Private Members' Business. - Hepatitis C: Motion.

Before I call Deputy Geoghegan-Quinn to move her motion I wish to remind Members that while the Chair is cognisant that the motion calls on the Minister for Health to amend the terms of reference of the current tribunal of inquiry into the hepatitis C controversy, under the rules and Standing Orders of the House "a matter shall not be raised in such an overt manner so that it appears to be an attempt by the Dáil to encroach on the functions of the courts or a judicial tribunal". Accordingly, Members should exercise caution in making their contributions and should not stray into the matters which could encroach upon the ruling of the chairman or the working of the tribunal.

I move:

That Dáil Éireann notes with concern the decision of the Irish Haemophilia Society to withdraw from the judicial inquiry investigating the hepatitis C controversy and calls on the Minister for Health to grant a debate on the interim report of the judicial inquiry and to amend the terms of reference of the judicial inquiry so that

(1) the circumstances of infection of all victims of this scandal will be fully and properly investigated; and

(2) all the questions raised by the late Mrs. McCole, including who authorised the legal strategy for her case, will be answered.

In the event that I have time left I wish to give it to Deputy Moffatt.

Is that agreed? Agreed.

To use the elegant words of his adviser, the Minister, Deputy Howlin, was not "absolutely shafted" by a senior civil servant at the tribunal of inquiry on Monday. For the women, men and children infected by the State with poisoned plasma, for the haemophiliacs left out of this procedure and for me that brief reported conversation sums up all that has been wrong in the approach to the blood tragedy. The approach has been "forget the victims, focus on ourselves, the impact on the Minister, the impact on the Department and on senior civil servants shafting or not shafting Ministers". It is not an issue of "senior civil servant absolutely shafts Minister".

What we have seen in recent months is selfpreservation within the system, the Blood Transfusion Service Board protecting itself by rationing the information it fed to the Department, the Department protecting itself by setting up investigation processes that it knew were doomed to fail and Ministers shamefully protecting themselves by the use of that most contemptible of political devices, the claim that "your lot did the same when you were in power".

Systems of justice, finance and health should serve people and not the other way round. However, the Government has elevated systems beyond the people they were created to serve. The Government is based on pious platitudes and impersonal concepts, never on concern for people. From the word go we have had to listen to lectures on openness, accountability and transparency and hear those words become gradually dissociated from any meaning, reality or humanity. Instead of approaching the blood tragedy through its famous pane of glass, the Government fled from accountability and rejected transparency, even if it had to denigrate the dying and attack the advisers of the sick to do it. The Government lost sight of the victims, the women, men and children whose blood the State had poisoned. It lost sight of present pain and the dark dread of the future that an infection like this brings with it.

This is the 25th occasion on which the hepatitis C scandal has been raised by me in the House. On each previous occasion I hoped this was the last time the Minister for Health would have to be harassed and hounded into granting the victims their reasonable request. While this will be my last time leading the debate on the issue, I do not doubt but that there will have to be further debates. I say this because all the other debates have shown that the Minister for Health and the Government have a blind spot in relation to this scandal. They have failed, and continue to fail, to recognise the State's responsibility in the matter and to appreciate the frustration and anger of victims. This has meant that every right for the victims has only been won after a long and tortuous battle. I fear the same battle lies ahead in relation to the issue we are debating tonight.

The Government's amendment will not address the difficulties and is yet another fudge in this State-based horror story of hepatitis C. Our proposal to widen the terms of reference of the current tribunal to investigate haemophiliacs' issues in relation to hepatitis C is the best way to proceed. The difficulties with the amendment relate in particular to paragraphs (iii) (b) and (iv). I welcome the Minister's decision to investigate the HIV episode which was highlighted late last year and involved people being at risk of contracting HIV from contaminated blood products. That episode once again emphasised that the Blood Transfusion Service Board has a long way to go before it is transformed into a model of public accountability. An inquiry into this episode has been promised for some time.

There is an important point I wish to make in relation to this episode, that is one specific case of HIV contamination is currently being prepared for the courts. As the Minister knows, there is a time constraint in this case, which involves the South Eastern Health Board, similar to that which obtained in the Mrs. McCole case. There will be requests for Department files, for files from the Blood Transfusion Service Board and for the pre-screening services and conditions and procedures available in the Blood Transfusion Service Board pre-1985. I ask the Department and the Blood Transfusion Service Board to respond for once in a caring and compassionate way to that very specific case where time is against the individual involved. It may be possible to deal with the case by way of a non-public hearing or in another way by Mr. Finlay. I ask the Minister to please let this case take priority over all the others because of the time constraints involved.

Paragraphs (iii)(b) and (v) of the amendment are unsatisfactory. If the interim report of the tribunal is anything to go by, the final report will make no reference to the difficulties the haemophiliacs are encountering in relation to hepatitis C. As the terms of reference of the tribunal stand, the haemophiliacs' issues are unlikely to be highlighted. They are not being investigated by the tribunal. What will change between now and the publication of the final report? The haemophiliacs sent huge amounts of correspondence to the tribunal about their problems before the interim report was published. However, this did not even merit a line in the report and until the Irish Haemophilia Society withdrew from the tribunal the matter had not come to public attention.

On this basis paragraph (iii) (b) of the amendment is not sufficient and is only kicking to touch. For the past two months the haemophiliacs have sought a simple addition to the terms of reference, this is that the tribunal investigates the circumstances in which its members became infected with hepatitis C. The Government amendment will not achieve what is required. The only way of ensuring the matter is correctly addressed is to amend the terms of reference of the tribunal in the way proposed in our motion. This must be done sooner rather than later as time is not on the side of haemophiliacs. These people are getting sicker and they need answers now. The proposal in the amendment is a huge mistake and is a tactic designed to long finger the issue. No doubt the Minister will accuse us of all sorts of things, apart from trying to achieve what is in the best interests of haemophiliacs. During the previous debates on hepatitis C the Minister accused the Opposition of playing politics and of overstating the seriousness of the situation. If I or the victims ever needed vindication for the statements we made we have it in the revelations before the tribunal. Our worst nightmare of a deep rooted cover-up has been realised.

This motion is as important as any of the other debates that have taken place. In some ways it is more important because it highlights the needs of a group which has been in the shadows up to now. Many people think the hepatitis C scandal is only about women who received the anti-D product and the consequences of this for their families. It is about this very large and important group who are very well organised and have received extraordinary leadership from their chairwoman, Jane O'Brien, and the Positive Action executive committee. It also received much media coverage — with up to 700 members it had sufficient people to go public and tell their harrowing tales. Many believe that men and children only come into the scandal through their connection with the anti-D women. They do, but men, women and children, such as haemophiliacs, transfusion victims and kidney patients, have been infected other than through anti-D. Their story is less well known because, understandably, many of them want to protect their anonymity. As fewer numbers are involved there are fewer volunteers to go public and, as the media prefer the personalised story, their spokespeople have not been reported to the same extent as those of victims. Merely because they have not been as vocal as other victims does not mean they are not as devastated. Their lives have also been shattered by the negligence of a State body.

