Lindsay Tribunal Report: Motion (Resumed).

The following motion was moved by the Minister for Health and Children on Wednesday, 23 October 2002:

"That Dáil Éireann:

notes the publication of the report of the tribunal of inquiry into the infection with HIV and hepatitis C and HIV 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 sub-committees, 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 healthcare continue to be made available; and

supports the Government 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."

Debate resumed on 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."

–(Ms O. Mitchell).

Mr. Connolly

A sum of €20 million has been spent on establishing and servicing the Lindsay tribunal of inquiry into the infection of more than 260 haemophiliacs with HIV and hepatitis C through contaminated blood and blood products. In light of its recently published report, the tribunal was an expensive exercise in futility. A vast amount of taxpayers' money was expended in discovering precious little, with scarcely apportioned blame for the debacle. Culpability and responsibility were fudged in the report to the extent that it injured the victims again and the second injustice was almost worse than the first.

The report demonstrated an appalling lack of sensitivity for the victims of this tragedy and a lack of understanding or appreciation of what the victims endured. It is patently clear that the major share of the blame must attach to the Blood Transfusion Service Board. Its failure to provide HIV-free home-produced product for haemophiliacs prior to 1984 is inexplicable. Its failure to heat treat Factor 9 and withdraw non-heat treated Factor 9 directly led to the infection of seven haemophilia sufferers with HIV, and the subsequent deaths of five people. The buck must inevitably stop with the BTSB, given its failure to warn GPs treating haemophiliacs of the risks of using commercial products which the BTSB had imported and for which it should have been held responsible.

The BTSB adopted a cavalier attitude and demonstrated an irresponsible lack of urgency about the infection of haemophilia sufferers. This was evidenced by the observation of Professor Ian Temperley, head of the national haemophilia treatment centre, in June 1986, that he believed five, and possibly six, haemophiliacs were infected with the virus as a result of the Irish blood product. There was an unwarranted delay in introducing HIV screening. The BTSB was responsible for supplying inaccurate and incomplete information to Ministers for Health between 1983 and 1992, including the former Minister, Barry Desmond, who unintentionally presented misleading information to Dáil Éireann in 1985.

Up to now, 79 haemophiliacs have died from contaminated blood products, most of which were supplied by international drug companies. It is imperative that a full inquiry into the role of international pharmaceutical companies in supplying contaminated blood to Irish haemophiliacs be set up without further delay. The Minister for Health and Children, Deputy Martin, should honour his previously stated commitment in this regard. Since the law regarding tribunals was amended this year, an inquiry can be headed by a judicially appointed inspector, rather than a judge, thereby precluding the necessity for a major tribunal.

In its failure to carry out its supervisory role over the BTSB, the Department of Health and Children must also accept some culpability. The BTSB had personnel and structural problems in the early 1980s and was clearly not competent to cope with the imminent threat from HIV and the spread of AIDS. The Department displayed both indecision and tardiness in its response. Its arrogant insistence that imported products were responsible for all the infection, when it was perfectly aware that its own home-produced product was responsible for part of the infection, is inexcusable.

Since the buck stops with the Department of Health and Children, it is essential that new legislation to expedite adequate and generous compensation for HIV-infected haemophiliacs be introduced without further delay. This is the least the State can do for the victims of this horrendous failure of one of its principal Government agencies.

Ms Lynch

The report we are debating has come in for much justified criticism because it did not draw conclusions, did not find anyone guilty and did not lay the blame at anyone's door. In addition, by the time it was published the report had lost much of its effect. We listened with great attention to the harrowing stories that emerged at the tribunal hearings and, therefore, anything the report might have contained could not have shocked us to the same extent.

The criticism has been made that the Minister who had appointed the BTSB – the same board that was responsible for the scandal with which the tribunal was dealing – could not force the board to produce documentation sought by the tribunal. That is incredible. Responsibility means that from time to time one has to make hard decisions. The first tribunal to investigate the scandal of people being poisoned through contaminated blood products was chaired by Ms Justice Hederman-O'Brien. That report was published in 1996 and I recall it mentioned a culture of arrogance within the BTSB. That culture of arrogance still remains there. In the wake of that report and the hepatitis C scandal, I thought the BTSB would have learned its lesson and would be more than anxious to co-operate with any tribunal. Instead, however, we find the culture of arrogance that existed when Ms Justice Hederman-O'Brien investigated the hepatitis C scandal still exists. That is worrying.

I was surprised to discover that the BTSB, which was charged not alone with supplying the country with blood but also with ensuring its safety and availability, decided with the wave of a hand to close the Cork blood testing centre in the Southern Health Board region. This left Dublin as the only blood testing centre in the country, with Cork relegated to being merely a repository of blood for distribution.

When members of the Southern Health Board, including myself, and the medics and clinicians involved, objected strenuously to this, we did not receive sufficient explanation for the closure of the Cork centre. It appeared to us that it was done as a virtual punishment because hepatitis C had been discovered in the Cork blood bank. Therefore, it came as no surprise to me that the same organisation refused to furnish documentation sought by the Lindsay tribunal. The arrogance of that board has not diminished and continues to re-emerge time and time again, despite two scandals and the decision of an international panel that there should be two blood testing sites. In the circumstances one might think that sort of arrogance would dissipate, yet it has not done so. Those charged with supplying blood should pay attention to people's needs.

