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Dáil Éireann debate -
Tuesday, 4 Feb 2003

Vol. 560 No. 3

Irish Blood Transfusion Service Procedures.

I had hoped that the Minister, Deputy Martin, would be present for this matter. I did not raise it to embarrass him or the IBTS or because I wanted heads to roll, but this issue is too important and worrying to ignore. When one hears, albeit some time after the event, that the new revamped and renamed IBTS had written to people whom it had previously infected with hepatitis C inviting them to donate blood, it makes one's hair stand on end. What does it take to bring home to people in the IBTS, the Minister and all involved the enormity of what happened?

It is almost 20 years ago since the chain of events was set in place. Despite all that has happened, deaths, ongoing debilitating illnesses, the enormous and incalculable impact it has had on the extended families, the ongoing enormous cost to the taxpayer and the burden on the health services, little has changed. One would have imagined that unassailable, cast iron safeguards would have been put in place to prevent even the remotest chance of infected persons donating blood, much less of them being invited to give blood by the very service that previously infected them. I cannot even begin to imagine the insult and hurt this must have caused to the people to whom the IBTS wrote.

From a public health point of view the main concern is the continuous undermining of confidence in the blood collection, treatment and distribution service. It was always going to be difficult for the IBTS to recover from what had happened, starting in the 1980s and continuing up to very recently. It was always going to be difficult to recover from the scandal of distributing contaminated blood and re-establish any kind of confidence in the service and the integrity of its blood products. It will always live in the shadow of what happened. It would be absolutely unforgivable and create an irretrievable situation for the IBTS if there was to be another accident. It has not really dawned on it that it must be absolutely above reproach. That is what it has failed to grasp.

It is not good enough for the IBTS to tell us that if people infected with hepatitis C had come to donate blood, it would have been detected later on. I am sure it would but 20 years on from the original scandals it leaves me almost speechless that it would be even talking about updating records at this stage. With its record, it has to be above reproach. What is most disturbing is that it does not seem to have grasped this.

During the course of a previous discussion on the Lindsay report the Minister for Health and Children assured us, rightly, of big changes that had taken place in investment and in terms of a new culture of accountability. Where is the proof of this? Is the Minister monitoring the situation and ensuring these changes are taking place? If so, how can this happen again? The report of the Lindsay tribunal has been much criticised but its recommendations were the one solid thing to come out of the process. They rightly identified that this was not a case of individual culpability but a systems failure. There was a failure on the part of management to create clear lines of responsibility in reporting; a failure to provide for information systems, data and good record keeping, the ability to look back at what had happened and relate it to what was happening; and a failure of communications. These mistakes are still been made. Have the systems changed?

It is not good enough for the Minister for Health and Children to offer us what now seems like a glib assurance – I do not think it was his intention to be glib – that everything has changed. It clearly has not changed. As far as the IBTS is concerned, nothing can be taken for granted. I just want the Minister for Health and Children to take a more personal interest in monitoring what is going on and ensuring the process of change is proceeding, rather than simply being reported as happening.

I make this reply on behalf of the Minister for Health and Children. I presume the Deputy is referring to the articles in yesterday's newspapers relating to correspondence between the Department of Health and Children and the IBTS received by a journalist under the Freedom of Information Act, and thank him for raising the matter on the Adjournment because it is an understandable cause of public concern.

The Department received a letter from Positive Action last year noting that one of its members who was hepatitis C positive had received a contact letter from the IBTS referring to donors who had been deferred because they had jaundice prior to their 13th birthday. On 3 January 2002 the IBTS introduced an additional test for hepatitis B, called the hepatitis B core antibody test, which detects hepatitis B at very low levels. This additional test allowed the IBTS to accept donations from donors who had jaundice before their 13th birthday and brought Ireland into line with practice throughout Europe and the United States. Up to this point, any donor who presented with a history of jaundice had been deferred from donating indefinitely. After the introduction of this test the IBTS decided to write to all those donors on its donor database who had been deferred because of a history of jaundice in childhood. This necessitated a mailshot to 8,000 donors.

Each donor was sent an explanatory letter outlining the rationale behind the introduction of the test. Attached to the letter was a questionnaire seeking additional information concerning the clinical details of his or her jaundice and his or her current state of health in order that this could be reviewed to decide if the particular donor was now eligible to donate. It should be stressed that the letter was in no way an invitation to donate, rather it was informing donors of the change to IBTS guidelines and the possibility that they could be reinstated onto the IBTS active donor panel. The letter stated:

We have reviewed our records and note that you informed us that you had jaundice in the past. We would be most grateful if you would complete he enclosed questionnaire so that we can advise you if you are eligible to donate . . . Please do not come to your local blood clinic with this questionnaire as you will not be able to donate until we have reviewed your questionnaire and amended your donor record if appropriate. We will write to you and let you know if you are eligible to donate.

As can be seen clearly from this excerpt, the letter to the donors was eliciting further information about the clinical details of their jaundice and current state of health. It was not an invitation to donate, nor could the donor donate on presentation of the letter or questionnaire at their local clinic. Therefore, as the letter was requesting further medical information, there was no danger to the blood supply as the recipients of the letter could not have donated without further medical assessment.

Unfortunately, two donors who were hepatitis C positive received these letters. This had not been intended – the two donors had been included in the file of donors with a history of jaundice in addition to being on file as hepatitis C positive. The IBTS had not picked up this discrepancy when checking its file of 8,000 donors with a history of jaundice. It apologised for this error and any hurt this may have caused. When this error came to light it amended its coding system in order that in future donors who were hepatitis C positive would be deferred with a code used exclusively for this purpose.

In 2002 there was an 8.6% increase in donations over 2001. This resulted in an uninterrupted supply to hospitals for elective surgery, treatment of patients with cancer and so on. This change to the guidelines and other initiatives have enabled the IBTS to recruit donors who would previously have been ineligible to donate and facilitated it in responding to the emerging threat of CJD.

Following publication of the Finlay tribunal report in 1997, a multi-million pound investment programme was approved to support the reorganisation and redevelopment of the IBTS nationally. The primary objective was to ensure it was resourced to provide a transfusion service in line with best international standards. The report of the Lindsay tribunal, published in September last year, also made a number of recommendations in relation to blood, blood products and clotting factor concentrates. The Department is working in conjunction with the IBTS and other relevant agencies to ensure the recommendations of the Lindsay tribunal are implemented in full. I thank the Deputy for raising the matter on the Adjournment and agree with her that vigilance in this area is essential.

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