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Dáil Éireann díospóireacht -
Wednesday, 25 Jan 2023

Vol. 1032 No. 2

Saincheisteanna Tráthúla - Topical Issue Debate

Residential Institutions

Mar is eol don Aire, baineann scéal fada leis na daoine óga a bhí tráth sna scoileanna cónaithe, leis an bhforéigean a rinneadh orthu, leis an obair gan rogha a bhí ann, leis an saol deacair a bhí ann agus leis an dualgas atá ar an Stát feabhas a chur ar a gcuid coinníollacha sa lá atá inniu ann.

The Minister is familiar with the long history of trying to address the abuse, forced labour and difficult life circumstances of the residents of residential institutions. The State has, to a greater or lesser extent, been trying to get to grips with this for many years. The issue that particularly concerns me is the follow on from Caranua, and the lack of action that has taken place in the past short few years. We know that what was first the Residential Institutions Statutory Fund was set up in 2012, and was later renamed Caranua on foot of, if I recall correctly, some of the draft recommendations of the Ryan report being worked on at the time.

The context of this, of course, is that many tens of thousands of children in residential institutions were subject to the most horrific abuse. Their childhoods were effectively stolen from them. Relationships with family were sundered, and in many instances they were forced to undertake significant labour. This left many of those children and survivors, many of whom have unfortunately passed away, in circumstances of hardship, emotional trauma, poverty and ill health. That is the legacy many of these institutions have left. A number of difficulties have flowed from that. Many survivors were dissatisfied with the way Caranua has carried out its business. They felt badly let down and even re-traumatised in some instances, with claims being closed where there was no real basis for closing.

However, the part I want to focus on is the fact that after Caranua was wound down, there was supposed to be a follow on. A group of survivors met with a group of facilitators appointed by the Minister's Department late in 2019 and came up with a number of recommendations. Those recommendations centred around fundamental things such as enhanced medical care or an enhanced medical card, housing entitlements, or a pension, as was the case with the survivors of the Magdalen institutions. Those proposals were submitted late in 2019, which is now more than three years ago. I understand there was one further meeting in late 2020, which the Minister was part of, but there has been nothing since then. They feel badly let down. They feel they are in the dark. I have raised with this with the Minister a number of times and she has informed me there is work going on behind the scenes. However, as far as they are concerned, nothing is happening, and time is not immaterial here. Most of these are older people, some of them are in very poor health, and of course they are worried. As time goes on more and more survivors will pass on and will not be in a position to benefit from any proposals that need to be brought forward.

The vacuum, which is there at the moment, is completely unacceptable. They feel very hurt by some of the issues that arose out of Caranua, and how that was handled. That has been catalogued and reported, but they feel hurt now by the lack of progress, and the lack of feedback they are getting.

I have a final point before I allow the Minister to respond. There is a particular category I will flag, namely, those survivors now living in Britain and elsewhere who feel completely out of the loop. What is the state of play and when are we going to finally get some feedback from those recommendations?

Tuigim féin agus an Roinn Oideachais cé chomh tábhachtach is atá an cheist seo. Tá sé thar a bheith tábhachtach. Tá an-chuid oibre déanta go dtí an pointe seo agus táim buíoch den Teachta as an seans é sin a chur os comhair an Teach seo.

I thank the Deputy and I want to acknowledge his personal engagement and interest in this, and I am fully cognisant of the importance of the body of work ongoing in relation to this. I want to say very clearly at the outset that the views of survivors of institutional abuse must be, and are, central when considering future supports and services to meet their needs. For that reason, as the Deputy will be aware, the Department of Education has been engaged in a structured process of consultation with survivors and survivor groups over a number of years, as he has outlined. This process began with the engagement by the Department of professionally qualified facilitators to undertake a series of consultations with survivors on the themes and issues of most specific concern to them.

The facilitators engaged with more than 100 people and held more than 30 meetings. These meetings enabled survivors to reflect on their experiences, the State's response to the issue of institutional abuse and to make any recommendations they might wish to make. This phase of the process resulted in the submission to the Department of Education of a report entitled Consultations with Survivors of Institutional Abuse and Themes and Issues to be Addressed by a Survivor Led Consultation Group. The report identified a number of priority issues for survivors, including the health needs of an aging population and the need to make services easier to access.