It was harrowing to listen to the stories of witnesses who came before the Lindsay tribunal, including mothers, fathers, brothers and sisters of victims as well as victims themselves and their children. The report of the Lindsay tribunal has much to offer if only that it allowed those voices to be heard. For the first time people were able to tell their stories in public. It was not just about their initial treatment, it was also about how they were treated as individual human beings subsequently.

The flaw in the report, however, is that it did not lay the blame where it would be clear to most people it should be laid. It did not ensure either that the pharmaceutical firms who supplied the products from abroad would be investigated. We cannot totally blame the Lindsay tribunal for that. The Minister for Health and Children is responsible for the IBTS. He can demand that it hand over the papers. He can abolish the board and appoint a new one. Equally he can decide to investigate foreign companies. It is within his power to do so. To continuously wash his hands of what is happening as if it did not concern him at all is equally a scandal.

These people have suffered enough and if they have not suffered as individuals, they have watched close members of their families suffer. They looked on this tribunal as a watershed which would bring closure, and it has done neither.

When the Minister replies I hope he will accept the amendments tabled by Deputies Mitchell and McManus. I hope that once and for all the people who were deeply affected by this devastating scandal which virtually wiped out a segment of the population will at long last be able to see a conclusion to this issue and be able to say with dignity that they know what happened, who is responsible and, above all, that they feel safe and secure in the knowledge that it will not happen again.

Mr. Perry

I am delighted to speak on this important issue. I also call on the Minister to accept the amendments put forward.

We must speak about the impact this has had on the lives of the people concerned and the pain it brought to the extended families of those who died. I sympathise with everybody concerned. People are worried that, as in the case of haemophilia, the condition is passed on to the next generation. There are between 500 and 600 people currently at risk, and they are very concerned.

This problem arose from the use of blood products in the 1980s derived from donors infected with HIV. At that time the job of the blood bank, which is now the IBTS, was to ensure products were safe, but the Lindsay tribunal report indicates that this was not what happened. The impact of that has been far-reaching and it has resulted in loss of life. Although the remit of the Lindsay tribunal was somewhat confined the report provides consolation to the extended families of the 79 people, but still, a number of people are very worried about it.

The State needs to learn from what happened. This has been a major learning curve. The Government must invest in quality products for haemophiliacs and ensure that products are bought centrally through the health boards. There should be no curtailment of the level of care required. More nurses and doctors with expertise should be employed by the State. We talk about a specialised centre of care in Dublin, but that should complement the primary care through the health boards in the different regions. There is no point in duplication of specialised care which will be needed for many years to come. I accept the need for a centralised caring unit in Dublin which would specialise in ensuring that all of the necessary supports are in place.

The report criticises the doctors and others who used the service at the time of the crisis. At that time there was insufficient monitoring. Clearly, that is a lesson we must learn. The greatest tribute which can be paid to all of those who have died is to ensure that something like this cannot happen again.

We should provide the support staff for dental and orthopaedic care, and that speciality care unit should monitor the side effects of blood products. There is also a great need for counsellors. All of these things have to do with the essence of care. We must realise the human side of this, the number of people who are in pain and the impact this has on so many people.

Up to €70 million has been spent on blood products in the past year. Given the scale of this problem the health boards should be monitored with regard to how they use this money. I earnestly appeal to the Minister to ensure that this centre of excellence in Dublin will work with health boards to complement the level of care provided. Certainly, duplication of services should be dealt with but, judging by the level of dissatisfaction with the Lindsay report – many of the families are quite dismayed with the report – the State should reassure people that the supports will be put in place and provide whatever financial backing is needed for the families who will have to cope with this problem for many years. Due to the life expectancy of sufferers and the fact that the infection can be passed on to the next generation, it is important that the reassurances should be stated clearly and the lessons should be learned.

The Minister should take on board amendments put down by Fine Gael and the Labour Party. There have been many tribunals of inquiry but because this case involved such huge loss of life and suffering for so many, one cannot comprehend its impact and the far-reaching consequences it will have for many years.

Many Deputies have spoken about the findings of the Lindsay tribunal and the level of dissatisfaction with certain parts of the report. The next-of-kin, for whom the struggle for an inquiry has been huge, felt dejected and bitter. They sought the truth and they sought accountability. There were 79 people infected with HIV who died as a result. We hear of inquiries into the loss of money and there was a big debate here about that, but the loss of life is the greatest loss of all. The level of priority that this should get should be far greater than that given to any other tribunal and the recommendations should be acted upon even more quickly.

I am quite certain the medical profession has learned from this. The Irish Blood Transfusion Service has had a difficult time reassuring people and regaining their confidence, but it has learned from this. It is its job to ensure the quality of the products.

It is very important that the Minister should have a clear system to monitor the side effects of blood products being used at present. That should always be monitored. Although I am not an expert, it is clear looking at this with compassion and dealing with the many people affected by it that this period in our history will never be forgotten by many people. Controls must be put in place to ensure the quality of the products and care given to people who are ill. It is astonishing that something like this could happen in modern times. It is no consolation to the people who have died but we must nevertheless ensure such a tragedy will not happen again. The families of those affected must be supported and reassured.

