Dáil Éireann debate -
Tuesday, 25 Mar 1997

Vol. 476 No. 7

Report of the Tribunal of Inquiry into the Blood Transfusion Service Board: Motion (Resumed)

The following motion was moved by the Minister for Health, Deputy Noonan(Limerick East), on Thursday, 20 March 1997:

That Dáil Éireann,

(a) notes the Report of the Tribunal of Inquiry into the Blood Transfusion Service Board (BTSB) and acknowledges the gravity of the findings made against the Blood Transfusion Service Board, its servants and agents;

(b) accepts in full the recommendations of the Report;

(c) fully understands the extraordinary anguish and distress experienced by the victims and their families;

(d) notes and acknowledges the widespread sense of public outrage at the matters disclosed in the Report;

(e) supports the Minister for Health's request to the BTSB to make known its position on liability in all outstanding cases forthwith, in the light of the findings in the Report;

(f) supports the Government's intention to reappraise and amend the Scheme of Compensation and its Terms of Reference, including the question of whether the Tribunal should be established on a statutory basis in the light of the Report, the reappraisal to take place following consultation with representatives of the victims and with the Chair of the Compensation Tribunal, and consideration of any necessary legal advice;

(g) notes the Government's decision that the benefits of any adjustment to the Compensation Scheme will be made available to all victims, including in particular cases which have already been determined by the Tribunal, or which will be determined between now and the date any adjustments are put in place, and

(h) notes that the Government will not seek to resile from or repudiate any of the findings of fact in the Tribunal Report in any proceedings either in Court or before the Compensation Tribunal.

Debate resumed on amendment No. 1.

To delete all words after "Board (BTSB)" and insert the following:-

"condemns the Minister for Health for failing, yet again, to make the victims a first priority, following the publication of the report;

condemns the political handling of the scandal by Ministers Howlin and Noonan;

Condemns the refusal by Minister Noonan at the time of the establishment of the Judicial Inquiry to allow an investigation into how the State and State agencies acted when legal proceedings were instituted by the late Mrs. McCole;

calls on the Government to give an unreserved apology to all victims of the hepatitis C scandal;

calls on the Government to make a full admission of liability to persons infected with hepatitis C through the wrong doing of the State and State agencies; and

calls on the Government to amend the terms of reference of thead hoc Compensation Tribunal to provide for

(a) awards of aggravated and/or exemplary damages;

(b) a right of appeal to the High Court; and

(c) a procedure whereby victims (including victims since deceased) who have accepted awards from the State can apply for aggravated and/or exemplary damages in addition to sums already awarded to them."

—(Deputy Cowen.)

Dr. Moffatt

Even though the House has debated hepatitis C on approximately 30 occasions certain problems still remain to be resolved, for example, the procedure for taking blood and from whom. The Minister reassured us that he has reorganised the BTSB, yet there is no evidence of this. Computers are only as good as the information fed into them. The Minister should start with the basics and ensure a proper questionnaire is used when taking blood. This questionnaire could include simple questions such as whether donors have received blood, a blood product or anti-D, whether they are on medication or suffering from a disease and whether their occupation or lifestyle puts them at a risk in terms of being a donor. This type of information has not been sought or correlated by the Blood Transfusion Service Board. The media is uncovering new problems every week. While most of these are clerical in nature, nevertheless they highlight the problems in the BTSB. This does not enhance the good name of the BTSB.

Is it necessary to change the management structure of the BTSB? Would an executive chairman solve the problems? We should not downgrade the product of the BTSB. I am happy from a safety point of view that we have a reliable product, be it whole blood, blood product or anti-D. We should not scare people who must have operations or need blood products. Neither should we politicise certain aspects of this issue. It is the job of the Opposition to criticise and ensure improvements and not to criticise and damage a good service. This service is based on voluntary donations from a pool of blood which has a low incidence of any serious type of infectivity and, therefore, it should not be a major problem to deliver a safe product of which we can all be proud.

There are other issues which need to be addressed and perhaps the Minister will deal with these in his reply. What type of aggravated damages does he have in mind? The language he uses in relation to same is still somewhat equivocal. Will there be an appeals mechanism? How will the people who have already received settlements from the compensation tribunal be brought into the reckoning at this stage? What is the position of the dependants of those people who have unfortunately died?

Positive Action, Transfusion Positive, haemophiliacs and transplantees have said this is not solely a matter of compensation. Money cannot buy health, which is what we are primarily concerned about here. An apology from the services and those who let down these people and then tried to cover up the issue should have been forthcoming long before now. I wonder if we would be talking about aggravated or punitive damages today if the plight of these people had been addressed differently during the initial stages by Ministers. I think not.

The services for those affected need to be improved. The hepatology services provided under a medical card are satisfactory. It is unfortunate that affected patients needing rheumatology services, bronchoscopies, etc., have to queue with other public patients. Their medical services card should entitle them to priority treatment in those areas. These people have been hard done by and should be recompensed.

The recommendations for improving the service need further elucidation. The development plan, previously referred to, does not appear to be in place despite the fact that it is some months since it was first mooted. A biannual review of the Blood Transfusion Service Board by the National Drugs Advisory Board is not sufficient. A better monitoring system must be put in place. The reporting of abnormalities and reactions must be put on a proper basis. The establishment of a blood services consumer council would give the BTSB a much needed boost in regard to maintaining confidence. A procedure for recalling products should be implemented immediately. If the proper systems are put in place, the recall of products will not be necessary in future.

If best practice had been implemented at the outset, this problem would not have arisen. The BTSB was negligent at that time because jaundice is hepatitis until proved otherwise. If that had been recognised by the people operating the service at the time, we would not have the problems we are facing today.

It is important that people using the transfusion service have confidence in it. We have a good product and I hope people will not be unduly concerned about using it in future. From reading today's newspapers, it appears that people with leukaemia and others requiring transfusions and other blood products are concerned, but they should not be frightened to avail of existing blood products.

Mr. Shatter

With the agreement of the House, I wish to share my time with Deputy Frances Fitzgerald.

An Ceann Comhairle

That is in order.

Mr. Shatter

As Members of the House, we owe a debt of gratitude to Mr. Justice Thomas Finlay for the comprehensive report produced by him in a short period. Arising out of this tragedy, we know that over 1,600 women were mugged and poisoned by a State agency charged with the duty of protecting their health. We know Brigid McCole died because of that failure of duty. We do not yet know the number of women who died during the 1980s or early 1990s due to being administered contaminated blood products because the look-back programme has not yet fully investigated that issue, and we may never know the true number.

We know that what occurred was not a result of medical ignorance or lack of scientific knowledge but a failure by the BTSB to adhere to its own procedural guidelines. We know that each time the alarm bells rang, somebody switched off the alarm and played deaf. We know that when what occurred was made public, the full story was not told, inadequate counselling was provided for the victims of this scandal and some were asked for intimate details of their sexual lives, giving rise to the suggestion that their health difficulties may have been caused by promiscuous conduct.

We know that the Hederman-O'Brien committee was not furnished with all information relating to this scandal by either the BTSB or the Department of Health. We know that successive Governments failed to provide adequate resources over a period of 20 years to ensure proper inspection by the National Drugs Advisory Board of the BTSB, and that the need for resources was constantly made known to the Department of Health.

We know that when the late Brigid McCole took the State and the BTSB to court to establish who was responsible for the tragedy that destroyed her life, she was treated like an enemy of the State, and legal defences were fired on the basis that the BTSB and the State had no responsibility for what occurred. We know that no effective mechanism was put in place to allow into the public arena the full story of this awful scandal going back over two decades, and to establish full responsibility, until the Finlay tribunal was, rightly, established by the present Minister for Health. We now know as a result of the Finlay report that both the BTSB and the State are culpable.

The victims of the scandal were forced to fight a legal and political battle for three years to get the truth. Too many political, legal and bureaucratic obstacles during those three years obstructed progress. In 1994, again in 1995 and subsequently, I called for the Garda Commissioner to initiate a criminal investigation and for a file to be submitted to the DPP. One newspaper reported nine days ago that the Garda have finally commenced an investigation. Is the Minister in a position to confirm the accuracy of this report?

Upon the publication of the Finlay report, the Cabinet forwarded it to the DPP. Without a Garda investigation and file being submitted to the DPP containing evidence to warrant the bringing of prosecutions, I do not believe the DPP will be in a position to bring criminal proceedings. Nevertheless, I welcome the fact that the report has been furnished to him.

I have asked previously that the manner in which the State and State agencies treat citizens of this State who litigate, alleging a serious wrong done to them by the State, be examined and new structures put in place to ensure no one is again treated in the manner Brigid McCole and her family were treated. To date, nothing has happened in this regard. It is a problem that must be addressed in the future.

Reading the Finlay report led inescapably to the conclusion that the victims of this dreadful scandal are entitled to aggravated damages. While extra damages paid cannot make good the dreadful wrong done to them, justice, decency and humanity demand that aggravated damages be forthcoming as an acceptance by the State and the BTSB of their responsibility and liability for what occurred.

Last Friday week I publicly stated that I believed aggravated or exemplary damages should be paid. I also said that I hoped and expected colleagues in Cabinet would take such a view. The women affected by this scandal and their families have been put through more than is humanly acceptable. Mary Quinlan, whose High Court proceedings are to be heard shortly, should not have to litigate the issue of aggravated damages and be put under the strain and pressure of a court hearing.

I wholeheartedly welcome the announcements last Thursday by the Minister for Health on the changes proposed to the workings of the compensation tribunal. The Minister was correct to establish the compensation tribunal, under the able chairmanship of Mr. Justice Egan. It has proved a most appropriate forum to facilitate the victims of this tragedy to process claims for damages without being under the type of additional pressures that normally fall on the shoulders of those who have to litigate in the High Court. He is correct to agree to allow the tribunal to make awards of enhanced or aggravated damages.

