Priority Questions. - HIV Infected Blood.

Máire Geoghegan-Quinn

Question:

9 Mrs. Geoghegan-Quinn asked the Minister for Health if he will give details of the contacts, if any, he has had with the management of the Blood Transfusion Service Board in relation to the infection of blood with HIV; if he has satisfied himself with the level of communication between the Blood Transfusion Service Board and his Department; if he has full confidence in the Blood Transfusion Service Board's handling of the matter; and if he will make a statement on the matter.[24716/96]

Liz O'Donnell

Question:

11 Ms O'Donnell asked the Minister for Health when he and his Department were made aware of the residual problem relating to HIV infected blood; the reason the Blood Transfusion Service Board did not inform him that, on legal advice in August 1996 letters were being sent by the Blood Transfusion Service Board to hospitals in September 1996 with details of potentially HIV infected batches; whether he will publish the contents of such letters; whether he has satisfied himself with the current and former board's response to the existence of 16 untraced persons who may have been infected with HIV from contaminated blood supplied by the Blood Transfusion Service Board prior to 1985; whether he has received a more complete report on this matter; and if he will make a statement on the matter. [24715/96]

Limerick East): I propose to take Questions Nos. 9 and 11 together.

As I informed the House on Tuesday, 10 December 1996 in reply to Private Notice Questions, I was made aware of the residual problem relating to HIV infected blood on Monday, 9 December when I was briefed by my Department on the incident at St. Luke's Hospital, Kilkenny.

The BTSB has confirmed it did not inform my Department until 8 December 1996 of the residual problem relating to potentially infected HIV blood. The residual problem can be stated as follows. It has not been possible to date to trace all the recipients of the 16 issues derived from potentially infected blood donations made prior to 1985 from the blood of seven donors who have tested positive for HIV since HIV testing of blood donors commenced in October 1985.

As I informed the House on Tuesday, 10 December, 24 blood donors have tested positive in the 11 years of testing. Eight of these donors were first time donors and, accordingly, no risk of HIV transmission to recipients was involved. In the case of nine of the remaining 16 donors, recipients of issues regarded as being at risk were traced and none of the recipients tested positive.

The tracing of recipients of the issues from the remaining seven donors has been rendered very difficult by the absence of the BTSB dispatch records for the period prior to 1986. Of the 31 issues from these seven donors, 17 were donated prior to 1981 and are not regarded as a potential source of infection. As I have already stated, the residual problem relates to tracing the recipients of the balance of 16 issues derived from potentially infected blood donations made prior to 1985.

As I informed the House on 10 December, I understand that following the introduction of the HIV donor screening test in October 1985, no look-back was undertaken in the period between 1985 and 1989 in respect of earlier donations made by donors who now screened positive. However, their donations were not used and they were advised to contact their general practitioner for further assessment and counselling. I also informed the House on 10 December that the BTSB had, from 1989 onwards, a look-back procedure for newly presenting donors.

It was under this procedure that a look-back on previous donations took place in respect of a donor who tested HIV positive in March 1993. This particular donor had donated previously in November 1989 and May 1990. The 1990 donation was traced and tested negative. The BTSB, therefore, considered it unnecessary to undertake a look-back on the 1989 donation. I should emphasise that this 1993 donor is one of the nine donors whom I have already mentioned where recipients of issues regarded as being at risk were traced and none of the recipients tested positive. I indicated that last Tuesday in reply to the Private Notice Question.

Following the 1993 look-back on this particular donor, the then chief medical consultant of the BTSB wrote to the chief medical officer of my Department on 16 April 1993 outlining the action taken following the identification of this donor. The letter was at that stage brought to the attention of the other relevant senior officers in the Department by the CMO. This letter was brought to my attention by officials of my Department on Friday last, 13 December.

Following receipt of this letter of 16 April 1993, I understand that at the next meeting of the board of the BTSB, held on 21 April 1993, the chief medical consultant reported to the board meeting on the recent look-back and was requested by the board to prepare an updated Protocol for the handling of such cases in the future. I understand that a revised Protocol was submitted and accepted in principle by the board of the BTSB at its next meeting on 26 May 1993.