Phase 2 of the process involved the establishment of a survivor-led consultative forum to further consider the themes and issues identified. This was again supported by facilitators who were engaged by the Department of Education. A method the Deputy outlined was for the forum to personally engage with survivors in Ireland, and indeed in the United Kingdom, and to hear directly from them. Officials from my Department have also met with the forum on a number of occasions to discuss its work. I would like to acknowledge the commitment and insight of the survivors who have participated in the consultation process, as well as the support and significant expertise provided by the facilitators involved in the process.

The final report of the forum was submitted to the Department last year. The report has provided a very good insight into the areas where survivors feel that supports are required into the future. As the Deputy will be aware, there are also a number of other published reports highlighting the ongoing needs of survivors and the lifelong difficulties they encounter due to their childhood experiences in residential care. These reports, alongside other relevant submissions, are currently being considered by the Department with input from colleagues from other Departments. Significant resources continue to be devoted to the progressing of this work and will feed into the consideration of proposals to Government in this context.

In parallel with this process, the Department has also been engaging with officials from other relevant Departments to identify existing services which are of particular relevance to survivors and to examine how these services can support survivors into the future. This engagement is also feeding into consideration of proposals to Government which will be progressed in the shortest timeframe possible.

I would also like to note that as part of the State's response to individual's experience of stress as a result of trauma and abuse in childhood, a free professional and confidential national counselling service is operated by the HSE. Full details of this are available on the HSE's website.

I thank the Minister. Before I continue I want to clarify something. The response may have been drafted late last year given that this Topical Issue matter was to be taken last year, which is fair enough, and it might just be an error. The response states that the consultative forum's report was submitted late last year. I would say that should state "in late 2021" because I have a parliamentary question from my colleague, Deputy Paul Murphy, and the response to that written question, which was given in December 2022, suggests the document was submitted "last year". Will the Minister clarify this? Was it submitted in 2021 or 2022? I suspect it was 2021. Obviously, there is a huge difference. If it was late 2022, it could only be a few weeks ago and we could all understand the delay. However, in reality, I think it is almost 13 months since that report was submitted. If the Minister has the information to hand, I would appreciate if she could clarify this.

The response I have received here does not give me a whole lot of new information. These are all ongoing processes but survivors listening in and reading back on this afterwards will be wondering about the timeline and when are things actually going to happen. I have no indication of that here and this is what people need. As I already very clearly outlined, many of these people are older, many are in poor health and some of them are in very poor housing conditions. Some of them are suffering very severe hardship even to this day, despite the efforts of organisations in the past. Counselling and so on is all well and good but that is to do with their trauma and their emotional well-being, and it is important that those supports are there, but these people have material needs as well that have not been fully addressed. The pension, which was provided to the Magdalen laundries survivors, is a huge issue for them. It would provide stability and a decent standard of income in their final years as well as housing and enhanced healthcare as was provided in those other instances. What is timeline and when was that report submitted?

I will be absolutely honest and say that I am very aware of Deputy Ó Laoghaire's personal engagement in relation to this matter. I will not lead the Deputy astray regarding the date. I will check it and get back to the Deputy today with the information. I want to reiterate that I am very cognisant of and I fully understand the importance of the view of the survivors being at the heart of what we are seeking to achieve here. I want to acknowledge that the report of the consultative board, which was a very significant body of work, has been funded by the Department and externally facilitated. The fact that it was externally facilitated is hugely important. There was an independent facilitation of the entire process. Along with other relevant reports and submissions, it is under active consideration by the Department with input from other relevant Departments. Deputy Ó Laoghaire outlined the variety of areas of interest of survivors and he will recognise that they are cross-departmental. We are engaged in a significant body of work. In terms of the body of work and the reports provided, I want to acknowledge that it has been valuable because it is these reports and submissions that are providing an insight into the issues which the survivors have nominated as being of most importance. The Department will continue to work with other Departments in many of the areas the Deputy highlighted, particularly in relation to areas of health and all the different issues that have been raised and were worked through in other instances. It is a significant body of work and it is continuing.

I appreciate that we need the quickest resolution possible to this and I appreciate the urgency. It will be in the shortest timeframe possible. I am happy to keep the Deputy updated in that regard. A significant cross-departmental approach is being taken. In terms of resources, there are other agencies involved, aside from the Department of Education, and we are moving that work ahead as quickly as we can.