Mr. Kehoe

Although I am not an expert in this field I can sympathise with the victims of this awful tragedy. I thank the Minister for giving me the opportunity to discuss this important report. This is the greatest medical disaster in the history of the State and it is with great sadness that I speak in this debate.

No Member of this House can know how the 260 affected people or their families feel but we know they have been devastated by the actions of a State agency. Given that the report took three years to prepare and that a considerable amount of money was spent on it, it deserves the degree of attention it has received.

I am saddened that the report does not identify the people responsible for what has happened. The State has not recognised the importance of what has happened and I am disappointed to learn from the report that simple questions have not been answered. We still do not know why hundreds of sick people were fatally affected and their lives destroyed by the actions of a State agency. Surely, after spending three years and €12 million, the answers to these questions could have been found. I know an affected person and the question continually asked is, "Why did this happen?". I have some understanding of how this person feels but no one can truly know what the victims have suffered in recent years. The tribunal report cannot assure us that something similar will not happen again. Have lessons been learned from the mistakes of the past?

The tribunal was set up by the Government when sick people began to fight the wrong that had been done to them. Many of them simply wanted to know the truth and were determined not to go away until they had heard it. However, these people have not heard the truth or been treated with the respect they deserve. Consider the greater importance given to other tribunals and their reports. Surely, a report of events which left people sick for the rest of their lives deserves more importance.

The blame lies firmly with the Minister. It was the total mismanagement of the blood transfusion service that led directly to mistakes being made. The effect of the crisis fell on totally innocent people. I often wonder how the members of the Government of the day feel when they think back on this mismanagement.

Why did some health boards and hospitals refuse to co-operate with the tribunal or to hand over important files which could have revealed valuable information? I hope these bodies are not hiding important information.

The blame lies totally with the Minister and I hope he realises this. What actions will he take to ensure that something similar does not happen in the future? Traceability is one of the most important principles in dealing with any medical condition. Money must be continually invested to ensure this does not re-occur.

No one knows what the victims and their families have suffered in the past number of years. I hope they will keep up their fight and continue to hope that they will receive the answer as to why they received contaminated blood products. The victims, with the support of their families and friends, had to struggle to receive proper compensation.

The Minister must come up with the proper answers to ensure this does not happen again.

Dr. Cowley

This is perhaps the most important debate ever held in this House. No feeling person would wish to add to the pain and hurt already inflicted on the haemophiliac population. That is why I unreservedly apologise for any part I played in the events in the Dáil when we spoke on this issue two weeks ago.

I express my sincere sympathy and condolences to the families of the haemophiliacs who have died. As a GP I frequently see tragedy but this is a tragedy of tragedies. It is a cross which must be carried by these families into the future.

Anyone who has witnessed the systematic annihilation of the haemophiliac population of Ireland must be saddened by it. Out of a population of a couple of hundred people 79 are dead and 260 are infected with hepatitis C and are HIV positive. These people did no wrong and committed no crime. Through no fault of their own they were born with a hereditary disease. As citizens they had a right to life, to live that life, to bodily integrity and to be treated equally. They were not treated equally. The story of the haemophiliac population is terrible and shameful. It is one of gross inefficiency and neglect. There was financial neglect of our health services by Government and dominance by the rights of international commerce over those of the citizens of Ireland. It is a story of the failure of a minority group of vulnerable citizens to get even natural justice, the greatest tragedy of all. They have tried hard to get justice and truthful answers, which was the least they could expect.

The Lindsay tribunal has failed our haemophiliacs. They had every right to expect much more from it. The haemophiliacs needed clear answers, an explanation of who was responsible for those terrible deeds and to see those people brought to justice. Those were not unreasonable expectations. Who otherwise had been so grievously wronged or had lost their sons, brothers, fathers or grandfathers? These families are still suffering.

The haemophiliacs did not lack backbone and were not found wanting in playing their part. They did not lack the heroism needed to go forward and give testimony. They gave remarkable evidence. One man who died – a mild haemophiliac – had received a once-off treatment for haemophilia after a nose bleed. This would have been a minor event for anyone else but he should not have been given this treatment because a safer alternative was available. This man subsequently died but even the medical details of his death formed part of the evidence to the tribunal. Did he, his family and other brave people not have the right to expect clear answers, a proper explanation and to see justice done? The haemophiliacs were clear in their evidence and surely the conclusions of the tribunal should have been just as clear in laying the blame where it should have been laid.

I did many locums all over the country in my time and I remember one place where I treated a haemophiliac family. One little lad who had fallen and who was brought in by his father needed only a simple treatment of drug products. That wide-eyed boy sat on his father's lap and I keep wondering if he is dead or alive because he got a clotting factor that he expected would do him good. He expected that that injection would not be the cause of his death, and I hope it was not. However, it could well have been.

There was a duty of care owed by doctors, the agencies of the State and the pharmaceutical companies, but it was breached. The fact that this duty of care was not observed screams out for justice and for those responsible for ending precious life to be named and shamed. This should be done no matter who is involved – doctors, hospital workers, agents of the State or anyone else – because justice demands that much at least. The medical profession, whatever part it played, should not be slow to apologise either.

It would be reprehensible if any documents or evidence required so justice can be done were not surrendered forthwith and the process of natural justice should be allowed to continue. Nobody in his right mind should stand in the way of anyone who could help this tribunal to stop him or her from doing so.

