Hepatitis C Compensation Tribunal (Amendment) Bill, 2002: Second Stage.

Question proposed: "That the Bill be now read a Second Time."

On behalf of my colleague, the Minister for Health and Children, I am pleased to bring proposals to the Seanad to provide compensation to HIV-infected haemophiliacs and their dependants. The proposals will also be of benefit to the dependants of people with hepatitis C who have died as a result of receiving blood or a blood product or where hepatitis C was the significant contributory factor to the cause of death.

The Bill has its origins in circumstances which have resulted in much grief, suffering and the loss of many loved ones. The haemophilia community has suffered to a truly extraordinary degree and the loss of fathers, husbands, brothers and sons within that community is a tragedy of immense proportions. The Bill is about compensation and how the State addresses – or to be more accurate, readdresses – this tragic episode with deep and bitter consequences for so many people. The proposals aim to bring closure to the efforts of the State to compensate persons with haemophilia and their families arising out of the consequences of HIV. While financial compensation alone cannot undo the harm done or make up for the loss of life, health or well-being, it is nevertheless one measure which can assist haemophiliacs and their families and ease the burden of what they have suffered and continue to suffer.

The particular circumstances associated with the infection of haemophiliacs with both hepatitis C and HIV have been investigated by the Lindsay tribunal and we have all heard graphic testimony from haemophiliacs who are infected with hepatitis C and HIV. The evidence presented by the families of those who died was particularly moving. We await the report of that tribunal, which will address the role of treating physicians and State agencies which had a responsibility in regard to the treatment and care of such persons.

In 1999, during discussions between the Department of Health and Children and the Irish Haemophilia Society in relation to the terms of reference of the Lindsay tribunal, the society raised the question of compensation for haemophiliacs with HIV. It felt that the 1991 settlement was inadequate and that it did not provide fair compensation. In particular, it pointed out that whereas hepatitis C claims are calculated on the same basis as awards of the High Court, the 1991 settlement did not do so.

In light of the representations made by the society on behalf of its members, in December 1999 the Government accepted that it would be fair and equitable to review the compensation arrangements for HIV-infected haemophiliacs and dependants of deceased HIV-infected haemophiliacs. The Government committed itself to bringing forward proposals to provide compensation for HIV haemophiliacs and their families on a similar basis to those persons infected with hepatitis C, subject to such modifications as might be necessary to take account of the special circumstances of HIV infection. Detailed discussions followed between the society and its legal advisers and the Department and its legal advisers.

The development of compensation proposals was extremely complex. The fact that there had been a full and final settlement in 1991 was one of the complicating factors. Apart from the legal complexities, the preparation of proposals was unavoidably delayed due to the fact that the society and the Department were heavily involved in the Lindsay tribunal. It was necessary for the Department to devote considerable time to its participation at the tribunal which heard evidence over 196 days, completing its public hearings on 28 November 2001. The involvement of the Department in this tribunal significantly affected the timescales involved in bringing forward proposals.

The circumstances of persons infected with HIV and their dependants were the subject of detailed submissions by the society. I would like to summarise for the House the special circumstances relating to HIV which the society outlined. HIV infection in the 1980s and the early 1990s was effectively a death sentence. Those infected became seriously ill very quickly and died harrowing deaths; many died relatively young, including some children. The rapid deterioration of the health of those infected was extremely difficult for the families. The stigma and fear associated with the virus, especially around the time of the bereavement, added immensely to the trauma and suffering of the families. The support and counselling services for the primary victims and their families were inadequate and this inadequacy aggravated the pain and suffering. There was a significant risk of onward transmission of HIV especially in sexual relations.

I am pleased to inform the House that, on behalf of the Government, the Minister, Deputy Martin, has reached an agreement with the society which resolves the issue of additional compensation arising from the HIV infection. The principal terms of this agreement are as follows. Persons who are infected with HIV from the administration of blood products within the State will have access to the compensation tribunal. Dependants of those HIV-infected haemophiliacs who have died will be entitled to claim the general damages, including pain and suffering, to which the deceased would be entitled were he or she in a position to make his or her claim to the tribunal. Dependants will also be entitled to claim for financial loss arising from the injury and death of the person with HIV. A dependent spouse, child, mother or father may claim if they have suffered post-traumatic stress disorder arising from the death of the primary victim. Dependent spouses or children may claim for the loss of society, including the loss of care, companionship and affection of the deceased. A spouse or partner may claim in respect of the loss of consortium, including the impairment of sexual relations, arising from the risk of the transmission of HIV.

The Bill is extremely complex and contains a number of novel provisions. It provides that the dependants may claim for the general damages, mainly pain and suffering, that the deceased would have been entitled to if he or she had survived. This is a significant departure from the civil liability provisions which exclude dependants from claiming the pain and suffering of the deceased. The Government approved this provision because those who died were not in a position to make a claim on their own behalf before death. In addition, under the Civil Liability Acts, dependants may only claim from the date of death of the deceased and not from the date of injury. We have included a provision which will allow the dependants claim for financial loss from the date of injury. This will enable dependants to be awarded compensation, for example, where the deceased was unable to work because of his or her illness and the dependants lost out financially.

It should also be noted that, while the Bill is primarily aimed at resolving the issue of HIV compensation, the benefits will also extend to persons infected with hepatitis C and their dependants. A number of amendments were agreed in the Dáil yesterday to ensure parity of treatment of persons suffering from hepatitis C or HIV. These amendments were made following representations made to the Minister by Positive Action and Transfusion Positive.

I now turn to the detailed provisions of the Bill. Section 1 defines various terms used in the Bill. I draw attention to the definition of "relevant product" which is defined as a blood product or blood component used to treat persons with haemophilia or other blood clotting disorders in respect of those conditions. The use of such products has been implicated with the transmission of HIV to members of the haemophilia community here.