Since my statement to the House on 10 December 1996, I have met with Mr. Liam Dunbar, chief executive officer of the BTSB, and officials of my Department have also met senior management of the board on a number of occasions. I sought an explanation as to why the board did not inform me or my Department until last week of the residual problem which exists in relation to untraced donations.

The BTSB has provided me with a detailed document setting out its approach to the look-back in respect of the seven donors and 31 issues which gave rise to concern. I do not want to read a long report into the record of the House because I would probably be accused of attempting a filibuster. However, I intend, a Cheann Comhairle, to make the report I got from the BTSB on this issue available to Deputies. I am also, as requested, circulating a copy of the BTSB's letter of 25 September addressed to the hospitals. In addition, I am circulating full details of the main features of the work programme undertaken by the new management of the BTSB since April 1995.

As Deputies will note from a reading of the document dealing with the look-back, it was decided by the BTSB to avail of the mechanism of the tracing programme for hepatitis C undertaken by the hospitals to determine the possibility of tracing the small number of potential HIV infected individuals. Then it planned to assess the results of that initiative in terms of the number of issues traced or untraced. When the outcome of this was known, it was intended to inform the Department of Health with a full assessment and recommendations for action at that stage.

I feel that the BTSB should have informed me and my Department in advance of the arrangements which it intended to put in place to trace the recipients of the potentially infected blood issues. However, I accept that the management of the BTSB acted in good faith and saw valid reasons for proceeding in the manner in which it did.

During the past week the BTSB, with the assistance of my Department, has intensified its efforts with hospitals in tracing recipients and I was informed earlier today that the position is as follows. There are 31 outstanding issues, 15 of which relate to pre-1981 donations and are not considered to be a potential source of infection. There are 16 issues of concern, of which six have now been traced, leaving ten issues of concern which remain to be traced.

As I assured the House last week, I have given this matter very serious consideration. I am advised there can be no guarantee that all the remaining ten issues will ever be traced. I am also aware that some donors who may have been HIV positive prior to the introduction of the screening of donations in October 1985 have not come back to donate since 1985 and, therefore, cannot be identified.

I have, therefore, decided that there should be an optional HIV testing programme put in place for blood transfusion and blood product recipients between the beginning of 1981 and October 1985. I have instructed my Department to put in place the necessary arrangements with the BTSB and other health agencies so that the optional testing programme can commence in January 1997, aimed at the cohort of people who were recipients of blood or blood products during this period. Of course, the trace back will continue in parallel for the ten issues which have not been traced.

Deputies who tabled questions have asked me to make a statement on this matter. Since I replied to the Private Notice Question on 10 December, there have been criticisms made of the board's performance and, in one instance, a call made for its disbandment. I think it is essential to put the matters raised by the Deputies in context and to avoid creating further avoidable problems in what is an already difficult situation.

I would hope that the Deputies share with me an appreciation of the enormous difficulties which face the board and its new management in undertaking a vast programme of reorganisation and restructuring in one of the State's most vital health agencies. This is being undertaken against a background of unprecedented adverse circumstances which have their origins in events which occurred over a period of 20 years.

I have circulated to Deputies details of the 17 major initiatives undertaken by the new management team since April 1995. I would, in particular, like to highlight the significant steps which have been taken to improve quality assurance measures. These include improvements in donor screening; archiving of samples of all donations; improvements in the structure of the laboratories, including the construction of a specific hepatitis C laboratory; upgrading of the quality assurance function and the introduction of environmental monitoring; ensuring standard operational procedures manuals are in force in all areas of the BTSB; and the introduction of HLTV I and II viral screening.

In addition to this, the new management has had to cope with an unprecedented volume of litigation and the preparation of documentation for submission to the tribunal of inquiry. It has also managed to maintain the blood supply, the essential and primary purpose of its existence. It is my view that the scale of the renewal and reorganisation process is such that it will require a further number of years of intensive work before the BTSB's job is completed. During this period the board and management of the BTSB needs and deserves the support of the Minister and the House.