This motion is about haemophiliacs, the group that has been most in the shadows. Two weeks ago it took the dramatic step of withdrawing from the hepatitis C tribunal. Fianna Fáil regards this as a matter of great concern. The Irish Haemophilia Society took this step only as a last resort and after making every attempt possible to have its concerns heard at the tribunal. The society does not believe the tribunal, under its current terms of reference, will deal with its issues of concern. It also does not believe the amendment proposed by the Minister will achieve what is required for its members who have been infected with hepatitis C.

The issues of concern to haemophiliacs are real. Haemophilia is an inherited bleeding disorder where one of the blood's clotting factors is missing or present at a much reduced level. Treatment is administered via injections of the missing clotting factor when bleeding occurs. Like anti-D, the treatment used is made from pooled human plasma. The method of treatment has led to the contamination of the haemophilia population with hepatitis C; half of the 450 haemophiliacs have been infected with the disease. According to the Irish Haemophilia Society four of its members have already died directly from hepatitis C while 66 have died from combined HIVhepatitis C infection.

The prognosis for people with haemophilia infected with hepatitis C is significantly worse than for individuals infected with hepatitis C without haemophilia. Haemophiliacs have had multiple exposures to the virus due to frequent injection with pooled plasma products. Multiple exposure results in infection with several types of hepatitis C. Many hepatitis C haemophiliacs are also infected with hepatitis B and-or hepatitis A. Those viral infections, when present with hepatitis C increase damage to the liver. Many are also infected with HIV which accelerates the development of serious liver disease.

It is obvious haemophiliacs need to ask distinct questions, the answers to which were known before the tribunal began. How did all blood products manufactured by the BTSB, including anti-D, factor 8 and albumin, become infected with hepatitis C? How did children born in the last six or seven years become infected with hepatitis C when administered BTSB supplied factor concentrated blood product? Viral inactivation procedures should have been implemented in the past seven years. There have been continuing problems at the BTSB not only in relation to anti-D but in relation to products used by other groups. Why did the BTSB commercially obtain concentrates from the plasma of paid overseas donors in 1982? Why was a self-sufficiency policy in respect of blood plasma for the fractionation of factor concentrates not developed at that time? That might have prevented infection of blood products. Why was there improper viral inactivation by the BTSB of factor 8 concentrates which the board had started to manufacture in 1986 from Irish derived plasma as part of a policy of self-sufficiency? The need for the BTSB to investigate all aspects of donor selection was identified.

The Irish Haemophilia Society needed to get information as much as any other victim. Alarm bells about the BTSB began to ring even louder in the society in October 1996 when a product alert was raised. Details of that alert, which had not been widely publicised, related to a batch of factor concentrates which was recalled at a very late stage because of fears that it was not adequately virally inactivated. The batch had been sent out to haemophiliacs when a concern was raised that a blood donor, whose plasma was used in the manufacture of the product, had subsequently tested positive for hepatitis C. A product controller in St. James's Hospital in Dublin sought to contact haemophiliacs directly at their homes rather than going through the Irish Haemophilia Society, the central administrative organisation for haemophiliacs. The first the society learned of the alert was when panic telephone calls were made to it. It has since emerged that the product was adequately virally inactivated. Obviously, the BTSB must have contacted St. James's Hospital to warn of a potential problem. While this was the correct thing to do, the concern in this episode is that there was no procedure in place for dealing with the alert two years after the new management had been put in place at the BTSB. It certainly signalled that the process of transforming the BTSB and improving its communications structures has a long way to go.

Because haemophiliacs continue to depend on the blood supply, they have a real interest in the tribunal. However, neither the Minister nor his Department consulted the Irish Haemophilia Society before the terms of reference were published or even before tonight's amendment was put down.

At the time the terms of reference were about to be published last year, I was alerted to the concerns of groups representing victims and the failure to consult them. When the Minister for Health provided a briefing before the publication of the terms of reference for me and for the progressive Democrats spokesperson on health, Deputy O'Donnell, in mid-October 1996, we specifically asked if all the vicitims of the hepatitis C scandal would have an opportunity to raise their issues at the tribunal as it was to be constituted. The Minister for Health informed me it was his intention that all victims would get the same treatment and would have an opportunity to raise their concerns. This comment echoed what the Minister for Health said on the Six One News on 8 October last. In regard to the inquiry, the Minister stated, "The focus will be narrow. It will be to inquire into all the circumstances of the infection since 1976 both of blood products and blood and how so many persons, men and women, got infected". The Irish Haemophilia Society and other groups were also assured by the Department of Health that the circumstance of infection of their members with hepatitis C would be a matter for direct consideration by the tribunal.

The assurances given to me by the Minister and by the Department to the groups resulted in Fianna Fáil co-operating with the passage of the terms of the tribunal. While I remained unhappy with many aspects of the terms of reference and had put down amendments in that regard in the Dáil, I was assured by the Minister these difficulties would not present a problem.

The Irish Haemophilia Society then entered the tribunal in good faith. It had made reasonable submissions asking for representation on a limited number of issues. These were rejected by the chairman of the tribunal. The only group of victims granted representation were those relating to anti-D and this concentration by the tribunal on just one blood product which was manufactured by the BTSB has continued. This is why there are few grounds to believe the final report of the tribunal will make any difference to haemophiliacs as the circumstances of their infection are not being directly investigated.

The Irish Haemophilia Society and other groups sought a judicial review in the High Court over representation. In granting leave to seek a judicial review, Mr. Justice Shanley noted that the terms of reference had been narrowly construed by the tribunal. The matter was later settled on the basis of limited representation being granted to the Irish Haemophilia Society on 27 November.

The terms of that settlement achieved by Mr. Justice Finlay are interesting. Legal representation was granted at the opening of the oral hearings of the tribunal. During the course of the tribunal's deliberations a transcript of the evituted dence was to be laid before the tribunal on a daily basis, proofs of the prospective evidence were to be given and sight of or copies of such documentation as was necessary were to be provided to inform the said parties of the tribunal's deliberations. The right to apply to the tribunal to be permitted to cross-examine any witness was granted, as was such representation as was necessary for the purposes of advising in the course of the tribunal's deliberations. Also granted were the right to attend and be represented at the tribunal when any of the parties' witnesses were before the tribunal and to make a closing statement.

These terms were accepted by the Irish Haemophilia Society. Two days later, on 29 November, the society's solicitors wrote to the tribunal asking how it proposed to deal with the issues of concern. Concerns were also raised about the attitude the tribunal was taking to documentation made available by the BTSB. It soon became clear that the tribunal would not deal with the issues as raised by the Irish Haemophilia Society.