Section 2 provides for a change in the title of the compensation tribunal which in future will be known as the Hepatitis C and HIV Compensation Tribunal. The references in any Act or regulation to the tribunal will be construed accordingly.

Section 3 provides for two technical amendments of section 3 of the 1997 Act. Paragraph (a) provides that certain notices which may be issued by the tribunal may be delivered to the place where a person to whom the notice is directed carries on any trade, business or profession rather than delivering it to his or her home address. Paragraph (b) inserts a new provision in the 1997 Act which provides that certain requirements of the tribunal may be enforced by the High Court. These may require a person to attend the tribunal to give evidence or produce documents to the tribunal. The compensation tribunal has received full co-operation from all relevant State agencies, doctors and others. Nevertheless, it is considered desirable to make such provision now that we have an opportunity to do so.

Section 4 provides for a series of amendments to section 4 of the 1997 Act. Paragraph (a)(i) is a technical amendment to clarify the intention of section 4(1)(c) of the 1997 Act. Paragraph (a)(ii) amends the provision in the 1997 Act in relation to carers of persons with hepatitis C. The existing provision enables a carer to make a claim for financial loss or expenses that he or she has incurred. This is now being extended to include financial loss or expenses which he or she will incur.

Paragraph (a)(iii) extends the categories of persons who may apply for compensation to the tribunal to include persons affected by HIV infection. The new provisions are at paragraphs (f), (g), (h), (i) and (j). Paragraphs (e) and (k) already appear in the 1997 Act and are being repeated for drafting reasons. Paragraph (f) refers to a person who has been diagnosed positive for HIV as result of receiving a relevant product within the State. Paragraph (g) refers to children or spouses of such a person who have themselves been infected with HIV. Paragraph (h) refers to a person who is married to or cohabiting with an infected person and enables that spouse or partner to make a claim for loss of consortium, including impairment of sexual relations arising from the risk of transmission of HIV or hepatitis C. Paragraph (i) enables a person responsible for the care of an HIV infected person to make a claim for the financial loss or expenses that he or she has incurred or will incur. Paragraph (j) enables dependants of HIV infected persons who have died to make a claim for compensation to the tribunal.

Section 4(b) inserts a new provision after section 4(2) of the 1997 Act which section provides that a person is not entitled to make a claim to the tribunal if he or she has received an award from any court or a settlement arising out of the circumstances which could give rise to a claim at the tribunal. The new subsection (2A) provides that this prohibition will not apply to any person who has received a payment under the 1991 settlement or an award from any court, including an award from a court on appeal from the tribunal, or a payment in respect of an action against a party other than the State or a relevant agency. This provision is necessary to ensure the persons who received payments under the 1991 settlement or in settlement of litigation against the pharmaceutical companies are not debarred from making a claim to the tribunal. It will also ensure persons infected with both hepatitis C and HIV will not be debarred from making a claim in respect of their HIV condition where they have previously received an award in respect of hepatitis C.

Section 4(c) inserts a new subsection (6A), paragraph (a) of which requires a claimant to advise the tribunal whether he or she has previously made a claim to the tribunal or received a payment under the 1991 settlement. In the case of claims by dependants, the dependants will also be asked to indicate whether the deceased person had previously made a claim to the tribunal or received a payment under the 1991 settlement.

Paragraph (b) authorises the Minister to furnish the tribunal with particulars of the 1991 settlement if the tribunal requires this in order to process any claim. Paragraph (c) provides that where a co-infected person has not made a claim before the commencement of this Bill, the tribunal can choose to hear and determine together the claims in respect of HIV and hepatitis C. This will enable the tribunal to consider all aspects of any case and help to eliminate duplication and delay. Paragraph (d) is a transitional provision which ensures that where there are claims pending before the Bill comes into force, the tribunal may deal with these and any fresh claims from the same claimant at the same time if it considers this appropriate.

Section 4(d) is a cross-referencing adjustment. Section 4(e) sets out the proofs which persons making claims related to HIV infection will be required to satisfy on the balance of probabilities. Briefly, a HIV-infected person will be required to show that his or her infection resulted from the use of a relevant product within the State. A child or spouse infected by an infected person will be required to show that this was the source of his or her infection. A carer will be required to show that the HIV-infected person he or she is looking after was infected following the receipt of a relevant product while dependants will be required to show that the deceased was infected following the receipt of a relevant product.

Section 4(f) provides that in making a claim for aggravated or exemplary damages a claimant may rely on the facts found in any report of the Lindsay tribunal. Section 4(g) is a cross-referencing adjustment.

Section 4(h) sets out the time limits within which claimants must bring claims arising from the infection of persons with HIV. These follow the format used in the 1997 Act for hepatitis C claims. In summary, the time limit is three years from the date of the relevant event, for example, the date of injury or date of death, or three years from the date of commencement of this Bill, whichever is the later. Section 4(i) and (j) are cross-referencing adjustments.

Section 5 of the Bill provides for the amendment of section 5 of the 1997 Act, which sets out the basis on which awards are to be calculated by the compensation tribunal. Generally, the tribunal is required to apply the principles governing the measure of damages in the law of torts and relevant statutory provisions, including Part 4 of the Civil Liability Act, 1961. It provides for a series of important and, as I have mentioned, novel modifications of the usual rules governing personal injury actions and fatal claims which will be of significant financial advantage to the dependants of deceased persons.