The issue of extending the current tribunal of inquiry to examine the questions which have arisen in relation to HIV infection has been raised. The current tribunal of inquiry in relation to hepatitis C has been conducted with widely acclaimed efficiency, expedition and care by Mr. Justice Finlay.

I am advised, and it is my own view, that it is not appropriate that the careful planning and scheduling of that inquiry should be disrupted in midstream, but rather that it should be allowed complete that work. Deputies will be aware that the terms of reference for that inquiry include provision for an interim report not later than the 20th day of oral hearings. I understand that the tribunal will adjourn this week for the Christmas break and I expect to receive the interim report during the Christmas recess.

It is very important that neither I nor the House should presume upon the willingness of any particular person to conduct a further inquiry into a different, although related, matter. Any new questions would involve the assembling of new documents and statements, steps which would involve further time and effort of unknown dimensions.

What I propose is exploring the feasibility of either extending the existing terms of reference or setting up an additional but related inquiry to deal with specific questions which are now being raised in relation to HIV infection and the way that that problem was handled by the Blood Transfusion Service Board. The success of the current tribunal is widely ascribed, among other things, to the specificity of the terms of reference and if there is to be an extension of this inquiry, or an associated inquiry in relation to HIV, then that example should be followed.

It is my hope that terms of reference which express specific questions can be drawn up with care and reasonable expedition and put before the Dáil at the end of January, at which stage the interim report will be to hand and it will hopefully have been possible to explore with the tribunal whether it, or some variant of it, could best undertake these further inquiries.

I hope, a Cheann Comhairle, you will be lenient with us considering the length of the Minister's reply which lasted almost 15 minutes.

I suggested to the Minister this morning that he should come before the House in a special way, and not just in response to Priority Questions, to deal with this issue. The necessity for this has been borne out by his reply. There are two documents which neither I nor Deputy O'Donnell possesses. The first is the full work programme of the new management and the second is the report of the Blood Transfusion Service Board to the Minister. I appreciate the reason he gave for not having either of those for us.

(Limerick East): I will arrange with the ushers to have them circulated.

I think the Minister will appreciate it is rather difficult for us to go through them at this stage. We know from the Minister's answer that on 16 April 1993 the chief medical consultant of the Blood Transfusion Service Board brought the HIV contamination problem to the attention of the chief medical officer in the Department. The Minister stated that the chief medical officer brought that to the attention of the relevant officials in his Department. Did they tell the Secretary of the Department at that time? Did the Secretary of the Department tell the then Minister? When the Minister realised that he had not been informed, did he ask the Secretary why? I have great difficulty in establishing what, if any, new Protocols have been put in place by the Minister since the hepatitis C scandal. The Minister did say last week at the committee that if anybody should have learned from the mishandling of the hepatitis C scandal, it should be the Minister for Health. I would have expected the same. I want to know what communication there is between the Blood Transfusion Service Board, the chief medical officer of the Department and the Minister, and at what level. Why are there Department of Health officials on the Blood Transfusion Service Board if not to keep a watchful eye on the Minister and to report back to him if necessary?

(Limerick East): A number of questions have been raised. In my reply to the House last Tuesday I outlined the number of donors who offered blood to the BTSB who had tested positive for HIV from 1985 to 1996. In my reply I stated that three people presented in 1993, one of whom was the subject of the letter to which we refer. The circumstances are that a donor came forward to give blood and tested positive for HIV. His blood was not used, but it was discovered that he was a repeat donor who had given blood in 1990 and in 1989. There was discussion between the chief medical officer of the Department of Health and the chief medical officer of the BTSB. There was an immediate look-back at the donor who, it was discovered, had tested negative in 1990. That information was given orally and, in effect, the all clear was given. The problem when a donor tests positive is not that his blood will be used, because it is screened out immediately, but whether he or she was in the system previously. The all clear was given quickly that the donor had tested negative in 1990. Subsequently, in May, details that had already been given orally were made in writing. There is no mystery about it. It was just the manner in which one donor out of the 16 donors who tested positive from 1985 to 1996 was dealt with. Senior officials in the Department were informed. The Minister was informed of the problem in the first instance and, very quickly thereafter, was informed that in 1990 the donor had tested negative. The letter, which has been the subject of much comment in the newspapers, simply put in writing information that had been given already. Nothing hinges on that.