The report said there were serious failures on the part of the State agencies and was critical of the BTSB. However, the Lindsay tribunal was unable to refer the report to the Director of Public Prosecutions, and I welcome the fact that this is being done. The report was unable to extend itself to investigate the role of the international drug companies, despite the disturbing evidence of Dr. Donald Francis who said that the plasma used to manufacture the haemophilia products should rightly have been thrown down the sewer because the blood was obtained from people likely to have been infected with hepatitis C and AIDS.

In the streets of New York I saw signs saying "Blood wanted, apply within" and there were queues of drug addicts waiting to give blood. To think that that blood could have been used to kill the haemophiliac population makes my blood boil. However, the Lindsay tribunal would have been par for the course if it was not for the Flood tribunal. Using the benchmark or yardstick of the Flood tribunal, it is a gross understatement to say that the Lindsay tribunal fell far short of the mark of what it should have done. Clear actions and clear conclusions are required.

The Lindsay tribunal will not be in vain if a proper investigation is finally conducted into the actions of the international drug companies in this scandal and if those responsible are brought to justice. They must be imprisoned if justice demands it. Although they may have committed crimes of omission, they were criminal acts nonetheless – even though there may have been no criminal intent – given that safe treatment which was available was not given and people died as a result.

Reading between the lines of the Lindsay findings, it is obvious that Government health cuts also played a part in ensuring that safe blood products were not used. Health cuts, as is well described even by those who inflict them, affect the old, the sick and the poor. They hurt haemophiliacs as well and I believe they have done so.

The Lindsay tribunal is a start and all will not have been in vain for haemophiliacs and ourselves. It is fundamental that those who hold power contemplate deeply what has happened. I congratulate the Irish Haemophilia Society and the haemophiliacs of Ireland on their work. I have children myself, as I am sure does the Acting Chairman, and I do not know where we would begin to pick up the pieces or cope if we had to go through what the haemophiliac population had to go through and the enormity of the tragedy that engulfed it. I wish the haemophiliac population well and hope the Government will continue to provide the necessary funding for the Irish Haemophilia Society to do the work it must do on behalf of its members.

All this will not bring back the haemophiliacs who have died or save those who will die, but at least justice will be seen to be done and that is the least our haemophiliacs can expect.

Mr. J. Higgins

The conclusions of the Lindsay report are insipid in the extreme and were it not for the evidence and testimony given by the victims of this sorry saga, it would have been a complete waste of time. The Lindsay report does not vindicate the human suffering of those who were poisoned by the Irish medical system, nor does it vindicate the 79 people who died as a result or the hundreds who are victims for life and have to carry the disability that has resulted.

Even judged against its own terms of reference the report falls down hopelessly. Paragraph 3 speaks about an investigation into the adequacy and timeliness of the decision of the board and others in the selection of products which caused the infection, and paragraph 6 relates to the time when the board or other relevant persons in the State became aware or ought to have become aware that products were causing infections. These are precise terms of reference which have been missed hopelessly in terms of the tribunal following them and making findings according to the evidence that was put in front of it.

The tribunal totally funked the challenge of investigating the pharmaceutical firms that supplied contaminated blood products to Ireland. This could have been done within the terms of reference originally given to the tribunal at the end of paragraph 14. Again, there was another opportunity for the tribunal to reconsider its original refusal to investigate these pharmaceutical companies when the Minister for Health and Children formulated a request that the tribunal consider such and investigation.

The reason the Lindsay report gives for the refusal to investigate the multinational pharmaceutical companies is simply incredible, namely, that it would be unfair to the parties before the tribunal. As far as I am concerned, there was one key party in front of the tribunal, which was the body of people who were grievously wronged as a result of the negligence, and perhaps worse, of elements within the BTSB and the pharmaceutical companies. The key party comprised the haemophiliac victims and that was the only consideration that Ms Justice Lindsay should have taken into account in determining whether she would examine the role of the pharmaceutical companies. That this was not done, allegedly in deference to other people, is scandalous.

This approach of the tribunal was consistent with the testimony of victims themselves or relatives who gave testimony and who were treated in an adversarial manner. In some cases they were made to feel unwelcome. They were made to feel as if they were being tolerated rather than valued for the evidence they could provide in the attempt to seek the truth about what happened.

The pharmaceutical companies must be brought to book. Armour Pharmaceuticals continued to distribute its product despite knowing that its heat treatment to kill the HIV virus was ineffective. This amounted to criminal complicity by company bosses in the pursuit of profit and at the expense of human life. Incredibly, the report is silent on this issue.

It was already known by December 1982 that HIV-AIDS could be transmitted through blood products and further transmitted through sexual activity, yet Hyland Baxter Travenol and Miles Corporation Cutter continued to supply produces after that time which they knew to be dangerous. The report finds that one third of the haemophiliac community became infected after 1983, more than a full year after the facts were known. Take the scenario where manufacturers supplied baby food to supermarkets and, after having done so, they found it was contaminated but they left the product on the shelves so that babies died or were disabled and, even worse, they then continued to supply the product to the supermarkets. There would have been an immediate outcry followed by the pressing of criminal charges against such reckless negligence and conduct. That is what the pharmaceutical companies did, yet the report does nothing to call them to account.

