Dáil Éireann debate -
Wednesday, 26 Jul 1995

Vol. 455 No. 7

Adjournment Debate. - Contaminated Blood Supplies.

Mrs. Geoghegan-Quinn

I thank the Minister for Health, Deputy Noonan, for listening to my please over the past number of weeks about the difficulties which signing the health regulations would have caused, particularly for those in psychiatric care. I am pleased to welcome the climb-down in relation to the regulations.

We must look at the latest controversy about hepatitis C in the same way as the original controversy about Anti D. There is, however, one significant difference. The women who received Anti D were in good health in contrast to those who received blood transfusions because, as we all know, one only gets a blood transfusion if one is seriously ill. That is the first major difference between the two groups.

The contaminated blood was supplied to the second group from the same source, namely the Blood Transfusion Service Board. They suffer the same uncertainties as Anti D sufferers and, in many cases, the prognosis appears to be worse. It is important that the hospitals concerned with the treatment of the transfusion hepatitis C sufferers should be willing to provide all their medical records. As the Minister said, they are entitled to that. However, not all the sufferers have been provided with their full medical records. It is important that the Department and the Minister give a lead to ensure that this becomes the norm in every health board area.

It is important to emphasise that this second group of hepatitis C sufferers includes not only women; but men and children. The services which have already been provided to the Anti D women should be provided to the transfusion hepatitis C sufferers and I include, in particular, out of pocket expenses. I wrote to the Minister earlier this week about one of my constituents. While I will not mention the person's name, I would like to explain the circumstances of the case. This woman has been refused travel and subsistence expenses for hepatitis C testing by the Blood Transfusion Service Board. Her hospital bills, which were not fully covered by the VHI, and which she sent to the Blood Transfusion Service Board for a refund of the outstanding amount have been returned. It said it would only include this group in out of pocket expenses in hardship cases. Many of the people I deal with live in remote areas and must travel some distance for treatment. Often they must get somebody to look after the home and their partner must drive them to the hospital or unit for treatment. It is important that out of pocket expenses are available to them in the same way as it is to Anti D sufferers.

In the light of what we have now discovered, it is important that the Minister implements what he said he would consider two months ago and give them equal access to the tribunal. The Minister has admitted, through the Blood Transfusion Service Board, that there are at least 500 people in this category of which 100 cannot be traced and I would like the Minister to explain why. This creates a difficulty for the Blood Transfusion Service Board in terms of confidence. Each time I spoke on this issue I said that my first concern is for those who have contracted hepatitis C and that my second concern, which is an equal one, is that confidence in the Blood Transfusion Service Board's services and the level of donations should be maintained. That is important because blood is a vital part of the health care system.

I ask the Minister to initiate not only a Lookback study, but an independently chaired study of those infected by contaminated blood through transfusions. That is the only ethical way in which the Minister can restore the confidence in the Blood Transfusion Service Board which has been damaged to some extent.

Minister for Health (Mr. Noonan,

Limerick East): I thank Deputy Geoghegan-Quinn for raising this matter. The health insurance regulations are draft regulations and extensive consultations are now complete. I will take the views of the 23 interest groups we consulted into account, including the representatives of the psychiatric hospitals. I do not know how much I will be able to enhance the terms for psychiatric patients, but I will be able to do so to some extent. I am not a free agent and, as Deputy Brennan knows, I must check this out with the Commission in Brussels. I will not be dealing with the health Commissioner, our former esteemed colleague, Padraig Flynn, but with the competition Commissioner. Insurance industry regulations rather than health provision regulations are the problem. I am not up against a deadline to sign the regulations by the end of July, but I hope they will be ready and signed to submit to the Houses of the Oireachtas in October.

I am glad Deputy Geoghegan-Quinn raised the issue of hepatitis C. I will first deal with screening and the establishment of who has hepatitis C as a result of a blood transfusion as distinct from an Anti D product. I will then deal with what has been described as the unequal treatment of different people infected with hepatitis C, especially in respect of travelling expenses, which the Deputy stressed and with which I agree.