On 18 December, the society wrote to the Minister for help, outlining its concerns. It told him it had been endeavouring to work within the terms of reference but that there was a catalogue of problems. It asked him to amend the terms of reference to specifically include the issues relating to people with haemophilia and their circumstances of infection with hepatitis C. That remains its and our position.

The last straw for the haemophiliacs appears to have been a letter from the tribunal on 10 January. The solictor to the tribunal said that the tribunal was "solely concerned" with the licensing arrangements for anti-D and that the blood products manufactured by the BTSB and used by haemophiliacs were not relevant to the terms of reference. In particular, the letter stated that donor screening for one of these products, which is a huge issue for the haemophiliacs, was not considered to be relevant. The Irish Haemophilia Society withdrew from the tribunal on 15 January and Fianna Fáil has since taken up its concerns.

This saga raises many issues. Is Mr. Justice Finlay construing too narrowly the terms of reference of the tribunal? Did the Minister for Health mislead Members of this House and the public when he said that all victims would be able to raise their concerns? Was the Minister misled by his Department or the Attorney General about the terms of reference and what they meant? One of these scenarious must be the case because no other conclusion can be drawn.

Fianna Fáil is extremely concerned about this issue. Haemophiliacs comprise one of the most vulnerable groups in society and they already feel they are the miner's canary, so to speak, in the field of infection and the use of blood products. Their dependence on the blood supply puts them in the front line of every crisis. They are the most frequent users of blood products and are those most reliant on them.

In the interests of fairness and equity, Irish haemophiliacs deserve to have their questions in relation to hepatitis C answered at this tribunal. The BTSB manufactured more products than anti-D but, as the tribunal stands, it neglects and omits to acknowledge that there were other difficulties pertaining to the BTSB. No one product should be preferred over another.

We believe it has been a gross mistake for the Minister for Health to have ignored the exclusion of haemophiliacs for so long. How can he admit now that the terms of the inquiry were inadequate when to date he has claimed they were adequate? In some ways this tribunal is more necessary for haemophiliacs than for others. Much of what has emerged at the tribunal in relation to anti-D would have come out eventually as there has been discovery for a number of court cases in relation to the product, including the case of the late Mrs. McCole and another case which is pending. However, there has been no similar discovery in relation to haemophiliacs and, based on what has emerged from the tribunal so far on anti-D, it is reasonable to believe that another catalogue of errors and a cover-up will emerge.

The reason there has not been a court case involving haemophilia products is that haemophiliacs are desperate to protect their anonymity. They know that if there is a case, like Mrs. McCole, they will not be allowed to retain their anonymity. Last weekThe Irish Times carried the sad tale of the parents of two unnamed young haemophiliac boys who had been infected with hepatitis C at a time when the blood products were supposed to be treated for the virus. They want to know how the infection occurred at a time when it should not have occurred. The parents' only option may be to go to the High Court but, if they do, their sons' anonymity will be lost.

It is amazing that none of the difficulties relating to the terms of reference were highlighted in the interim report from the chairman of the hepatitis C tribunal. What hope is there that the final report will change matters? While we all want to see an efficient and expeditious inquiry, we do not want it to be at such a pace or on such narrow terms that some victims feel it is at their cost. The tribunal is the appropriate forum to address haemophiliacs' concerns in relation to hepatitis C. It is wrong that it has not been considering those matters to date, but even now it is not late. Given that the tribunal is considering many of the relevant issues, the matters relating to the haemophiliacs could be dealt with expeditiously.

The second part of our motion relates to the need to amend the terms of reference of the tribunal so that the questions raised by the McCole family may be addressed. One question raised by the family — that relating to who authorised the legal strategy for their mother's case — is not within the scope of the tribunal. This matter is of great significance. Only for the work done on the late Mrs. McCole's case this tribunal would not have been able to proceed as quickly as it has. The truth would not have come out but for her case.

The tactics employed in Mrs. McCole's case were despicable and were designed to frustrate the truth. They were not in the interests of the victim or in the public interest, although many of the threats were made by agents of the State. The "hardball" tactics included an attempt to use the statute of limitations; a challenge to the date for an early hearing; a threat from the Chief State Solicitor that the case would be pursued all the way; the making of a lodgment to raise a threat of costs and an attempt to get the family of the late Mrs. McCole to sign off any claims they might have after their mother's death. The stonewalling, barracking and blocking went on for months.

I raised the question of who authorised the legal strategy at the time the terms of reference first went before this House. I received support from three Government Deputies for an amendment I proposed to address this problem. However, when it was put to a vote, those Government Deputies ignored everything they said during the debate. Everything that has since emerged at the tribunal would show that it was a deliberate act by the Minister not to allow any questions on the legal strategy used in the McCole case.

If the tribunal has shown anything, it has highlighted the role played by the Minister in keeping the victims in the dark. He knew all along that the BTSB had no defence to offer in any court case. He did not do enough to acknowledge the scandal involved and to ensure disclosure of the cover-up. Instead, he participated in it and, as we have seen in recent days at the tribunal, he took other actions. He resisted a tribunal of inquiry even though he knew the expert group was flawed. He was told that the information relating to the Therapeutic Substances Act, 1932, which was supplied by his own Department, was wrong but he still published the report.

When questioned in the Dáil on this matter by me on October 16, 1996, the Minister suggested that anti-D did not require a licence under the Therapeutic Substances Act, 1932. Yet the Minister was given a memorandum by an official in his own Department in early 1995 saying that a licence was required under the Act and that the law had been broken between 1970 and 1984. At the tribunal, the Minister claimed that if he had put this into the public domain he would be criticised for it. Who would have criticised him for telling the truth once and for all? Why did he block the judicial inquiry for so long when he knew the Department's advice was to this effect and that the BTSB had not been honest or open with the expert group.

The Minister has maintained the charade at the tribunal about the expert group report and the discovery of the file relating to infective hepatitis which clearly shows the state of knowledge of the BTSB when it went about manufacturing its poisons. Deputies will not forget that the Minister told the House that the file about infective hepatitis did not change the expert group report. The Minister's officials told the tribunal that the first time they knew donor X had been diagnosed as having infective hepatitis was when details of the file emerged.

Even more remarkable than the Minister for Health's evidence at the tribunal has been that of the former Minister and his officials. No two versions of the events of that time in 1994 are the same and this is a matter of great public concern.

The Government should remember in tonight's debate the wise aphorism that he or she who does not learn from history is condemned to repeat it. Deputies on the Government side of the House should recognise the inadequacy of what is being proposed and inequity of the treatment so far for haemophiliacs.

