Vol. 453 No. 5
1 Mrs. Geoghegan-Quinn asked the Minister for Health if he will consider compensation claims for people infected with hepatitis C through blood transfusions; if he will meet with the infected people; and if he will make a statement on the matter. [9558/95]
3 Ms O'Donnell asked the Minister for Health, in view of the recent reports of 10,000 doses of anti-D being manufactured from a donor later found to be HIV positive, if he has satisfied himself that Irish women who received their anti-D from such a source are not at risk to HIV infection; and if he will make a statement on the matter. [9561/95]
7 Kathleen Lynch asked the Minister for Health if his attention has been drawn to the concerns that those infected with hepatitis C as a result of blood transfusions may have to bear considerable expenses relating to time lost from work because of their illness and related treatment, travel and medical expenses and other such expenses; if his attention has further been drawn to the fact that the Blood Transfusion Service Board has made no effective efforts to trace the source of victims' contamination; if his attention has further been drawn to the fact that victims have considerable difficulty obtaining information either by letter or telephone from the Blood Transfusion Service Board; his views on whether the counselling service now being offered by the Blood Transfusion Service Board is adequate; the proposals, if any he has to remedy these deficiencies; and if he will make a statement on the matter. [9272/95]
17 Mrs. Geoghegan-Quinn asked the Minister for Health if he is considering referring his files on the hepatitis C scandal to the Director of Public Prosecutions, especially in view of the latest revelation that the Blood Transfusion Service Board only notified his Department officially nine years after it learned that an anti-D donor was HIV positive. [9452/95]
26 Mr. L. Fitzgerald asked the Minister for Health if his attention has been drawn to the case made by a group called Transfusion Positive representing people who have contracted hepatitis C through infected blood transfusions; if his attention has further been drawn to the fact that such sufferers face an uncertain, if not somewhat sinister future; his views on whether they are experiencing a similar unexplainable trauma to that of other groups; if his attention has further been drawn to the fact that this group is extremely disappointed at the alleged failure of the Blood Transfusion Service Board to trace the source of their contamination and at the quality of counselling and information input that has been made available to them from the board; and if he will make a statement on the matter. [9271/95]
28 Mr. O'Malley asked the Minister for Health if he has satisfied himself that counselling services are now in place in all areas for women who contacted hepatitis C from anti-D; and if he will make a statement on the matter. [9457/95]
30 Miss Quill asked the Minister for Health if compensation will be paid to women and men infected with hepatitis C through blood transfusions; the testing and counselling provisions that have been put in place for them; and if he will make a statement on the matter. [9465/95]
45 Mr. Gregory asked the Minister for Health his response to the concerns expressed by the group Transfusion Positive who represent persons who contacted hepatitis C through infected blood transfusions. [8322/95]
46 Mr. D. Wallace asked the Minister for Health, in relation to women who are now virus-positive for hepatitis C as a result of receiving infected anti-D vaccination, the number who have been blood donors since their infection; if all their donations have been traced; and if the recipients have been screened for the virus. [9527/95]
Limerick East): I propose to take Questions Nos. 1, 3, 7, 17, 26, 28, 30, 45, and 46 together.
Treatment for those diagnosed positive for hepatitis C, irrespective of the source of infection, is being provided at the following six designated hospitals:— Beaumont Hospital, Dublin; Mater Hospital, Dublin; St. James's Hospital, Dublin; St. Vincent's Hospital, Dublin; Cork University Hospital; and University College Hospital, Galway.
The treatment may initially involve an out-patient visit which may be followed by a short admission for clinical investigation and follow-up treatment, if required.
The treatment, including prescribed medication, is being provided by the public hospital service free of charge. A counselling service is available at the following locations: Dublin, Cork, Limerick, Tipperary, Clare, Donegal, Wexford, Sligo, Mayo, Galway, Cavan-Monaghan, Westmeath and Kilkenny.
