Dáil Éireann debate -
Wednesday, 23 Oct 2002

Vol. 556 No. 1

Lindsay Tribunal Report: Motion (Resumed).

Debate resumed on the following motion:

That Dáil Éireann

–notes the publication of the Report of the Tribunal of Inquiry into the infection with HIV and Hepatitis C of persons with haemophilia, and related matters and acknowledges the gravity of its findings;

–accepts in full the findings in the report;

–acknowledges the extraordinary suffering endured by those persons with haemophilia who were infected, and by their families, and acknowledges the harrowing personal testimonies given to the tribunal of inquiry by some of those who have suffered;

–notes and acknowledges the widespread sense of public dismay at the matters disclosed in the report;

–supports the Government decision to refer the report to the Director of Public Prosecutions;

–supports the Government's commitment to implement the recommendations in the report, and specifically to appoint a National Haemophilia Co-ordinating Committee, and appropriate subcommittees, on a statutory basis;

–acknowledges the high standard of care currently being provided to persons with haemophilia and supports the Government's undertaking to work in partnership with the Irish Haemophilia Society and treating clinicians to ensure that the highest standards of health care continue to be made available;

–supports the Government's commitment to ensuring the availability of an adequate and ongoing supply of clotting factor concentrates that meet the highest national and international standards of safety and efficacy.

–(Minister for Health and Children).

Minister for Health and Children (Mr. Martin)

I glossed over recommendation six, which concerned the records of the National Centre. We will agree with that and we will keep the Irish Haemophilia Society informed.

The seventh recommendation by Ms Justice Lindsay addresses an area of great concern. "Doctors should ensure that test results in relation to patients are given to them as soon as such results become available, unless there is compelling medical reason to the contrary, and that appropriate support and counselling is available." In order to ensure that every effort has been made to identify, contact and offer hepatitis and HIV screening to any recipient of a blood product that may have been infected, the health boards, in conjunction with the National Centre and the IBTS and with the support of the Irish Haemophilia Society, will undertake another examination of hospital records.

The consultation process with clinicians involved in the management of haemophilia has commenced. Discussions have also been initiated with the Irish Haematology Society, to which the consultants are affiliated. In the short-term, however, all health boards have nominated a consultant haematologist or equivalent to assist in carrying out another examination of all hospital records to ensure that anyone who may have been exposed to potentially infected blood products and who may still be unaware of the risks from such exposure is contacted and invited for hepatitis or HIV testing. Appropriate counselling and supports will be available to anyone who may be identified in this examination.

The final recommendation refers to procedures to be followed in relation to any new tests. The tribunal report says: "The Irish Blood Transfusion Service should establish protocols to ensure that, with any future new tests for infective agents, positive test results are communicated to the relevant donor as soon as possible, referral is made to counselling services, and look back procedures are put in place." These protocols are currently in place at the IBTS and will continue to be followed in the future whenever any new tests are introduced.

As I have outlined, the Government is fully committed to implementing the recommendations of the report in partnership with the Irish Haemophilia Society and the other stakeholders. I have already mentioned that discussions have commenced between the IHS and my Department in this regard. I hope the implementation of the report will mark a new way forward which will allow all those with an interest in the care and treatment of persons with haemophilia, together with haemophiliacs themselves, to play their part in what must be, from here on, a collaborative and inclusive process.

I have already described how the principle of patient advocacy and consumer input already works particularly well in the Consultative Council on Hepatitis C. The four main patient support groups – Positive Action, Transfusion Positive, the Irish Kidney Association and the Irish Haemophilia Society – perform a vital role as advocates for their members and are represented on the consultative council. As well as this, regular meetings are held at national level between the support groups, service providers and the Department in order to monitor services and identify emerging needs on an ongoing basis. Hepatitis C liaison officers in each health board co-ordinate primary care services and provide a contact point for hepatitis C patients and the four support groups. Relationships are also being developed at regional as well as national level. The support groups also meet individual hospitals and consultants to discuss specific issues of concern to their members. In addition, the effective working relationship between the National Centre and the Irish Haemophilia Society has already been referred to.

The Government particularly appreciates the efforts of the Irish Haemophilia Society to enter into a meaningful dialogue on the future direction of the haemophilia services. The society, as recognised in the tribunal report, has played a seminal part in representing their members' best interests at all times. The Department provides funding on an ongoing basis to the IHS in respect of support services for its members and similarly funds the other support groups representing persons with hepatitis C. Over the past five years my Department, through the Eastern Regional Health Authority, has provided cumulative funding of more than €1 million to the society. It has asked me to consider increasing this funding and I am committed to providing a substantial increase in funding for next year. Officials from my Department will discuss with the society the best way in which to target this additional funding.