I do not believe that the justification which I am sure the Minister will give for saying that the issues of concern will be raised in the new tribunal will stand up to scrutiny. The Minister's amendment to the motion states that " ... such further matters in respect of blood and blood products as may require investigation in the light of the report of the hepatitis C tribunal ... " will be included. I want the Minister to give a commitment that between now and the end of Private Members' Business tomorrow evening he will revise that section of the motion to specifically include haemophiliacs. That is the only basis on which haemophiliacs will believe the Minister, the Department or the BTSB. Everyone has reason to accept their concerns in that regard. That is the only amendment that will be acceptable because I believe there will be no reference in the final report to haemophiliacs, their concerns or the fact that they walked out of the tribunal.

I am aware that, since 8 a.m. yesterday, when he was abroad, the Minister discovered an interesting piece of news on the radio and he has the champagne ready, the bucket is in the corner of his office and the ice is in the freezer. While this will be my last time leading this debate, I will still be responsible for summing up tomorrow night and I will have much more to contribute at that time. Therefore, I ask the Minister to keep the champagne, the bucket and the ice ready. In contemplating what I have said, the Minister should make one generous gesture, not for me, Fianna Fáil, the Progressive Democrats or the general public but for those who make most use of blood products — the 450 haemophiliacs and the other victims of haemophilia in Ireland. That gesture might begin to restore the faith of this House in the Minister, his Department and the procedures therein.

I support the motion outlined by our spokesperson on Health, Deputy Geoghegan-Quinn, which expresses concern that the Irish Haemophiliac Society has withdrawn from the judicial inquiry into hepatitis C and requests that the interim report should be debated and the terms of reference of the inquiry altered to properly investigate the problems relating to these issues and address questions raised by the Bridget McCole case. The Government's amendments to the motion do not address concerns about this matter, particularly those of haemophiliacs. Any astute manoeuvring by the Minister or the Government does nothing to enhance the reputation of the Government or the judicial review. An inquiry, by its terms of reference, will only partially complete its work if it neglects the real and ongoing fears of the Irish Haemophiliac Society.

Great strides were made in the 1970s in respect of anti-D immunoglobulin, blood transfusions and the manufacture of factors 8 and 9. These developments led to changes in the lives of haemophiliacs. For the first time, they had the possibility to lead normal lives. Up to that time, their lives were endangered by the smallest trauma which could lead to bleeding into joints and other areas and additional unfortunate consequences. When that problem was solved, new difficulties emerged with the advent of various viruses — hepatitis A, B and C, AIDS and other co-infections — and the contamination of blood.

However, in the 1980s, the Blood Transfusion Service Board — under the auspices of the health boards — had access to the knowledge and technology relating to viral inactivation which is required to deal with many of those problems. Due to errors and suppositions, contamination occurred unnecessarily. Attention was not paid to donor selection, quarantine periods and fractionation methods and other matters relating to a safe blood system were not properly addressed.

Haemophiliacs are concerned because it takes large amounts of blood to manufacture products such as factors 8 and 9 and consequently, there is a greater risk of contamination. If the blood is not properly inactivated, different kinds of problems can result. Haemophiliacs should not be dying as a result of contracting hepatitis C; at least four patients have died during the past year. It is enough to be afflicted with the problem of haemophilia without being obliged to run the gauntlet of viruses such as hepatitis C. As Deputy Geoghegan-Quinn stated, hepatitis C is very aggressive in the case of haemophiliacs and generally leads to early death.

Haemophiliacs are not like the anti-D patient recipients, who may receive injections of that substance between one and six times during their lives, or the recipients of blood transfusions. People may receive blood transfusions on one or more occasions but haemophiliacs are wont to receive factors 8 and 9 many times. That leaves them open to contamination if the blood is not of the highest standards. It is for this reason that haemophiliacs should be given every consideration at the inquiry.

Having considered the issues relating to haemophiliacs, I believe they have a special case. They are more liable to be contaminated than any other group in society. As late as 1996, there was a scare regarding factor 8. The way this problem was managed and dealt with left much to be desired. Some patients were not informed of the dangers involved and read about it in the newspapers. Much progress has been made in respect of blood products such as factors 8 and 9. However, it is the responsibility of the Minister and his Department to ensure that the best standards obtain in this country. We should not be obliged to purchase blood products from abroad. If the Blood Transfusion Service Board had access to the correct equipment and the goodwill of the people, it could supply sufficient amounts of blood required for various trauma cases and people who need it, particularly haemophiliacs.

I entreat the Minister to seriously consider our spokesperson's comments in respect of the debâcle concerning blood products. It is time we put our house in order. The technology is available to eliminate viruses of which we are aware at present. I presume that further viruses will emerge in the future but if we use best practice today we cannot be accused of not taking due care. As I stated earlier, haemophiliacs are a special case and they should be treated in a special way, particularly by the tribunal. Not only have they fears about the past and present, they also have fears about the future because they will be the greatest users of many of the products to which I referred. On mature reflection I hope the Minister will agree to the motion as proposed by our spokesperson on Health, Deputy Geoghegan-Quinn.

Limerick East): I thank Deputy Geoghegan-Quinn for her contribution and I wish her well on her retirement from politics. I hope that, in her private life and whatever career she takes up, she will be successful and fortunate.

I move amendment No. 1:

To delete all words after "That" and to substitute the following:

"Dáil Éireann

(i) welcomes the publication of the Interim Report of the Tribunal of Inquiry into the Hepatitis C infection of blood and blood products manufactured and distributed by the BTSB;

(ii) acknowledges the concerns expressed by the Irish Haemophilia Society;

(iii) welcomes the announcement by the Minister for Health that the Government has agreed to establish a Tribunal of Inquiry to examine specific urgent matter of public importance, namely:

(a) the HIV infection of blood and blood products manufactured and distributed by the BTSB; and

(b) such further matters in respect of blood and blood products as may require investigation in the light of the Report of the Hepatitis C Tribunal; and

(iv) notes that detailed terms of reference will be prepared after the Report of the current Tribunal becomes available."

This is an amendment to the motion before the House, it is not to be suggested in any way that this is the framework for the terms of reference of a new tribunal — I hope there is no misunderstanding about that.

I wish to remind the House of the background to this debate. The announcement that a health service worker in Kilkenny had tested positive for the HIV virus following a blood transfusion she received prior to the introduction of HIV screening by the BTSB precipitated a debate into the lookback procedures of the Blood Transfusion Service Board. I subsequently stated in the House that I would explore the feasibility of either extending the existing terms of reference of the present tribunal or setting up a separate but related inquiry to deal with the specific questions then being raised in regard to HIV infection. I have been having discussions with my Cabinet colleagues on this matter since the middle of December last.

The Irish Haemophilia Society had sought legal representation at the tribunal of inquiry into hepatitis C, but that was not granted by the tribunal as the tribunal felt it was neither necessary nor appropriate for the task which it had to carry out — I am referring to what the tribunal said. The society then sought a judicial review in the High Court in November last and that was allowed. Following that there was an agreement on the level of representation to be allowed to the Irish Haemophilia Society at the tribunal. The Irish Haemophilia Society withdrew from the tribunal of inquiry into hepatitis C on 15 January last because it felt that the issues of concern to it and to its members were not being addressed by the tribunal.