What I do not understand is why the Deputies who have addressed themselves to this issue seem to have avoided the main issue, which is why no look-back took place from 1985 to 1989 or subsequently.

We asked the Minister that last week.

(Limerick East): The Deputy had colleagues who were Ministers for Health from 1987 until 1994. There were two repeat donors who tested positive in 1987, there were none in 1988, one in 1989, one in 1990, one in 1991, two in 1992, three in 1993 and two in 1994. Two of the Deputy's colleagues who are medical doctors were in the Department of Health at that time. The Deputy leader of Fianna Fáil was in the Department of Health at the time, but the Deputy is asking me to explain why nothing was done until I became Minister. The look-back commenced last May, as nothing had been done up to then about the problem of people who got blood between 1980 and 1985. I am not ascribing political blame to anybody, but I am tired of explaining the defects of the regimes of my predecessors; I am tired of explaining things that happened in the distant past. If I get my way this will go into the inquiry along the lines I suggested, and it can be explored.

Let me put something else to the Deputies across the floor. Everybody knows the 1989 election was triggered on a vote during Private Members' time. The approximate cause of the 1989 election was the fact that haemophiliacs had been infected and the manner in which the Government of the day refused point-blank to give them any compensation. Subsequently there was a very uncertain result to the election but eventually, after a long period, the former Deputy Haughey and Deputy O'Malley came together and formed a Government in 1989. That Government gave a commitment to give compensation to haemophiliacs. How is it that the people in the parties who now have all the wisdom did not have a review of HIV infection in blood product when that was the cause of the election that brought them to power? Why did they not raise the issue of HIV infection in the blood supply? It was a current issue all over Europe in the 1980s. It was not an issue in my time, unfortunately for 1,600 people, mostly women. Hepatitis C was the issue which concentrated our minds before I became Minister for Health and during my time as Minister for Health. No donors tested positive for HIV in 1995 or 1996. Donors tested positive in every year from 1985 to 1994, and every party in this House held power during that time. I will not be lectured on probity by people on the other side of the House when they had better opportunities nearer the event to deal with these matters.

I put in new management in discussions with the new chairman of the BTSB, Professor Shaun McCann, who has now returned to his professorship at Trinity College and has been replaced by a full-time chief medical officer who is a haematologist, and Mr. Liam Dunbar, the former chief executive of St. James's Hospital. They took on this task when it would have been difficult to get people to take it on. It is no joy to run the BTSB at the moment. Because of all the difficulties, it is not a great career move to run the BTSB, if one has another job. I would like to see people giving a small bit of credit to these people for their public spirit in actually taking on this task.

I have put all the facts before the House and stated how we will proceed. We will have an optional testing programme to trace those who have not been traced already. We will continue with the look-back programme the BTSB is running. I have laid out in great detail the manner in which I intend to proceed in getting this matter inquired into judicially. When we come back in January, I hope to present the House with terms of reference and we can have the fullest debate possible. We will not simply debate my tenure in the Department of Health. We will debate everything from 1980.

Nobody is blaming the Minister for the failure of the BTSB to do anything in terms of tracing those persons whom they knew, 11 years ago, to have been possibly contaminated by their product, HIV-infected transfusion. My question relates to the board which has beenin situ since his term of office. That is the political question which is asked of the Minister today. The Minister continually cites the maintenance of public confidence in the blood supply as the paramount objective of both him and his Department. Does he consider it inspires public confidence in the blood supply when, on three occasions in the space of a week, he had to explain to the House the failure of the board to inform him and his Department that, on the basis of legal advice obtained this summer, it investigated this matter and distributed a cryptic and misleading letter to 45 hospitals? Does he also consider it inspires public confidence that, up to last Friday night, his Department advised that it was first notified of contamination last week and that he is now a permanent apologist for the board and the previous board?

The present board was meant to be a fresh start, yet it is taking up where the outgoing board left off in terms of lack of accountability, secret operations and failing to keep the Minister informed of crucial matters for which he is politically responsible. Is he satisfied that until last Friday night, the response of the board was one of self preservation and damage limitation, in the same mode as the previous board?