Subsection (2A)(a) provides that damages in a dependant's claim will accrue from the date of injury of the deceased rather than from the date of death of the deceased, which is the usual rule. Subsection (2A)(b) enables the tribunal to make an award to a dependant consisting of an amount equal to the amount of general damages, including damages for pain and suffering which the deceased suffered during his or her lifetime, to which the deceased would have been entitled had he or she survived and brought a claim for compensation to the tribunal. Normally, damages for pain and suffering can only be recovered by the primary victim, not by his or her dependants. However, the situation we are dealing with is unique and it has been decided that the usual rules should be set aside in this instance.

Subsection (2A)(c) allows the tribunal to make an award to a dependant in respect of aggravated and exemplary damages if the dependant can establish that the deceased would have had a legal entitlement to such damages against a relevant agency or the Minister had he or she survived. This is another significant departure from the existing law, under which aggravated and exemplary damages are only payable to the primary victim, not to his or her dependants.

Section 5(b) makes special provision for the children, spouses, fathers or mothers of persons who died as a result of contracting HIV or hepatitis C or where either of those conditions was a significant contributory factor to the cause of death. The tribunal is being empowered to make an award to such dependants for any post-traumatic stress disorder or nervous shock they suffered arising from the death of their loved ones. I have already alluded to the graphic testimony given at the Lindsay tribunal and also the Finlay tribunal of the devastating impact that such deaths have had on family members. This will allow the tribunal to make awards of damages for post-traumatic stress disorder, also known as nervous shock, in appropriate cases.

Section 5(b) inserts a new section 5(3B) in the 1997 Act. Paragraph (a) will enable the tribunal to make an award in respect of the loss of consortium, including the impairment of sexual relations, suffered by a person who is married to or the partner of an infected person arising from the risk of transmission of HIV or hepatitis C. Paragraph (b) allows certain dependants of persons with HIV or hepatitis C, that is children, spouses or parents, to make a claim in respect of the loss of society of the deceased including loss of care, companionship and affection. The new subsection (3C) defines “spouse” for the purposes of subsections (3A) and (3B).

The new subsection (3D) provides that in considering a HIV claim, the tribunal may consider any previous payment made under the 1991 settlement. Section 5(c) provides that an award arising from the infection of a person with HIV will not serve to revive claims discharged or waived under the 1991 settlement and is also without prejudice to indemnity given under that settlement. Sections 5(d) and 5(e) are minor technical provisions.

Sections 5(f) and 5(g) provide for the extension of certain time limits. The latter provides that a person making a claim may decide whether to seek a single lump sum award or a provisional award up to the conclusion of the hearing, rather than at the commencement of the hearing as is currently the case. Paragraph (g) enables the Minister to extend by regulation the period of one month within which awards by the tribunal to minors must be submitted to the High Court for approval. Provision is made for extension of the time available to a claimant who is a minor to decide whether to accept an award. It has been argued that the special circumstances applying in respect of awards to minors mean that the period of one month may be too short. This Bill will enable the Minister to extend the relevant period.

Section 6 amends section 9 of the 1997 Act, which enables the Minister by regulation to extend the class or classes of persons who may bring a claim for compensation to the tribunal. The existing provision was used some years ago to allow certain relatives of hepatitis C-infected persons who had become infected to apply for compensation. The main effect of the new pro vision will be to enable the Minister to make similar regulations for persons infected with HIV.

Section 7 amends section 10 of the 1997 Act, which provides for the establishment of a special account to fund awards made by the tribunal. Regulations were made in 1998 to enable funds from the special account to be used to pay awards made by the High Court on appeal from the tribunal. The provisions of those regulations are being enshrined in primary legislation.

Section 8 provides for amendments to section 11 of the 1997 Act, which established a reparation fund from which an additional amount equivalent to 20% of the tribunal's award is paid to persons in lieu of aggravated or exemplary damages. The 1998 regulations were used to enable payments from the reparation fund to be made in a case of awards by the High Court on appeal from the tribunal and the provisions of paragraph (a) will consolidate that in primary legislation. Paragraph (b) is designed to remove any possible ambiguity relating to the interaction of sections 5(7) and 11 of the 1997 Act. It makes clear that a claimant who has received a provisional award and returns to the tribunal for further compensation under section 5(7) will be entitled to have a 20% top up payment from the reparation fund. This will also apply in the case of awards from the High Court on appeal under section 5(7).

Section 9 provides that if difficulties arise during the first 12 months of this Bill's operation, the Minister may introduce regulations introducing measures which appear to be necessary or expedient. In normal circumstances one would hesitate at including such a provision in legislation, but a similar provision in the 1997 Act proved its worth. It is desirable that such a facility should be available in the event of difficulties during the first 12 months of the operation of the new legislation.

Section 10 provides that nothing in this Act or in section 5(10)(a) of the 1997 Act shall prevent a person from instituting or continuing proceedings for damages by a party other than the State and the other parties to the 1991 settlement. This will ensure that there is no interference with ongoing litigation between certain haemophiliacs and certain pharmaceutical companies.

Section 11 contains the usual provisions in relation to Short Title, collective citation, construction and commencement. The Act will come into operation on such day or days as the Minister may fix by order. It is the intention that the Act will come into operation at a very early date and as soon as the Bill is passed, the Department will make contact with the compensation tribunal to agree a timescale for the commencement of the legislation.

It was both the Government's and the society's priority that a Bill would be brought before the House this week. This objective has been achieved as a result of considerable and exhaustive efforts by staff in the Department and the Attorney General's office. I record the Minister's appreciation of the substantial efforts of all of those involved. I acknowledge the co-operation of the House in facilitating the discussion and in ensuring the Bill has a speedy passage.