It is incredible that the tribunal did not investigate the Accuscience affair, which involved a company importing unlicensed factor-8 concentrates and where the chief technical officer in the Blood Transfusion Service Board was a company director. It beggars belief that the BTSB allowed a public servant charged with the crucial responsibility of ensuring a safe blood supply to moonlight in a sleazy, money making exercise using the very service that he was supposed to be advancing. On this failure alone the then members of the board should have been interrogated by the tribunal. It beggars belief that the report is silent on this issue.

The Irish Haemophilia Society in a professional and closely argued response to the report contrasts the conclusions of the recent interim Flood tribunal report with the milk and water terms in which the Lindsay report is couched. The society refers to the language used in the Lindsay report, including the use of such words as "regrettable", "inexplicable", "surprising", "wholly unacceptable" or "unsatisfactory". By contrast, the report fails to use words such as "negligence", "complicity" or "responsibility" to describe the outright failures of the BTSB and the criminal action by the drugs companies. It appears not to know that such words exist in the English language.

The Irish Haemophilia Society refers to an incredible situation where, in one of many tragic circumstances, four children were infected with hepatitis C at a time when safe factor concentrates were available. The Lindsay report finds that the availability of these concentrates was a missed opportunity, as if the children had been in line to participate in the television programme "Opportunity Knocks". It beggars belief.

The tribunal should have investigated the links between the health cuts being implemented at the time and the criminal negligence of the BTSB. At the time, those involved in the Ansbacher scheme were salting away their hundreds of millions of pounds in foreign accounts while cuts were implemented in State services, including the BTSB. This report does not bring closure to this issue. We must find a way to ensure that the truth emerges and that responsibility for what happened is apportioned.

Mr. Healy

This is one of the most important debates to have been held in the House for a long time. It covers a sensitive subject and will bring back harrowing memories and trauma to the families affected. It is rare that we deal with an issue in the House that affects the lives and deaths of individuals. Sadly and traumatically, what happened here led to the deaths of 79 people and the infection 260 others. It traumatised the haemophilia community, one that was entitled to expect the best services that money could provide. Unfortunately, it got a deficient service, lacking everything that could have been expected. The country must apologies to the haemophilia society for this. What happened deserves much better consideration than that provided for in the Lindsay tribunal report.

I welcome the Government response to the report. I am sure everybody welcomes the decision to refer the report to the DPP, the acknowledgement in the Government motion of the suffering endured by those who were infected and their families and the acknowledgement of the harrowing personal testimonies put by individuals before the tribunal. I also welcome the commitment in the motion to ensuring the availability of an adequate and ongoing supply of clotting factor concentrates to the highest national and international standards of safety and efficacy. I hope the Minister will accept and welcome the amendments to the motion which call on the Government to initiate an inquiry into the relevant international pharmaceutical companies involved and to provide adequate funding to the Irish Haemophilia Society to support the haemophilia community on an ongoing basis.

This is a deeply flawed report. It does not apportion blame and is vague and indefinite in its conclusions. It fails to meet the demands of the House or, more importantly, of the affected families. The Irish Haemophilia Society has produced a critique of the report which criticises the methods and conduct of the inquiry and its findings.

It is worrying that three years later, and with €20 million costs accrued, there is no closure to the issue and that the report has added to the trauma which the families have endured.

The main questions in regard to this matter are what happened, and how and why did it happen. Unfortunately these questions are not adequately dealt with in the report, which contrasts poorly with the recent Flood report which reached definite conclusions. The Lindsay report does not deal with the questions raised in any real way and leaves quite a number of questions hanging.

It is unacceptable that documents which the tribunal requested were not made available and this matter needs to be addressed. The report does not in any way apportion blame and raises the fear that there will not be any prosecutions. That contrasts significantly to what has happened in France and Portugal where the state began legal proceedings which proved effective. Some people went to jail as a result of the investigations and in one case a minister ended up in court. However, one does not have the feeling that this will happen here, although it is the type of action that is necessary to bring closure to this episode for the families concerned. It is almost as if a crime has been committed yet no one is responsible.

I have been involved in the health service for over 20 years and am concerned that the climate of cutbacks that we experienced throughout the 1980s was instrumental in bringing about the situation we are discussing. The Minister should be mindful that crucial services such as health and education should not be the subject of cutbacks in the future. We have already had indications of cutbacks in the health service this year and we heard the Taoiseach say only yesterday that more severe cutbacks are on the way. I appeal to the Minister to ensure that the health service is exempt from these cutbacks because of the potentially fatal repercussions. The fact that no link was made between the cutbacks at the time and the situation that developed in the BTSB in regard to haemophiliacs is also a damning indictment of this report.

I welcome the debate and the extended time made available for it. I hope that the Minister will take on board the sincere sentiments that have been expressed on this side of the House.

Mr. Boyle

Sometimes we have to be careful about what we wish for because it might happen. The current knee-jerk response in Irish politics to issues of public concern and scandals when uncovered is to call for a tribunal of inquiry or some form of inquiry that would provide the answers to which those who are aggrieved feel they are entitled.