Haemophilia is a bleeding disorder which results in the blood of the haemophiliac not clotting in the normal way because some of the clotting factors normally present in blood are missing. Treatment for haemophilia consists of replacing the missing factors with blood derivatives to allow normal clot formation to occur and thus avoiding haemorrhage. Haemophiliacs are, therefore, not only frequent users of blood products but also totally reliant on blood products for their quality of life.

Before the introduction of this replacement therapy in 1967 a person with haemophilia could expect to live to his or her middle 30s. Following the introduction of replacement therapy, life expectancy for haemophiliacs increased to between 65 and 70 years, not quite up to average life expectancy for the rest of the population but significantly near it. It is clear how effective the replacement therapy has been for a group which is the greatest user of blood and blood products and consequently most at risk from virus or infection in the blood or blood products. When the HIV virus began to appear in blood products the life expectancy went back again to the middle 30s. The viral infection of blood products is obviously a crucial issue for the Irish Haemophilia Society and its members who rely so much on the quality of blood and blood product supply.

I was disappointed with the decision of the Irish Haemophilia Society to withdraw from the present tribunal. I am aware the society feels that a number of its concerns are not being dealt with by the present tribunal of inquiry. The terms of reference of the current inquiry specifically allowed for the tribunal to make me aware, at the interim report stage, of any changes which the tribunal considered were necessary to its terms of reference. The interim report stated that there were no matters which the chairman considered necessary to draw to my attention at that stage — I put the interim report before the Houses of the Oireachtas and it is available to every Member. It would, therefore, be inappropriate for me to seek to influence the tribunal in the discharge of its mandate given to it by the Oireachtas. The terms of reference specifically stated that if the tribunal wanted to draw to the attention of the Oireachtas any matter, including a change in the terms of reference, that could be done. The interim report stated that there was no such matter which the tribunal needed to bring to the attention of the Members of the Oireachtas.

I too am very concerned that the circumstances of the infection of all blood products are fully and properly investigated and, to this end, the Government has today agreed to the establishment of a tribunal of inquiry to examine specific urgent matters of public importance, primarily in regard to HIV infection of blood and blood products manufactured and distributed by the BTSB.

I now wish to deal with the substantive issues of the debate. The interim report of the tribunal of inquiry into the hepatitis C infection of blood and blood products manufactured and distributed by the BTSB was laid before this House on 8 January 1997. I take this opportunity to express my grantitude to the chairman, Mr. Justice Finlay, for the speed and efficiency with which this report was produced and presented to me. The terms of reference of the tribunal of inquiry into hepatitis C, as approved by this House, included the stipulation that the tribunal should report on an interim basis on the following four matters: the number of parties then represented before the tribunal; the progress which had been made in the hearings and the work of the tribunal; the likely duration of the tribunal proceedings and any other matters which the tribunal believed should be drawn to the attention of the Minister for Health at that stage, including any matter relating to the terms of reference.

Six parties have been granted full representation before the tribunal for the duration of the inquiry: Positive Action; the family of the late Mrs. Bridget McCole; the Blood Transfusion Service Board; the National Drugs Advisory Board, now known as the Irish Medicines Board; the Department of Health and the Minister for Health; and a team of lawyers nominated by the Attorney General to represent the public interest. Limited representation before the tribunal was granted to the following four bodies: Transfusion Positive, the Irish Kidney Association, the Irish Haemophilia Society and Crumlin Hospital. Three persons who were witnesses were granted representation in connection with the giving of their testimony.

All the parties to the action brought by the late Mrs. Bridget McCole agreed that documents discovered by them in those proceedings should be made available to the tribunal. In addition, orders for the discovery of documents relevant to the terms of reference of the tribunal and not already discovered in the court proceedings were made against the following: the BTSB, the NDAB and the Department of Health. Orders for discovery were also made against Positive Action, the Coombe Hospital and Crumlin Hospital. In addition, the Irish Haemophilia Society, the Irish Kidney Association and Transfusion Positive supplied documents on request to the tribunal.

At the outset the tribunal decided that it would divide the terms of reference into two separate groups for the purpose of taking evidence and consideration of documents. Items Nos. 1 to 4, inclusive, and item No. 9 of the terms of reference, were taken first, to be followed by items Nos. 5 to 8, inclusive, of the terms of reference. Prior to the commencement of oral evidence on 2 December 1996 the tribunal circulated to parties a statement of facts seeking their agreement or dispute with such facts as itemised. The interim report states that this represented a very significant contribution to the expedition and clarity of the proceedings.

The tribunal sat for 11 days from 2 to 17 December 1996 during which it took evidence from 29 witnesses. The names and occupations of those witnesses are set out in an appendix to the interim report.

The interim report states that, save for a very limited number of topics in which some oral evidence may be required in the second part of the proceedings of the tribunal, in the view of the chariman the oral testimony and the documentary testimony necessary to reach conclusions on the terms of reference already dealt with, items 1-4 inclusive and item 9, is completed.

I would like to comment on the likely duration of the tribunal proceedings in so far as that was capable of being estimated when the interim report was presented. The extensive preparatory work carried out before oral evidence commenced on 2 December 1996 on the first segment of the tribunal's work was also carried out in relation to the remaining terms of reference, items 5-8 inclusive. The interim report states that this process is likely again to clarify and greatly expedite the taking of the evidence which remains to be heard.

The taking of oral evidence recommenced on Monday, 13 January 1997. The interim report stated that: "... while it is particularly difficult at this stage to estimate the duration of oral evidence the Chairman considers it likely that it may be concluded within approximately 3 weeks and that thereafter a period of another 3 weeks may suffice for the final preparation of the report."

At this stage it appears the oral hearings will conclude this Wednesday or Thursday and the final report of the tribunal will be received around the end of February.

As Deputies are aware, in terms of the interim report the House asked the tribunal to report on any other matters which it believes should be drawn to the attention of the Minister for Health at that stage, including any matter relating to the terms of reference. As I said earlier, the interim report stated there were no matters which the chairman considered necessary to draw to my attention at that stage when the interim report was presented.

All reports of the tribunal's proceedings to date indicate it is operating efficiently and effectively and that this is due, in large part, to the fact that its terms of reference were very specifically drawn up to satisfy the desire of this House that the inquiry be completed in as economical a manner as possible, consistent with a fair examination of the matters referred to it. The tribunal has confirmed it would not be practical to extend the terms of reference of this inquiry and the Government accepts this view.

There were two ways of approaching the concerns of the Irish Haemophilia Society and HIV issues which arose before Christmas. One was to extend the terms of reference of the current tribunal and the other was to set up a related tribunal with new terms of reference with, perhaps, the same personnel to examine a new area requiring investigation or a new module of work. The Government, through the Attorney General, contacted the tribunal and it confirmed that, from its perspective, it would not be practical to extend the terms of reference of this inquiry, and the Government accepts this view.