As well as funding for the support groups, the provision of targeted funding for the development of primary care and hospital services has also been recognised by the support groups as being an important element in the overall model of services for persons with hepatitis C. My Department, and successive Ministers for Health, have reiterated the commitment to provide sufficient funding for the continued development of services for persons with hepatitis C and HIV. The Consultative Council on Hepatitis C and the support groups are agreed that funding to date has been satisfactory and look forward to the continued provision of funding at a level sufficient to maintain and develop services which are responsive to emerging needs.

In her report, Ms Justice Lindsay said it was inappropriate to make any comment in relation to the possibility of a future tribunal of inquiry into the actions of certain pharmaceutical companies, since I had commissioned and obtained independent advice on the matter. As the tribunal is an independent entity, its conclusions in this regard must be respected. Ms Justice Lindsay's findings in this matter were made in accordance with her statutory terms of reference, which were agreed after long and careful consideration.

On 7 November 2001 I appointed Mr. Paul Gardiner, Senior Counsel, to advise me on a possible investigation into the actions of the multinational pharmaceutical companies whose products are implicated in the HIV and hepatitis C infection of persons with haemophilia. As part of his investigations Mr. Gardiner liaised with the solicitors acting for the Irish Haemophilia Society. He travelled to the United States and spoke to a number of relevant experts, including the lead counsel in HIV-haemophilia litigation in the United States. Mr. Gardiner also received legal advice from a major New York law firm in relation to the matters relevant to his investigations. I have had full consultations with Mr. Gardiner and, subject to further discussion with the Attorney General, I believe it would be possible to mount a useful investigation which would allow access to publicly available material and to persons and bodies willing to co-operate. I am in consultation with the Attorney General and all other parties, including the Irish Haemophilia Society, on an effective template, and I will return to all concerned parties with proposals.

I know I have the full support of the House in reiterating that while we acknowledge the mistakes of the past, there is an ongoing need to protect and maintain the national blood supply. To ensure that blood is available whenever and wherever needed, it is imperative that donors are encouraged to give blood, and to continue to do so on a regular basis. This year, despite all the adverse publicity, the level of donations has been very high and I commend those who have demonstrated true generosity of spirit by taking time out of their busy schedules to think of the needs of others. However, because of the short shelf life of blood and blood products and the seasonal variations in donation patterns, it is essential that people continue to donate blood regularly.

It was the Government's priority that this motion was brought before the House as soon as possible, and it will be our priority to implement its recommendations. I am sure I speak for everyone in the House in expressing our sorrow at the suffering that people with haemophilia have endured and resolving that a similar tragedy will never happen again.

Ms O. Mitchell

I move amendment No. 2:

To add the following to the motion:

"–calls on the Government to initiate the promised inquiry into the relevant international pharmaceutical companies; and

–supports the provision of adequate funding to the Irish Haemophilia Society on an ongoing basis to allow the society to fully represent the interests of people with haemophilia."

I thank the Minister for allowing additional time to discuss this report. It is without question the biggest medical catastrophe ever to happen in the history of the State where 260 people and their families were literally devastated by the actions of a State agency. We now have a report which took three years and €12 million to prepare and it deserves our detailed attention.

The Minister may be aware that the haemophilia society has prepared a 30 page response to the report in which it is extremely critical of the manner in which the inquiry was conducted and presented. It vigorously disputes some of the critical findings of the report.

I am acutely conscious that in 20 minutes I cannot even begin to touch on many of the serious issues the society raised. I could not even read its concerns into the record in any great detail. It is essential that all the issues are given the attention they deserve. There is one point I want to make because it came across to me very strongly in the IHS response and in my discussions with it. This relates to the general sense of dissatisfaction and disillusionment of the society with the whole tribunal experience rather than just with the report. While it acknowledged the tribunal had value in giving at least some public expression and appreciation of the extent of the calamity which befell victims, it expressed very severe disappointment at the failure of the report to identify the individual people responsible for what happened. Dissatisfaction with the report goes even further. I genuinely believe that the failure to find individuals culpable might not have been so important had the whole tribunal experience been a happier one or if the victims felt it was sympathetic to them. However, their experience was the reverse. They felt from the outset that the extent of the catastrophe which befell them was in some sense downgraded or belittled by the appointment of a Circuit Court judge, while a beef tribunal merited a High Court president. They cite the time allotted to the debate, which I am pleased has been increased, relative to the time given to the Flood tribunal, even its interim report, and the difference in the cost of the two reports, as indicating that one was far more important to the public than the other and was, therefore, made more available. This reflected the unsympathetic approach of the State and its continuing unwillingness to recognise the magnitude of what had happened. Above all, it was the adversarial attitude of the tribunal which hurt most. They cite comments such as that of the tribunal's senior counsel that the tribunal should not over-indulge a witness giving evidence on the death of her father. How insensitive can one be? How could one possibly over-indulge someone in these circumstances at a tribunal that was supposed to be sympathetic to those affected? In another incident during the course of the inquiry one witness, who I believe was infected with HIV, was asked how did he spend his compensation money, as if he should apologise or explain or that it was somehow frivolous of him to have spent his money. They complain also of difficulties in accessing data and documentation, and primarily of the refusal of the tribunal to pursue particular lines of inquiry which the haemophilia society felt were absolutely crucial to getting to the truth. No one knew more about the truth than the victims.

