manufacturers around €1.5 billion, when all is said and done.

Given that DePuy are already (inaccurately) attempting to suggest that there was a deadline in August 2012, anything which further delays these cases from commencing is potentially disastrous.

A seven month delay (the Injuries Board’s self declared average) could be the difference between having a valid claim for personal injury compensation, and having none at all.

The Injuries Board have no part to play in claims for compensation for faulty DePuy hip implants. If claimants or their solicitors erroneously lodge an application with them, it is vital that the Injuries Board immediately reject it. Anything else puts injured people’s rights at risk.

Heat

Overheating or inadequate heating of the body are two aspects of the same problem. The body maintains a deep body temperature of about 36 – 39° C. The system for maintaining the equilibrium of body temperature is called the homeostatic mechanism. It is remarkably effective and over a period of one day, irrespective of the variations in temperature in the surroundings, the body temperature will remain very stable.

It is possible to throw a strain on the homeostatic mechanism, resulting in its breakdown. To understand how this happens, it is necessary to look at how the mechanism works. Its operation is a function of the interaction of;

• Metabolism ;

• Evaporation ;

• Convection ;

• Conduction ;

• Radiation ;

• Storage ;

Metabolic heat is generated by the digestive activity of the body, producing energy from food and, in fuelling the physical activity of the body, more heat is generated from the movement and exercise of the muscles in the course of that physical activity.

Perspiration is produced in the course of strenuous physical activity, thus wetting the skin. Wet skin gives off heat to the air much more efficiently than dry skin, which is the reason we feel chilly on stepping out of a shower and is also the reason we like to run in and out of the sea on a hot summer’s day. The loss of heat through perspiration is called evaporation.

The effectiveness of evaporation will depend on the temperature of the air immediately adjacent to our skin. If the transfer of heat to that air from the body raises its temperature relative to the rest of the body of air, of which it forms part, the heated air will rise or otherwise move, and be replaced by cooler air. This air movement is called convection.

Convection will not function in conditions where the temperature of the air is generally higher than the body.

The body can lose heat directly into solid or liquid surfaces in immediate contact with the body. This is known as conduction.

Radiation is analogous to metabolic heat in that it is a source of heat and increased temperature to the body as opposed to reducing agents like convection, conduction and evaporation. Radiation may have other effects than raising the deep body temperature and these will be referred to later.

Lastly, the body has a capacity to store heat and retain it. Body fat is particularly important in this regard. When it was in fashion, female swimmers of the English Channel tended to be chubby women, a valuable attribute when long periods immersed in cold water are in prospect.

The interaction of all these factors determines the deep body heat of the human person. Of course the need for clothing is clear. Clothing is used around the world to maintain proper body temperature. In the deserts of the Middle East and North Africa the people wear long loose fitting gowns. These protect against the radiant heat of the sun and permit access of air flows to the body to facilitate convection. In Ireland we rely on cosy clothing to protect against cold.

The Symptoms of  Heat Exposure

In the case of a temperature rise, sweating and dilation of the peripheral blood vessels, resulting in skin reddening and more rapid transportation of excess heat to the skin, through the blood circulation system, will occur. Thirst will be experienced with loss of fluid. If the temperature rise continues the worker may feel weak or dizzy.

The Effects of Heat Exposure

Efficiency of workers will begin to fall. Levels of confusion will increase accompanied by an increase in mistakes  in the work in hand. Any of these mistakes can result in injury to the worker or his/her companions or members of the public. Loss of time off work can be reasonably anticipated.

Heat cramps will very likely ensue caused by a loss of salt through perspiration. Continued lack of attention to the problem can lead to heat collapse . There are variations of tolerance between individuals but heat collapse will ensue in more than two thirds of cases where body heat reaches 40-43° C. The worker will abruptly lapse into a coma. He/she will require immediate hospitalisation and immediate attempts to lower the body temperature. If the worker is to survive, his/her deep body temperature must be reduced to at least 40° C.

Radiant heat, apart from raising deep body temperature will damage skin, with skin reddening as the symptom, resulting in soreness and dryness. Cataracts may form in the eyes leading to permanent loss of function.

Dermatitis can arise due to excess temperature or humidity.

People at Risk

Workers at or in foundries or other hot working conditions generally are at obvious risk. Laundry workers  can be exposed to considerable temperatures although without the element of radiant heat from the hot metal of a foundry.