Issues in regard to blood transfusion have had more than their share of tribunals of inquiry and their like. Some have provided answers, some have provided responses, while all have made those of us in the system – the political, the judicial or the medical – think of how the services can be improved; and improvements have been made. However, it has to be acknowledged that this tribunal of inquiry has been a disappointment to all concerned, in terms of the recommendations made and the answers being sought not being provided.

This was the inquiry of which most was expected because, regardless of all other ongoing inquiries concerning political or business corruption, or other areas of medical malpractice, this was an inquiry that was meant to be dealing with the effects of malpractice and collusion in a cover up that resulted in the deaths of innocent people; needless deaths that were painful and which claimed so many young victims.

This Chamber should not be satisfied with the report put before it. We should ask that the terms of reference that have obviously proved so limiting for the sole member of the tribunal should be reassessed and put forward in a new format. It is the entitlement of those who have been afflicted by this set of circumstances that the tribunal that was originally requested by this House be provided. The Minister and the Government should present such a proposal to the House so that we can go on from this debate and know what answers can and should be sought.

The results of this tribunal report contrasts greatly with the circumstances of similar scandals on the same issue in other countries. The case of the French haemophilia blood scandal, where people did go to jail, people were held politically responsible and people in political positions were held judicially responsible, has been highlighted several times. Until we can reach a situation where such repercussions follow, I do not think anyone who has been involved in this controversy over the past 20 years will receive any degree of satisfaction.

This House has to be concerned about the information that was given to it at various stages during debates by a number of Ministers for Health who, admittedly, were badly informed. Yet we have still not been informed as to why that information was provided to those Ministers to present to this House.

On a basic political level the report is unsatisfactory. However, on a more important human level it is the least satisfactory of the tribunal reports we have witnessed in the past number of years. The ongoing need for answers from the report in regard to investigating pharmaceutical firms is something that we cannot lose sight of or let go. I look forward, in particular, to a response from the Minister and the Government regarding that issue. It is unfortunate that the pharmaceutical industry which deals in products that are meant to prolong and improve people's lives has often been involved in malign activities. The pharmaceutical industry in the United States, where many of the companies who should have been investigated for their involvement in this scandal are based, has been involved in the recent American elections. They have provided $30 million to fund political campaigns, to have their people elected and their policies pursued. This is not an industry without resources. It is prepared to spend resources in a particular way to achieve particular results. The challenge for this Parliament and the Government is to make sure those resources are used in a way that those who have been affected by haemophilia as a result of blood transfusions can have confidence that those in the companies who were responsible will admit it and take the legal responsibilities both morally and financially.

Haemophiliacs and their families have been dealt with on the margins of Irish politics for too long. When they moved to centre stage it has always been for the most cynical of reasons. It should not be forgotten that the general election in 1989 was held on the pretext of what resources should be provided to people suffering from haemophilia. Yet 13 years later we have not only failed to see an adequate improvement in resources and standards of services, we have seen a litany of events that have worsened the quality of life of haemophiliacs. That is a matter of shame for this House, the Governments since 1989 and anyone involved in political life in this country. We must go on from here and admit that the political system has failed badly those who it was meant to serve. We have to provide the answers in an immediate, acceptable and readily understandable way for people who have not been helped by the system.

I hope the Minister will respond to the various amendments to the substantive motion and lead this House in getting those answers, otherwise the debate we are now having will be repeated in future with different circumstances and different victims.

Mr. Crowe

It is difficult for anyone to adequately cover this issue. I spoke during the debate on organ retention and felt it was very difficult to articulate the pain, suffering and sense of loss that many of those families have gone through. I feel much the same now. I would like to be able to make a speech that could express the anger, frustration, sense of loss and the lack of closure. As the Minister knows, when one talks to families one finds they are looking for answers. I clearly do not have the answers. The system let down these people just as the system let down the families affected by organ retention. If anything is to come out of this debate, it must be that such things will never happen again.

I reiterate what Deputies Ó Caoláin and Morgan said. They welcomed the publication of the report of this tribunal but they spoke about it limitations. No blame has been put on anyone and the families feel let down by this. People have said the families got the opportunity to have their stories heard. Each family has its own story but there is no sense of closure. I support the Government's motion and the amendments tabled by Fine Gael and Labour. Perhaps the Minister will accept these proposals. I welcome the decision to refer the report to the Director of Public Prosecutions.

I was concerned about the adversarial nature of the tribunal. Some of the questions that senior counsel put to families that are still grieving were disgraceful. The attitude of many of the senior counsel seemed to be that people are in this simply to gain compensation. As with the organ retention scandal the victims were being blamed. In this tribunal people were asked what they spent their compensation on. It does not matter what way people spent it, it will not bring a life back – that whole line of questioning was a disgrace. The senior counsel that posed those questions should look into their own hearts. In what type of world do these people live? Families who had been through the worst were dragged through it again by senior counsel who showed them no sympathy. Why were these victims put in a position where they felt they were defendants? It is clear they are the victims. It can be argued that the pharmaceutical companies, the State or different Ministers were responsible. It is clear the people knew that blood products were infected. It continued and the system did not recognise its own faults.

The arrogance displayed by the medical profession was the same. The families of children whose organs had been retained asked questions but were told they did not need to know the answers and to go away. There is something wrong with the medical profession if that is its attitude. The Minister deals with such cases all the time as Deputies, families and counsellors write to him – he hears these stories. It is clear the victims were let down by the system.