I would like the Minister to clarify whether the BTSB will automatically accept that victims of this scandal are entitled to be awarded such damages, and that it will merely be the function of the tribunal to determine the amount of damages to be awarded, or whether liability for the payment of such damages to individual applicants is, in any application, to be contested in any way. I would also like the Minister to confirm that aggravated damages will be paid into the estate of the late Brigid McCole, and that liability to pay such damages will not be contested in Mary Quinlan's proceedings.

I have long been of the view that the tragedy that has befallen the victims of the BTSB scandal transcends party politics. It is not an issue for crass party-political point scoring and game playing. The victims of this tragedy deserve more. At all times they deserve to be treated with insight and sensitivity and not turned into a political football. I deplore the statement by the Fianna Fáil spokesperson on Health, Deputy Brian Cowen, announcing triumphantly some victory for Fianna Fáil arising out of the Government's decisions and criticising the Government for making a U-turn.

Mr. Cowen

The Deputy was not here to listen to it.

Mr. Shatter

The Government has made the right decisions arising out of the Finlay report, and this crass and foolish response from the Fianna Fáil Party spokesperson, whose full speech I heard, is extraordinarily inappropriate.

Mr. Cowen

What about Deputy's colleagues?

Mr. Shatter

Equally unnecessary was his bombastic and self-righteous performance in the Dáil last Thursday.

Mr. Cowen

The Deputy would know all about that.

Mr. Shatter

His response this afternoon is typical of the type of politics this discussion could do without.

Mr. Cowen

I will not take lectures from that side.

Mr. Shatter

I would have expected more humility from the spokesperson of a party whose members filled the position of Minister for Health during many of the BTSB's appalling failures at a time when there was a lack of resources to ensure proper inspections by the National Drugs Advisory Board.

Mr. Cowen

The politically correct brigade.

Mr. Shatter

On various occasions inside and outside the Dáil over the past three years I have expressed concern at the manner in which successive Governments have dealt with the consequences of the BTSB scandal. I share the anger of many at the manner in which the BTSB has failed in its duty and destroyed people's lives. My views in this regard have also been expressed privately to Fine Gael Party colleagues. Upon its publication I was entitled to express a public view on RTÉ on the consequences of the Finlay report and, as a Member of Dáil Éireann, I had a duty to do so. The views I expressed last Friday week reflected the views of a great many people throughout the country and, were welcomed by many. The decisions now made by Government have been equally welcomed.

At the time when I called on the Government to agree aggravated damages no Cabinet decision on the issue had been made. I assume that was the reason no reference to the payment of aggravated damages or to any changes being made to the compensation tribunal's terms of reference was contained in the statements issued at the ministerial press conference held by the former Minister for Health, Deputy Brendan Howlin, and the present Minister for Health, Deputy Michael Noonan, on the publication of the Finlay report. At the time of my broadcast, Positive Action had called on the Government to agree to the payment of aggravated damages and to amend the terms of reference of the compensation tribunal. I felt it was entitled to both political and moral support in the call it was making. I was anxious that it should not feel it was entering a new phase of yet another long drawn out political battle. I believed that these women and men who have been through so much were at least entitled to that.

I was astonished to read of the despicable personal attack subsequently launched on my alleged motives by an unnamed source as reported by some members of the media. I do not believe that the Taoiseach or any Government Minister is responsible for the comments made. I regard as contemptible the suggestion that my expressing support for the payment of aggravated damages to the victims of the BTSB was motivated by some perceived personal electoral gain. It is unfortunate that on occasion credibility is given to cowardly political spin doctors hiding in the shadows of the corridors of Leinster House who lack the courage to publicly identify themselves and say openly what they have to say.

Mr. Cowen

Hear, hear.

Mr. Shatter

Having said that, I acknowledge this particular minor storm in a tea cup is of no significance when compared with the fate of those whose lives have been blighted by the failures documented in the Finlay report. It is the victims of this scandal and the future safety of blood products which should be of central concern in this debate.

Ms F. Fitzgerald

I thank Deputy Shatter for sharing his time with me.

Even in the past few days the situation within the BTSB has continued to be problematic. There is no doubt that Mr. Liam Dunbar has a difficult task and that, at one and the same time, he must try to regain confidence in the blood supply service while dealing with continuing administrative errors. It is critical for the people who need blood, for their families, and for all of us that there should be confidence in the blood service. Mr. Dunbar faces such a difficult task because it is the very agency which he is trying to change that lies at the root of this major scandal. He is right to call for confidence, but he needs to realise just how difficult it is for people to hear his message now that there is such a well documented explanation of the series of the blunders in the board. Full trust has to be earned. Confidence has to be earned, and it will only be fully earned when every woman and man who has had contact with the Blood Transfusion Service Board has the fullest information about their own case and when the wider community has full belief that the systems in place are as efficient and as well managed as any blood transfusion service can be, given the state of our current technical and medical knowledge.

As the Ministers, Deputies Michael Noonan and Brendan Howlin, said, the tribunal of inquiry laid blame fairly and squarely. Its report is an analytic document showing clearly where the mistakes were made. There were mistakes made by all Administrations, by people from all political parties. Of that there is no doubt, but party-political wrangling is not the way forward. The way forward is a critical analysis of and reflection on the issues that remain to be addressed and of the underlying sets of beliefs that allowed this scandal to develop in the way it did.

Positive Action's current demands should be met in full. They include the right of appeal to the High Court with anonymity guaranteed. That is a fundamental right which should be built in. The question of aggravated damages should be dealt with on an individual basis, and each claimant should have the right to have the circumstances of his or her claim fully examined. As Ms Jane O'Brien of Positive Action says clearly, each woman is taking the report and linking it to her individual circumstances and wants to see justice. It is also clear that a second tribunal will have to be set up to deal with the huge number of cases. Otherwise the waiting times will be intolerable. I hope that ongoing consultation with Positive Action will ensure that all these concerns are met in the weeks and months ahead.

I welcome the Government motion on the tribunal of inquiry into the board. It is of the utmost importance that the Government accepts the recommendations of the report and fully understands the anguish and distress experienced by victims and their families. I wholeheartedly welcome the changes announced by the Minister, and I believe the benefits of any adjustment to the compensation scheme should be made available to all victims, including those whose cases have already been determined by the tribunal.

There is widespread public outrage at the matters disclosed in the report. We have to reflect on the mistakes made and on how different judgments and decisions might have been made. The series of appalling events affecting over 1,500 women is almost overwhelming. It is the worst health scandal ever. The limitation of activity and capacity that has affected so many parts of victims' lives, personal relationships, work and financial security is enormous. Inexcusable mistakes have been made. The betrayal of public trust is shocking. The trust of the public was betrayed. Trust of some was betrayed when they were given infected products. The trust of all donors, the conscientious men and women who gave blood for the service, was betrayed. It will take time to get their confidence back.

To ignore explicit warnings in the way we now know they were ignored within the BTSB raises enormous questions about professional arrogance and about standards in public services. To have hoped that a potentially lethal problem would go away is breathtaking. The basic principle of respect for clients was absent. Had patient X been told that her blood was being used, her own good judgment on the issue would have led her to realise the dangers involved, but did any of us ever imagine that the professionals in charge would not have made that decision first? General practitioners made reports of patients who had adverse reactions and they were ignored. There is something truly appalling in the disregard of women and women's health throughout this saga. An arrogance towards and a marginalising of women is constantly evident. Positive Action was always concerned with the truth, and in the report it has got the truth at last. In accepting the report and its recommendations the Government is acknowledging the wrong that has been done. I do not intend to go into detail on the recommendations which include the relocation of the board, inspections and the setting up of a blood consumer council, but these are all very important Changes. These recommendations are welcome but many of them are procedures that should have been put in place before this scandal ever had a chance to begin.

It is also shocking that so many years after the scandal broke what would seem to be basic procedures would, in some instances, need to be spelled out still. When I first spoke on this issue in the Dáil in 1994 I said that this was the most major and serious health problem ever to face Irish women. I said that the women should be empowered to get the treatment, information and response from the health service that they needed. I said that a policy of containment was not needed but a policy of empowerment with the support of the health services. I said that the women who had been diagnosed needed information regarding the consequences of a positive test. They needed information on the focus of the illness and possible treatment alternatives. They needed information on the implications for their families and partners, on the effects of this diagnosis on their VHI and their life insurance.

I called for funding to give these women accurate information and support and I called for a comprehensive health package. I said that there was a controlled anger in the women at that stage and that it had to be addressed comprehensively. I said that the women deserved the fullest backup from the State, top-class medical care and attention to treatment. I said I was not being alarmist but that it was critical, that this was a major health crisis that called for a major response. I said what was being said by ordinary women watching how the State was handling mistakes by the State, which had health and life-threatening consequences. We did not learn fast enough and change our structures quickly enough to deal with this crisis. At a public meeting in Liberty Hall two and a half years ago a consultant visiting from England asked the women present who had had a liver biopsy to put up their hands, and he told me afterwards that he had never seen so many women gathered in one room who had had a liver biopsy. The scale of the crisis has been apparent.

On behalf of the political system all of us in this House must apologise. The BTSB must apologise and act to ensure it means that apology. Everybody affected by the hepatitis C scandal deserves and must be treated with exceptional sensitivity and a new approach to consumers of health services must be adopted as a result of this debacle. The professional approach to consumers of health services must be based on civility and respect, partnership and information. An important beginning is setting up the Blood Service Consumers' Council. By keeping this council informed of relevant matters concerning blood and blood products and giving it the right to make representations to the BTSB and the Irish Medicines Board, a more advanced approach to consumers of health services seems to be emerging. The people entrusted with the role of managing those services must listen and be able to respond.