I have been asked by the Minister to put on the record of the House an extract from the statement which was made on his behalf at the Lindsay tribunal:

The Minister and the Department very much regret the pain and suffering caused to all of those who have been infected by blood and blood products and acknowledge that the impact on the haemophilia community has been particularly devastating. The toll in human lives has been great and the loss of so many children is a tragedy of immense proportions. That such an immense tragedy should befall citizens of this State whilst availing themselves of State health services is a matter of profound regret.

I commend the Bill to the House.

I welcome the Minister of State to the House and thank her for taking us through the different provisions of the Bill. As she said, it is complex legislation and it is therefore unfortunate that there is no explanatory memorandum with it. This makes it difficult for Members and I am at a further disadvantage because I am not my party's spokesman on health.

When I was requested to speak on the Bill, I was mindful of a motion I moved in the House in February 1989, which stated:

That Seanad Éireann calls on the Minister for Health to recognise the special problems of the haemophiliacs infected with AIDS and HIV positive through transfusions of contaminated blood, and to set up a trust fund to help meet the basic needs of themselves and their families.

At that time, I had come into contact with the Irish Haemophilia Society and, through it, I met many of the 106 haemophiliacs who had been infected with HIV. Regrettably, six had died at that time. Their deaths were as a result of transfusions of blood clotting concentrates which, unfortunately, were contaminated. The meetings we attended were heart-rending because, at each one, we were informed of another death. I understand that, of the original 106, 64 have died. The Minister of State said that rarely has a Bill come before the Houses of the Oireachtas which had its origins in circumstances which resulted in so much grief, suffering and loss of loved ones, such as fathers, husbands, brothers and sons. It is a tragedy of immense proportions within the haemophilia community.

There was another dimension to this terrible tragedy. As a result of their infection, it was impossible for these people with haemophilia to obtain endowment or life insurance to protect their families and homes. Each of them who had developed HIV knew his lifespan was shortened. Some faced certain death. At the same time, they could not make adequate provision for their families. This must have been a horrifying experience. It is no harm to remind the House that, in Christmas 1988, one man made an appeal to the media and an anonymous generous person responded with a gift of £25,000 to meet the needs of that family. The man said he could die happy because he knew his wife and family were being looked after.

Unfortunately, my motion was defeated and, in a similar motion in the other House, the Government was defeated. This resulted in the general election of 1989. In 1991, the Government made a settlement which contained fixed payments ranging from €25,000 to €127,000. A stipulation of this settlement was that all infected haemophiliacs had to sign up to it, thereby waiving their right to appeal to the courts. Initially it was thought that all infected blood products had been imported from abroad, but evidence has since emerged that the Blood Transfusion Service Board, as it was known then, was at least partially to blame for what happened. BTSB products have been directly linked with eight causes of HIV infection.

In 1999, the Government decided that the 1991 settlement was unfair and proposed a fairer and more equitable means of compensation for HIV-infected haemophiliacs similar to the way people infected with hepatitis C were compensated. The measure before the House is a major departure from previous compensation schemes because it will allow dependants of haemophiliacs who have died to claim damages for pain and suffering to which the deceased would have been entitled had he or she been able to make a claim before the tribunal.

I am happy to support the principal terms of this agreement as outlined by the Minister of State, namely, that people infected with HIV from the administration of blood products within the State will have access to the compensation tribunal and that dependants will be entitled to claim under a number of different headings. These include that dependants, such as spouses or children, may claim for the loss of care, companionship and affection of the deceased. A spouse or partner may also claim for the loss of a loving, physical relationship arising from the risk of transmitting HIV. As the Minister of State said, while financial compensation cannot make up for the loss of life or health, it goes some way to help alleviate the pain and suffering caused to those who have been infected by these blood products.

I intended to ask the Minister of State the position of hepatitis C victims following the administration of the anti-D product, whether their claims were covered by the Bill and if their dependants could claim. The Minister of State answered that when she told me that, yesterday in the other House, amendments were passed to ensure parity of treatment of people with hepatitis C or HIV. These were made following representations to the Minister from Positive Action and Transfusion Positive. I am glad to hear that.

It is only right and proper because of the significant wrong done to HIV-infected haemophiliacs that the State, after almost 17 years, should provide compensation in the Bill. I have no doubt that this has been due to the continuing efforts of the Irish Haemophilia Society under the tenacious leadership of Mr. Brian O'Mahony. On this occasion, he had the ear of a sympathetic and understanding Minister. For that, I am thankful. I have no difficulty in giving this important measure speedy passage through the House.

Bille an-tábhachtach é seo agus aontaíom go h-iomlán leis na téarmaí a bhaineann leis. This is an important Bill. It is important and correct that I begin as the Minister of State concluded by reading the statement from the Minister. He said he regretted:

the pain and suffering caused to all of those who have been infected by blood and blood products and [acknowledged] that the impact on the haemophilia community has been particularly devastating. The toll in human lives has been great and the loss of so many children is a tragedy of immense proportions. That such an immense tragedy should befall citizens of this State whilst availing themselves of State health services is a matter of profound regret.

There can be no doubt about this. When members of society submit themselves to health care and receive a product, by way of intravenous infusion, which seriously threatens or curtails their lives, great grief and hardship are caused to their loved ones. If the tears of those affected by this terrible scourge were ink, they would fill all the volumes ever produced by this and the other Chamber.

It is never too late to do the right thing. I strongly agree with Senator Doyle's closing remarks that the Irish Haemophilia Society had the ear of a sympathetic Minister. It is important that, even after a lapse of many years, this measure is taken and due recognition given to the pain and suffering of those who are left and must cope on a daily basis with their grief at the loss of their loved ones.