These and many other actions in the course of the tribunal left the haemophilia society and its members with a general sense that they, as the clear victims, somehow were the defendants. I am raising this point on their behalf for two reasons. First, it is a tragedy and travesty that despite all they have been through and all we now know, they are left with a feeling that there is an ongoing denial by the State and its agencies of responsibility for what happened to them and, second, it goes to the very heart of what tribunals in their various manifestations are about. If we want a tribunal to establish culpability and heads to roll, then the terms of reference must clearly say so. The manner in which the tribunal is conducted will then inevitably be adversarial. If we want to get to the truth – this tribunal did not get to the truth – and establish what happened and why it happened, so that we can ensure it does not happen again, then the manner of a tribunal should be merely inquisitorial.

The haemophilia sufferers went into this tribunal believing that it would be inquisitorial in nature. Certainly the terms of reference implied that was what was expected of it. For instance, the terms of reference referred to the adequacy of procedures and criterion, the timeliness of actions and so on. It was about finding out why these people were infected with products prepared and supplied to them or procured for them by a State agency. If that had been established with any degree of clarify, the haemophilia society would now view the report in a very different light. It would feel it had its say, that the anguish of its members had in some way been acknowledged and it would be confident that a similar catastrophe could never happen in the future. Instead what it got was an adversarial tribunal with inquisitorial terms of reference. In these circumstances, there could never be a happy or satisfactory outcome from anyone's point of view. The need to be defensive and deny would always get in the way of establishing the truth. I mention this because as a country we will go down the road of having tribunals every time there is a failure of due process. As it appears that is the way we are going, there are important lessons to be learned from the experience of the tribunal and the general sense of dissatisfaction with the report of the tribunal.

When I first saw the report, I, in common with everyone else, was appalled at the absence of clear and concise conclusions. On reading it, I realise it is not that there are no conclusions. Certainly the tribunal reached conclusions and formed views on most of what was required of it under its terms of reference. However, the conclusions, such as they were, were buried in the body of the report. The report is not well produced or laid out. The conclusions were difficult to find and very easy to miss. The method of dividing examination of each term of reference over a discrete number of years – I can understand why that was done – added to the confusion and took from the effect of any conclusions reached. Where there were criticisms of inaction or failure of judgment of either individuals or bodies, they were almost always qualified in some way as if to reduce the responsibility by offering a mitigating context.

In fairness to the tribunal, we have a fairly painstaking account of who knew what and who did what at various times. However, following three years of an inquiry and a cost of €12 million we still do not know why this happened. After reading the report a couple of times, and rereading parts that seemed confusing, I do not have a sense of what happened. We do not know why hundreds of sick, vulnerable, dependant and trusting people were fatally infected or had their lives destroyed by the actions of a State agency.

In setting up a tribunal to discover the truth, surely the least we could expect is to find out the answer to that question. For those infected and their families the overriding question is: "Why did this happen to us?". The answer to that basic question just does not emerge, even from the most detailed reading. Certainly, issues and moments which are referred to could be regarded as critical to what happened, such as the decision to concentrate on a particular method to achieve self sufficiency in the national blood supply or the failure to recall non heat-treated products during certain critical months in 1985. However, none of these, nor any of the other issues examined, together give us a comprehensive explanation of why the blood gathering and testing system so utterly failed to protect the people it was designed to serve.

As well as being an important question for the families affected, the "why" is also a vital question for anyone who intends to use the health service. If we do not know why this disaster happened, how can we ensure that a similar disaster never happens again? If a tribunal of this kind is to have any lasting value, it must contribute such an outcome. Having read the report, I have no conclusive sense of what set in motion this catastrophic chain of events and why serious errors of judgment were repeated and compounded almost up to the present day. Instead, any reader of this report is left with the impression of a blood service in total disarray, under resourced with poor records, little or no effective management, a poor chain of command and a lack of decision-making ability or any sense of management responsibility to implement decisions. Significantly, there was an absolute failure of communication, both within the BTSB and between it and those providing care and treatment to the haemophiliac community. Perhaps it is within this amalgam of disastrous management, communications and structural deficiencies we find a multi-faceted answer as to what happened, rather than in any one action of one individual or agency. I intend to return to this when dealing with the recommendations.