The option of extending the terms of reference of this inquiry is not available. I suggest the tribunal is correct in its assessment and that the way the Government is proceeding is the better way because there are many arguments against extending the terms of reference of the present tribunal. They include the fact that the present tribunal team considers it is neither practical nor feasible for the current tribunal of inquiry to meet the requirements of the Irish Haemophilia Society which were put to it. Discovery of documents is also an issue. Document collection and appraisal of documents would have to commence in respect of any new matters arising and this would add significantly to the postponement of the publication of the final report of the current tribunal. It is not only in the public interest but in the interest of all parties participating in the tribunal and victims of the hepatitis C scandal that, when the body of work which the tribunal was set up to do by the Houses of the Oireachtas is almost complete and when the tribunal has informed me that it can report in about four weeks, we should be very reluctant to change its terms of reference in any way which would prevent it from delivering on this.

When we came into the House to debate these issues the arguments put forward were that the anti-D scandal should be investigated and that the hepatitis C infection of anti-D product and its consequences for blood and blood products should be investigated with specific terms of reference to ensure, in so far as possible, that we would get an early report and that we would not opt for an open-ended tribunal as some kind of exigency of the political system to kick uncomfortable matters into touch. We were looking for the truth. We wanted the truth after a thorough examination and we wanted it reasonably quickly. The tribunal has informed me and both Houses of the Oireachtas that it is in a position to deliver on this in about four weeks' time. We should hesitate before deciding to take a course of action which might lead to an unforeseeable delay.

If I came in here to change the terms of reference, I envisage that Deputies opposite would very quickly say I was deliberately extending the work of the tribunal because I do not want the report to come out, that I am hiding behind the procedures of the House and taking action to ensure the tribunal does not report at an early date. I am sure charges would be made that I was trying to postpone the publication of the report of the tribunal until after a general election. I consider it is in the best public interest that the report is finalised promptly, that it is important there is no lengthy gap between the giving of evidence, which may be completed tomorrow or the day after, and the publication of the report.

The House will appreciate that the public has already heard a good deal of evidence from the tribunal. Many of them have an open mind on it and others may be making up their mind about it. Because the issue in respect of the BTSB and confidence in the blood supply is so serious, it is very important that the tribunal should adjudicate quickly. It has told me it will be in a position to do so in approximately four weeks' time. It is important that report should be made available as quickly as possible and I am very pleased that the tribunal has decided to do that.

That is not to say there are not other outstanding important issues. The House should support me in dealing with them in a systematic and equally efficient way so that we get answers once more in respect of other problems and that the truth is again arrived at. I do not want a situation to develop where, in attempting to do everything together, we do nothing effectively. It is much better to order our business in the manner I am proposing to the House and that we come back with a related tribunal which will inquire into very serious matters concerning the blood supply, and hope we can again draft specific terms of reference, in co-operation with all sides of the House, which will allow an equally efficient inquiry to arrive at the truth.

I will deal briefly with the background to the HIV element of the proposed tribunal. As I informed the House in December, no lookback programme was undertaken by the BTSB following the introduction of HIV screening in October 1985 in respect of the earlier donations by donors now screening positive, although their donations were not used. The BTSB had, from 1989 onwards, a lookback programme for newlypresenting donors.

A total of 24 blood donors have tested positive for HIV since screening was introduced in 1985. Eight of those 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 potentially infected issues 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 despatch records for the period prior to 1986. Of the 31 issues from those seven donors, 15 were donated prior to 1981 and are not regarded as a potential source of infection. The residual problem relates to tracing the recipients of the balance of the 16 issues derived from the potentially infected blood donations made prior to 1985. Six of the issues have been traced leaving ten issues of concern remaining. I was advised that there can be no guarantee that all the remaining ten issues will ever be traced. There is also the possibility that some donors who may have been HIV positive prior to the introduction of HIV screening of donations in October 1985 may not have come back to donate since 1985 and cannot, therefore, be identified. As I said in the Dáil on 17 December, I therefore decided to introduce an optional HIV testing programme, the details of which are being finalised. It will commence shortly.

The success of the tribunal has been ascribed,inter alia, to the specificity of its terms of reference and, when the terms of reference of the HIV inquiry are being drafted, it is important that that example is followed. In finalising the terms of reference account will be taken of such further matters in respect of blood and blood products as may require investigation in light of the report of the hepatitis C tribunal. Particular attention will be paid to the concerns of the Irish Haemophilia Society. I wish to enter into consultations with it before the terms of reference are finalised in the House. I understand its concerns.

The tribunal of inquiry had terms of reference which allowed it to look at the chain of infection from anti-D to blood and blood products and it allowed the society partial representation. In its report it may deal with some but not all of the issues. I wish to enter consultations with the society before I bring forward terms of reference in the House and in the light of what may be contained in the report which we expect to receive in about four weeks.

It is my hope that the terms of reference for the new inquiry which will express specific questions can be drawn up and brought before the Dáil as soon as possible. It will not be possible to do this, however, until the final report of the tribunal of inquiry has been presented. Until that is available it will not be possible to say what matters of urgent public importance remain unaddressed. It is expected around the end of February.

We are talking about events that occurred in the 1980s. People have waited a long time for answers. I have proceeded with one tribunal which will present its report in four weeks time. There is no kicking to touch. We will bring forward the terms of reference in the Dáil as soon as we are able to do so. If I brought forward terms of reference tonight which dealt with generalities and said there would be an examination, it might satisfy the political demands of the moment but a future tribunal may drift on and on and the truth would not be arrived at.

The Houses of the Oireachtas did a good job in drafting the last terms of reference. There are outstanding matters, some of which are of deep concern to the Irish Haemophilia Society. I wish to enter consultations to identify the matters that need to be addressed and to continue the process in the House. It is important and central to the health service and confidence in the blood supply.

Will the Minister give way? He is talking about HIV. Will he, or somebody on his behalf, respond tomorrow night on the specific health care worker in Kilkenny and the problems in relation to the time constraint?

(Limerick East): I will not promise that somebody will respond tomorrow night but I would appreciate it very much if the Deputy would give me or officials of my Department the details privately. The matter will receive consideration. The anonymity of the person concerned in Kilkenny was not preserved and I do not want talk across the floor of the House about an individual whose identity is known.

On 16 October I made a comprehensive statement in the House on the legal strategy adopted by the State in the High Court case arising out of the action taken by the late Mrs. McCole. It is not necessary or appropriate for me to restate the rationale for the approach adopted in this matter.