Women's experience of the health service has not been good despite the technical quality of the service. I welcome the consultation that has been carried out extensively under the Minister, Deputy Noonan, in the past year in developing a new model of involvement for women in the health services. That is extremely important. Positive Action has been professional, competent and clear. Its demands were always appropriate, as the outcome of the tribunal and the Government's decision today affirms. I hope the women's new health strategy will begin to meet women's health needs in a comprehensive way. The Government's approach to liability in cases such as this needs to be examined. We cannot just go along with the assumptions made in this regard in the past.

The Government's commitment to partnership comes under intense scrutiny in the light of this report. If listening to consumers of the health service had been a principle in practice, Positive Action would not have had to overcome such huge obstacles before it got the hepatitis C scandal on the agenda. Positive Action was too often seen as another marginal interest group making an unnecessary fuss, and the need for a model of consumers' rights which incorporates the process of consultation, empowerment and partnership. must be a priority.

The Government and those who work on our behalf administering State services must learn that consumers are people who know what they need, are more than capable of understanding and whose demands and concerns must be taken seriously. A sophisticated concept and understanding of consumer rights and partnership must be developed. I hope it will be possible for trust, which has been undermined by this scandal, to be rebuilt in the health service and that the experience of the women affected, as well as the men and children, in dealing with the health service in the future will be a positive one.

Positive Action has been reasonable and informed and, in justice, its request should be accepted. I hope everyone in this House will acknowledge that without the determination of Positive Action we might never have known the truth, a possibility that is worthy of reflection.

Miss Harney

I wish to share my time with Deputy Batt O'Keeffe.

An Ceann Comhairle

That is in order.

Miss Harney

Many words have been spoken about hepatitis C since this major health scandal first came into the public domain two years ago. Because of the complexity of the issues, the full extent of what was involved and the trauma inflicted on so many victims only came to public attention with the death of Brigid McCole. The complexity of the issues involved — hepatitis C and anti-D, terms not in common usage — allowed Governments to get off the hook at a very early date. I join others in paying tribute in particular to Positive Action. If it had not been for its commitment and dedication and particularly the leadership shown by Jane O'Brien, its chairperson, the truth would never have come out. If it had not been for the great personal courage of Brigid McCole and her family, we would never have had a tribunal of inquiry. It is a tragedy that it took three years, with determination, courage and hard work on the part of a dedicated group of women, for the truth to emerge.

I very much regret there will not be an opportunity at the end of this debate to put questions because I would like to put several questions to the Ministers, Deputies Noonan and Howlin. For example, I would like to ask them one simple question: why did it take so long for the truth to be revealed? Why did the Minister, Deputy Howlin, not inform the House or apparently his Cabinet colleagues, or Positive Action that there was a certain source of contamination in 1991? Why, for example, were some of the women who were contaminated by anti-D products in 1991 put through the most appalling questioning by the Blood Transfusion Service Board? Why was one woman asked in the presence of her husband about her sexual behaviour and whether she was a drug abuser? Any State that treats people who are victims as a result of its incompetence, as a result of a gross dereliction of duty, in such a way should be ashamed of itself.

Who decided on the strategy in the late Brigid McCole's case? Why was she denied an opportunity to protect her anonymity — there is nothing more private than health matters? Why was she forced to come into the open? Why was she told that the statute of limitations would be used against her? As I said before, it is a fraudsters' charter, when the State has no other moral defence it simply has a case thrown out on a technicality. Why was Brigid McCole told that if she pursued her case for aggravated damages the State would take her through the courts for all the costs? History will judge the State very cruelly as a result of the way it treated that woman. No Irish citizen has ever been treated so shamefully by the Government. Why was part 5 of the McCole family letter not the subject of the terms of reference of the tribunal? Who in the Blood Transfusion Service Board constantly denied liability?

There are many questions one wishes to ask, but the tribunal did not include in its terms of reference political accountability or political responsibility. Politicians must be made accountable in Dáil Éireann. In a democracy three things are very important: a vigilant Opposition, good Government and a free press. If any of those pillars is eroded or damaged, democracy suffers. It is the job of the Opposition to make Governments accountable. The manner in which victims have been treated since 1994 when we became aware of the scandal is as great a tragedy as the scandal itself, and that may seem extraordinary. If anybody had told me that Ministers, the Department of Health and the blood supply service knew the truth but had gone out of their way to conceal it, tried to fob off the women, hounded them into a compensation tribunal where the truth could never come out and told them that if they went to the tribunal they could not then go to the courts, I would have been astonished, yet that is what happened.

It is a pity more emotional feeling was not shown for the victims of this dreadful scandal. It seems every effort was made to spare the State finance. I am very committed to fiscal rectitude, but when a grave injustice has been done to so many citizens in that they have contracted a life threatening illness through the fault of the State that is supposed to protect them, regardless of the financial implications, those people must be recognised and told the truth and should not require lawyers or tribunals to get the truth from the Government.

The priority all along has been the protection of political careers, saving money for the State and protecting the reputation of the Department of Health and the Blood Transfusion Service Board. I paid tribute earlier to Jane O'Brien, Brigid McCole and the many other women who are the sad victims of this dreadful scandal, but I also pay tribute to some of the journalists, such as Emily O'Reilly, Fintan O'Toole and Feargal Bowers who did not take no for an answer and continued to pursue the story. They played their part in ensuring that the truth came out. They explained the scandal in as simple a way as possible to the public who have become very confused.

I do not believe any of us can fully understand the misery hepatitis C has caused to its victims. Two weeks ago a man talked to me at length over the telephone about what his wife and children are going through and, even though I could sympathise with him, I found it difficult to understand what he was really going through. The State is responsible for this scandal and, as politicians, we must ensure it does not happen again. Words are not sufficient, we must take action.

A file on the matter has been sent to the Director of Public Prosecutions, but we should not hold our breath. Three years ago the file on the beef tribunal was sent to the Director of Public Prosecutions after the publication of the report, but nothing happened as a result. When it comes to systematic abuse of our laws and institutional incompetence, we move at such a snail's pace that it would appear to some that certain sections of our society are free from the full rigours of the law. We should remind ourselves that the golden handshakes to officials of the Blood Transfusion Service Board exceeded the awards received by many of the women concerned. What does that say about our society? More taxpayers' money was used to give golden handshakes for incompetence and gross dereliction of duty than was used to compensate people who have been given a life threatening illness by the State.

I have been accused of scaremongering because of my lack of confidence in the Blood Transfusion Service Board. The column inches devoted to my comments would give the impression that it was me and not the Blood Transfusion Service Board that was responsible for infecting 1,600 mothers with hepatitis C. It is pointless shooting the messenger in this society. The public's lack of confidence in the Blood Transfusion Service Board predates my comments. The same was said when questions were asked about the BSE crisis and the Urlingford drugs debacle. Any time the State is in difficulty the first port of call is to accuse those who raise questions of being irresponsible and damaging the national interest.

It is time we stopped burying our heads in the sand. We should confront the issues and tell the truth. The public lacks confidence in the Blood Transfusion Service Board because of the revelations, the wrongdoings and the delay in disclosing the extent of the scandal and accepting culpability. The public also lacks confidence in the board because of the strategy adopted, particularly in regard to the late Brigid McCole and Mary Quinlan from Carlow. People lack confidence in the board because it has not been proactive. Even though it knows who received the contaminated supplies, those people have not been contacted. Screening has been done only when people have come forward on a voluntary basis as a result of advertising campaigns. Why does the State not write to all the people who received the contaminated blood product? Why are we afraid to do that? Surely the least people deserve is to be told they received contaminated blood and given the opportunity of screening. When a nurse was infected with the HIV virus last summer and the Blood Transfusion Service Board wrote to more than 40 hospitals to check the batches, why did it not tell them to check for HIV? What did the board do when only 16 hospitals had responded after three months? Why was a clerical error, which could have had fatal consequences, made when evidence was being given to this tribunal? Those are some of the reasons the public has lost confidence in the Blood Transfusion Service Board. We can either ignore the public's message or do something about it.

Some people have argued that to voice concerns about the public's lack of confidence in the Blood Transfusion Service Board damages confidence in the blood supply. That is not the case. Apart from anything a public figure might say, public confidence has been seriously eroded. There is much evidence to suggest that even the procedures for gamma globulin testing for people travelling abroad have been refused in many cases. The letters "BTSB" no longer command public confidence. We need a new agency to manage and develop blood products. Moving the Blood Transfusion Service Board to St. James's Hospital is not sufficient. We need a new institution to go with the new location, the central value of which must be therapeutic patient care. The central characteristic of the new institution must be full personal and professional accountability at every level. Never again can anyone working with blood products expect to avoid personal responsibility for serious personal errors, not to mention breaches of duty.

Some people may hope that public confidence will slowly return by physically moving the Blood Transfusion Service Board and closing the file on this succession of scandals. The surest way to guarantee restoration of public confidence is to rebuild a new blood products institute at St. James's Hospital with the values and standards to which I referred. That is not to say people employed in the Blood Transfusion Service Board would not have a future role to play, but everyone who wishes to join the replacement agency must accept from the outset that they are in a new era in which new standards apply and they must also accept new levels of personal responsibility and accountability. This will be an era in which the interests of blood recipients and donors will come first and in which the pursuit of excellence will be the watchword of the blood supply.