It is impossible to deal with all of the reservations expressed by the Haemophilia Society but I will raise one issue with regard to the conduct of the inquiry. I find it quite inexplicable that the tribunal did not interview the members of the board of the BTSB at any stage. Although there are references in the report to what the board might have known and when it might have known it, nobody ever asked the board members directly what they knew. Three members of the board, who were possibly also members of staff, were interviewed. Whatever the board knew or should have known is a critical issue. In any organisation, responsibility rests ultimately with the board. The chairperson was appointed by the Minister and there was always a Department representative on the board, acting as the eyes and ears of the Minister. The point at which alarm bells rang in the Department depended on their communication with the Minister. If those alarm bells had rung earlier, a great deal of anguish could have been avoided. As the Minister will recall, the issue of what information went from the board to the Government ultimately led to the fall of a Government. It also led to further hurt on the community because the level of compensation was based on what we now know to have been misinformation about the source of infection and the responsibility for it. The role of the board was crucial but that was ignored. It was almost as if the board was a disinterested party to the whole series of events.

If anything of value is to emerge from this tribunal, it is in looking to the recommendations, to which I am glad to note the Minister paid particular attention. They were of a general nature and could apply to almost any organisation. However, the deficiencies in the structures, communications, records and information flows within the BTSB were at the root of what actually happened. While I appreciate that the Minister has put substantial investment into the new blood service, it will require more than just putting in money. Very careful monitoring will also be required.

In the short time remaining to me in this debate, I will refer to two of the requirements of the Haemophilia Society, both of which appear as amendments. The Minister has already referred to the possibility of an investigation into the role of the international drug companies. Wherever that may lead, they should not be let off scot free. An investigation is worthwhile and I accept the Minister's good faith and commitment in that regard. I regret the lack of details at this stage and I will return to this again.

The other requirement of the Haemophilia Society is adequate funding for its very important advocacy and support work for its community. It is not tolerable that the society should have to fund-raise among its own devastated community to provide supports to its members. The funding needs to be doubled and I ask the Minister to consider that seriously. I do not wish to divide the House on this but it is an important issue and we owe haemophiliacs that much at least.

Caoimhghín Ó Caoláin

I wish to share time with Deputies Gormley, Cowley and Twomey.

Acting Chairman (Mr. Kirk)

Is that agreed?

Ms McManus

No, it is not agreed.

Caoimhghín Ó Caoláin

On what grounds, may I ask, is the objection being made?

Mr. Gormley

I appeal to my colleagues. This is not the time or the place to score political points. This is a very sensitive issue. I can understand that there are issues—

Acting Chairman

Deputy Gormley, I cannot allow a debate on this.

Mr. Gormley

I appeal to Deputy McManus to withdraw her objection.

Acting Chairman

I understood there was an agreement on arrangements for this debate.

Ms McManus

I object to this. I have got the agreement of the Taoiseach to extend the debate, thereby facilitating all Deputies. I object to the sharing of time.

Caoimhghín Ó Caoláin

In an earlier situation in relation to statements on Iraq the Labour Party did not object.

Acting Chairman

My understanding is that there was an agreement on the arrangements for sharing time and I believe we should proceed on that basis.

Ms McManus

Unanimous agreement is required in relation to Deputies sharing time. There is a precedent and it was accepted by the Chair that, where there is not unanimous agreement, sharing of time cannot proceed. I do not wish to delay the work in which we are engaged but the precedent is there.

Acting Chairman

We have a precedent. I am advised that the Ceann Comhairle ruled on this matter last week. We have to have unanimous agreement on sharing time. As Deputy McManus is objecting, we have disagreement in this instance.

Ms McManus

This is such an important matter that we need to have substantial statements at the outset. There will be more time available. I insured that and I am grateful to the Taoiseach. All Deputies will have a chance to speak and I expect that the Technical Group will use that opportunity. This is the time for substantial statements. That has been the precedent and I am grateful the Chair has made the ruling.

Mr. Gormley

I think—

Acting Chairman

Deputy Gormley we are wasting the time allocated for the debate.

Mr. Gormley

Deputy McManus has let herself and the Labour Party down.

Acting Chairman

I ask Deputy Gormley to resume his seat.

Caoimhghín Ó Caoláin

I am sorry that Deputy McManus and the Labour Party would seek to stymie the chance of other speakers from the Green Party and Independent Members to contribute on this of all issues. It is a disgraceful interruption.

Acting Chairman

I suggest that it be brought up at the relevant forum.

Caoimhghín Ó Caoláin

I have no option but to seek a vote on this. It is an outrageous interruption and is uncommonly indecent in view of the issue before the House. Two members of the medical profession, Deputies Cowley and Twomey, wish to make a contribution. My colleague, Deputy Gormley, is Health spokesperson for his party. The objection of the Labour Party is a poor reflection on their position on this issue and has arisen because they do not like coming after those other speakers. It is unacceptable and has no place in the House. Accordingly, I seek a vote.

Acting Chairman

I must advise the Deputy that this is not a votable issue. We have a precedent. The Ceann Comhairle has ruled on it. I am following a precedent which has been established in the House.

Caoimhghín Ó Caoláin

I am advised that it is a votable issue.