The Blood Transfusion Service Board (BTSB) will arrange transport for people from Meath, Kildare and Wicklow to attend at the BTSB or the Well Woman Centre for counselling.
Arrangements for counselling may be made by contacting the Blood Transfusion Service Board (BTSB) or by contacting a general practitioner. The counselling service arranged by the BTSB is currently being reviewed to ensure that the service is responsive to the great variety of needs of those diagnosed positive for hepatitis C.
The services put in place for persons who have tested positive for hepatitis C will be available for as long as they are required. The needs of those who have been diagnosed as positive for hepatitis C will be monitored and re-assessed on an on-going basis to ensure that the necessary support services are provided to meet their needs.
I have asked the BTSB to ensure that information required from the board is forthcoming on request to people with hepatitis C who received blood transfusions or anti-D. In this regard, a free phone service is being operated by the BTSB.
The Blood Transfusion Service Board is currently implementing a targeted look back programme to identify persons who may have been infected with hepatitis C as a result of receiving a blood transfusion. This programme has two phases, the first phase will attempt to identify donors who have tested positive for hepatitis C, the product (red blood cells, platelets or plasma), the hospital to which the product was issued and the recipient. The second phase will trace the recipient with a view to offering screening. Phase one of the programme is well advanced.
The BTSB has advised that it has identified approximately 100 donors to date who were anti-D recipients who may have donated while positive for hepatitis C and whose donations will be traced.
The BTSB is also endeavouring to trace the infection source of those persons who are known to be positive for hepatitis C and who received a blood transfusion in the past.
A limited ex gratia expenses scheme is being operated by the BTSB to ensure that all anti-D recipients are in a position to avail of the screening, counselling and treatment services.
The policy document, A Government of Renewal, included a commitment to fair compensation for women infected by the hepatitis C virus from anti-D. The Government has decided to establish, as a matter of urgency, a tribunal which will assess compensation on an ex-gratia basis in respect of anti-D recipients who are infected with hepatitis C antibodies-virus and the partners and children of these women who are also infected with hepatitis C antibodies-virus.
Other groups who have members who are positive for hepatitis C are also seeking compensation. There is on going consideration in my Department of the position in relation to people who are positive for hepatitis C or who were recipients of blood transfusions. I have met with representatives of Transfusion Positive, who represent 48 blood transfusion recipients who are hepatitis C positive and advised them that decisions in relation to access to the compensation tribunal, when established, for groups other than anti-D recipients will be made in due course. Further discussions will take place in the coming weeks.
The BTSB has advised that there is no evidence that HIV infection can be transmitted through anti-D. Furthermore, worldwide, no cases of HIV transmission have ever been reported with intravenous immunoglobulin.
I am not considering referring the hepatitis C files to the Director of Public Prosecutions.
The Minister stated in the House some time ago that he had accepted the Miriam Hederman-O'Brien report but has he accepted full and complete liability for the injuries caused? Why does he feel that an ad hoc tribunal rather than a statutory tribunal would satisfy the continuing needs of these women and their families, some of whom have children as young as five years?
(Limerick East): There was nothing about liability in the report of the expert group chaired by Miriam Hederman-O'Brien. I have indicated that I would like to proceed to pay compensation to women who have hepatitis C as a result of receiving anti-D product. Women have a perfect right to go through the courts and the setting up of a tribunal does not take away the right of anyone to process her claim through the courts. If they decide to process their claim through the tribunal that I set up, the tribunal will offer compensation by way of full and final settlement but only if that is accepted will recourse to the courts end.
There are advantages for women to process their claim through the tribunal. Previously as Minister for Justice I inherited the difficulties that litigants were experiencing in respect of the Stardust fire and I was involved in setting up that tribunal which expeditiously dealt with between 800 and 900 claims. It was very difficult as cases had been embedded in the courts for years. Women might seek recourse to the tribunal for the following reasons: (1) it will be faster than the courts; (2) because compensation will be on an ex gratia basis the women will not have to prove liability in any way and all they will have to establish is that they were infected with hepatitis C as a result of receiving anti-D product. The argument before the tribunal would be the degree of compensation in proportion to their medical situation and their needs; (3) cases before the tribunal can be pursued in private whereas it would not necessarily be the case before the courts. That is an important consideration because many of the women who have hepatitis C have not told anybody outside their immediate family circle and in a number of cases they certainly have not told their employers in case it would have an adverse effect on their employment prospects.