(Limerick East): I outlined how the new management of the BTSB reviewed the look-back programmes in respect of the 16 individual donors and how a look-back was undertaken to trace infections every time a positive donor was discovered. In so doing, the board found a significant gap which it proceeded to trace, putting discreet arrangements in place. I already indicated that it would have been better if the board had informed me at the start of the process. However, it advised that it was trying to follow the trail to identify the risk before reporting to me and my Department. This is a tenable explanation.

This event occurred between 1980-5 when many Ministers and boards were in office, and many political appointments were made to the boards. While the first management group to address the issue, undertake a look-back——

In secret.

(Limerick East):——and endeavour to ascertain the exact difficulty and the number of people potentially infected so that they may be traced is subject to criticism, it is unfair to dump on it, as some Deputies are doing. It is similarly unfair to call for the abolition of the BTSB, as the Deputy's party has done. Indeed, it is ridiculous populism to call for its abolition in circumstances where it is the only supplier in the country, with people undergoing operations every day and with the attendant increase in the number of accidents over Christmas. It would be more realistic to call for the abolition of the Electricity Supply Board.

We have exceeded our time on priority questions. While some latitude is necessary on this issue we cannot go on indefinitely.

The Ceann Comhairle agreed to latitude on this matter. I do not apologise for asking the Minister to attend the House to answer questions.

(Limerick East): I like to attend the House to answer questions.

The Minister is very touchy. The Opposition required 24 sessions in the House to get action on hepatitis C.

He is being realistic and factual.

If the Deputy intends to stay in the House he must hear the Member in possession.

The Minister did not reply to the question on communications. What is the level of communication between the chief executive officer, the board, the officials in the Department of Health and the Minister? What changes has the Minister made since the hepatitis C scandal? I presume he changed the Protocol on the communication of vital information to him from an institution, such as the blood board.

Did the Minister appoint a senior official from his Department to be based in the BTSB? If so why and when was this done? What functions within the board does this individual have? The Minister says that the BTSB should have informed him in advance. What was the response of the Chief Executive Officer to this?

(Limerick East): I told the chief executive officer of the BTSB that he should have informed me in advance of putting procedures in place for the look-back programme, which investigates the residual problem described by the Deputy. He agreed that, on consideration, he perhaps should have done so. However, he then explained why it was his intention to report at the end of the process. He knew there would still be a residual problem because the records were bad and rather than presenting the opening position he decided he would complete the process, which we are now reaching, and then advise. While this is a tenable explanation, I would have preferred if he had informed me at the outset.

The relationship between my Department and the BTSB is regular and ongoing. In line with all situations involving agencies, I have delegated communications to the Secretary of my Department. An assistant secretary has specific responsibility in this area. I meet the chief executive officer, the chief medical officer and the chairman of the board when it is appropriate to discuss specific matters. An officer in my Department joined the BTSB.

Was there a change in procedure from the time of the hepatitis C controversy?

(Limerick East): The flow of information is stronger and better than it was prior to the time when my predecessor was Minister. As Minister for Health in 1994, he told the House of the position regarding hepatitis C and the fact that so many people had been infected. The reporting procedures improved significantly from that point.

I am happy with the reporting procedures, although I should have obtained information on this issue in the early summer rather than in the first week in December. However, the only difference this would have made would have been in respect of my ability to communicate it earlier to the House, but not with the level of certainty I have today.

I will obtain a more detailed reply for the Deputy regarding an official from my Department. An officer from my Department at either principal level or assistant principal level assisted Mr. Dunbar for a period. However, nothing hinges on that. He was only involved in helping the incoming chief executive officer of an organisation with a long tradition and who required specific assistance. There was nothing peculiar about his involvement and I will communicate more detailed information to the Deputy in due course.

I welcome the Minister's advise that an optional screening programme will be put in place and a possibility that the terms of reference of the current tribunal into the hepatitis C infection will be extended to deal with this matter. When dealing with the Department of Health Estimate last Thursday, the Minister was questioned by Deputy Geoghegan-Quinn and me on the level and state of knowledge of his Department with regard to possible HIV infection in blood. Did his officials make him aware of the letter of 16 April 1993, to which he referred today?