Mr. Gormley

Is the Chair saying that one Deputy can object to the sharing of time and be obeyed? It is outrageous that one Deputy can do that. There should be a vote. The Chair should allow a vote and we will accept the outcome.

Acting Chairman

I must safeguard the Ceann Comhairle's ruling. The Whips meet regularly and I am sure they can deal with the matter. I remind the Deputy that the time for debating the motion has been extended and the Deputies who do not have an opportunity to contribute now will have time later.

Mr. Gormley

We are calling for a vote on this issue.

Acting Chairman

I stand by the ruling of the Ceann Comhairle. If necessary the sitting will be suspended. Deputy Ó Caoláin should proceed.

Caoimhghín Ó Caoláin

I find the situation impossible. I understand that a vote is permissible. The Labour Party's continual interruption is losing important time.

Acting Chairman

We are eroding the allocated time.

Caoimhghín Ó Caoláin

This is not my doing. I believe a vote is permissible.

Acting Chairman

There is a long standing precedent for a proposal to share time. If there is unanimous agreement it is acceptable. There is not agreement. The issue can be dealt with by the Committee on Procedures and Privileges.

Dr. Twomey

I was elected on health issues. I do not believe that ideology should be put above what I was elected to represent. It is disgraceful that Deputy McManus who is a Health spokesperson—

Acting Chairman

There are procedures for dealing with these matters. If we continue with the interruptions the discussion cannot proceed.

Dr. Cowley

We are being denied our democratic rights by the Labour Party.

Acting Chairman

There is a forum for these matters. I cannot decide on them. I must follow the precedent.

Dr. Cowley

I have the right to speak.

Acting Chairman

Anyone has the right to speak.

Caoimhghín Ó Caoláin

There is an important matter. If a five minute suspension is required to decide if a vote can be taken, I request that the full information be sought.

Acting Chairman

Please respect the Chair's ruling. It was made in good faith.

Caoimhghín Ó Caoláin

Will the Chair seek the full advice of the Ceann Comhairle's Office? I have been advised that a vote is permissible notwithstanding that this has not happened before.

Acting Chairman

If Deputy Ó Caoláin proceeds we will check it and have guidance by the time he has finished. We should have a decision in five or six minutes. I am meeting the Technical Group halfway.

Mr. Gormley

Will there be a vote then?

Acting Chairman

It depends on the advice I receive.

Caoimhghín Ó Caoláin

I will proceed. I hope that the Chair's advice will confirm our information. I proceed with regret on this important issue.

I welcome the publication of the report of the Tribunal of Inquiry into the Infection with HIV and Hepatitis C of Persons with Haemophilia and Related Matters. I ask the Government why this debate which deals with matters of life and death was not initially allocated comparable time to the debate on the second interim report of the Flood Tribunal. It is most regrettable. The time should have been allocated. It is not just of equal importance but is more important.

Minister for Health and Children (Mr. Martin)

The Government does not order the business of the House. Time slots are agreed among all the Whips. When a view was put forward that the debate should be continued we did it. There was no difficulty. The Deputy is effective at the Whips' meetings.

Caoimhghín Ó Caoláin

I am recording that point with the Minister. In welcoming the report I echo the concerns of victims and their families about the reluctance of the report to assign responsibility for the infection with HIV and hepatitis C of haemophiliacs.

It is disappointing that the tribunal chairperson did not deliver the report in a more clear and concise manner, including an executive summary of its findings. The report should have indicated what was outlined by the Irish Haemophiliac Society, namely, what went wrong, who was responsible and recommendations to prevent future repetition.

Sinn Féin broadly supports the Government's motion, particularly the sections acknowledging the extraordinary suffering endured by haemophiliacs who were infected with HIV and/or hepatitis C. I support the amendments tabled by the Fine Gael and Labour parties. I welcome the Government's commitment to implement the recommendations in the report and its commitment to ensure the viability of an adequate and ongoing supply of clotting factor concentrates that meet the highest national and international standards of safety and efficacy.

Sinn Féin welcomes the Government's decision to refer this report to the Director of Public Prosecutions. However, I am concerned that, as with the report of the Finlay tribunal, there is a question mark as to whether prosecutions will result. The failure to prosecute those responsible for the tragic blood contamination scandals which have occurred in Ireland contrasts poorly with other countries which have experienced similar blood contamination scandals in recent years. In France and Portugal, those involved in such scandals have gone to trial for fraud, criminal negligence, failing to adequately screen blood and for propagating contagious diseases.

The failure of the tribunal to investigate certain matters becomes clear upon reading this report. Why were all the board members of the BTSB not called to give evidence, given that Judge Lindsay notes in the report that "on the tribunal's analysis, the board was not entirely blameless"? Why did the tribunal not investigate various Ministers for Health who had ultimate responsibility for policy decisions such as the non-implementation of national policy in respect of the Council of Europe recommendations. I am particularly concerned by Judge Lindsay's decision not to comment in detail on the appropriateness of the response of the Department of Health and Children to the infections on the grounds that the current Minister had reviewed compensation for those involved.