Many of the victims were angered by the failure of the report to include any criticism of Armour. In June 1988 that company took the decision to continue supplying a product, about which it had serious safety concerns, to the BTSB. Evidence was also given to the tribunal of the knowledge of Armour Pharmaceuticals Limited of the HIV infection risks posed by the company's products which it continued to distribute in Ireland. The families who spoke to me were also angered by the failure of the tribunal to investigate a number of issues which they felt were central to the infection of blood products. These included the failure to call all members of the BTSB and the failure to investigate various Ministers for Health who had ultimate responsibility for policy decisions.

The report also failed to address the conflict of interest involving the late Mr. Sean Hanratty, former chief technical officer of the BTSB. He 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 that were responsible for some of the infections. Mr. Hanratty was involved in a company supplying products and he had a key role in deciding which products the BTSB used. Evidence of documents being destroyed was given at the tribunal, which created a difficulty in following the paper trail. This is a criminal act for which no blame has been apportioned.

Ms Justice Lindsay's report also refuses to comment on the possibility of a future tribunal of inquiry into the role of international drug companies in the infection of haemophiliacs in Ireland and perhaps the Minister will enlighten us in this regard. The Minister sought and obtained a report from Mr. Paul Gardiner, SC, on the matter. I reiterate the demand of my party colleagues for the immediate release of Mr. Gardiner's report and for the establishment an adjudicative tribunal to investigate the role of pharmaceutical companies. Such companies were criminally complicit in infecting people with HIV. Those involved must be prosecuted as this issue cannot be allowed to drag on. The families have suffered too much and for too long. A total of 79 people died and many families were affected by those deaths. Everyone who has met them has been affected. One would have to have something wrong with one to walk away from a meeting with them without feeling useless, let down and angry at a system that would allow this to happen.

Mr. Ferris

I welcome the presentation of the report as it has brought the events surrounding the conflict into the public domain and it has increased our understanding of the suffering the victims and their families endured. In addressing the issue of the Lindsay report people with haemophilia considered its detail with severe disappointment. There were a number of reasons for this but, perhaps foremost among them, was the fact that the report failed in large measure to identify persons who were responsible for what happened.

The failure of the tribunal chairperson to deliver the report in a clear and concise manner indicating those responsible for the wrongdoing and her failure to provide recommendations which could, if implemented, prevent a future repetition of these events, are major defects. The failure of the report to apportion blame is leading to a general erosion of trust in the tribunal system. These failures, together with the fact that successive Ministers for Health, as has been stated by a number of previous contributors, were not hauled before the tribunal to give proper account of their role as the Ministers directly responsible, is a damning indictment of this entire process.

The tribunal failed to investigate certain issues that were central to the contamination of blood products. Examples of these include the decision in 1988 of Armour Pharmaceuticals Limited to continue supplying a product to the BTSB that it knew constituted a serious risk of contamination to blood products and the failure of the BTSB to withdraw untreated products between October and December of 1985. Ms Justice Lindsay found that one third of the haemophilia community in Ireland became infected after June 1983. Consequently, at least one third of people with haemophilia could have been saved by prompt action on the part of the pharmaceutical companies and the authorities.

I reiterate that we want an adjudicative tribunal into the actions of the pharmaceutical companies. Individuals and Ministers were prosecuted and, in some cases, sent to prison for their part in similar scandals in France and Portugal, while in Japan three drug company executives were prosecuted for selling blood tainted with HIV and they served terms in jail. A tribunal rarely results in prosecutions whereas in other states the issue is dealt with through the criminal justice system. An adjudicative tribunal would have similar powers and we would be far more likely to see justice done.

The cutbacks in public services being planned and implemented by the Government remind me of the cutbacks in the 1980s that forced the BTSB to cut corners irrespective of whether it cost people's lives. The board put financial considerations before the lives of people. This is nothing short of criminal negligence and those responsible must be held accountable. It would be easy to write all of this off as a systematic failure but it was much worse than that. A group of individuals made a clear decision to place people's lives at risk. They, either wilfully or negligently, infected people and the consequences of this were fatal and brought immense suffering to hundreds of people. The victims of this tragedy seek accountability for what could be described by some as murder. It is time that they got it.

Minister for Health and Children (Mr. Martin)

I thank all those who contributed to the debate on this motion on the Lindsay tribunal report. No words can describe the gravity of the issues examined by this inquiry and the human loss and suffering that resulted from the infection of the haemophilia community with HIV and hepatitis C. The Government acknowledges the courage of those who gave personal testimony to the tribunal and, on behalf of the State, I again unreservedly apologise to these persons and their families. In order to ensure that these personal testimonies are put on record and given the acknowledgement which is their due, I have decided that they should be published, subject to normal rules of natural justice, as a memorial to the bravery and courage of those who have borne witness at the tribunal. I will also ensure that this publication is undertaken in consultation with the Irish Haemophilia Society, is available at no cost and is circulated as widely as possible.

As I informed the House on 23 October, the Government has decided to accept the findings of the report in full. Having considered the report carefully, the Government has also decided to refer it to the Director of Public Prosecutions as a mark of the seriousness with which it views the events which are documented in the report. My officials forwarded the report to the Director of Public Prosecutions last Friday. As the report itself acknowledges, the events that were investigated took place some time ago. Significant improvements have taken place since then in regard to services for people with haemophilia.