Cancer Research

Every year in Ireland around 290 women get cervical cancer. Almost 90 of those women die from it. In women aged from 25 to 39 years cervical cancer is the second most common cause of death due to cancer. It is the responsibility of individuals, families, communities and the State to do everything possible to drive this number down. This week is European Cervical Cancer Prevention Week and an important week to highlight that cervical screening is one of the best ways to protect from cervical cancer. Recognising the importance of this protective measure, the State provides free, regular cervical screening tests to women aged between 25 and 65. I, like thousands of others in Ireland, am used to receiving letters informing me that my screening is due. I cannot emphasise how important it is to make this appointment. We are all busy and rushing around but this screening is a vital part of healthcare.

When discussing this, it is important to acknowledge the CervicalCheck scandal. The tragic death of Vicky Phelan is a symbol of this massive and unforgivable State failure. Her dedication and unyielding spirit brought this scandal to light. We now know that 206 women had developed cervical cancer after having a misdiagnosed CervicalCheck smear test. Of these, 106 were not informed of the initial incorrect results. We are still feeling the impacts of this scandal. While I strongly disagree with the Government's handling of much of this matter, including the adversarial tribunal, the important thing for us as public representatives now is to highlight the reforms of the system and the absolute necessity of regular screening.

There has been reform of the cervical screening programme because of Vicky Phelan and many other women who became involved in the CervicalCheck issue. In Dr. Gabriel Scally's final review of the implementation of changes to the CervicalCheck screening programme, he said that women can have confidence in and should take full advantage of the cervical screening programme. It has saved many women's lives and will continue to do so.

Nonetheless, there were issues raised in the scandal that need to be addressed. Open disclosures are crucial to help prevent the likes of the CervicalCheck scandal in the future. The Patient Safety (Notifiable Patient Safety Incidents) Bill 2019 is the main legislative reform to change the culture of the health service through a system of mandatory open disclosure of serious patient safety incidents. However, that Bill is moving disgracefully slowly given its significance. It was introduced in 2019 under the previous Government and there was a nine month delay between Committee Stage and Report Stage. This legislation needs to be progressed. The Bill needs to be prioritised and advanced immediately.

The other major issue which goes to the heart of the CervicalCheck scandal is the commitment for a national screening laboratory. The HSE response to the final Scally review notes that this lab has been commissioned, however there is long delay for it to be completed. Screenings are still being sent to the United States for analysis and while we are assured by experts that this is an effective and reliable system there is still the Government commitment and the public desire for a national cervical screening laboratory, fully staffed with appropriate medics and scientists. This is essential. Will the Minister of State provide an update on this important matter? Although there are outstanding issues, from the CervicalCheck scandal it is essential that all public representatives align and advocate for everyone to avail of these really important screening processes.

I thank Deputy Cairns for raising this important Topical Issue matter which I am taking this on behalf of the Minister for Health, Deputy Stephen Donnelly. This week marks European Cervical Cancer Prevention Week. This is significant initiative in women's health and it is the first time the world has committed to eliminating a cancer as a public health problem. It is a perfect opportunity to reaffirm the Government's commitment to eliminating cervical cancer as a public health problem for women in Ireland.

The HSE launched Ireland's roadmap to reach the global targets set by the WHO. In Ireland we are already well on the way and we are in a strong position to meet the targets. This is due in large part to the introduction of cervical screening and improvements in early diagnosis as well as our HPV vaccination programme. The incidence and mortality rates from cervical cancer are declining. We are all united in our desire to eliminate this cancer, which is within reach of us. We are one of a small number of countries with the best in class testing and offering HPV screening, and this is more effective than previous screenings. As well as screening we also have a highly effective HPV vaccination programme. Last year the Minister announced an extension to the programme, the Laura Brennan HPV vaccination catch-up programme. It is important to acknowledge the role Senator Martin Conway from Clare played in this. He raised it with me more than three times in the past two years in the Seanad and has been a very strong advocate. This programme now offers an additional opportunity to those who were previously eligible for the HPV vaccine but, for whatever reason, did not get it. The Minister was pleased to show his strong commitment to the elimination of cervical cancer and has invested more than €750,000 through the women's health fund. This is for the strategy, information, and communication campaigns and the new HPV vaccination catch-up portal. Included in this funding is a research element to explore the use of self-sampling of cervical cancer, which may assist in understanding and assessing barriers in marginalised groups when providing cervical screening. Importantly, National Cancer Registry Ireland has reported that, since the introduction of cervical screening in 2008, the incidence and mortality rates for cervical cancer are declining. Women who attended screening were more likely to be diagnosed at an earlier stage.