Does the Minister totally agree with the assertion of the Blood Transfusion Service Board that there was absolutely no risk to Irish women who received one of the 10,000 doses of anti-D from a donor who was later found to be HIV positive? What steps has the Minister taken in the public interest to ensure that the assertion of the Blood Transfusion Service Board is true? Can he stand over the board's competence in this matter given what happened in the past? This was known in 1985 when testing for HIV began but it was not revealed until 17 February 1994. What steps has he taken to independently evaluate the potential risk, which is quite frightening, especially in light of the other shocking revelations about the blood bank?
(Limerick East): Testing for HIV was not carried out until 1985. The Hederman-O'Brien report points out that one donor tested positive. The advice available to me from the Blood Transfusion Service Board and others is that the process of fractionation involved in the manufacture of the immune globulin product removes all risk of HIV infection. While the blood of the donor could be HIV positive the process of manufacturing the anti-D product eliminates any risk. This is the international experience. No cases of HIV transmission from intravenous immune globulin has been reported worldwide. Testing of the product proved negative. In the Munster area 3,000 women were checked and all were negative. I appreciate the way in which the Deputy put the question. It is a frightening topic. All the evidence is that the process involved in manufacturing the anti-D product from the infected donor's plasma eliminates all risk. We are talking about a blood product manufactured prior to 1985 and if there was a risk it would show now in cases of HIV and AIDS. There is no evidence of that.
It is in the interests of the Minister and those infected with hepatitis C to have the matter resolved by a tribunal. Positive Action and the Transfusion Positive group have put this case to the Minister. We must accept, as the Minister does, that these women were the victims of the actions of a semi-State company. Whatever support is available to them must be State guaranteed, not just now but in future. The tribunal must look at injury already caused, future injury, injury that will be caused to the infected children who are as young as five years old, the ongoing health care and counselling that will be necessary. The Minister will not always be the Minister for Health and the women need to be assured that it will be State guaranteed. Does the Minister accept the truth of what I am saying? Will he ensure the tribunal is statutory based?
(Limerick East): I accept that the Deputy's interests are similar to mine. The concerns of the women is the priority issue. A statutory tribunal would not have the flexiblity to deal with individual cases. It is not a case of there being any particular advantage to the State in going the non-statutory route but it would be a more effective way of delivering what may be required. We are having discussions with Positive Action and other groups to see how best to achieve the objective of fair compensation. Under the Infectious Diseases Act, hepatitis non A B, which was the designation prior to 1989 and which would now be deemed to include hepatitis C, is an infectious disease. Any person who has the disease is entitled to free medical care in public hospitals. I am looking at the possibility of giving further statutory help in this area. I do not want to be tied to this but for discussion purposes it may be possible to have a card which would entitle the holder to the same rights as a medical card. I do not know what it would be called but something along those lines which would have a statutory base might be appropriate. I make a distinction between ongoing medical care which the Minister is obliged to provide — regardless of how hepatitis C was contracted — and compensation. We are talking to women, Positive Action and the representatives of other groups. There are advantages in having a non-statutory tribunal which I wish to tease out.
Let us not forget the time factor.
There are nine questions.
The time for dealing with Priority Questions is running out.
Why did the Minister decide not to send the file to the Director of Public Prosecutions? Is it open to another person to do so? The two reports mention activities which would appear to indicate the board is culpable.