The tribunal found that the situation in Ireland regarding the supply of recombinant clotting factor products now compares favourably with many other countries and was remarked upon by many of the international experts who gave evidence to the tribunal. It should be acknowledged that we have a state-of-the-art facility at the National Centre for Hereditary Coagulation Disorders. There is ongoing communication between the centre and the Irish Haemophilia Society in relation to the management of haemophilia. A person-centred service where the voice of the consumer is a key factor in shaping the services provided is a pivotal aspect of service development. My Department is in consultation with consultant haematologists around the country and with the Irish Haemophilia Society to ensure that services adhere to the highest standards of quality and there is optimal co-ordination of services. I will meet the Irish Haematology Society and the Irish Haemophilia Society in the coming weeks to ensure their respective views are taken on board in the development of all services.

I have already outlined to the House how my Department intends to implement all the recommendations in the Lindsay report. In particular, the Department will proceed with the establishment on a statutory footing of a national haemophilia co-ordinating committee, which will be called the national haemophilia council. Representation on the committee will include professionals involved in haemophilia care, the Irish Haemophilia Society representing consumers of the service, health boards, my Department and relevant interests. The results of poor communication and lack of co-ordination of services in the past point to the need for a streamlined uniform system of communication between service providers and a consistent high quality system of care delivered throughout the country. The council will oversee, monitor and advise on all aspects of haemophilia care. Its overall aim will be to ensure improved communication between clinicians and improved co-ordination of services resulting in a consistent quality of care, whether a person being treated for haemophilia lives in Donegal, Dublin or Kerry.

A major sub-group of the national haemophilia council will be the product selection and monitoring group. A key task of this group will be to ensure that all decisions regarding the selection, procurement, distribution and monitoring of products used in the treatment of haemophilia adhere to the highest standards. The Irish Haemophilia Society will play a pivotal role on this committee, along with the National Centre for Hereditary Coagulation Disorders, the Irish Blood Transfusion Service, health boards and other relevant interests. An ad hoc group is already in place for over a year and shortly its membership will be expanded to involve key professionals with an expertise in various aspects of haemophilia treatment.

I am grateful to the Irish Haemophilia Society for its close co-operation with my Department over the years. I particularly acknowledge the contribution of Mr. Brian O'Mahony, chairman of the society. Brian is also president of the World Haemophilia Federation, which is evidence of the high esteem in which he and the society are held at home and abroad. I also acknowledge the significant input of Ms Rosemary Daly and all the staff at the centre. Rosemary worked tirelessly over the years in the cause of the Irish Haemophilia Society and its members. I understand she is now enjoying a well earned sabbatical from her role as administrator of the society and I wish her well for the future. The society requested an increase of €300,000 in its funding at a recent meeting with me. Having considered its request, I am pleased to inform the House that I intend to provide an additional €300,000 to the society next year to enable it to enhance the services it provides to persons with haemophilia.

There has been criticism about the cost of the Lindsay report which was set at €10 per copy. When the cost was being determined, it was seen as reasonable relative to the Finlay report which cost £5 in 1995. However, the Irish Haemophilia Society has pointed out that €10 is high relative to the €1 charged for the interim report on the Flood tribunal. While the society acquired as many copies as it requested free of charge from my Department, the point it made regarding the cost is valid and, as a result, I will request the Government Publications Office to make the report available at the nominal charge of €1. Copies will also continue to be available from my Department on request and an electronic version is available on the Department's website.

Calls have been made for a further inquiry into the actions of certain multinational pharmaceutical companies based in the United States whose products were implicated in the infection of persons with haemophilia with hepatitis C and HIV. Ms Justice Lindsay considered it inappropriate to comment on whether there should be a further inquiry into the actions of certain multinational pharmaceutical companies whose products were implicated in the infection of persons with haemophilia with hepatitis C and HIV since I had commissioned and obtained independent advice on the matter. As I have already informed the House, I appointed Mr. Paul Gardiner, senior counsel, to advise me on a possible investigation into the actions of these multinational pharmaceutical companies. I have had consultations with Mr. Gardiner and I will have further discussions with the Attorney General. I reiterate my belief that 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, following which I will revert to the Government and the House on my proposals. It is important for the House to have the fullest information possible regarding that inquiry and the pursuance of the pharmaceutical companies.

I thank Ms Justice Alison Lindsay, her staff and the many people who contributed to or co-operated with the tribunal. There was much criticism in the House of the content of the tribunal report. However, the Oireachtas set up an independent process. It has reported to the House and the motion notes the report. I am committed to the implementation of all the recommendations in that report. I commend the motion to the House.

Mr. J. Higgins

Will the Minister tell us when he will make a decision on the pharmaceutical company mentioned?

Mr. Martin

It is not a case of when I will do it. I will revert to the House with a full template following discussions with the Irish Haemophilia Society and the people I mentioned in my speech. There has already been criticism about the earlier terms of reference of the Lindsay tribunal and there were subsequent disputes about what they meant. Before the House decides, it should know in full about what it is deciding.

Amendment No. 1 not moved.

Question put and agreed to.

Dáil Éireann debate -
Wednesday, 6 Nov 2002