Protection

Shielding of the worker from radiant heat is an obvious remedy to be adopted. Protective clothing may suffice for this purpose although the eyes will need a face mask or goggles. Frequent periods of rest from physical effort will assist the worker in keeping down the generation of metabolic heat. Retreat from the source of the heat and exposure to cooler air will assist in heat reduction through convection. A supply of salt drink will replace the salt lost in perspiration and avoid the onset of heat cramps. Proper organisation of work with planned lowered work rates or lowered periods of work are a necessary step to be taken by the employer.

The National Institute for Occupational Safety and Health

The National Institute for Occupational Safety and Health (NIOSH) is a US agency charged with doing research, assembling knowledge and literature on specific subjects in the field of occupational health and safety. Its twin US agency is the Occupational Safety and Health Administration (OSHA). OSHA is the law-making body for US occupational health and safety. It also enforces those laws.

The NIOSH website records the following:

“In 2007, a total of 5,488 U.S. workers died from occupational injuries (1). Another 49,000 annual deaths are attributed to work-related diseases each year (2). In 2007, an estimated 4.0 million private-sector workers had a nonfatal occupational injury or illness; approximately half of them were transferred, restricted, or took time away from work (3). An estimated 3.4 million workers were treated in emergency departments in 2004 (the most recent data available) because of occupational injuries, and approximately 80,000 were hospitalized (4).

Work-related injuries and illnesses are costly. In 2006, employers spent nearly $87.6 billion on workers’ compensation (5), but this represents only a portion of total work-related injury and illness costs borne by employers, workers, and society overall, including cost-shifting to other insurance systems and most costs of work-related illness.”

And also this:

“Musculoskeletal disorders (MSDs) were recognized as having occupational etiologic factors as early as the beginning of the 18th century. However, it was not until the 1970′s that occupational factors were examined using epidemiologic methods, and the work-relatedness of these conditions began appearing regularly in the international scientific literature. Since then the literature has increased dramatically; more than six thousand scientific articles addressing ergonomics in the workplace have been published. Yet, the relationship between MSDs and work-related factors remains the subject of considerable debate.

Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back will provide answers to many of the questions that have arisen on this topic over the last decade. This document is the most comprehensive compilation to date of the epidemiologic research on the relation between selected MSDs and exposure to physical factors at work. On the basis of our review of the literature, NIOSH concludes that a large body of credible epidemiologic research exists that shows a consistent relationship between MSDs and certain physical factors, especially at higher exposure levels.”

EU-OSHA The European Agency for Health and Safety at Work

The European Agency for Safety and Health at Work (EU-OSHA) is an element of the European Union. Its purpose is that of an integrating and educational authority on questions of occupational safety and health for the EU and EFTA and EU membership candidate countries. It has, for example, produced an iPad App to assist employers in making occupational risk assessment. See it HERE. Its full range of publications on Occupational Safety and Health are available free HERE.

The World Health Organisation

The World Health Organisation (WHO) is a sub-agency of the United Nations. Its purpose is that of a directing and coordinating authority on questions of human health for the world.  It runs a considerable publishing programme on issues germane to its function in 7 periodicals and almost 80 new books every year. Its 2007 Global Plan of Action is HERE.

Occupational health is covered by WHO, often from a technical medical standpoint. It publishes an authoritative series of Health and Safety guides for workers handling industrial chemicals. Chemicals covered include:

• Acrylonitrile  1987

• Chlordane  1988

• Ethylene Oxide  1988

• Dichlorvos  1988

• Aldrin  and Dieldrin  1989

• Vinylidene Chloride  1989

The International Labour Office

The International Labour Organisation (“the ILO”) is the oldest part of the structure. It was founded in 1919 as part of the League of Nations. In 1945 the League of Nations was wound up and the ILO became a sub-agency of the UN. It has its Headquarters in Geneva, in Switzerland and its website HERE (and HERE [for Safety at Work])

In 1959 the ILO established a unit known as ILO-CIS (from it’s French name, Centre International d’Informations de Sécurité et de Santé au Travail) to provide an international source of information on work-related accidents and diseases and the means of preventing them. CIS collects data world wide on the prevention of occupational hazards and distributes it at international level. Many member states of the United Nations have permanent CIS units in their national systems of occupational health and safety. Ireland’s unit is in the Dept. of Labour . These national units send all significant literature on occupational health and safety published in their countries, which is then translated by CIS and entered into the list of publications available for purchase in Geneva. CIS receives approx. 40,000 documents each year under this scheme, of which over 2,000 are entered into the database. Purchases may be made by post or through designated sales agents around the world.

The subjects covered include;

• recognition, evaluation and control of hazards in all industries;

• conditions of work;

• ergonomics;

• occupational medicine;

• toxicology;

• epidemiology;

• industrial safety;

• machine guarding.