(Limerick East): No. As I said on Thursday I gave the Deputy the information I had which was effectively an update on what I had given on the Private Notice Question on Tuesday. I said I was not giving the Deputy a huge amount of additional information and I gave a commitment to come back with all the information I had at this point. I was shown the letter on Friday. They did not have that information until Friday when it was pointed out to them by the BTSB. Today I have given chapter and verse on it. Anybody who has held office will appreciate that when something happens suddenly the Minister is given as much information as possible and the most accurate information is given to the House at the first opportunity. Those among the Opposition who have held office will also know that additional information can come to hand subsequently. If it is relevant there is an obligation to communicate it to Deputies and that is what I did.

Anybody who has been in office or is an office holder when a major scandal erupts in the Department for which they have responsibility ensures that the flow of information from their civil servants to themselves is cleared in a specific way and that guidelines are laid down by them. The Minister's head is on the block in this House and with the public interest. It seems there is no communication between his officials and him. In that context how can we expect communication between the blood board and his officials? Will the Minister explain how he could have given one item of information on Thursday last — in an Estimates debate in which a substantial amount of his speech was devoted to the hepatitis C scandal, the hepatitis B issue and the HIV infection — and how his officials did not give him basic information relating to issues they knew he would be asked about? How can the Minister justify their not giving him that level of information?

What we are talking about in relation to these scandals in the blood board is not missing files but people's lives and the Minister being accountable for what is happening during his tenure in the Department and the lack of a flow of information. What changes has the Minister put in place in respect of communication between the blood board and his Department and between the Department and himself? Surely he will not tell me he is happy with the same flow of information which existed prior to the hepatitis C scandal. We must have learned since then.

(Limerick East): The Deputy seems to be a very wise administrator but she always misstates the position. I gave a normal speech on the Estimates debate and I did not deal with HIV or hepatitis C. When the Deputy raised those matters I answered the questions as fully as I could.

The Minister's officials were with him.

(Limerick East): I also pointed out to both Deputies that in respect of HIV and hepatitis C I did not have the relevant officials with me——

(Limerick East):——but rather the financial officials.

That is incompetence.

(Limerick East): One cannot bring every official in the Department to an Estimate's debate. I was accompanied by the relevant officials and there was nothing much about these issues in the Estimate. There was a head relating to hepatitis C but the relevant officials were not present.

In the middle of a scandal the Minister did not realise these questions were going to be asked.

(Limerick East): I had only financial officials.

It is unbelievable.

(Limerick East): I had briefed myself and I gave the full information. Do not make this great pretence. The problem across the House is this.

The problem is on its feet.

No interruptions, please.

(Limerick East): I have watched this very carefully for the past ten days. While I was asked various questions, I ask why no Fianna Fáil Deputy, including the spokesperson, and no Progressive Democrats Deputy, including the spokesperson, asked that this matter be inquired into judicially. The Deputy was prepared to attack the chief executive of the Blood Transfusion Service Board and call for its abolition but was not prepared to deal with the two central issues. She dealt with one, the look-back programme and the optional testing programme, but did not address the issue I am addressing today. I hope I will have political support across the floor of the House when I come back with terms of reference in January.

We will strengthen them for the Minister.

(Limerick East): I will be back in January.

Is that a commitment?

He will not have the full information.

(Limerick East): We are talking about the manner in which the inquiry will take place because the judge took on a specific task under specific terms of reference and there must be discussions. In my Department there is a free flow of information to me. Every Thursday morning I have a MAC meeting with all my senior officials and we review everything on a weekly basis.

I refer to the Estimates debate on Thursday last. The Minister seems to be evolving a new excuse from that of the Taoiseach——

(Limerick East): I am not making excuses.

——that the person did not ask the right question.

(Limerick East): I gave the Deputy full information.