The chief medical consultant of the Blood Transfusion Service Board has made a public appeal for blood donors to come forward to ensure adequate blood supplies are maintained. As the House understands, blood donations drop off around this time of year because of seasonal factors such as colds and flu. This is not a feature confined to Ireland. In the United Kingdom blood donations are down by 50 per cent in some places and the health authorities there have the same difficulties as we have. Elective operations have been cancelled in certain parts of the United Kingdom and a number of other countries have similar difficulties in maintaining their blood supply.

I am conscious of the need to ensure the blood supply in Ireland is adequate for the needs of those who are ill and in need of transfusions. There has always been a great tradition of giving in the health service. This is not confined to those immediately involved in health care, although health care workers are also significant blood donors. Blood donation allows those who work outside the health care area to provide something of benefit to those who are ill. Each year over 180,000 donations of blood are made.

I have on previous occasions highlighted the importance of ensuring an adequate supply of blood and blood products and pointed out that without an adequate supply the lives of patients are put at risk. Heart transplants and bypass operations, kidney and liver transplants and many other surgical procedures cannot take place without supplies of blood being available. The blood supply is at the core of the hospital service.

I, therefore, make a special appeal to blood donors throughout the country. These donors have been magnificent, especially in recent years. My appeal to them is to continue to donate blood in the same generous way that they have always donated and for the same reasons.

The policy of my Department is to continue to use voluntary unpaid donors and to remain selfsufficient in blood and blood products. This is also the policy of the European Union. I am most anxious to ensure this continues to be the position in Ireland.

Doctors will confirm that there is no alternative to human blood in treating patients who require transfusions and in keeping the hospital system operational. It will be many years before an alternative is available. In the meantime the health service will continue to rely on voluntary donations made by some for the benefit of others.

The strictest safety procedures are in place in the Blood Transfusion Service Board and its operation conforms to international standards. I have been involved in putting new management in place and its new chief medical consultant has taken up his appointment. I am confident that the blood supply has never been safer and that donors will come forward in their usual high numbers to ensure adequate supplies of blood are available for the patients who urgently need their help.

I ask other Members who have influence, particularly the spokespersons opposite, to make a similar appeal. It is crucial that blood supplies are maintained. The position improved significantly today. The awareness among donors that seasonal factors are impacting has led to an increased presentation of donors to give blood. Any support that others could give would be helpful also.

I am confident that all Members want to see the issues in relation to blood safety fully addressed and I am aware that all parties are anxious to ensure that whatever remains to be done is done. There should be no unanswered questions remaining following completion of the present and proposed inquiries. It is also essential to ensure that whatever institutional changes need to be made are made. I am anxious to deal comprehensively with these issues and to allow the new management structure to get on with planning the future needs of the blood supply without the constant need to become involved in investigating the past.

I hope everybody in the House will join with me in my wish to ensure that the public and patients have every confidence in the blood supply. The fact that this House is prepared to agree to have all of the matters at issue examined is a clear signal to blood donors that their concerns are our concerns and that the maintenance of the safety of the blood supply is an absolute priority.

In light of the amendment tabled by the Government I find myself in the somewhat embarrassing position of having to declare an interest in the matter. I appeared as counsel for the Minister for Health in the litigation arising out of the previous claims made by the haemophiliacs who contracted HIV from infected blood products. Some developed full blown AIDS. That matter led to a general election and the proceedings were subsequently compromised by the Minister for Health. I do not want anything I say here to be taken as going beyond that particular matter, in which I am bound by the confidentiality I owe to my former client.

Deputy Geoghegan-Quinn said there have been 25 debates on this subject. In the light of the announcement made by Deputy Geoghegan-Quinn two days ago, I want to take this opportunity to wish her well in the future. She has made a tremendous contribution to the proceedings of this House, in Government and in Opposition. She has done Trojan work vindicating the rights of this frightened and intimidated group of people. The work she has put into it will be one of the monuments to her in the future. We all wish her the best.

The matter in hand and the 25 debates we have had prompts certain reflections on the procedure of a tribunal of inquiry. We have had a number of these over the decades but I do not think there has been the degree of supervision of a tribunal of inquiry we have seen with this one, which I welcome. We all learnt the lesson from the previous tribunal of inquiry into the beef industry that there was a need for a more comprehensive control by these Houses of inquiries which we establish to report to us. As the Supreme Court made clear in their judgments on the previous tribunal of inquiry into the beef industry, these tribunals are creatures of the Houses of the Oireachtas. They are not, in any sense, a court of law. They may follow or adopt the procedures of a court of law, they may hear evidence and conduct the discovery of documents but they are established for the purpose of reporting to us and of conducting an inquiry on our behalf.

There is some discussion in the House at present about conducting these inquiries ourselves but it is better that we entrust that task to some person outside the House. With the best will in the world, we can all be guilty of strong party passions. I am not sure politicians are in the best position to judge when clear answers to disputed facts are required. We should pay tribute to former Chief Justice Thomas Finlay for the expeditious manner in which he has conducted the inquiry to date. It is encouraging and will foster the greater use of tribunals in the future.

As regards the motion before us this evening, I am disappointed the Government has not been able to come forward with a more reasoned amendment. The Minister concluded his speech this evening with a powerful appeal for donations to the blood bank. We all know how important the voluntary unpaid donor is to the Irish blood transfusion supply. I am happy to join with the Minister in that appeal. If he wants a response, he must realise the importance of maintaining public confidence in the administration of that system. If the most farreaching inquiries have to be conducted urgently, the Minister has to translate that into a practical exercise of political will to see that it happens. We on this side of the House join with him in appealing to donors all over Ireland to come forward and help out in the problem that has arisen. The Minister can also play a part in this by encouraging the most candid and full investigation into the matters raised in our motion. Their amendment does not address that.

I do not need to rehash the precise points made by the Haemophilia Society. They have already been set out by the party spokesperson, in correspondence received by every Member of this House and in the records of the proceedings. We were all disappointed when they led to the society withdrawing from the proceedings. They made the point that of the 210 people with haemophilia who have been infected with hepatitis C, three have already died, a further 34 have died of coinfection of hepatitis C and HIV and the majority have chronic liver disease. This is a group of people with whose interests we should be dealing as quickly as possible. That is not covered in the Government amendment, which disappoints me.

The Minister made a number of objections as to why it could not happen. He fairly set out the reasons against extending the terms of reference of the present tribunal. He said the present tribunal team considers it is neither practical nor feasible for the current tribunal to meet the requirements of the society. That is a matter of legal opinion. It is a notorious fact that lawyers can diverge in their opinions. Where there is a determination to see a matter resolved and ascer-tained, I believe lawyers can bend their energies, undoubted talents and intellect to that end.

Fresh discovery of documents may now be required. I would have thought a great deal of documentation has been discovered in the course of the existing inquiry which would touch on the matters with which we are concerned. It is not really a matter of an entirely fresh discovery but rather bringing documents to light with which the tribunal is, to some extent, already familiar, making them explicit or drawing out their implications.