The Minister of State outlined clearly and coherently the Bill's terms and I will not repeat what she said, although we should look again at the background, particularly the 1991 settlement. If we do not know from where we came, we will not know where we are going.

In 1989 HIV-infected haemophiliacs initiated litigation against, inter alia, the State in respect of their HIV-infection. In 1991 a settlement was reached between the Government and haemophiliacs whereby €10.2 million, or £8 million, was made available for distribution among those infected or the dependants of those who had died. The amount was distributed on a basis calculated by the society with the amounts paid to individuals varying from £21,000 for the next of kin of those who had died without dependants to £101,000 for those living HIV-infected haemophiliacs who were married with children.

In 1999, during discussions between the Department of Health and Children and the society about the terms of the Lindsay tribunal of inquiry, the society raised the question of additional compensation for haemophiliacs infected with HIV. It considered the 1991 settlement inadequate, which it was. The amounts paid out did not provide compensation in line with that available under the statutory compensation scheme introduced to compensate those infected with hepatitis C. On 22 September 1999 the Government agreed that it would be fair and equitable to compensate HIV-infected haemophiliacs and the dependants of those who were deceased in a similar manner to those infected with hepatitis C. It was agreed to bring forward proposals following detailed discussions with the society.

During those discussions it was accepted by all the relevant parties that the circumstances involved were unique and that the development of compensation proposals would be extremely complex. The fact that there was a full and final settlement for HIV-infected haemophiliacs in 1991 was one of the complicating factors, which is something of an understatement. Apart from the legal complexities, preparation of proposals was also delayed because the society and the Department were heavily involved with the Lindsay tribunal.

Last week the Minister reached an agreement with the society that resolved the issue of additional compensation arising from HIV infection. The terms of this agreement are reflected in the Bill, which was passed by the Dáil yesterday. Apart from allowing access to the compensation tribunal for all HIV-infected haemophiliacs and their dependants, it also allows for a novel approach towards the compensation of dependants of those who died and allows the spouses of living HIV-infected persons to make claims for loss of consortium.

While the Bill is primarily aimed at resolving the issue of HIV compensation, the benefits will extend to persons infected with hepatitis C and their dependants, which is not only central to the Bill but extremely important. Many amendments were agreed in the other House yesterday to ensure parity of treatment of those suffering from hepatitis C and HIV, which were made following representations to the Minister by Positive Action and Transfusion Positive.

What can be said now that has not been said already? It has all been said and all that is left is to pass the Bill. As I stated, it is never too late to do the right thing. The Minister has acknowledged the pain, suffering and loss of life inflicted on people who submitted themselves in good faith to the care of the health service and received a product that was seriously infected. I commend the Bill to the House.

I welcome the Minister of State to the House and her clear speech which explained everything that we need to know about the Bill which is important legislation. It was useful also that Senator Doyle explained the episode in 1989, when he attempted unsuccessfully to achieve the establishment of a compensation scheme. It is welcome that we have now come to this juncture. I know that a great deal of hard work has gone into the Bill and compliment the Irish Haemophilia Society on its efforts on behalf of its members and the families of deceased members.

Speaking on behalf of my own profession, while this has been a dreadful episode for the patients, it has been shocking for the doctors and members of the nursing and paramedical professions involved. Nothing is worse than being involved in the production of iatrogenic disease. The first principle of our profession is to do no harm. Therefore, to find that the treatment one provided caused such dreadful harm and death is terrible. A great toll was taken on members of the medical profession involved. They echo what the Minister for Health and Children said at the Lindsay tribunal, which I am glad was read into the record of the House, about the regret at the pain and suffering caused to so many by the administration of infected blood and blood products.

When I was doing medicine, I do not remember seeing a person with haemophilia who survived beyond 15 years of age as it is a very serious disease. The advances made in the 1970s were tremendous. We were proud that so many people with haemophilia were surviving longer. Therefore, it was devastating to have this happen in the 1980s and 1990s. At that time blood banks internationally were being encouraged to try to be self-sufficient. This put a great strain on our blood bank as it was inadequately staffed and funded. Most of the infections, as Senator Doyle pointed out, resulted from imported products, on which there is still a reliance.

It is important to learn from this episode and look to the future. At that time HIV and hepatitis C were presenting problems, not just in this country, but worldwide. Unfortunately, one cannot find out about something until it has occurred. This must never be allowed to happen again, but it will take the greatest vigilance and co-operation on an international scale to ensure this is the case. People have come to expect the best international standards to be implemented consistently here. We must be sure, therefore, that the framework is in place for this to happen. One of the most important lessons we must learn from this episode is there is a need for good co-operation between clinicians and those who work behind the scenes in the preparation of blood products or in any laboratory setting on the evaluation of tests, without which we will run into serious problems.

Senator Doyle referred to anti-D. Two general practitioners, Dr. Garret May and Dr. Peter Connolly, contacted the Rotunda Hospital to inquire if anything could be the matter because they had patients contracting jaundice. At the time the hospital requested the Blood Transfusion Service Board to look into the matter, but obviously the connection was not properly made.

It is hugely important to ensure there is sufficient co-operation between those involved in clinical practice and those working within laboratories. Those working in laboratories can only test for what they know about. This requires them to have all the information possible about the patients in their care. It is essential that this point be stressed. An accreditation system should be put in place for laboratories to ensure they meet required standards. Those working within them must get the necessary support to ensure this happens.

Every crisis leads to promises of financial support. Huge sums have been invested in upgrading the Blood Transfusion Service Board and increasing the number of staff. Previously it was totally inadequate. This sometimes led to a person being in control where he or she was rarely, if ever, questioned about his or her judgments. It is important that there is a proper level of staffing in order that they can query each other about the decisions they make, that they have the necessary clinical competence and that there is regular upgrading of their skills. Progress is being made in these areas, not by the day, but by the hour. It is essential that we ensure we are at the forefront of developments.