We know some populations are less likely to take up invitations to screening. CervicalCheck is committed to identifying any barriers to participation and working to overcome these. CervicalCheck regularly runs targeted campaigns to raise awareness among women over 50 that screening is still for them and the importance of taking up screening invitations. Screening at regular intervals is one of the best ways to reduce the risk of developing cervical cancer. It is exciting that we are one of the leading nations in cervical cancer prevention and that we continue to see our programme adapt and evolve. The WHO European regional director, Dr. Hans Kluge, has acknowledged and welcomed Ireland's new roadmap and our commitment, saying they look forward to Ireland as a trailblazer in achieving this ambitious goal. Most importantly, I urge Members to inform everybody, particularly women, parents, and young adults to get informed about the causes of cervical cancer and to understand how HPV vaccination, cervical screening, early treatment and awareness of symptoms are the key tools to fight against cervical cancer. Cervical cancer is preventable and curable if detected early and managed effectively. The HSE is running an extensive social media and communications campaign to highlight that. I am conscious the Deputy has raised issues that I have not addressed in the script and which I will bring back to the Minister, Deputy Donnelly, about open disclosure and the laboratory in Ireland. They were not addressed in the script but it needs to be addressed.

I thank the Minister of State for her response and for her commitment. I would appreciate an update on the laboratory. The Minister of State is also right to highlight that awareness and accessibility are essential to the success of the programme and ultimately to the prevention of deaths. The Department of Health and the HSE must continue to promote and explain the relevance of the service, and this must include multifaceted campaigns to reach everyone between the ages of 25 and 65. The Minister of State mentioned social media initiatives as being important to reach younger cohorts. We need easy to read information to improve accessibility and translated materials to reflect the diversity of people living in Ireland. On this particular issue I am glad the Minister of State is taking the question instead of the Minister for Health. Accessibility is an issue that is continually raised at the Committee on Disability Matters, especially around women's health. Physical barriers around entering GP surgeries or health centres are still common, and the complexity of transport remains a massive obstacle for people with disabilities in accessing healthcare. It is only right the screening service is free, but the Government needs to ensure there are no financial barriers to anyone who needs to access the service, because it is something disabled women have highlighted to the committee. People with a disability often live on fixed and limited incomes and have to pay for taxis and other transport to avail of services, and that sometimes involves delaying appointments or not making appointments, so we need to do everything possible to avoid those situations. While we appreciate the importance of the service, there are more steps the Government and HSE could take to ensure greater uptake and accessibility. I urge the Minister of State to look at those and engage with all stakeholders to develop a truly universal, free and accessible service. It was Disabled Women Ireland in particular who spoke strongly on that at the committee.

I thank the Deputy for giving me the opportunity to come in on that particular piece, and what she has raised is very important. When particular campaigns are being run and women have the opportunity to participate, there should be no barriers, especially when it comes to transport. We know accommodation issues such as access to primary care need to be addressed, particularly where a lady cannot access a particular service for whatever reason. I believe we have learned from Covid-19. We have inreach models and outreach models, so nothing should prevent the opportunity for that person to be supported, especially when it comes to screening. There should be, however, when it comes to all health issues, inreach and outreach options and transport available, which is one matter raised by the Deputy. Transport should not be the sole reason for being able to access it. It is very important that if a person feels there are barriers, he or she should identify those barriers and communicate them, after which we need to address them from a community public health point of view, because that is what it is all about.

Again, I thank the Deputy for raising this in the week that is in it. I pay particular testament to Ms Laura Brennan and her family. I acknowledge again the work the Minister, Deputy Donnelly, has done along with Senator Conway on this issue for the families who have lost loved ones. The Deputy raised many issues that I, as a female, believe strongly need to be addressed in a timely fashion. It should not be adversarial by any manner or means. There should be open disclosure and that legislation should come before us. At the same time, we have the best trained people in the country and we should look at having our own screening in-house and on our own soil.