The Minister is now saying he did not have the right officials with him when he was asked the questions. This is a new development and it is not surprising from this Minister. Will the Minister agree that up to Friday last the Department of Health denied it had any knowledge of HIV infection in blood, that it was only on Friday night when the media said it had information about a letter of 16 April and confronted the blood board with that fact, and ultimately the Department, that the Department of Health and the BTSB announced a damage limitation exercise stating there had been a letter but that the Minister had not been informed? It is convenient that the Minister was not informed because as we are aware from the Dominic Lynch affair, if the Minister does not know then the Minister is not responsible. He has conveniently described it to the House today, saying that maybe his officials knew but he did not know and cannot be accountable.

They are not telling the Minister.

(Limerick East): Deputy O'Donnell will always try to misrepresent what I said. When I addressed the House last week I gave the information I had to date on the Private Notice Question. I heard about the events on the Monday night and gave a very full answer on Tuesday afternoon. I approached the Estimate in the normal way with a full range of officials who were experts on the financing of the various sections of the Department. I briefed myself on the other matters in anticipation that the Deputies would raise them and gave very full replies. I am not making any excuse. The position still remains the same.

The letter of 1993 which was the cause of newspaper comment over the weekend was brought to my attention on Friday. I have examined the full facts and I have given the House the information. It was about a donor who was positive in 1993. Obviously they would not use his donation but they discovered he was a repeat donor. When the previous donations were checked they were found to be negative. As in any Department there was anxiety for a couple of days and the word came through that in 1990 the recipient was negative. Subsequently medical officer to medical officer reported by way of letter but nothing hinges on that. It was discussed as if the donor was positive at the time his blood was used. That is not the situation.

The donor tested positive the same as any donor giving blood. The blood was not used. Obviously when it was discovered he was a repeat donor that caused anxiety. When the immediate previous donation was checked and found to be negative the anxiety disappeared. Subsequently, because of this, it was reported in writing and a new Protocol was put in place at the next board meeting. That is my full information about that letter. That 1993 letter was not relevant to what I explained last week because it was about a donation on which there was a look-back and the all-clear was given.

I dismiss the Minister's explanation that he did not bring the appropriate officials to the committee meeting on the Supplementary Estimate last week because he was not aware this matter would be raised. He answered Private Notice Questions in the House and further information came into the public domain immediately after he answered them. His explanation that he did not believe this issue would be raised and that, therefore, he did not bring the appropriate officials does not hold water.

(Limerick East): I was fully briefed and I gave the Deputy the full information. What more does she want?

The Minister said he could not answer the questions because he did not have the appropriate officials with him.

(Interruptions.)

No interruptions, please.

I appreciate that the Minister is very touchy about this matter.

(Limerick East): I am touchy about people who misrepresent me.

I want to bring this question to a conclusion. Let us here the Deputy in possession, please.

Last Tuesday the Minister told us one person had been infected with HIV by way of a transfusion. However, by Wednesday the figure had increased to two.

(Limerick East): No.

How many people have been infected? Is the Blood Transfusion Service Board intensifying its efforts by way of further letters which mention the HIV infection or by way of phone calls and, if so, to whom are these being made? Members of the public who were given blood transfusions should have their concerns allayed. How could the chief executive of the Blood Transfusion Service Board say on 9 December that the HIV screening test had been effective when 16 of the issues could not be traced?

(Limerick East): The Deputy continues to misrepresent me.

I did not misrepresent the Minister.

(Limerick East): What I said is that the normal progress of HIV runs its course and there is quite a period between the date of infection and the development of symptoms — normally symptoms develop between the tenth and twelfth year. These incidents took place between 1980 and 1985. There was not the same level of risk during 1981 to 1985 and the risk increased nearer 1985. This is the way the infection came into the system.

I said that, on the basis of the empirical evidence, the numbers involved in absolute terms in 1996 will be small. More than 1,600 people were tested for HIV and the primary cause of infection was identified in only one case, apart from the Kilkenny case, as being blood related. That blood transfusion was received in another European Union country. I said in my statement that we had identified the person in Kilkenny who, unfortunately, had been infected. This is a great tragedy for her and I am sure all Deputies will join me in expressing sympathy to her and her family. I said that, apart from her, only one of the 1,600 people tested for HIV was positive, and that person was infected by a donation received outside the country.