While we have a very good body of medical scientists, there are too few of them. Not only does this impinge on places like the Blood Transfusion Service Board, it also creates a problem in regard to cervical screening as we do not have the necessary cytologists to look at slides. BreastCheck has been unable to expand around the country, not due to meanness on the part of the Department of Health and Children, but because we do not have sufficient radiographers. We have to look ahead constantly in regard to training to ensure we have an adequate number of personnel to do what is expected in the health service.

The Academy of Medical Laboratory Sciences was founded 23 years ago and has been instrumental in pushing for the upskilling of those involved in medical laboratories. Since 1992 all graduates in biomedical sciences hold a qualification at honours degree level. More recently, masters programmes in molecular pathology have been introduced. Many of these graduates are working to doctorate level. These developments are to be very much welcomed because, to avoid another episode such as the one we are discussing today, we have to have people in the background who can do the work.

It is very important that we try to bring forward the legislation dealing with the statutory regulation of these professions. The Minister of State came to the House and promised it for the autumn. Senator Hayes and I said we were more enthusiastic about the promised Bills than the one before us that day. It is very important that statutory regulation is provided for in order that we will be assured that those working in the health service are of the highest professional competence. The academy has had a voluntary professional enhancement programme in place for several years. What is now required is a commitment from the Government to provide adequate funding for the further development and maintenance of such programmes. It is most important that participation in such activities is funded under adequate training programmes.

A further point in regard to adequate staffing brings to mind an incident which occurred during the Finlay tribunal where a lady who gave evidence was described as the chief biochemist. Her title fascinated me as there was no other biochemist employed. One simply cannot run proper institutes unless there is adequate staffing. It is worthwhile remembering that we are competing on the international stage because the training provided here is reckoned to be good. If we do not have good career structures in place, graduates will be snatched by other health services and we will find ourselves in short supply despite having trained them.

Although HIV and hepatitis C are a universal problem, in this part of the world they have become serious, but manageable chronic conditions. I would not like to be a patient who has haemophilia with one or both of these conditions. It is a very sad situation because the side effects of the treatment are hard to bear. I am glad that the Minister of State spoke so much about the need to compensate those to whom the disease was transmitted sexually. No counselling was provided at the time, even though we did know that the disease was transmitted sexually. It is most unfortunate that there appears to have been a reticence in regard to telling people about this or in giving them the results of their tests fast enough in order that they would know it was essential for them to take precautions if involved in a sexual relationship.

I read a horrific newspaper story about one member of the Irish Haemophilia Society bringing condoms to the car park of St. James's Hospital to distribute them to those who came to clinics from parts of the country where it was impossible to get them. In view of the increased incidence of sexually transmitted diseases it might be worthwhile to try and bring forward a national sexual health strategy. Those working in the sexually transmitted diseases department of St. James's Hospital have suggested that this would be a good idea. The Southern Health Board is the only one I know of which has tried to do something in this area. We are very reticent about discussing the fact that we have a problem in regard to sexually transmitted diseases. This might be an opportune time to do something about it.

While the matter we are discussing is regrettable, the Government has done everything it possibly can to try to ameliorate the situation for those infected who are still alive. I am very glad the legislation has been extended to cover those infected by either anti-D or other blood products. While welcoming the Bill, the most important point is that we learn from this terrible episode and try to ensure nothing like it ever happens again. There must be greater encouragement of co-operation and communication between clinicians and those working within laboratories and more training, particularly in the medical laboratory sciences. One cannot do testing if there is insufficient personnel to carry out tests. That is simply de facto. We should ensure that there is proper funding and a proper career structure for those working in this area. I welcome the Bill.

I welcome the Minister of State to the House. The contribution of the previous speaker was very challenging and a sharp reminder to us all that a good deal of vigilance is needed and that greater provision needs to be made to ensure, as far as is practicable, that this kind of thing does not happen in another area. As that is not a matter in which I have expertise, I will confine my few remarks to the political dimension of the Bill.

This is a good day for politics. In the formulation of this Bill and in the manner in which he approached this issue, the Minister for Health and Children, Deputy Martin, has redeemed politics from many shames of the last 17 or 18 years. He has put in place a model of best practice for dealing with an issue of this nature if it ever arises again, which I hope to God it will not. I am sorry the Minister is not here, but I know the Minister of State, Deputy Hanafin, will tell him that we, as politicians, can hold our heads up today. In saying that I speak for every right-minded person in this House. We can say that at long last and after much pain, agony and hardship a grievous wrong has been put partially to right. It will never be put fully to right as it is not within our power to make up in a comprehensive way for the damage done to people as a result of the HIV scandal.

I remember, though I was a Member of the Dáil at the time, that a Bill on the matter was introduced in this House by Senator Doyle and even at this distance I commend him for that response. I was in the Lower House the night the Government was defeated on the HIV issue. The then leader, Mr. Haughey, was just back from Japan and when the matter was brought to his notice he tut-tutted it and held a general election.

That was a black day, but I remember a worse one. I remember the day that another Michael – this being a tale of two Michaels – the then Minister for Health, Deputy Noonan, stood up in the Dáil and made a speech during which members of Positive Action in the Gallery walked out, led by that brave woman, Jane O'Brien. That was the speech that hounded Mrs. McCole through the courts and to her grave. However, today is a better and brighter day. It is one of my last days in the Oireachtas and I am glad to be here to witness it. The Minister has redeemed politics through this Bill and I commend him for that.