The report also fails to deal with the conflict of interest of the late Mr. Seán Hanratty, the BTSB's former chief technical officer. Mr. Hanratty was a director and founder of Accuscience, a company which acted as an intermediary for Miles Laboratories Incorporated, which supplied non-heat treated and unscreened "cutter" products which were responsible for some of the Irish infections. Mr. Hanratty was one of those who had a key role in deciding which products were used and was the person who, after litigation had commenced, destroyed BTSB paperwork which could have identified precisely which products caused infection. The destruction of these documents has made it impossible to trace some 20 people who may be infected with HIV as a result of having been given blood products manufactured from donations from HIV-infected donors. It must be asked why the tribunal did not investigate the conduct of Mr. Hanratty. It looked at the decision in June 1988 to continue supplying a product over which its manufacturers, Armour Pharmaceuticals, if not the agency itself seemed to have major safety concerns. Though evidence was given to the tribunal of the knowledge of Armour Pharmaceuticals of the HIV infection risk posed by Armour products and that they continued to distribute those products in Ireland, the Lindsay report does not include any criticisms of Armour.

At a time when the people of the State are becoming increasingly concerned at the probability of further health cutbacks in the forthcoming budget, this report is a timely reminder of the harm that such measures have caused in the past. There is evidence that cutbacks in State health funding in the late 1980s were a contributory factor in the disaster that befell these innocent victims. Events referred to in this report should be seen against a background of an underfunded and overstretched health service and I hope the Minister will note those concerns.

The report concludes, on page 122, that the tribunal does not accept that decisions taken by the BTSB in regard to the distribution or supply of blood products were in any way compromised by financial considerations. This, however, does not equate with Professor Temperley's statement in 1989, and quoted in the report, that "some balance will have to be struck between cost and the infection dangers associated with blood products". The report does not deal adequately with the question as to whether the prioritising of monetary considerations occurred at the expense of the safety of people with haemophilia. It is remarkable that the tribunal did not accept that the decision by the BTSB with regard to the distribution of blood products was in any way compromised by financial considerations. I find that difficult to accept.

May I seek clarification from the Chair as to whether he has anything further to report?

Acting Chairman

Yes. We reaffirm that the original decision was the correct one. I am advised that without unanimous agreement, it is not possible to share time.

Mr. Gormley

So, is it the case that one person in the House can object and that is it?

Acting Chairman

Yes.

Caoimhghín Ó Caoláin

What is the situation in relation to this matter being put to the House?

Acting Chairman

This matter has been discussed and decided upon and I merely am advising the House what has been advised to me.

Dr. Cowley

What the Chairman is saying is that the Labour Party is preventing people who were elected on the health ticket from speaking on this important issue. This is a national disgrace.

Acting Chairman

We cannot have debate on this here, there is another forum for it.

Dr. Cowley

People elected on the health mandate are being silenced.

Acting Chairman

I have advised the House of the decision on the matter. I have sought the advice of the Ceann Comhairle's office and my original decision has been reaffirmed.

Dr. Cowley

I have spent months waiting to speak and I am being denied that right to speak because of a deal done between the Taoiseach and the Labour Party.

Acting Chairman

I have no control over that and I must allow the debate to continue. I ask Deputy Ó Caoláin to continue.

Caoimhghín Ó Caoláin

We accept the Chairman's ruling on the need for unanimity but he has not clarified whether we can proceed to a vote on this matter at this stage for which I and other Deputies have asked.

Acting Chairman

I am advised that it is not a question that can be decided by way of a vote at this stage.

Mr. Gormley

We asked for clarification on the Order of Business today from the Taoiseach and his words were that it was a matter for the House. That suggests that this matter can be put to a vote.

Acting Chairman

It is a matter for the House operating through the respective Whips who represent the interests of the different parties in the House.

Mr. J. Breen

On a point of order—

Acting Chairman

I ask Deputy Breen to resume his seat and allow Deputy Ó Caoláin to continue. We are eroding the time allocated for discussion.

Mr. J. Breen

How can the Chair rule me out of order when I am making a point of order? In a democracy the majority rules and in this case the minority is ruling—

Acting Chairman

I ask Deputy Breen to resume his seat and allow Deputy Ó Caoláin to continue. I have sought the advice of the Ceann Comhairle's office having discussed the matter across the floor with Deputy Ó Caoláin and others and I am advising the House that Members may not share time unless there is unanimous agreement and I am proceeding on that basis.

Mr. J. Breen

How can we proceed when there is not even a quorum in the Chamber. I am calling for a quorum.