We hear a great deal about openness, transparency and accountability. We need a blood supply service that is open, transparent, accountable and proactive. Those who are concerned about their careers or smarting from words that I have expressed should think first about the victims and the great injustice done to them. The one thing we can do for all victims is to make a fresh start and put in place a new blood transfusion service board. It is pointless holding inquiries and sending files to the Director of Public Prosecutions if the finger is not pointed and nobody pays the price. The standards that apply in the private sector, where incompetent people are made accountable, must also apply in a system of public administration. What is the point in being a competent, diligent and careful public servant if those who are incompetent and are responsible for inflicting a life threatening disease on 1,600 people get golden handshakes which in some cases exceed the amounts paid to the victims?

For many years we have buried our heads in the sand and held inquiries that have let us off the hook. Governments that have been in office since 1977 must take responsibility for this matter, but we must learn that problems do not go away. It is a pity it took the death of Brigid of McCole and the determination of a small group of victims to get at the truth in this case. This should not happen again. 1 I hope we will learn a lesson from this and put in place a blood supply in which the public will have confidence and to which the highest possible standards apply.

Mr. B. O'Keeffe

Everyone speaking in this debate will be conscious of the damage done to the unfortunate women and men who have contracted hepatitis C. Most speakers are conscious of the physical disability and mental anguish these victims, who have been dishonoured through a State mechanism, have had to endure.

Deputy Theresa Ahearn spoke about the political elements of the debate. If she had studied Deputy Cowen's speech she would have noted our concerns for the victims which were ably and respectfully incorporated in a thorough and incisive speech. Of course we must examine the background to this tragedy and ensure the truth wins out. We must also ensure that aggravated damages are paid, but we must always be conscious that the State can never compensate fully the victims and their families. One must be also conscious of the determination of the victims to get at the truth. We must also be mindful of the circumstances which brought out hepatitis C, the actions and attitudes of those in charge of the BTSB and the lack of control mechanisms put in place by the political masters who were ultimately responsible. Of necessity, the terms of office of the Minister for the Environment, Deputy Howlin, and the present Minister must come under close scrutiny so that we may determine how each handled their portfolio in relation to the matter. Even a cursory examination shows that the attitude of both was that if they ignored the problem, it would go away. The frustration of the Minister that he eventually had to set up the tribunal was evident in the choice of words used when he insulted the victims who took the unprecedented step of showing their outrage by walking out of the Public Gallery.

The decision to agree aggravated damages was wrung out of the Government because of pressure from Positive Action and Fianna Fáil. A continuous stream of pressure was necessary to move this tragedy to its logical conclusion. Is it surprising that the victims of hepatitis C are angry, bewildered and distraught by the insipidness and insensitivity of the Minister who had to be dragged bellowing to a situation where the truth could at last be extracted? The openness, transparency and accountability so espoused by this Government when it came to power have been left shattered in keeping with the frosted glass upon which it was based.

The tribunal uncovered something which we suspected all along, that the triumvirate of the BTSB, the Department of Health and the Minister would club together to cover each others' tracks, stymie investigation and embellish the outpourings of the Minister by his public relations gurus with no concern, remorse or basic humanity for the unfortunate people who suffered as a result of the most serious maladministration the State has experienced. The victims of hepatitis C must cynically view the exclusion of question No. 5 of the McCole family letter. It is extraordinary that political accountability should be omitted from the terms of reference of the tribunal report. It raises many questions and leaves many unanswered. Does it of necessity fall to the Opposition to highlight inadequacies, mismanagement and political posturing for what it is and to look for accountability and redress?

The Ministers involved claimed they were exonerated. The Minister went on a flight of fancy when he received the report. He did not start by apologising for paying off the blood transfusion management, who were condemned by Justice Finlay, or by promising aggravated damages to the victims. He began by claiming exoneration. In that one petty move, the Minister replayed the essence of his performance on this issue since he took over the portfolio — he took care of himself first. He did not even ensure the victims were each given a copy of the report before he came out with his self-serving pronouncements. This was the Minister's chance to prove himself bigger and better than the paranoia reflected in his performance to date, but he rejected that chance.

The second interesting thing about the claim of exoneration is that for a man of subtle intellect, the Minister missed a crucial point. To be found not guilty is not the same as being found innocent, a point which the Scots have long recognised. They have in their courts the verdict of not proven, which means that although something cannot be proven, a person will not commit the same offence again and they will always be surrounded by a shroud of doubt. At best, this warrants a verdict of not proven.

Justice Finlay did not praise the Minister for paying more than £0.5 million of taxpayers' money to the people who led the Blood Transfusion Service Board at the time it poisoned patients. It is difficult to imagine what he thought he was achieving by such a pay-out. He could not have believed it would dampen down the problem and prevent it going to court. If he had grasped the enormity of the outrage, he would not have taken that action. If he did not want faith in the Blood Transfusion Service Board to diminish, then he bluntly has no judgment. We have already established the Minister does not have compassion, and he is not alone in that regard.

Mr. E. Byrne

May I share ten minutes of my time with Deputy Derek McDowell?

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. E. Byrne

The hepatitis C affair is the worst medical scandal to hit the State since its foundation. A saga of unbelievable incompetence left about 1,600 infected with what could be described as a medical time bomb. Sadly, one victim, Mrs. McCole, has died. As we debate this issue, we should remember her courage and persistence in seeking the truth.

A safe blood supply is a fundamental public health requisite. That safety has been undermined by bureaucratic bungling of monumental proportions. The task facing us is not to cast stones but to ensure the mistakes made are not repeated. That was the intention behind the tribunal and Justice Finlay's recommendations will go a long way to ensure future generations will not experience the trauma suffered by those infected with hepatitis C and their families. No tribunal will undo the grave damage which has been done or will restore the health of those infected or the peace of mind of those who fear they may have been infected. No tribunal can repair the pain which has been inflicted on the families of victims or potential victims.

The tribunal told us what happened and the picture painted was one of unbelievable incompetence, sloppiness and bungling. It is right that we should be outraged by what happened in the past. We must, however, ensure that outrage results in constructive proposals which will guarantee the health of those dependent on the blood supply in the future. The victims of this debacle or patients dependent on blood or blood products will not be helped by the type of opportunistic scaremongering we witnessed on "Morning Ireland". Despite the fundamental differences in our policies, I have always had the height of respect for Deputy Harney as a woman of stead-fast principle who, like us all, brought the courage of her convictions to bear on the political process. However, in the run-up to a general election, politicians often utter statements which are ill-considered. I have rarely heard a senior politician make as irresponsible a statement as that which we heard on radio last week.

I am appalled that hospital patients and their families listening to "Morning Ireland" could have had their confidence in the blood supply undermined to the point that they may have been reluctant to accept a clinically indicated transfusion. I am a member of the Eastern Health Board and the board of the children's hospital in Crumlin and St. James's Hospital where hundreds of people are dependent for their lives on a supply of blood. I was astounded and shocked at the words of Deputy Harney, a senior politician.

The great fear and anxiety patients have before operations and transfusions would have been compounded by these irresponsible statements which are cheap, pre-election scandalmongering. The hepatitis scandal mainly affects women. Speaking in the Seanad last week, Senator Mary Henry reminded us that, during the 1960s, the major cause of death among women of child bearing age was haemorrhage. Due to the availability of blood transfusions, this was ended. Deputy Harney should consider the possible effects of her remarks on another generation of women.

I urge all those currently faced with a decision whether to accept a blood transfusion to heed only the advice of their doctors who are the people qualified to give clinical advice. I am especially concerned at the revelations in a report in The Irish Times today that patients are increasingly reluctant to accept blood products, even for life saving procedures, because of the hepatitis C scandal. Patients' concerns are understandable, especially in view of the recent tragic and scandalous report of a woman infected with hepatitis C being approached to give blood. I condemn the Blood Transfusion Service Board whose structures allowed this to happen. I accept its word that the procedures in place would have isolated that blood and that, were it given, it would not have made its way into the bloodstream of another human being. However, it has compounded the fears of many people dependent on a blood supply and transfusions in hospitals.

There is no doubt that the standards of the BTSB must be radically improved. That was made clear when it emerged that the woman infected with hepatitis C was contacted by the board to give blood. The recommendations in former Chief Justice Finlay's report and the measures outlined last week by the Minister for Health, Deputy Noonan, will improve standards and increase public confidence in the BTSB. Closing it down, as suggested by Deputy Harney, would make a bad situation worse. The blood supply could not be administered in the absence of the Blood Transfusion Service Board. Its suspension or closure would result in a health catastrophe equal to, if not surpassing, the hepatitis C scandal.

I welcome the Government's decision to reappraise and amend the compensation scheme to provide for the possibility of victims receiving additional special damages. It is their human entitlement and right. I also welcome the decision to place the compensation scheme on a statutory basis. This reflects the gravity of the issue and it is a logical response to the appalling catalogue of errors resulting in the unimaginable suffering of those infected with hepatitis C.

Despite the criticisms levelled at him, the Minister for Health has handled this complex and delicate issue with sensitivity, care and a full appreciation of the intensely personal issues involved. Last week he called on all Members of this House to choose their words carefully not to undermine the voluntary blood supply, one of our great national assets. I hope Members heed that in the interests of us all because any one of us may find ourselves dependent on the blood supply.

I congratulate and praise the dedication and humanity of those men and women who voluntarily make themselves available to donate their blood to the Blood Transfusion Service Board. They are deserving of applause, medals and certificates. They should be given a higher ranking as heroes of society because of their voluntary contributions.

Mr. D. McDowell

I join others in welcoming this report. Former Chief Justice Mr. Finlay and his team have rendered an important public service in conducting the hearings and producing the report in such a short time. The report is cogent, to the point and easily understood. Mr. Justice Finlay does not hesitate to reach conclusions, or to make judgments and recommendations. In common with many others, I had begun to doubt the value of tribunals of inquiry. Mr. Justice Finlay has restored my faith.