The legislation is complex, as the Minister of State has said, and I do not propose to go into the different elements of it. It came about very quickly and, though there is some dissatisfaction at the fact that there has not been more time to study its provisions, I take it on trust that it is a good Bill. It has the full support of Positive Action and Transfusion Positive and the full and enthusiastic support of the Irish Haemophilia Society. If it is good enough for them, it is good enough for me.

I warmly commend the grit and the courage of people like Brian O'Mahony and Jane O'Brien who kept the battle alive and continued the effort. They kept going, even in the days when the obstacles seemed insurmountable, until they brought us to where we are today. When we look back at the last century, people like them will be seen as the real heroes. They had conviction and courage. When they met the right Minister, a man who had a human understanding of the dimensions of the pain, agony and suffering, who empathised and was not guided totally by the legal eagles, it came right. I am very pleased to be here to talk about that.

I knew some of the families. I knew the Healy family in Cork and I know the agony and frustration they underwent when their fine son, full of youth and promise, was mown down by HIV. Pain is tough, but if on top of pain and loss you have a sense of grievance against the State that you believe is there to protect you, it adds to that pain to make it almost unbearable. That was there in large measure and I hope it will abate as a result of the provisions of the tribunal. I hope people will genuinely feel that there is justice and fair play and that they can put their sense of legitimate grievance behind them.

We politicians are all of one mind on this. There was consensus in the Dáil yesterday that this was the right and decent thing to do, though not before time. I hope we can all feel that whatever else anyone says about politicians, in this respect the honourable and decent thing has happened. I am very proud of the Minister for Health and Children for the way he handled this, among many other issues.

The points raised by Senator Henry worry me greatly. The layman is of the belief that if you have an ailment and put yourself in the hands of professionals, good will be done and that unless the man above, who has the ultimate say in everything, dictates otherwise, there will be people around equipped, trained and dedicated to providing a caring environment. The belief is that there will be no shortfall in the provision of care. Listening to Senator Henry I got an insight into the fact that there are a number of key shortfalls that need to be addressed and we should be very grateful that she brought them to our notice.

If something like the matter we are dealing with in this Bill were to happen again and we had missed the opportunity arising from this bitter experience to examine our system, to ensure there is no dysfunction, or lack of provision or communication, it would be very regrettable. We should ensure that our health service is as described, a health giving service. Senator Henry spoke about the pain and defeat felt by a number of doctors, which is such a diminishing thing.

To return to the hepatitis C sufferers who are involved in this tribunal, it was appalling that those who were poisoned by the system were women whose only activity was to bear children, the most natural function in the world. We have lived through bad times relating to Northern Ireland in the last 30 years and we have had tough times, but my worst experience during my time in Leinster House was talking to the women of Positive Action and listening to the stories of women who were ripe with life and life-perpetuating activities and were mown down by the administration of anti-D. That was a black day, and it must never be allowed to happen again.

I would like to pay tribute to Dr. Joan Power of the blood transfusion service in Cork. She was one of the first people with the insight, intelligence and instinct to detect that something was wrong. She will be forgotten of course, as Jane O'Brien will be forgotten, but at least I have placed their names on the record. She is another of the heroes who made an early detection when others did not seem able to make the connection between the disease and the product. I would like to put on record our appreciation of her intervention at that time. She at least led people on the right track.

The Bill is a complex one, but the Minister presented it with clarity and coherence, for which I thank her. We can have confidence that this Bill will achieve the intended outcome and will in some way alleviate the pain and suffering that was very wrongly inflicted upon innocent people.

Finally, I wish to discuss the need for proper sexual education and the issue of HIV. The whole continent of Africa stands to be wiped out unless we do something to deal with HIV. It is a horrendous prospect. This country has the best educated generation of people since the foundation of the State, and indeed going back much further than that, and it is remarkable that this critical element of proper sexual education is so absent and that young people, through ignorance, carelessness, negligence or a combination of all three, should become victims of HIV. It is a very serious issue on which we have to come out very strongly. We cannot afford pussy-footing. We have a duty of care to young people to give them the type of education that would prevent sexually transmitted disease. It is to the credit of people who go out to car parks and distribute condoms, but it should not come to that. Proper personal care and health should be a matter of individual responsibility, and that needs to incorporated into our education system.

I warmly congratulate the Minister for Health and Children, Deputy Martin, in his absence. I hope those who will benefit from this tribunal will take some comfort and consolation and hopefully enjoy better health as a result of the implementation of this Bill. I thank the Minister of State for being with us today.

I have but a few brief remarks to make on this Bill because most of its principal elements have been well articulated by the Minister of State and by other speakers in this debate. However, having taken an interest in this matter since it first entered the public arena, I think it appropriate to say a few words.

I congratulate the Minister, Deputy Martin, on having taken the opportunity to amend the Bill after consultation with the principal aggrieved parties in such a way that there is at last equity in this area. It seems to me that those groups particularly involved are now satisfied with the Bill, which is good. It is tragic that anybody should be infected in this way, and there is no doubt the State has to accept a degree of culpability. It is particularly tragic when citizens of a State attend clinics for medical treatment and become infected as a result of the treatment they received.

One has to remember that in the early days of this tragedy, we were not as fully aware of the situation regarding infection with HIV, for example. We have a tendency to look back with the knowledge we now have. I say that because a number of reputations have been severely damaged in the medical field, and that is tragic for them also. On some occasions they were guilty because of attitudes that were apparently harsh or uncaring, difficulties in communication, insufficient counselling and an apparently arbitrary way of dealing with patients. That is always regrettable because of course there is a very human element to this, particularly when these types of infections affect the sexual intimacy of those involved. I am very glad the Minister addressed this problem and has decided to offer a degree of compensation to spouses who may be affected by the diminution of sexual relations.