Are the others in the South-Eastern Health Board area?

(Limerick East): Under the look-back programme, the infection has been traced down to ten. A man in his 70s from the north west received one of these issues but he seems to be in full health. He received the blood a long time ago but is being tested. A deceased person from the west received an issue during his terminal illness but it is clear he died from the underlying causes of his illness. A deceased elderly man from the midlands — this area is covered by the South-Eastern Health Board — received blood in hospital but did return to hospital. The Deputy can draw her own conclusions from that case. A Dublin man who also received an issue died at 69 years. A person in the west who received an issue has been approached and is being tested. I hope this case works out well.

One person has tested positive for HIV, two people have not displayed symptoms but will be tested as quickly as possible and a number of people are deceased. There is no evidence to suggest that the blood the deceased people received contributed to their deaths as they died in advanced age. However, one can never be 100 per cent certain. It is very easy to sound callous when giving statistics. Regardless of the cause, the deaths were a tragedy for the people involved and their families. I extend my sympathy to those people caught in the wider reaches of this infection.

There are still ten issues which have not been traced and we are redoubling the efforts to trace them. Apart from the initial letter — this was the discreet approach in accordance with the look-back programme carried out by the BTSB in respect of hepatitis C — my Department contacted all chief executive officers and hospital managers to ensure there was absolute co-operation and to make it clear what was being sought. Extra people were brought in to check files. Rather than check the blood transfusion files with numbers of batches which no longer exist they are checking hospital files to see if the names are recorded on them. This is a big job and I hope that the other ten issues are traced. My advice is that even if the other ten issues are traced there is a group which will not be found. As Minister I have an obligation and duty — the House shares in this — to trace this group by offering an optional testing programme through GPs. We did this with great success in respect of hepatitis C when the records were not sufficient to identify people. We have identified a number of people and they have been approached. This is the way we are proceeding at present.

On the question of the inquiry, Deputies will appreciate that Judge Finlay willingly took on a very onerous task with specific terms of reference. I need to have discussions with the people associated with the tribunal before I decide whether a modification of the terms of reference or a parallel ensuing tribunal is the way forward.

We need it.

(Limerick East): Everyone agrees that the work being carried out by the tribunal on hepatitis C is very effective.

It is excellent.

(Limerick East): I do not wish to rush in before Christmas and do anything which would disrupt this work, particularly as I have been informed that the interim report will be submitted to me during the recess. I will be in a position to give the House more information after Christmas.

The Minister said he did not know last week when responding to Private Notice Questions that there had been correspondence between the BTSB and his Department in relation to possible infection, through HIV, of the blood supply and that he was made aware of this correspondence on Friday. At what time on Friday was he made aware of the correspondence and in what context? Who decided that this information should be given to the Minister? Is it the case that the Department did not bring this matter to his attention until it was confronted with the fact that a journalist was in possession of the information and was going to print it?

(Limerick East): I was made aware of the correspondence at some time on Friday afternoon. I understand that the information came from the BTSB. The BTSB was presented with many questions and in reply to one it said it had communicated about a positive donor in 1993 and that a subsequent letter outlining the issue had been sent to the CMO in the Department of Health.

The Minister said that the BTSB had volunteered the information.

I cannot allow an extension of the question.

Why was the information not volunteered by the BTSB earlier in the week? I specifically asked in my Private Notice Question if the Department were informed about the possible infection of blood with HIV. Why did the Minister not put those questions to the BTSB when preparing for the debate on the Private Notice Question?

(Limerick East): In reply to the Private Notice Question I outlined the 16 positive donors from 1985 to 1994. I described how look-back programmes were initiated in respect of some of those donors for various years. One of the three positive donors in 1993 was the subject of correspondence which led to the introduction of a new Protocol, but that is not the central issue. We had 16 untraced blood products which could have potentially infected Irish citizens between 1980 and 1985. Even though the infections took place between 1980 and 1985 and look-back programmes were initiated internationally from 1986, there were no such programmes initiated from 1985 to 1989. That is what we must examine. That is the central issue, not the issues that are being rehearsed all over the place.