The most important task given to the tribunal was to ascertain what exactly happened and to allocate responsibility. The response comes on different levels. First and most importantly, the report sets out clearly the events of 1976 and 1977 from which the conclusion is clear: the primary cause of infection of anti-D with hepatitis C was the use of plasma from patient X. The report goes on to state that the use of this plasma was clearly in breach of the BTSB's standards for donor selection. It further states that the use of plasma from donor X without her knowledge was unethical and has since undoubtedly caused her considerable trauma.

Mr. Justice Finlay proceeds to assess the responsibility of various named individuals and does not hesitate to point the finger. I do not want to discuss the issue of individual responsibility in any detail as I know the Government has asked the Director of Public Prosecutions to investigate the matter. I hope the DPP will expedite his consideration of that matter as it is of considerable public interest.

Had matters stopped there, things would have been bad enough, but they did not. The BTSB stubbornly refused to face up to the fact that something had gone badly wrong. It decided to ignore the fact, of which it was aware, that a form of non-A, non-B hepatitis virus existed which was capable of being transmitted by transfusion and for the presence of which no proper tests had yet been developed. The response to the letter from Middlesex Hospital in December 1991 can only be construed as "a blank refusal either to contemplate the consequences of what had been done in 1977 and a vague hope that, by ignoring the problem, it would go away".

These conclusions are appalling. It shows a public body and some of its officials largely preoccupied with their reputations and that of the board. This is understandable up to a point. Individuals involved with the board in the 1970s were justifiably proud that an independent transfusion service had been established. The bottom line is that the preoccupation with the standing and reputation was at least partly responsible for the pain and trauma which hundreds of women and men continue to suffer today.

The BTSB is a public service operated by and on behalf of the State. To that extent, the State is responsible for the injury caused to the people infected. It is also responsible in that the National Drugs Advisory Board, the body which was supposed to supervise the actions of the BTSB, was hopelessly underfunded and scarcely even attempted to discharge its duty. It is extraordinary that not even one on-site inspection was carried out during the course of the relevant period. The State is responsible for this failure and we must not shirk that responsibility, which is primarily to deal with the consequences of what happened.

The first and most important thing to do is to ensure infected people have access to the care and counselling they now need or which they may need in the future. The report points out that there were hiccups in the initial phase of doing this but my understanding is that the system of care is now working well. Our next response is to put in place a system of compensation fair to all concerned. I strongly argued in favour of a compensation tribunal at the time it was contemplated. I spoke in the debate in this House when the terms of reference were being considered. I still strongly believe a compensation tribunal has many merits to recommend it.

The last thing we should do, even now, is oblige any man or woman to go through the cost and trauma of an adversarial court hearing to establish the exact reason they were infected. Some of this difficulty could be avoided if the State were to accept liability in all cases. In the light of the tribunal report surely careful consideration must be given to doing that. If we simplify the court hearings by taking out any dispute in relation to liability, there are still significant benefits in going the tribunal route. On the face of it, the tribunal should be less demanding in reducing the duplication which would otherwise occur, there should be more consistency in awards than might otherwise be the case and the cost to all concerned would be reduced dramatically. However, for the tribunal to succeed it is vital that the applicants should be confident they will be dealt with in a fashion no less favourable than they would expect in a court of law.

I very much welcome the Minister's announcement in relation to aggravated or exemplary damages. The case for amending the terms of reference in that regard is overwhelming and there is no need for me to repeat it. Any fair reading of Mr. Justice Finlay's report leads straight to the conclusion that the State, through the BTSB, is responsible for an appalling wrong. The case for exemplary damages literally leaps off the pages.

The third element of the State's responsibility is to ensure that nothing of this kind ever happens again. The judge sets out his recommendations very clearly in Chapter 16 of the report. He recommends that the Dublin facilities of the board be very substantially upgraded and I join with others in welcoming the fact that this is under way. The judge recommends a process of inspections and reports and the Minister has agreed this will be done. The report recommends procedures for the reporting of abnormal patient reactions and for the recall of unsafe or suspect products. The Minister has told the House that all of this is under way. The tribunal recommends a Blood Service Consumers' Council should be set up. That is a fine idea, in principle, and I am happy the Government has accepted the recommendation.

All of these moves are needed to restore public confidence in the blood supply. It is easy for those of us who are in good health to forget there are very many who rely on regular transfusions of blood. There are also many more who rely on transfusions in cases of emergency. It is absolutely critical that all of those people should be reassured that the blood products in use in this State are of the highest possible quality.

Mr. Justice Finlay is effusive in congratulating the new management of the board put in place in 1994 and 1995. It is important that the public should know and appreciate that the reorganisation and restructuring of the BTSB is under way. There is a particular onus on public representatives not to do or say anything which would or could inhibit the provision of the best possible patient care. I do not intend to labour this point because it has been well made. I will say only that I listened, with concern, to Mr. Dunbar on the radio this morning when he suggested a patient or patients may have refused blood in circumstances where it was needed. To say the least, it would be a gross dereliction of duty if any Member through his or her utterances were to contribute to that situation.

I listened with some care last week to all of Deputy Cowen's speech on this matter. It was well rehearsed, well researched and detailed. He clearly followed the proceedings of the tribunal with some care, for which I commend him, but there the plaudits must stop because he hardly dwelt at all the major issues in his lengthy contribution. He concentrated instead on those minor issues where he thought he could gain some element of party political advantage. It is difficult to avoid the conclusion that Deputy Cowen and his party read the report not with the interests of the infected people but with those of Fianna Fáil in mind. They were and are sadly attempting to exploit the plight of the unfortunate victims of this scandal for their narrow party political advantage.

Mr. Justice Finlay subjected the actions of the Ministers, Deputies Howlin and Noonan, to a measure of scrutiny which is almost unprecedented. In Chapter 13 of the report alone the tribunal considers the adequacy of the Department's response and, directly or indirectly, the response of the Ministers concerned. The response is considered under seven separate headings and 18 conclusions are reached. The Ministers are considered to have reacted appropriately in 15 of these 18 conclusions. That includes all of the more important ones, which I do not have time to go into in detail.

Some mistakes were made and the Minister, Deputy Howlin, has accepted that. Deputy Cowen in his contribution last week reserved much of his bile for Deputy Howlin. He is more than capable of speaking for himself but I will share with Deputy Cowen and other Members something to which they would not have had previous access. I attended the parliamentary Labour Party meeting which I believe took place on the same day as the Cabinet meeting to which Deputy Cowen referred last week and my clear recollection is that the complete focus of the contribution of the Minister, Deputy Howlin, that day was on dealing with and catering for the infected women. He was anxious to bring matters into the public arena as soon as possible so that the measure of the problem could be ascertained. He moved immediately to put a screening and information process in place. He was actively criticised by some professionals because he moved too quickly. It may well be that Deputy Howlin did not focus immediately on the business of allocating blame. He focused immediately on the provision of proper care for the women concerned.

This has been an appalling episode in the history of our health services. Those responsible must be held accountable. Those affected must be cared for and compensated fairly, but above all we all have an overwhelming duty to ensure nothing like it happens again.

Mr. B. Ahern

I join other Members in thanking Mr. Justice Finlay for his work, the manner in which he dealt with the presentations and witnesses before him and his speedy delivery of the report to this House.

I wish to address the comments made by the chief executive of the Blood Transfusion Service Board who claimed that the debate about the blood supply has gone beyond reasonable debate. He made accusations of scaremongering against politicians, but Fianna Fáil has not participated in any scaremongering. Any comment we made was reasonable and balanced. As pointed out today by the president of the Irish Medical Organisation, many matters need to be exposed if there is to be change, and I would have thought everybody would agree with that. Fianna Fáil is interested in ensuring we have the best blood supply system possible and that we will not cower from that task, which is a matter of major public importance.

The chief executive of the BTSB suggested in his radio interview this morning that there was something underhand in the way the woman infected by anti-D who was asked to give blood had sought an apology. I felt her credentials and motivations were being questioned in a most unfair and unjust way. He also said a spin had been put on the story, as if the facts were not extraordinary in their own right. The BTSB may not have liked what it heard which was all backed up by facts. Shooting the messenger will not solve the problem.

We were informed last week that following the revelation of this episode involving a hepatitis C infected woman being called to give blood, the Minister called the chairman and chief executive of the BTSB to his office, gave them a dressing down and an error was acknowledged. Based on this morning's interview it does not appear the Minister gave any significant dressing down to the people involved. Even though the BTSB apologised last week, this week it appears to have returned to a defensive stance and it continues to display an arrogance in the face of bungling.

It also appears to be warning patients who come forward that if they complain they may be criticised in public. Did the Minister authorise that course of action? Is he in charge? It was only last Friday, more than three months after the incident, that the woman received a written apology from the BTSB, despite requests from her and her family. It must also be noted that, despite everything, the BTSB still does not ask donors if they have received anti-D. The Minister for Health has claimed on many occasions that the new management he has put in place in the blood bank has reformed it. However, it is clear from this episode and the one at the end of last year in relation to HIV infection of blood that the BTSB has a long way to go before it is a model of public accountability, which is what we all want to see it achieve.

The judicial inquiry into hepatitis C concluded that the actions of the Minister for Health in reforming the BTSB were quite adequate. However, there must be doubts about those conclusions and the adequacy of the political response to reforming the BTSB. It is ironic that those charged with maintaining confidence in the blood supply are most likely to damage that confidence. Through the media, they have attacked politicians for prolonging the story. Once again the Minister for Health has failed to take charge of the situation and left the BTSB to its own devices. Surveys have indicated public concern about the BTSB. The Government has failed to allay that concern. The lack of confidence is not helped by the Government saying that the recipients of potentially infected blood or blood products were not a priority. These people have a right to know what happened and to seek treatment if necessary. They should be told the truth. The Minister should insist that the BTSB contacts these people as a priority.