It is also very important that all this material came out into the open through tribunals and we knew exactly what the situation was, regrettable though that may be. That has had a further consequence, which is to damage the reputation of the blood transfusion service. That is a very important point because we still must rely on the blood transfusion service and I hope very strong efforts will be made to rehabilitate that image and to ensure the public continues to have confidence in it. We all, at some stage in our lives, may have to depend on the availability of blood supplies, particularly in the rare blood groups.

There has been, in the aftermath of this tragedy, a considerable decline in the numbers attending blood transfusion clinics and in the amount of blood being made available to hospitals. I hope the Government will mount an effective campaign to ensure that blood supplies are maintained. Now that we have cleaned up this mess, I hope we have also reassured the public that this kind of thing will not happen again, the very highest standards will prevail, and that people will be encouraged to continue making donations of blood.

In the light of what Senator Quill said, it is very important that the programme of information education regarding the transmission of HIV is constantly monitored. I have noticed recently a considerable decline in the promotion of this message to young people, and I am very concerned because I think that message may now be falling on partially deaf ears. I believe young people are once again engaging in unsafe sexual practices because the whole horror of HIV has become but a dull echo. I see nothing in advertisements, newspapers or the media altering the citizens of this country to the continuing danger of HIV infection.

When I was involved more directly in this sort of education programme, I was attacked in some newspapers for suggesting this was a broad infection and not just confined to the gay community. Tragically, all the predictions we made at that stage have come true. Probably the major route of transmission is through heterosexual intercourse. We need to alert young people to this fact.

Senator Quill also referred to the fact that when the matter was discussed in the Dáil some years ago, there was a certain level of cynicism on the part of the then governing party. There is no doubt that party politics were played with this issue. There was a feeling that if a comparatively limited amount of money was available to these people, they should be grateful and then go away and shut up about it. That did not happen, and I would like to pay tribute to the courage, determination and persistence of lobby groups who ensured that at the end of the day, their members would receive appropriate compensation – both those infected with HIV and with hepatitis C.

This House was not immune from that cynicism. I recall debates in this House when we attempted to get the provisions of the tribunal extended to include Mrs. McCole and her family. I have developed a certain amount of cynicism listening to the bleeding heart rhetoric on the subject of hepatitis C and compensation and the name of Mrs. McCole being invoked by people who voted against the inclusion of Mrs. McCole in that tribunal. We must be careful not to publicly contradict ourselves in a way that causes scandal and makes people raise questions about the level of integrity which exists and the extent to which politics is being played with people's lives.

I welcome the Bill and the fact that the Minister had the courage and flexibility to meet the requirements of the lobby groups who met with him late in the day and to make the necessary changes at the eleventh hour. Had he not made those changes we would be having a very different debate today. There would have been unseemly rancour which would have caused further distress to people already in a tragic situation.

I do not believe financial compensation on its own meets the requirements of this case. I hope the welfare of the families and individuals involved will continue to be monitored and that they will be given the kind of support they need in terms of counselling, advice and continuing medical intervention. Simply writing a cheque does not resolve the human problem. With advances in treatment, many of these people may very well live longer than anticipated.

I welcome the Bill. It is a good day's work and I congratulate the Ministers involved in its introduction.

Go raibh maith agat. I thank Senators for their contributions on this important Bill. It is useful and interesting to hear Senators of long-standing in this House take us through their recollections of this sad story. Having gone through some very black periods we have reached a stage where we cannot redress all the wrongs, but we can at least, through this legislation, provide some solace and comfort to people by way of financial compensation.

The Bill does not try to suggest that that is sufficient. One cannot take away pain and suffering or bring back those who died. One cannot give adequate recognition to people who have lost loved ones but the partnership approach involved in bringing this legislation forward through the Department, the Minister and the society shows we have, fortunately, moved forward in our thinking on this and in recognising that mistakes were made. I am glad Senators who were part of the original trauma are here today to hear that. I refer in particular to Senator Quill who made many sensitive contributions on this issue.

Senators Henry and Norris rightly recognised the need for significant investment in the Irish Blood Transfusion Service. Many developments are taking place in that area. The points regarding the need for co-operation and communication were very valuable as is the point regarding the need to ensure we put in place procedures which ensure the highest quality standards.

Among the developments taking place are: new state-of-the-art national headquarters off St. James's Hospital; investment in new diagnostic tests to detect viruses more effectively; new PCR testing for hepatitis C is being introduced ahead of many other countries, as is PCR testing for HIV; the appointment of new quality assurance managers; and a new haemovigilance system to collect data on adverse reactions to blood components as early as possible.

Ireland has been to the fore in replacing blood-based products for persons with haemophilia. These products are genetically produced and do not use human blood. There is also significant liaison between the National Centre for Coagulation Diseases at St. James's Hospital, the Irish Haemophilia Society and the Department of Health and Children. A product selection group is currently improving the arrangements for selecting products for new haemophiliacs. This is a good model of partnership between the users, the clinicians, the suppliers and is fully supported by the Irish Haemophilia Society.

A great deal has been learned not just by politicians about how we deal with this issue, but by way of practise in ensuring we can go forward and protect people. I fully accept what has been said about education and awareness. Evidence shows that sexually transmitted diseases are increasing. Obviously, our young people need to be made aware of the dangers in this area.

I hope this Bill can bring an end to at least one chapter of the tragedy which has existed for a number of years and that it will assist in some small way in easing the burden of those who have suffered.

Question put and agreed to.

An Leas-Chathaoirleach

When is it proposed to take Committee Stage?

An Leas-Chathaoirleach

Is that agreed? Agreed.

Agreed to take remaining stages today.