Data is available in written form or through computer on-line access HERE. CIS has established a system of Chemical Information  Sheets (IRCIS) furnishing information in the form of “Material Safety Data Sheets ”. There are 70,000 of these already available. Bibliographies on particulars topics are regularly published and may be specially requested on a particular topic for a fee. The full text of a publication and copies of the original may be obtained by quoting a CIS abstract number.

CIS  publish a bimonthly bulletin “Safety and Health at Work” detailing news and developments in occupational health and safety world wide.

The CIS database  is also available on CD-ROM. The compact discs or disc contain up to 600 million characters each. Using a read-only drive unit and a personal computer very substantial sections of the CIS database may be directly accessed on the compact discs.

Ireland was a member of the League of Nations, of which the International Labour Organisation formed part. As an International person, the League of Nations, and later the United Nations, promoted a system of International Conventions. The League had as one of its principles that “universal and lasting peace can be established only if it is based upon social justice”. From its inception, therefore, the ILO promoted conventions intended to improve working conditions. In 1919, the year of its founding the following conventions were opened for signature.

• Unemployment 1919

• Night Work (Women) 1919

• Minimum Age (Industry) 1919

• Night Work of Young Persons (Industry) 1919

Ireland has ratified these Conventions and many more up to the present day. The ILO also has a system of Recommendations, more numerous than the Conventions and Ireland has adopted many of these also. Having so ratified these conventions, Ireland is, under international law, bound to observe their terms and where required, take positive steps to implement them. Of timely relevance is the “Employment Relationship Recommendation, 2006 (No. 198)” which recites;

“Members should formulate and apply a national policy for reviewing at appropriate intervals and, if necessary, clarifying and adapting the scope of relevant laws and regulations, in order to guarantee effective protection for workers who perform work in the context of an employment relationship.”

The National Industrial Safety Organisation (NISO)

NISO was founded in 1963. It is a voluntary body with membership consisting principally of private firms, trade unions and insurance companies. It is in receipt of an annual Government grant from the Department of Jobs, Enterprise & Innovation and has offices at A11 Calmount Park, Ballymount, Dublin 12.

The organisation runs courses and seminars on safety and health at work and has a library of booklets, leaflets and posters. These are supplied either free or for a small fee. It also has a catalogue of films and videos available for hire. Its website is at http://www.niso.ie/

Beaumont Poisons Information Centre

Because Toxicology   (the study of the effects of poisons on biological systems) is a specialised subject, the Dept. of Health has centralised services on this topic in the Poisons Information Centre in Beaumont Hospital in Dublin. The Centre answers written or telephone enquiries from other health workers or agencies or from members of the public. It does not provide a diagnostic or inspection service. The records of the Centre are not of great value as a source of information on the incidence of toxic events in Ireland. It is not a clearing house on such matters. The centre will become aware of an incident only in the event, usually, that a general practitioner or a hospital will seek advice on treatment where poisoning has been diagnosed. Its website is at http://www.poisons.ie/about.asp

The Health and Safety Authority

The Health and Safety Authority is a recent newcomer to Ireland’s governance. It was set up in 1989 under the Safety, Health and Welfare at Work Act 1989.

Its predecessor was the Industrial Inspectorate section of the Department of Labour. The Inspectorate had a relatively narrow remit under the Safety in Industry Acts 1955-1980 and the Mines and Quarries Act 1965. It would have been inadequate for the work required to be done under the Safety, Health and Welfare at Work Act 1989, hence the establishment of the Authority into which the Inspectorate was subsumed.

The duties of the Authority are the administration of the Safety in Industry Acts 1955-1980 and the Mines and Quarries Act 1965, the provisions of the Safety, Health and Welfare at Work Acts 1989-2005, and providing an expert support centre of advice and information on Occupational Safety and Health. It is charged with developing safety training for everyone concerned with work in Ireland. In addition it will promote research and studies into the prevention of accidents and disease at work.

The Authority has a website at http://www.hsa.ie/eng/

Despite limitations, the current best source of information on the rate of death and injury from occupation in Ireland is the Health & Safety Authority.

The major limitation is that employers are required to report incidents to the Authority only when injuries cause four or more days’ absence from work. There is also an underreporting problem.

In 2011, 54 workplace fatalities were reported to the Authority. In that year there were 6,956 cases of reported injury.

However, the figures compiled for 2010 are more significant because they are not limited to the reportable injuries. In 2010, there were 79,287 cases of occupational injury or illness. A little less than half of these were reportable to the Health & Safety Authority.

These figures do not include injuries sustained in road accidents; even when these happen in the course of employment they are rarely recognised as a work related accident.