Ligfidh mé don tríú hábhar Shaincheist Thráthúil seasamh ar feadh nóiméid toisc nach bhfuil an Teachta anseo. Bogfaidh mé ar aghaidh go dtí ábhar Shaincheist Thráthúil uimhir a ceathair.

Fire Service

I will raise an issue about first responders. In Cobh in east Cork, which has a population of approximately 14,000 people, there is a retained fire service but there are no first responders. The fire service is trained in first aid and first response. There was a case over Christmas where someone suffered a cardiac arrest. I spoke to members of the fire service. They were frustrated that they were sitting at home. They were well aware that something had happened but they could not go out to assist that person. In Cobh there is a strong community-led volunteer base including a proactive Tidy Towns committee and an excellent chamber of commerce that is proactive and engaging. As there is only one road in over one bridge in Belvelly, it is sometimes difficult for the emergency services to access Cobh. I will not even go into the ambulances and so on. The crux of the matter is that this service is free to the individual when it comes to an incident. The frustration of the fire services in east Cork and especially in Cobh - that is the one I am talking about - is that they are trained and no one can give them a definitive answer as to why they cannot respond as first responders in such a vital case on an island.

A report published by the Minister, Deputy Darragh O'Brien, The Retained Fire Services in Ireland: a Review of Recruitment and Retention and the Future Sustainability of Service Delivery contained a caption I saved on my phone. It gave a list of items that are not charged anyway. The frustration is that while it is technically a free service to the public, there may be a charge to Cork County Council, it also includes a non-exhaustive list of waivers on incidents. I refer to where the report states "a review should be completed for any potential areas of response work that could be undertaken by the retained fire services for other agencies". I am trying to get a response from the Minister of State or some guidance on who I should go to, on behalf of the people of Cobh and east Cork, to say that if we do not have first responders in an area but have a retained fire service, it is wrong that the latter is not permitted to respond. The fire service is trained and capable of responding. It can respond. Why is it not permitted to?

I thank Deputy Buckley for raising this important matter. I will give an overview of the fire service.

The provision of a fire service in its functional area, including the establishment and maintenance of a fire brigade, the assessment of fire cover needs and the provision of fire station premises, is a statutory function of individual fire authorities under the Fire Services Acts 1981 and 2003. My Department supports fire authorities by establishing policy, setting national standards for fire safety and fire service provision, providing a central training programme, issuing guidance on operational and other related matters and providing capital funding for priority infrastructure projects. Fire services are provided in Ireland by local authorities in accordance with the provisions of the Fire Services Acts 1981 and 2003. Under this legislation, 31 local authorities provide fire prevention and fire protection services for communities through 27 delivery structures. Local authority fire services are delivered by approximately 3,300 local authority staff engaged at 217 fire stations nationwide - they do fantastic work - with 16 of these stations being staffed by full-time firefighters. A further four have a mix of full-time and retained staff and 197 are staffed by retained firefighters, including the one to which the Deputy's issue relates. Responsibility for the provision of emergency medical services, including pre-hospital emergency care, rests with the HSE, which operates the National Ambulance Service, NAS, and emergency departments in hospitals in accordance with health sector legislation and national policy.

Fire authorities created under section 10 of the Fire Services Acts 1981 and 2003 are empowered under section 25 of that legislation to carry out or assist in any operation of an emergency nature. The NAS may call for assistance before its crews reach an incident. Many fire services are equipped with automatic external defibrillators and the majority of fire services have trained their firefighters in cardiac first response and emergency first response to Pre-Hospital Emergency Care Council standards for health and safety reasons. Therefore, fire services personnel in many fire stations are already trained and equipped to a standard that could enable them to respond to life threatening emergencies. Given the infrastructure of fire services around the country and particularly in rural locations, the retained fire service is well placed to assist the HSE with responses to such life-threatening emergency calls.