(Limerick East): The Bain report is a consultancy one and not relevant to this topic. However, the Hederman-O'Brien report is relevant. It is open to anyone to refer anything to the Director of Public Prosecutions. Deputy Geoghegan-Quinn and others suggested that this bordered on criminal negligence. As I understand it, that is a common law offence. If, as a result of our conversation today, the Director of Public Prosecutions were to take the file, he would not be able to act under statute law. The proof would be “beyond reasonable doubt” and the best that could be established, from a close reading of the report, was that people did not do certain things rather than that people did certain things.
Is that not a matter for the Director of Public Prosecutions?
(Limerick East): It is.
Why did the Minister not send it to him?
(Limerick East): It is not for me to send it or suggest that there are grounds for a prima facie case but that does not prevent anyone else doing so. Many groups represent the women. The Irish Kidney Association and haemophilia groups are also involved. They all receive legal advice but no one has referred anything to the Director of Public Prosecutions.
The Minister should again look at the question of whether the report should be sent to the Director of Public Prosecutions in view of the public concern yesterday about a letter which did not come to light for some time. This is also as a result of a letter which somehow did not come to light either. There are many victims in both cases. Does the Minister accept that there must be extensive, multifaceted counselling and that the level of counselling being provided is not acceptable? Will he confirm that he has asked Positive Action to indicate what is required in this area? Will he ensure that haemophiliacs and kidney patients who have been affected are included in whatever tribunal is set up? What efforts has the Blood Transfusion Service Board made to trace the source of the contamination in its cases? Will he reassure the House——
That should be adequate.
——that the board will respond as a matter of urgency to all the transfusion positive people who have made efforts to get information from it and who have experienced enormous difficulty in getting same?
(Limerick East): I met representatives of both the Irish Haemophilia Association and the Irish Kidney Association and I am disposed to helping them. They have the same access to health care and counselling and the ex gratia expenses scheme as the women from the two anti-D groups. On the question of compensation, unfortunately the members of the Irish Haemophilia Association are going over the same ground — they had difficulties previously with HIV-AIDS. However, they found that the way in which compensation was delivered on that occasion was effective and met their needs. I am discussing with them whether their needs would be best served by inclusion in the tribunal or by something along the lines done previously. I will meet with them again and my officials are in ongoing contact with them.
Similar arguments apply in regard to the members of the Irish Kidney Association. In terms of compensation, their needs would be more similar to those of haemophiliacs than those of the women in Positive Action and other associated groups. There is ongoing discussions between me, my Department and the representatives of various groups and we are trying to fulfil the commitment in the Programme for Government to give fair compensation.
On the measures being taken to check the source of the infection, the primary sources of infection identified in the Miriam Hederman-O'Brien report was from anti-D product from a donor in 1976-77 and from a second donor in 1989. Some of the women who received the anti-D product and contacted hepatitis C subsequently became blood donors. This is where the targeted lookback programme comes in. One is tracing donations of blood from women which would not have gone into blood product and one must look at both men and women in the follow up. Since hepatitis C has only been a recognised manifestation of hepatitis since 1989, some blood donors during the 1970s and 1980s had hepatitis C. There was no way of screening these people out of the system until screening was introduced here in the autumn of 1991. Consequently, there is another trace back here.
Obviously, donors who were active in 1991 when screening was introduced and whose donations were refused as a result of testing positive for hepatitis C are documented and one can trace them. However, one cannot do the same in regard to donors in the 1970s or 1980s as some of them discontinued being donors because they changed jobs, emigrated, died or got married. There is a background level of hepatitis C in every country which has nothing to do with infection from blood. This is a wide, complex and difficult issue and I am proceeding carefully with a view to being fair to everyone.
What about the quality of counselling?
(Limerick East): The quality of counselling has improved substantially. At its last meeting with my officials Positive Action said it had improved significantly and it was much happier now. It said it would draw attention to any inadequacies and we gave a commitment that we would remedy those.
The Minister asked them to draw up proposals.
If we do not have a reply to Question No. 2 immediately it cannot be dealt with.
(Limerick East): That is phase one.
The Chair has been liberal in this matter.