Fianna Fáil and the victims have called for a national study of the true incidence of hepatitis C. Will the Minister address this matter this evening? The BTSB should come clean on how many people received infected blood or blood products but have not presented for testing. Last week's Sunday Business Post alleged that the BTSB knew that some people who have only now presented for testing had received suspect anti-D batches. The BTSB is also aware of at least 335 deceased people who received these products. No relatives have been notified, even though the BTSB has known the names since 1985. The Minister should instruct the BTSB to inform the relatives.

One of the key elements of our amendment is our condemnation of the Government's failure to allow an investigation into who authorised the despicable legal strategy in the McCole case. It was a disgrace that the Government did not allow the tribunal to address this issue. That strategy was designed to intimidate victims under the false guise of the BTSB having a defence. The BTSB did not have any defence for its actions. However, the Minister for Health allowed the board to block the victims' legal actions even though he knew it had no defence since the 1976 file was discovered. There are aggravated damages claims today because of this outrageous bully boy defence directed by the Minister for Health. Justice demands that these damages be paid.

Fianna Fáil has argued that the 1976 file clearly showed that the BTSB had no defence. That file is crucial because it showed the BTSB's state of mind when the anti-D was made. The Minister claimed that the expert group supported his insistence on fighting the McCole case and his refusal to establish a judicial inquiry. Both these assertions were shattered by the Finlay findings.

Last Thursday the Minister engaged in selective quoting from the tribunal report in a vain attempt to justify his behaviour. He had the nerve to suggest that we withdraw our charges about the significance of the 1976 file. We will not do so because there is nothing to withdraw. The tribunal report supports this view. The Minister should stop attempting to apply a veneer of vindication to himself.

The investigation into who authorised the McCole legal strategy remains a matter of public policy. The Minister has resisted all attempts to allow the tribunal consider this matter. He even refused to admit question No. 5 as put by the McCole family. The Minister has been aided and abetted in this cover up by the Taoiseach and the Tánaiste. They have a duty to protect the public interest and ensure that citizens are treated fairly and honestly. They promised higher standards in Government so that no one would ever mislead this House. This has not happened. Both men stood idly by while the Cabinet was briefed by the Minister on how Mrs. McCole would be dragged to every possible legal extreme.

There were times when the Minister was under pressure in this House because it was beginning to be known that the BTSB had no defence. However, the Taoiseach and the Tánaiste directly participated in ensuring that the cover up would not be exposed. They shored up the Minister for Health and Deputy Howlin even though their behaviour was unjustifiable. The hepatitis C affair is a clear example of where the people should have come before politics. This has not happened under the rainbow Government. The Taoiseach and the Tánaiste have not been held accountable. They have been invisible during this affair. The only leadership shown has been by the groups representing the victims. Despite the lip-service paid by the Taoiseach and Tánaiste they are culpable in this cover up. They turned a blind eye to the way the scandal was handled. They put politics above the rights of the victims to the truth and justice. They ignored the calls of victims and allowed terrible things to be done in the name of the State. Their indifference in a scandal of this magnitude displays a moral bankruptcy and a contempt for the public and the victims. The spoils of office have made them cavalier and arrogant.

Had the Taoiseach and the Tánaiste not supported the Minister for Health's handling of the affair, how could scandalous tactics have been used to browbeat the late Mrs. McCole? How else could there have been approval for the stone-walling, the barracking and the blocking? How could the Government shore up the BTSB in the full knowledge that it had no defence? For that reason alone the Minister should explain the matter in this House.

As a former colleague of Deputy Howlin, I was outraged when the facts emerged about his mishandling of the controversy. He was wrong to withhold information from his Cabinet colleagues, the Dáil, the public and the medical profession. Deputy Cowen has outlined his failings. Deputy Howlin failed to follow through on any of the seven goals he set himself at the beginning of the controversy. The most telling revelation was that he never called in anyone from the BTSB and kept the controversy at arm's length. It is impossible to imagine a Minister failing to call in the BTSB to see what it was doing.

Deputy Howlin's worst hour was when Positive Action told him of its concern regarding the questions being asked by the BTSB about the private lives of women who received anti-D after 1977. The Minister knew of the 1991 infection yet he never informed the women and allowed the outrageous BTSB behaviour to continue. He has tried to defend himself from Fianna Fáil's criticisms. In the process he has misrepresented our arguments. He has claimed that we called for people to be sacked from the outset. We never said this. We said that when he knew that the BTSB was facing down his authority and not co-operating with the expert group he should have done more than he did.

Deputy Howlin has tried to defend his role in the recall of the anti-D products. He accused Deputy Cowen of many things. On "Questions and Answers", Deputy Burton tried to write this off as sour grapes over 1994. What spin doctor dreamed that up? It will not carry much weight. When the Labour Party tries to write this off as a grudge from 1994 this indicates how out of touch it is on this issue. It is trying to minimise a very tragic matter. As Opposition we are highlighting this tragedy and seeking to get answers.

Ninety-five per cent of what offended Deputy Howlin were things which were said at the tribunal. The Minister's subjective view is that he did his best. However, his best is not good enough. Those of us who thought he was a hands-on Minister have been shocked by his incompetence on this issue. It was low of him to use Positive Action as a defence. The chairperson of Positive Action pointed out on Radio Ireland that the victims do not think that the Ministers did a good job. Deputy Howlin's defence shows that he is grasping at straws.

The Minister for Health is now promising to help hepatitis C victims. No doubt his object is to keep the focus off his failures in this scandal. However, he has a poor track record in delivering on promises made to the victims. For example, the promises in the programme of this rainbow coalition Government to pay fair compensation may only now be fulfilled, two years on. Another victim remembers the Minister's promise to consult them before publishing the health care Bill; that never occurred. Victims also remember that he announced the ad hoc compensation tribunal while negotiating with them about it. He needs to give legislative effect to his promises and introduce a Bill as a matter of urgency and, if that is not possible, he should follow the example of his colleague, the Minister for Arts, Culture and the Gaeltacht, who has just published the heads of a Bill on broadcasting. When replying he should clearly state whether that is his intention.

There has been much confusion about what the Minister proposes. He must spell out whether the State is admitting liability or whether that is to apply only to the Blood Transfusion Service Board. He must also state whether the compensation tribunal will have exactly the same powers as the High Court in relation to awards and whether a right of appeal will exist.

Victims in every category, including anti-D and transfusions, must be treated fairly by the Government, as must the families of those already deceased, such as the late Mrs. McCole. It would be an outrage if she, who exposed all of these matters, did not have her case reappraised in the light of the findings of the compensation tribunal she was instrumental in establishing.

I had an opportunity to listen to some comments of the former Minister for Health, Deputy Howlin, on the RTE "Liveline" programme today. Would the current Minister clarify the position, since those comments appeared to be totally at odds with the line he has been adopting to date? In the course of that interview the former Minister for Health disclosed, in relation to the conduct of the State in the handling of the Brigid McCole case, that: "The legal strategy was decided by Government and that is a question that needs to be answered." When asked whether he had taken that decision he said, "Governments made a decision as to how all these things happen." He further admitted: "I now see that that did not suit certainly the McCole family and that they were right to go the course that they went." That explains why the fifth question in the McCole letter was excluded from the terms of reference of the hepatitis C tribunal. That is the first public admission by a Minister that collectively this Government was responsible for the strategy adopted in the McCole case, a damning indictment of all its members from the Taoiseach and Tánaiste down.

Mr. S. Brennan

Hear, hear.

Mr. B. Ahern

While I am grateful to Marian Finucane and others for having obtained the information for us, I should like the present Minister, who has not taken this line to date, at least to confirm that at the end of this debate.

Like all other Members, but especially those in the Fianna Fáil Party, I want to see the Blood Transfusion Service Board transformed and properly resourced so that it can get on with its job, in which we wish it well. We need that body to be strong and clear in its mandate. Notwithstanding what I said at the outset, those employed by that body should not feel they can threaten politicians on the issue. Rather they should listen to what we say, learn from the mistakes of the past and build on it so that we can have as near to a perfect future as possible. The lesson to be learned from this controversy must be that health and other State agencies must serve the people, that people always must come first in respect of such issues.

Mr. S. Brennan

Hear, hear.

Mr. B. Ahern

It is my hope that this debate, the commitment and effort my colleagues put into preparing for it over the past 12 months, including my former Front Bench colleague, Deputy Máire Geoghegan-Quinn, our present spokesperson on health, Deputy Cowen, and all others within this party who have engaged in much research along with their back-up teams — Jackie Gallagher and others who pursued every issue — will have advanced victims' interests even further. I also thank Positive Action and all those who highlighted this issue. Members of my party have worked hard on it, not in any cynical manner or for party political purposes but in the fight for the rights, interests and support of victims and their families. We make no apology for having done so.

Mr. S. Brennan

Hear, hear.

Mr. B. Ahern

I hope our considerable efforts will be of some use to the victims. They deserve that support from a Government that has failed them.

Minister of State at the Department of Foreign Affairs (Ms Burton)

I welcome Mr. Justice Finlay's meticulous report and the fact that the Government immediately accepted his recommendations.

I regret that Fianna Fáil, Deputy Cowen in particular, should attempt to use the scandal of the Blood Transfusion Service Board to replay the fall of the Fianna Fáil-Labour coalition Government in an effort to settle old scores.

Mr. Cowen

Is the Minister of State a psychologist or something?