I wish to clarify the position in relation to offering screening to people who have received blood transfusions prior to 1991, when the screening of blood donations for hepatitis C commenced. My overall objective is to identify all persons who have contracted hepatitis C from infected blood transfusions. I am approaching this objective in a comprehensive and structured manner. The target Lookback programme which is well under way is the first step in achieving my overall objective.

I would like to make it clear that I have not ruled out the possibility that it may be necessary to offer screening to blood transfusion recipients. I am awaiting detailed information from the targeted Lookback programme which is currently being undertaken by the Blood Transfusion Service Board. before I am in a position to make an announcement on this matter.

The hepatitis C Lookback programme currently being undertaken by the BTSB is targeting recipients of blood transfusion, prior to 1991, by tracing the past donations of donors now identified with evidence of hepatitis C virus infection. These donors include a number of women who were infected with the hepatitis C virus, following the administration of Anti D and who subsequently became blood donors. The Lookback programme also includes donations given prior to 1991 by donors who were identified hepatitis C positive following the introduction of routine screening of blood donations in 1991.

The targeted Lookback programme has two phases, the first phase will identify donors who have tested positive for hepatitis C, the product — whole blood, red blood cells, platelets or plasma — the hospital to which the product was issued and the recipients. The second phase will trace the recipients with a view to offering screening. Phase two of the programme is now under way. Contact is being made with recipients through their general practitioners, with a view to assessment and obtaining blood samples for testing for hepatitis C The targeted Lookback programme will identify those people who are known to have received a potentially infected blood transfusion.

At present there is not enough information available to me to advise blood transfusion recipients to be screened. Important information for blood transfusion recipients will be available to me from the target Lookback programme in the coming weeks. This information will include inter alia, the risks to blood transfusion recipients of having received potentially infectious blood, the transmission risks to those recipients and a firmer indication of the number of recipients who cannot be traced under the targeted Lookback programme. Such information will enable blood transfusion recipients to make fully informed decisions in relation to screening. I hope I will be in a position to fully inform the public in this matter in September, not December as quoted in some newspapers.

I have every confidence that the personnel in the BTSB undertaking the targeted Lookback programme are competent to do so and are in the best position to trace those blood transfusion recipients who are at risk of having contracted hepatitis C.

A new chief medical officer and a chief executive have been appointed to the Blood Transfusion Board. I would like to deal with the issue to which Deputy Geoghegan-Quinn referred, that women represented by Positive Action are treated more favourably than those who contracted hepatitis C from blood transfusions. They all receive the same medical treatment. Anyone with hepatitis C is entitled to full free medical treatment for life. They are also entitled to national counselling which has been put in place.

Interferon is a modern drug which is effective in some cases. A minority of women are being treated with Interferon and it is available free to all persons infected, regardless of which cohort they are in.

There are two areas outstanding where there is a difference in treatment. One is in relation to ex gratia payments. Out of pocket expenses are paid to the women infected through Anti D. The people infected with hepatitis C as a result of blood transfusions were not getting out of pocket expenses, except in hardship cases. A legal difficulty was brought to my attention and I had to get legal advice. I have taken that advice and I wish to announce that I can extend this payment. I am glad Deputy Geoghegan-Quinn brought this to my attention over the past few months. The ex gratia payment is now being extended to that group.

The outstanding matter is the question of the tribunal. The Government has decided the tribunal will deal in the first instance with the persons who have contracted hepatitis C from Anti D products. There is also provision within the terms of the tribunal to extend it to other groups. I have indicated that I feel there is a moral obligation in this regard. However, I have not got all the information to be able to decide where I can draw a line on extending it to other cohorts. It is not an open ended tribunal; it has to deal with the legitimate difficulties of targeted groups. I am not saying "no", but eligibility for the tribunal is a matter I have to decide later in the autumn.

I thank Deputy Geoghegan-Quinn for raising the issue today and for being constructive in bringing these matters to public attention. Now that I have extended the scheme perhaps the Deputy's constituent would resubmit her application. I do not know if I can legally backdate the provision but if she resubmits her case I will have it dealt with by my officials within the legal constraints.