Notice taken that 20 Members were not present; House counted and 20 Members being present,

Caoimhghín Ó Caoláin

In part six of Judge Lindsay's report she refuses to comment on the possibility of a future tribunal of inquiry into the role of the international drug companies regarding the infection of persons with haemophilia in this country. The Minister sought and has obtained a report from Mr. Paul Gardiner SC in regard to this matter. Will the Minister release Mr. Gardiner's report and will he establish an adjudicative tribunal to investigate the role of the pharmaceutical companies? The pharmaceutical companies are the focus of both amendments before us, and I have already indicated support for them. It is imperative that the full role of those companies and that full information, particularly Mr. Gardiner's report, is made available to all Members. I hope the Minister will affirm in his reply that he is prepared to co-operate with that request.

The haemophilia society's own briefing in relation to Judge Lindsay's report says that in essence Judge Lindsay felt it would be "unfair to extend the tribunal's remit and investigate the pharmaceutical companies at that late stage." It appears from the sequence of correspondence that it was never the intention of the Lindsay tribunal to investigate these pharmaceutical companies which were responsible for the manufacture of blood products that infected 97 haemophiliacs with HIV and many more people with hepatitis C. The society's notes indicate that blood products manufactured by these companies were responsible for the death of 74 Irish citizens. It is most important that a commitment is made to pursue the pharmaceutical companies with vigour and to ensure that responsibility in that area, as well as other areas of this tragic story, is firmly established and followed by prosecutions.

The victims of this tragedy sought accountability from this report. Instead, after long deliberation, the Lindsay report is a vague product which fails to hold anyone ultimately responsible. The language used in the report is in marked contrast to that used in the definite conclusions of the second interim report of the Flood tribunal. This cannot have escaped the attention of anyone in the Chamber. It certainly has not escaped the attention of the people most concerned, namely those who deserved that this report would properly reflect on their experiences, pain and suffering and on the need for truth and justice to be established. It is regrettable that the Lindsay tribunal did not do more to bring closure to this tragic episode in the history of the blood services. It is essential now that we restore by every means and effort the confidence of the public in the accountability of the blood services. I call on the Minister to do this.

Ms McManus

I wish to move an amendment to the motion.

Acting Chairman

It is not possible to move the Deputy's amendment until amendment No. 2 is decided upon.

Ms McManus

I accept that. I take it from what the Minister said that he is accepting the amendment in terms of the investigation into the pharmaceutical companies and in terms of funding the Irish Haemophilia Society. I want to pay tribute to the Irish Haemophilia Society. It represented its members valiantly through the long, hard struggle to reach this point. For over two years it negotiated with the Government to establish this tribunal. It was a process fraught with difficulty and great hopes were generated when the terms of reference were finally agreed. It was accepted at the time that the tribunal would and could investigate fully the circumstances that led to haemophiliacs contracting HIV infection and hepatitis C from contaminated blood products. The investigation was to include in its brief the role of the international—

Dr. Cowley

On a point of order, we do not have a quorum.

Notice taken that 20 Members were not present; House counted and 20 Members being present,

Mr. Stagg

For the information of the House I wish to raise a point of order. The Whips have agreed that this debate will continue on the next Tuesday for a period of three further hours so that everybody who wants to contribute will have an opportunity to do so.

Acting Chairman

Go raibh maith agat. Can Deputy McManus be allowed make her contribution now without interruption please?

Ms McManus

The investigation was to include in its brief the role of international pharmaceutical companies and the role of the BTSB in the use of its own products. One lesson that should have been learned from the Finlay tribunal was how crucial terms of reference can be. In that case the terms of reference were flawed because they failed to encapsulate an investigation of the circumstances of infection of people with haemophilia or hepatitis C. The Irish Haemophilia Society, at the time, was forced to withdraw from the process. In the case of the Lindsay tribunal, the terms of reference were supposed to provide for a comprehensive investigation into all aspects of the blood scandal as it related to haemophiliacs.

In the debate on the establishment of the tribunal in May 1999, I urged the Minister to ensure there was resolute analysis of products which came into the country and, if needs be, legal action to obtain the evidence about their origins, but that did not happen. I asked that there be full disclosure from the BTSB of all documentation, and that did not happen. Those who suffered so much were entitled to know how and why the disaster happened and who was responsible. Regrettably and tragically, that did not happen either. In fact, during the tribunal the Irish Haemophilia Society was often thwarted and blocked in its search for the truth. While it did its work, some of its members suffered and died because they had been poisoned by contaminated blood products. Others lived and continue to live with terrible infections. For the first time, Irish people learned the real extent of their horror and heartbreak.

The testimony of haemophiliacs at the tribunal was harrowing. One young man lost his mother and two brothers as a result of the blood contamination scandal. A young mother has three sons who contracted hepatitis C as a result of an infected blood product. Even after these children were diagnosed as hepatitis C positive, they were left untreated for five years. Theirs are terrible, tragic stories that should never have had to be told. It required fortitude and courage to come into the tribunal for these people to tell of their experience. They did the country a great service. It is a pity that the State did not return the compliment.