Ms Burton

As a woman Deputy——

Mr. Cowen

I have been a Member of this House a lot longer than the Minister of State. It appears we now have an amateur psychologist in our midst.

Ms Burton

As a woman Deputy and a Minister, one of the lessons to be learned is that, had the medical profession and the Blood Transfusion Service Board paid more attention to a problem that mainly affected women, none of us would have found ourselves in this position.

Deputy Cowen should not attempt to make a political football out of what has been a tragedy for the many women affected and hundreds of families. It ill-becomes him or his party to do so.

Mr. Cowen

It ill-becomes the Minister of State.

Ms Burton

When Fianna Fáil and the Progressive Democrats called for a tribunal of inquiry the Government agreed. It appears that Deputy Cowen is endeavouring to write an alternative report to that of Mr. Justice Finlay, a judge of outstanding reputation who has restored the reputation of tribunals. Clearly, somebody on the opposite side of the House is less than satisfied with his good work.

I want to reply to two allegations made by Deputy Cowen last week, the first being the suggestion that not all women were offered screening in 1994 when this tragedy was first discovered.

Mr. Cowen

I did not say that. The Minister of State should read my contribution.

Ms Burton

The Deputy should read his statements.

By the end of January 1995, 56,000 women had been tested. Some 770 have been affected right up to the current year. In his contribution last week Deputy Cowen also referred to eight women having been affected as a consequence of events in 1991.

Mr. Cowen

I withdrew that when the Minister was present.

Ms Burton

There were none. I suggest that Deputy Cowen's examination of the evidence contained in the report of the tribunal of inquiry into the BTSB was less than perfect.

Mr. Cowen

Ninety-nine per cent accurate.

Ms Burton

I might also refer the Deputy to a question that I contend rightfully arises relating to comments contained on page 51 of the report of that tribunal when it examined the events of 1991 during a Fianna Fáil-Progressive Democrats coalition Government. If the wisdom of hindsight must be attributed to Members on the Government side of the House, then it is also in order to ask what was done during the Fianna Fáil-Progressive Democrats' watch. The report specifically states:

Unfortunately evidence adduced before the tribunal indicates the problem that a number of persons may have been affected with hepatitis C from the transfusion of blood or blood products between February and October 1991 who might have avoided infection had screening been introduced at the earlier date.

How does Deputy Cowen account for that comment? In terms of his recollection of the Fianna Fáil-Labour coalition Government in the period 1994 to 1995, if he has so many questions to ask now, it is quite legitimate to ask him and his party leader where their questions were when members of that Government.

Mr. Cowen

We assumed the Minister for Health was keeping us informed.

Minister for Health (Mr. Noonan,

Limerick East): At the outset of this debate, I undertook in my winding up speech to answer all legitimate questions raised by Deputies opposite. I will endeavour to do so in the time available to me. I have no intention of chasing after irresponsible allegations which are groundless and whose sole purpose is basely and abjectly political in nature. Deputy Brian Cowen, in particular, has engaged in such political allegations. I appreciate where the Deputy is coming from and I believe he is suffering from a major misconception about how a spokesman on health should conduct himself particularly in dealing with this scandal.

Mr. Cowen

Am I to be lectured now?

Mr. Noonan

(Limerick East): The health brief can provide plenty of opportunity for political advantage and point scoring — advantage which can only be gained on the back of the human suffering and tragedy which has been visited upon innocent victims. I sympathise with Deputy Cowen in his inability to come to terms with the political realities surrounding the fall of the last Government.

Mr. Cowen

Who wrote that script? Address the issues.

An Leas-Cheann Comhairle

No interruptions, please.

Mr. Noonan

(Limerick East): That is no basis for objective parliamentary debate on an issue of unparalleled importance in the history of health-care in Ireland.

Mr. Cowen

We expected more from the Minister.

Mr. Noonan

(Limerick East): I can understand the historical difficulties with which he is confronted — members of his party held office as Ministers for Health in the 20-year period since this scandal first began. An appointee of a Fianna Fáil Minister for Health was chairman of the BTSB when the scandal broke and for a long period prior to that.

Mr. Cowen

The Minister, Deputy Howlin, never spoke to him.

Mr. Noonan

(Limerick East): As a politician I can appreciate why he wishes to concentrate as much attention as he possibly can on me and my immediate predecessor. As a political strategy it is transparently false. This debate is concerned with the report of the tribunal of inquiry into the BTSB and related matters. Specifically it is about issues of far greater importance than Deputy Cowen's or Deputy Liz O'Donnell's political posturing.

Mr. Cowen

The Minister is shifting ground.

Mr. Noonan

(Limerick East): It is about people's lives — 1,600 women's and men's lives and about how we can ensure this scandal never occurs again. The motion before the House affirms the Government's commitment to implementing in full the recommendations of the report. I will not dwell any further on the baseless attacks made on me and my predecessor or on the Government as a whole. I repeat what I said in my opening speech in this debate on Thursday last. No words of mine, or of any previous holder of the office of Minister for Health, can ever adequately apologise to those women and men for the damage done to them by a system in which they had previously placed their fullest trust and confidence, a system which tragically failed them.

Since we have had the opportunity to debate the issues in full it is appropriate to proceed in an objective and realistic way to deal with the tragic consequences of this scandal and to compensate the victims in a sympathetic and humane way, without inflaming political passions more than they already are. Deputies opposite have been complaining that I have refused to answer questions in this House. Questions were ruled out of order not by me but on the basis that they anticipated this debate. I have no difficulty in answering the questions which have been put in this House and I will cover as many as possible in the course of my reply.

Mr. D. Ahern

The Minister could have waived that.

Mr. Noonan

(Limerick East): On Thursday last, I commented on the recent incident in the BTSB involving the contacting of a victim infected with hepatitis C with a view to obtaining a blood donation. I have been asked to explain the circumstances surrounding this matter. Mistakes such as these, even when there is no risk to the blood supply, are unacceptable. The background to the incident is as follows. The BTSB has a statutory obligation to ensure an adequate supply of blood. When there is a shortage of blood or a particular blood group is needed urgently a comprehensive list of all donors containing relevant information, including their donor status, is produced for the donor organising department. This list is used by the clerical staff to make telephone contact with the donors in the local clinic area to boost the clinic attendance.

Such a list was produced by the BTSB for the evening of 3 December for the local clinic because the BTSB needed to increase donations. The clerical officer who telephoned this particular donor, who had been diagnosed positive for hepatitis C, did not note the deferral information on the list. During the telephone call the error was identified and the clerical officer apologised to the donor at that time.

The following day, 4 December, the donor's husband telephoned the Blood Transfusion Services Board and complained about the matter. It was investigated by one of the doctors on the staff and the donor's husband was telephoned on 6 December. An explanation of the error and an apology was given. The donor's husband telephoned again on 11 March 1997 requesting a written explanation of the incident. The BTSB responded on 21 March expressing regret to the family.

The staff in the BTSB have been urged yet again to be extra vigilant when checking lists so that all relevant donor history is noted. As a result of a meeting I had with the chairman and chief executive officer of the BTSB that organisation is implementing necessary changes to its computer system.

I have been asked also about the donor selection procedures operating in the BTSB and whether these procedures ensure public safety and confidence. As a result of this incident last week, the public is understandably concerned about the safety of the blood supply. There was never any risk to the safety of the blood supply arising from this incident.

Approximately 170,000 blood donations are collected annually by the BTSB. There are well defined steps taken by the BTSB in relation to donor selection and donor eligibility. Blood donations are on a voluntary, non-remunerated basis. Only donors in good health are accepted and the decision as to whether a potential donor is suitable rests with the medical officer who evaluates the donor on the day of donation. The donor questionnaire must be satisfactorily completed after the donor has read and fully understood the specific notice concerning transmissible diseases. Where there is doubt about the suitability of a donor the donation is not taken.

The first step in ensuring that all those receiving blood are not put at risk at any time is to take maximum care when selecting persons who donate their blood voluntarily. The guidelines for donor selection by BTSB medical officers are revised regularly in line with the UK National Blood Authority guidelines for medical assessment of donors and the Council of Europe Guide for the Preparation, Use and Quality Assurance of Blood Components Blood Collection. These guidelines have a dual objective to protect the recipient from any ill effect through transmission of disease by blood transfusion and to protect the volunteer donor from any harm to his or her health. In applying these guidelines the BTSB is among the most stringent transfusion centres in the world, a fact that is attested by all objective commentators internationally. The standard of testing which the BTSB applies to the testing of blood donations is fully in line with best practice in Europe. The average annual deferral rate of donors attending clinics is between 13 per cent and 15 per cent, which is among the highest in the world.

I turn to an issue that has arisen since the publication of the report of tribunal of inquiry. It relates to 74 recipients of 1977 anti-D who had an episode of jaundice. Appendix G of the tribunal of inquiry report states:

We the BTSB are thus aware of 74 recipients of 1977 anti-D who had an episode of jaundice at that time which is most likely to be related to exposure to Hepatitis C. As these persons do not show any reaction on laboratory tests for Hepatitis C an epidemiology study is planned to investigate transient infection which has subsequently cleared.

The BTSB has confirmed that the 74 women referred to in the tribunal's report have all been contacted and tested and all are antibody negative. An epidemiology study in relation to transient hepatitis C infection will be undertaken.

The issue has been raised as to whether a national epidemiology study to determine the prevalence of hepatitis C in the population should be undertaken. This would be a major logistical and organisational undertaking. Given that the majority of the population have no known risk factor for hepatitis C infection, that there is no constructive intervention such as a vaccine which can be used and that there exists no satisfactory cure for hepatitis C, the ultimate value of the information produced by a national survey would be limited. Apart also from those who contracted hepatitis C through infected blood or blood products and apart from other groups with wellknown risk factors, I am reliably informed there is no evidence to suggest the prevalence of hepatitis C is any higher than in other comparable countries.