As Minister of State with policy and legislative responsibility for fire safety and the provision of fire services by local authorities, a primary concern must remain, in accordance with the Fire Services Acts 1981 and 2003, that local authority-provided fire services are meeting their statutory obligations in respect of their primary role in the provision of fire services and fire safety. These responsibilities include the important activity of community and other fire safety initiatives, as well as response to fire and emergency calls such as road traffic accidents, river rescues and chemical or hazardous spills, for example. Fire services generally respond to calls for assistance from external bodies in accordance with protocols operated within the fire services' three regional communications centres. The feasibility of the HSE commissioning fire services outside the Dublin Fire Brigade's area of operations to provide a response service to life-threatening emergency calls in support of the NAS was discussed at national level at the fire services national oversight and implementation group, which comprises fire service management and staff representatives. It produced a discussion document to underpin discussions with the health sector. The document was discussed at the management board of the national directorate for fire and emergency management in July 2018. A number of issues, including the transfer of risk and mechanisms for funding, were raised. These remain as items of discussion with the Department of Health.

Any proposal for formalising this assistance would need to be subject to appropriate governance and cost reimbursement arrangements and to be set in the context of a service agreement between each participating local authority, the HSE and the NAS and must not impact on or adversely affect fire services' primary roles. It is critical that local authority and fire services' resources are not inappropriately diverted from their statutory fire service and fire safety responsibilities.

I thank the Minister of State for his response. I will raise a few points in the short time I have.

The retained fire services are well placed to assist the HSE with responses to such life-threatening emergency calls. There does not seem to be any obstacle to that. The National Ambulance Service is simply protecting its patch. I have not heard of any engagement between it and the fire services. The Minister of State noted "it is critical that local authority and fire services' resources are not inappropriately diverted". It is not that they are inappropriately diverted. This person died while retained fire servicemen and women were sitting at home on Christmas Day knowing that an incident was taking place. It was not possible to get an ambulance onto the island. We are playing politics with people. The National Ambulance Service does not have the capability to contact the fire service. The Minister of State knows where I stand on the HSE. It is bloated at the moment. What I am trying to do here? As a local representative I would like, if possible, to meet the National Ambulance Service, the HSE, Cork County Council and the fire service in east Cork to tell them we need a strategic plan. We are short of certain resources but have the capability to fill those gaps. Yet the Minister of State's concluding statement, as provided, states "Fire services must be confident in their ability to balance commitments so as not to impede capacity to respond to their core statutory responsibility of fire service provision". I, the Minister of State and most people know that most people who are in the fire service, the ambulance service or who are nurses, doctors or clinicians get into it for the love of it and for the attachment they have to it. At some stage in life, something affected them and they wanted to do better for society. The reason I raise this issue is to ask the Minister of State whether it would be reasonable in my capacity to meet these people to address the gaps that are there. People are dying because of red tape between three agencies, when it could be simple to fix. These people are already trained and are willing to respond. I have done the defibrillator courses and so on, so I know what to do. The greatest thing in life is giving life and protecting people. I would like to know if that is possible.

Once again I thank the Deputy for raising the issue. As he identified, my Department recently published a review of retained fire services. That review made a number of recommendations, one of which the Deputy referred to, namely, recommendation 6.

It states, "A review should be completed for any potential areas of response work that could be undertaken by the retained fire services for other agencies." The review's recommendations are intended to support firefighters, improve working structures within the retained fire service and, ultimately, ensure the best service possible for communities that are served so well by the retained fire services.

The work and response profile of the retained fire services has evolved over the years. This can be seen in the increased support for front-line work and in the assistance for other principal emergency services such as the National Ambulance Service, NAS. The scope of such work needs further consideration as necessary in areas such as medical assistance, cardiac first responders, special rescues and support. Fire services would always look to assist other emergency services when called upon. However, there currently exists no formal arrangement between the fire service, the HSE and the NAS to provide a first response service nationally and fire services are under no statutory responsibility to provide those services on behalf of another service. Fire services must be confident in their ability to balance commitments so as not to impede capacity to respond to their core statutory responsibility of fire service provision, prior to formalising any additional service level agreements.

I will follow up on recommendation No. 6. There is a need for a national response and I will take that up with the national fire service to see how we can progress on that recommendation. There is a need for a national response to put formal structures in place. This is something I will follow up on with the national fire service in my capacity as Minister of State.

I congratulate the two new Ministers of State, Deputies O'Donnell and Richmond. I did not get an opportunity to congratulate Deputy Richmond as his Topical Issue matter did not come up.

Cuireadh an Dáil ar fionraí ar 9.52 a.m. agus cuireadh tús leis arís ar 10 a.m.
Sitting suspended at 9.52 a.m. and resumed at 10 a.m.
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