The kernel of the Minister's case is that he is anxious to see this matter finalised within the next four weeks. I do not know whether this is a signal of the possible timing of the next general election but he seemed to be very concerned that matters would conclude in the next four weeks. I agree this is important. It is obvious from how the former Chief Justice has conducted his work that a further extension to deal with this matter would not take up a great deal of time. Whatever the lawyers may say, it is clear from how the chairman of the tribunal has approached his task that he would be in a position to deal with the matter in an expeditious fashion. Having made those objections, the Minister gave an undertaking. I am pleased he did this because the Government amendment refers to the "HIV infection of blood and blood products manufactured and distributed by the BTSB".

As I said at the outset, I do not want to comment on that other than to say it does not appear to relate to the infection of haemophiliacs with hepatitis C. It is curious that the amendment is proposing an entirely different inquiry from the matter we raised. It goes on to say "such further may require investigation in the light of the report of the Hepatitis C Tribunal". It is clear that the chairman took a strict view of the interpretation of the terms of reference. I do not fault him on that. The Oireachtas settled the terms of reference and it probably assisted him in the rapid disposal of his business that he adopted a strict construction of his terms. However, subparagraph (b) in the amendment refers to "such further matters" and is open to a strict interpreta-tion which does not apply to the question we raised in our motion.

For that reason, I was glad to hear the Minister say it was a matter of particular concern to him that any terms of reference would be settled in consultation with the Haemophilia Society. I urge him to do that. I do not see why he cannot do it here and now and bring this matter before the Houses as soon as possible in the form of resolutions. Wherever the hare may run on this issue, it is essential we maintain public confidence in the blood supply.

The other matter raised is the question of the McCole case and the authorisation of legal strategy on the defence of her claim. We have not included that in the motion for any prurient political interest to ascertain some facts that might cause political embarrassment to this or that Minister. There is a wider question involved here because there is the public suspicion that the legal strategy adopted by the defence — and I am not making any suggestions or allegations about the Ministers in this regard — was adopted essentially for the purpose of concealing facts from the public. The public is concerned about the degree of concealment that took place at the BTSB and, therefore, the whole question of the legal strategy could very well throw light on the findings of fact which the tribunal should make on the overall questions posed to it by the terms of reference. That matter deserves to be examined in further detail. I wish to share the remainder of my time with Deputy McDaid.

I thank my colleague, Deputy Lenihan, for sharing his time with me and my other colleague, Deputy Geoghegan-Quinn, who has been foremost in pursuing this matter in recent years and who will see it through until justice as she sees it is done in this case.

In the short time available to me I do not want to go over what has been said here tonight but rather concentrate on two aspects of the motion, namely, the call on the Minister for Health to grant a debate on the interim report and that all questions raised by the family of the late Mrs. McCole should be answered.

I regret the Minister has refused to grant us a debate on the interim report because in the first three or four days of the tribunal I learned more about the scientific ongoings in the BTSB than I learned here or about medicine in general in the past five years. I was absolutely horrified by what I found out in the first few days of the tribunal and it is only right that we should debate it in this House. I intend to raise just one specific point from the first week of the tribunal to outline the reason we should have a debate on the interim report.

I have been somewhat disturbed by the recent change in what the tribunal has undertaken. It has gone from producing scientific knowledge and fact finding to what appears to be a debate about who is at fault between the Department of Health and the BTSB. Officials on one side seem to blame officials on the other side and it is unfortunate that the tribunal has reduced itself to that. A debate on the interim report should be granted by the Minister because this House has failed the people involved in the hepatitis C crisis. Such a debate would at least bring some of the facts out into the open. Facts not previously known to us or the Minister are now known and they should be debated and perhaps apologies made.

The second part of the motion refers to the questions posed by the family of the late Brigid McCole. The entire nation was enormously impressed by the dignity with which Mrs. McCole's family have conducted themselves throughout this terrible trauma. Brigid McCole was given an injection in 1977 that was meant to save the life of her baby but in fact was to cause her death 18 years later. We have heard from Mrs. McCole's daughter of her harrowing suffering in recent years. The media and the entire population described this case as a tragedy and a travesty, but to describe the case in that way after what we have heard is totally inadequate.

The picture that has emerged in the first week of the tribunal is not one of a tragic scientific mistake involving a relatively new condition but of revelations that have shocked the scientific medical world. It appears the facts which have emerged from the tribunal and which caused Brigid McCole's death were known to the BTSB before she received her injection. An analysis of the evidence given to the tribunal in chronological order reveals that a doctor identified the source of the infection of one of his patients as an injection of anti-D and informed the BTSB, as did a consultant who wrote to him. That letter was dated 4 October 1977. Brigid McCole received her injection on 5 November 1977.

I put it to the Minister that in July of that year the BTSB received at least seven reports of severe hepatitis in women who had received anti-D five months before Brigid McCole received her injection. In that same month the BTSB knew precisely where to look for the source of the problem — batches of anti-D from patient X. I have great compassion for patient X because even the so-called expert group that reported to the Minister referred to her as donor X. That was totally unfair to this patient because neither she nor her doctor knew her blood was being used in this way.

Why did the BTSB use plasma from such a patient? There are two basic reasons they should not have used it. Patient X was diagnosed in 1976 as having infectious hepatitis and the BTSB accepts that it is probable she received her contamination from blood transfusions. Yet it was made clear in the first few days of the tribunal that the BTSB had a clear rule dating back to 1968 that blood was never to be taken from a person who ever had jaundice of any kind.

It may never be known how patient X became infected but it has emerged that in 1975 the entire stock of anti-D in Pelican House was placed in a refrigerator in a special hepatitis laboratory thereby probably exposing it to the risk of crossinfection. Patient X may take that as a suggestion but we will never know how she became infected. This fact was made known to the tribunal by a scientific biochemist, Stephen O'Sullivan, who demanded and was told that stock would be destroyed. The entire batch was brought back and continued to be used.

The second basic reason patient X plasma should never have been used was that patient X was attending Crumlin Hospital three days per week for a plasma exchange programme. Throughout the world the blood of people receiving such exchanges is never deemed sufficiently healthy for the manufacture of anti-D. Crumlin Hospital sent samples of patient X's plasma to the BTSB, and nine of those samples were marked "Infective Hepatitis". The BTSB was asked to test one of the samples for hepatitis B, but despite the fact that those samples were marked "Infective Hepatitis" the BTSB continued to make anti-D from that plasma. That decision could have been reversed in 1977 but the BTSB took an extraordinary step. It decided to cease using the plasma to make new anti-D but continued to use the anti-D already made. The first question in relation to Mrs. McCole, therefore, is very pertinent because one of the batches already made was batch 250. For the next 18 years that decision by the BTSB determined the quality of life of Brigid McCole because she received her injection from batch 250.

Debate adjourned.