There are no proposals at present to conduct a national survey to establish the prevalence of hepatitis C in the population as a whole. It is an issue which requires further examination and I propose to seek the advice of the statutory Consultative Council on Hepatitis C which I established last November and which recently held its first meeting. The remit of the consultative council includes the monitoring of matters relating to research and it has a broad spectrum of expertise, including nominees of the four main representative groups, namely, Positive Action, Transfusion Positive, the Irish Haemophilia Society and the Irish Kidney Association.

Concern has also been expressed that all recipients of potentially infected blood and blood products should be traced in the targeted lookback programmes. The BTSB has a substantial duty of care to trace each and every one of these recipients. In order to fully comply with this duty, an experienced and professional team has been put in place with a view to achieving the objective of the targeted lookback programme — TLP. This dedicated team comprises medical, nursing, clerical and administrative support. The TLP's modus operandi is to identify the infected issues and trace the issues to a named recipient. The person is then located and arrangements for testing are made in as sensitive a manner as possible. Extensive efforts are being made to trace all the issues of blood and to locate the named recipients.

Specific concerns have been expressed as to why the BTSB has not contacted persons who it knows received potentially infected blood or blood products. In a number of cases the BTSB has only the name of the recipient and no other information. In other cases the name and date of birth are known and the person's GP has been contacted but no current address is available. Every conceivable effort is being made to identify and then locate such recipients.

Concern has been expressed that a number of persons who received anti-D in 1977 have not come forward for screening. In 1977 and 1978 a total of 17,214 vials of anti-D, made from plasma which included that of patient X, were issued. Of these, 4,062 vials of anti-D were issued from the 12 batches which were prepared after patient X became jaundiced. The Finlay report has summarised various efforts in relation to the targeted tracing of those persons who have received these infected vials at the request of the tribunal of inquiry.

At the request of the tribunal of inquiry the medical consultants at the BTSB prepared a document which is summarised in Chapter 5 of the tribunal's report and reproduced in full at Appendix G. In relation to recipients of infected 1977 anti-D, the document states: "We have previously directly invited known recipients of infected 1977 Anti-D for hepatitis screening. However, a number of recipients have not yet presented for testing and we the BTSB are therefore following this up with individual recipients and hospitals with specific attention to recipients of PCR positive batches". All recipients of potentially infected blood products are, as far as possible, being traced under the targeted lookback programme.

Finally, to ensure that no one escapes the net and to ensure that all recipients of blood transfusions and blood products are given the option of being tested for hepatitis C, I announced the national optional testing programme on 12 September 1995. Testing is free of charge to all and has been regularly advertised in the national media.

On 17 October last, during my reply to the debate in this House on the motion establishing the tribunal of inquiry, I responded to Deputies who asked during the debate if I could assess the impact of the tribunal of inquiry on the compensation tribunal. I stated: "The inquiry tribunal will establish the facts and there will be no immediate consequences for the compensation tribunal that I can forsee at present. However, if there are consequences, I will be prepared to amend the terms of reference." The Finlay tribunal established the facts in a clear and deliberate fashion. As a result, the acknowledge which we now have of events at the BTSB and of those responsible has been altered considerably.

In the light of the commitment which I gave on 17 October, I am changing the terms of reference of the compensation tribunal and I am putting the tribunal on a statutory base. This will take some time and, in the meantime, I am determined the operation of the compensation tribunal will not be disrupted or delayed. It will continue to operate as normal under the direction of Mr. Justice Egan and all of those who have already applied for a hearing will get that hearing as arranged. I will seek to ensure that everyone who has either gone through the tribunal, who is currently before the tribunal or who will be before the tribunal in the near future will benefit retrospectively from any changes which may be made.

In my opening remarks last Thursday night, I referred to other elements of the tribunal. However, one issue of fundamental importance has arisen and I wish to confirm that it is my intention that the terms of the compensation scheme should provide for an appeal to the High Court on the amount of awards made by the compensation tribunal.

Mr. Cowen

Is that the final concession or is there more to come?

Mr. Noonan

(Limerick East): On Thursday last, I also indicated the Government's intention to reappraise and amend the terms of reference of the compensation scheme following consultation with the representative groups and the chairman of the compensation tribunal. I am hopeful this consultation process can commence with the groups at an early date.

I hope Deputies will appreciate the extent of the efforts which the Government is taking to implement the recommendations of the report of the tribunal of inquiry and to set up the compensation tribunal on a statutory basis. More than possibly anyone else in this House I am acutely conscious of the deep sense of anger and betrayal felt by the victims and their families on foot of this unprecedented scandal in our health system. I also fully appreciate the genuine concerns of Deputies regarding both the extent and the impact of the tragedy on the lives of the victims and their families.

I do not wish to indulge in political recrimination. This would be a futile exercise. Not only would it not contribute one whit to the alleviation of the suffering of the victims, but it would also be a luxury no party in this House could afford. My main concern is to ensure that, where possible, I can contain the damage which this appalling human tragedy has visited upon innocent victims. This I hope to do as a result of the House endorsing the terms of the motion which will now be put before it.

An Leas-Cheann Comhairle

I am required to put the following question in accordance with an order of the Dáil of this day: "That the words proposed to be deleted stand part of the motion".

Question put.

The Dáil divided: Tá, 72; Níl, 61.

Tá

• Ahearn, Theresa.
• Allen, Bernard.
• Barrett, Seán.
• Bell, Michael.
• Bhamjee, Moosajee.
• Bhreathnach, Niamh.
• Boylan, Andrew.
• Bradford, Paul.
• Broughan, Thomas.
• Browne, John (Carlow-Kilkenny).
• Bruton, John.
• Bruton, Richard.
• Burke, Liam.
• Burton, Joan.
• Byrne, Eric.
• Carey, Donal.
• Connaughton, Paul.
• Connor, John.
• Coveney, Hugh.
• Crawford, Seymour.
• Creed, Michael.
• Crowley, Frank.
• Deasy, Austin.
• Deenihan, Jimmy.
• Doyle, Avril.
• Dukes, Alan.
• Durkan, Bernard.
• Ferris, Michael.
• Finucane, Michael.
• Fitzgerald, Brian.
• Fitzgerald, Eithne.
• Fitzgerald, Frances.
• Flaherty, Mary.
• Shortall, Róisín.
• Stagg, Emmet.
• Taylor, Mervyn.
• Flanagan, Charles.
• Gallagher, Pat (Laoighis-Offaly).
• Gilmore, Eamon.
• Harte, Paddy.
• Higgins, Jim.
• Higgins, Michael.
• Hogan, Philip.
• Howlin, Brendan.
• Kenny, Seán.
• Lowry, Michael.
• Lynch, Kathleen.
• McCormack, Pádraic.
• McDowell, Derek.
• McGahon, Brendan.
• McGinley, Dinny.
• McGrath, Paul.
• McManus, Liz.
• Moynihan-Cronin, Breeda.
• Mulvihill, John.
• Nealon, Ted.
• Noonan, Michael (Limerick East).
• O'Keeffe, Jim.
• O'Shea, Brian.
• Owen, Nora.
• Pattison, Séamus.
• Penrose, William.
• Quinn, Ruairí.
• Rabbitte, Pat.
• Ring, Michael.
• Ryan, John.
• Ryan, Seán.
• Shatter, Alan.
• Sheehan, P.J.
• Timmins, Godfrey.
• Upton, Pat.
• Walsh, Éamon.

Níl

• Ahern, Bertie.
• Ahern, Dermot.
• Ahern, Michael.
• Ahern, Noel.
• Andrews, David.
• Aylward, Liam.
• Brennan, Matt.
• Briscoe, Ben.
• Browne, John (Wexford).
• Burke, Raphael.
• Byrne, Hugh.
• Callely, Ivor.
• Connolly, Ger.
• Cowen, Brian.
• Cullen, Martin.
• Davern, Noel.
• de Valera, Síle.
• Dempsey, Noel.
• Doherty, Seán.
• Ellis, John.
• Fitzgerald, Liam.
• Flood, Chris.
• Foley, Denis.
• Gregory, Tony.
• Haughey, Seán.
• Hilliard, Colm.
• Hughes, Séamus.
• Jacob, Joe.
• Keaveney, Cecilia.
• Kenneally, Brendan.
• Keogh, Helen.
• Killeen, Tony.
• Kirk, Séamus.
• Kitt, Michael.
• Kitt, Tom.
• Lawlor, Liam.
• Lenihan, Brian.
• McCreevy, Charlie.
• McDaid, James.
• McDowell, Michael.
• Moffatt, Tom.
• Molloy, Robert.
• Moynihan, Donal.
• Nolan, M.J.
• Ó Cuív, Éamon.
• O'Dea, Willie.
• O'Donnell, Liz.
• O'Donoghue, John.
• O'Hanlon, Rory.
• O'Keeffe, Batt.
• O'Leary, John.
• O'Malley, Desmond.
• O'Rourke, Mary.
• Power, Seán.
• Ryan, Eoin.
• Smith, Brendan.
• Smith, Michael.
• Treacy, Noel.
• Wallace, Dan.
• Walsh, Joe.
• Woods, Michael.

Tellers: Tá, Deputies J. Higgins and B. Fitzgerald; Níl, Deputies D. Ahern and Callely

Question declared carried.

Amendment declared lost.

Amendment No. 2 not moved.

Question, "That motion No. 26 on today's Order Paper relating to the report of the tribunal of inquiry into the Blood Transfusion Service Board is hereby agreed to", put and declared carried.