In France when the scandal of contaminated blood was discovered, the state began a legal process that proved effective. People went to jail in France and a Minister ended up prosecuted through the courts. In Ireland we set up a tribunal in good faith. Our aim was to bring some closure and comfort for victims and for the families of victims. It was also to find out who did what and who was responsible for this catastrophe. Neither aim has been realised.

The report does not come to clear conclusions. It does not apportion responsibility even though profound questions needed to be answered. The outcome is, in effect, a crime that has many victims and yet no perpetrators. We have all heard of a victimless crime. According to the report, it would appear that this was an offenderless crime. A total of 79 people died and yet no one is responsible.

There is a terrible symmetry about the fact that this debate is taking place soon after the debate in this House on the Flood tribunal report. In 1989 when Ray Burke received up to £100,000 in corrupt payments the Government at the time collapsed because it refused to allocate a few hundred thousand pounds as compensation to haemophiliacs who received contaminated blood products. The two reports, one on the issue of political corruption, the other on matters of life and death, were published within weeks of each other. It says a lot about the strange priorities of this House that the Flood tribunal report was given top billing and was debated in the first days of the Dáil's new session while those who have suffered so much were made wait until the third week before the Lindsay tribunal report was debated. The contrast between the two reports is very stark and the Lindsay tribunal report is a disappointment for the families of haemophiliacs. While the Flood tribunal report uses clear, concise and devastating language to lay blame squarely, the Lindsay tribunal report has set out to describe a tragedy unparalleled in modern Irish history in words that are simply inadequate to the task. No one in this report is culpable or negligent.

As a report it is a great disappointment, but as a record it raises questions that are not going to disappear into the ether. This morning on behalf of the Labour Party I sought more time in the House to allow Deputies the chance to debate this report.

Dr. Cowley

I must object. This is not a legal sitting of the Dáil. A quorum is not present.

Ms Sexton

As a medical doctor, the Deputy is a disgrace to his profession.

Notice taken that 20 Members were not present; House counted and 20 Members being present,

Ms McManus

I wish to record that I feel ashamed at the fact that the debate on such an important matter is being continually interrupted.

Deputies

Hear, hear.

Mr. Stagg

It has been interrupted by a so-called medical doctor. He is a stooge.

Dr. Cowley

The Labour Party does not want Members elected on the health mandate to speak.

Mr. Stagg

Deputy Cowley is a stooge.

Acting Chairman

Deputy Stagg should allow Deputy McManus speak without interruption.

Ms McManus

As a report it is a great disappointment, but as a record it raises questions that are not going to disappear into the ether. This morning I sought more time in the House to debate the report because it is important that it be subject to full scrutiny and analysis. There is also something deeply offensive about giving less than a three hour debate, which turned out to be an hour and a half, to this tribunal report while more than two days of Dáil time was given to the Flood tribunal report. I welcome the response from the Taoiseach in this regard and that the Whips have agreed on extra time to be allocated. I look forward to hearing the speeches of other Deputies, some of whom have, unfortunately, left the House, but I hope they give their views now that they have an opportunity.

I propose that the tribunal be subject to scrutiny by the Joint Committee on Health and Children. The many aspects of this report can be given extended time and consideration in committee that is simply not possible in this format in the House. Even allowing for the restrictions put on us by the court decision in the Abbeylara case, the committee has a contribution to make and I propose that we embark on such a project when the new committee is constituted.

The most disturbing aspect of this investigation is the role played by the BTSB regarding information it had in 1986 about the HIV infection of seven people, some of whom died, as a consequence of the use of Factor 9, a product made by the BTSB. In effect this was an Irish product made from Irish blood. When the tribunal examined this, it found there was an "ambivalence and blurring of the facts". I disagree with the report and agree with the Irish Haemophilia Society which maintains that there was a cover-up of the facts. Sadly, I can only say that it is a matter of opinion. The reason we cannot be definitive is because the Lindsay tribunal never called the chairman of the board to attend. Had the judge done so or had she even asked other members of the board to attend to ask straight questions of them, we would know the full facts and be able to debate them.

The Irish Haemophilia Society stated in its analysis of the report:

Mr. Keyes in his evidence referred to the BTSB coding their minutes. At one stage the minutes referred to "the executive consultant informed the board that the situation with regard to Factor 9 was unsatisfactory and he was examining this as a matter of urgency and he requested that one of our consultants meet Prof. Temperley to review standards". This would clearly seem to be a reference to the infection of BTSB Factor 9 with HIV. According to Mr. Keyes's evidence this is what it refers to. It is surely beyond the bounds of possibility that any semi-intelligent group of people sitting on a board, when told about an unfortunate situation with regard to a product, would not have at least asked:

(a) What was the situation which had arisen, and

(b) What urgent attention was it receiving and why was it necessary?

Professor Temperley complained that he was becoming a bore, constantly telling the board with regard to the responsibility of Factor 9 for HIV infections.

Debate adjourned.