Friday July 19, 2002...
Eight years on from when the original hepatitis C scandal first became public and after two Tribunals of Inquiry, the Irish Blood Transfusion Service (IBTS) remains in crisis. That in itself is a scandal.
Another Tribunal is not required to show the public that the State's blood service, one of the most critical health systems, is a dysfunctional organisation which can not manage its affairs and does not deserve public confidence. Successive governments, it seems, have been unable or unwilling to take the necessary action to end scandal, controversy and resolve the blood crisis once and for all. Where is it to end?
Last month, the Irish Blood Transfusion Service reached a substantial out-of-court settlement with its Chief Executive, Martin Hynes, a man who was brought in to reform the service in 1998. He officially leaves at the end of October. As revealed by irishhealth.com this week, correspondence from Mr Hynes to the IBTS Medical Director, Dr Willie Murphy written on July 1 alleged hostility and resistance at Board level to the proposed inquiry by the Health Minister - an inquiry that has been backed by the organisations representing 28 blood donors who were not told they were infected for some years and others infected by the original hepatitis C scandal.
The letter by Mr Hynes also claimed that some individuals at Board level did not appreciate that some blood donors were not told in 1993-94 or since that in many cases they had tested positive much earlier than the date of notification.
The inquiry proposed by the Minister and supported by those infected would be headed by a Senior Counsel and backed up by a number of barristers, all of whom would have access to medical experts. It could complete its work within months and report quickly, ending public concern and restoring confidence. The inquiry team would be sent into the IBTS to find the truth.
It would also look at important questions such as whether the original source of hepatitis C infected blood products just involved two individuals known as 'Patients X' and 'Donor Y'. There is good reason to believe now that as many as 12 other women who were undergoing a treatment called plasmapheresis may have had their blood used by the Blood Bank to make products which were contaminated. A group of Guinness workers were also used to make blood products and many questions remain there.
In relation to the 28 blood donors (all from the Munster region served by the Cork Blood Service) who were infected but not told at the time, all but one has been kept in the dark about the facts relating to their case. If they had been told in time, they could have secured earlier treatment and protected their partners from possible infection.
Since February of this year, a steering group has been in place comprising representatives of Positive Action, Transfusion Positive, the Department of Health and the Blood Bank to devise the terms of reference for the inquiry. The Blood Bank representative, its National Medical Director, Dr Willie Murphy was there with the backing of the IBTS Board - or so people thought. Last night, after a marathon Board meeting, the Blood Bank effectively rejected the proposed inquiry backed by victims and instead called for a Judicial Inquiry. The Board statement supported the 'objectives' of the terms of reference. This was a spanner in the works and has been met with shock and dismay by some of those infected. Remarkably, the decision was also made by the Board while its own Medical Director, Dr Willie Murphy, who had negotiated with victims, was on summer holidays.
In what was clearly a tactical move, the Blood Bank proposed a Judicial Inquiry - against the wishes of those infected who have backed a swifter, more efficient and less costly inquiry headed by a Senior Counsel. It has set the Health Minister and the support groups on a collision course with the Blood Bank. Who will win - will the victims of infection loose again? The Blood Bank argues that a Judicial Inquiry would be more transparent and fully independent. On the face of it, it seems odd that the victims want something different to a Tribunal. But the history of the blood scandal explains why.
There are good reasons why the IBTS would prefer a Judicial Inquiry. Firstly, it remains unclear whether the IBTS is suggesting a Tribunal of Inquiry in public or something quite different in private along the lines of the inquiry into the Dublin & Monaghan Bombings. Both options pose difficulties. A Tribunal would take years to report, privileged documents would not have to be released and it would be open to a series of legal challenges. At the recent Lindsay Tribunal, dozens of files were not handed over by the Blood Bank as it claimed legal privilege over them. A Judicial Inquiry would not have the powers of a Tribunal - the ability to compel witnesses to appear and the production of documents. At best, the IBTS move delays everything and raises a questionmark about how the truth is to be arrived at once and for all.
Victims of infection viewed the idea of yet another Tribunal as a final option, if the original independent inquiry proposed by the Minister failed to secure proper disclosure.
In any event, it seems remarkable that a third Tribunal would be needed to answer questions that should have been answered long before. We should also learn from history - the two blood Tribunals already held have not resulted in a Blood Bank that people can have full confidence in, so why should a third Tribunal achieve this? The problem with donors not being told in time that they were infected was originally highlighted in the 1997 Finlay Blood Tribunal report, so why did the IBTS fail to act after that ruling and wait until now, when it faced a lawsuit, to start informing the 28 donors? The Finlay Report also raised wider questions never answered - about whether there were much wider sources of infection and whether batches of blood products which the IBTS insisted were negative to infection were in fact infected.
The Health Minister, Micheal Martin now faces some stark choices. Is he to allow the body which is to be investigated - the Irish Blood Transfusion Service - to dictate the terms of reference and the nature of an inquiry into itself? This is the same organisation that has failed to reform itself and as each week goes by, lurches from crisis to crisis. It is an organisation that has seen the departure of two CEOs in recent years while some of those central to the original controversy remain. It is also an organisation that has put its own Medical Director in a very difficult position.
In a letter to Health Minister, Micheal Martin two years ago, the former chairperson of the IBTS, Dr Patricia Barker (who also quit the IBTS last year) recommended sweeping changes to the IBTS structure. Significantly, she also said that after the original 1994 scandal, clear blue water should have been put between the old Blood Bank and the new. That was never done. During the time of the original blood scandal, the current Tanaiste Mary Harney suggested in a radio interview on RTE's Morning Ireland that the IBTS should be shut down - while heavily criticised at the time (the Rainbow Coalition was in power) it now looks like a most valuable contribution.
Micheal Martin can demand that the inquiry he has proposed, and one that is backed by those infected, go ahead. If the IBTS Board resists he has the power to sack the Board and proceed. If the inquiry fails then there is the option of a full Tribunal of Inquiry.
He could opt now for a Judicial Inquiry but should ask himself this question - why has the Blood Bank only now raised this option? Why did its representative help draft terms of reference for a totally different inquiry, alongside the victims of infection, only to have this effectively thrown out last night by the Board? Are the claims by the former CEO about resistance to a proper inquiry true and why did the IBTS not defend its original decision to suspend Martin Hynes in open court? The remarks by Mr Justice Thomas Smyth after the out-of-court settlement was announced between Mr Hynes and the IBTS were telling. Having privately read the legal papers in the case he said that 'being efficacious of concealment did not find an echo from the public, the broken lives in the background were more important'.
The worst possible outcome would be for blood donation levels to fall below the critical level, placing lives at risk, due to a complete collapse in confidence. Recipients of blood must also be anxious with so many questions still not answered.
Too many lives have already been lost and others devastated by the failure of the Irish Blood Service. It is a scandal that first became public in 1994 and here we are in July 2002 still without full closure. It's time to call a halt to this sorry mess.
* Fergal Bowers is the editor of irishhealth.com
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