Thursday 29 September 2016

Blood groups III - anti-D scandal

Having laid the scientific groundwork about blood groups and Rhesus incompatibility, we come to a sorry tale of a mistake; partly due to slack practice in the Irish BTSB - Blood Transfusion Service Board; and cover-up that left a number of women dead, and many more suffering from chronic liver failure. BTSB's head quarters, at the corner of Leeson Street and Adelaide Road, was called Pelican House, after the legend that the bird pricked its own breast to feed its chicks with fresh blood. The seeds of death were sown in 1977 when the BTSB accepted, against established protocols, a donation from someone who had jaundice due to an infection by Hepatitis C Virus HCV. By then the BTSB had moved on a long way from acting as a clearing house for whole blood: taking donations in 500ml bags, typing them for ABO and Rhesus+/- and then distributing them to operating theatres across the country. As I explained in an earlier post about haemophilia, the BTSB reduces almost all blood donations to its component parts: serum, platelets, packed red cells and minute quantities of several circulating proteins.
You need quite a jolt of anti-D to be sure that you sweep up all the Rhesus antigen from the fetus, and no one person can supply that amount. So they must isolate the anti-D from many donations, mix 'em up and then aliquot them into lots of doses for injection towards the end of pregnancy. That HCV contaminated donation was thrown into the anti-D processing vat at BTSB and a number of vials of anti-D turned from being a life-saver into a ticking time bomb reproducing in the liver cells of the recipients. Nobody knew that there was a problem because HCV wasn't isolated, named and characterised until 1989. A couple of years later, their British oppos alerted the BTSB to the fact that one of their anti-D vials had probably been contaminated. The BTSB did nothing. Over the next tuthree years, as new donations were routinely screened for HCV, Dr Joan Power, a worker at BTSB in Cork, twigged that too many of the donors who were HCV+ve were Rhesus-ve. You expect only 15% because that's the frequency of Rh-ve in Ireland but almost all of them were Rh-ve and they were also female, had been pregnant and were of an age that they must have been given anti-D. Power wanted to investigate further, so that women outside of her catchment area could get a diagnosis, an explanation and treatment. She was stalled at every turn by comfortable apparatchiks who didn't want any awkwardness to disturb their plans for golf at the weekend.. It wasn't until 21 Feb 1994, that the BTBS were backed into a corner enough to call a press conference which started with "Er Pelican House, we have a problem". None of the journalists, all Arts Block educated, understood what they were being told but they made it their business to find out and Ireland got an emergency education in immunology.

As with any complacent organisation where profits and poroductivity trump ethics, it was the implicit policy of the BTSB, the Health Board and the government to divide and bully their victims into silence. We seen this as the foundation of most of the public interest Tribunals which have hoovered up tax-dollars since the foundation of the state. As an illustration, the first woman to take an anti-D case against the BTSB and the government was a mother and farmer from Donegal called Brigid McCole. Like Joan Power she was stonewalled. Treated by The Man as at best a charity case but more often portrayed as a disruptive and selfish compo-claimant and hardly ever as the innocent victim of a culpably negligent, mismanaged organ of the state. She had been demonstrably sick with hepatitis for ten years but, for two years, she stuck to her guns and finally, finally secured £175,000 compensation in October 1996. She died next day. Her husband topped himself 4 years later. The ongoing publicity helped anti-D/HCV women find each other to found Positive Action, so that they could share information, support each other and collectively force an admission of liability. Some money to help with their health care costs wouldn't go amiss either. The Finlay Tribunal was convened in the same month that Mrs McCole died; it reported 6 months later and cost £4.5 million. The maths indicate that the lawyers invoiced for 25x the amount reluctantly given to Mrs McCole.
Why give money to a farming family from Donegal? They wouldn't know how to spend it.

As a result of the Finlay tribunal, the Health Service Executive shelled out £840 million in compensation to the victims of shoddy practice, error and cover-up. The lawyers, who experienced no adverse consequences, netted £135 million. One firm Malcomson Law founded 1858 is still touting for business. You might think that the BTSB would be especially vigilant about screening donors and their donations. But no, in 1994 as the balloon was going up, they contrived to accept another HCV-contaminated donation and distribute that widely through the population. It beggars belief. Eventually, 30 years after the precipitating donation was accepted, criminal proceedings were taken against Dr Terry Walsh, the Assistant National Director at BTSB. He died before the case came to trial. The Gardai then went after Cecily Cunningham, a BTSB biochemist, recently retired from her position. Her case was struck out in 2007, four years after she was charged and eight years after a file was sent to the DPP. That took a visit to the Supreme Court which castigated the DPP for "inordinate and inexcusable" delay which breached Ms Cunningham's rights to s speedy trial.

Positive Action has not faired well. At least 25 of their members have died from liver-failure, liver cancer and other sequelae of HCV infection. Many of the rest are feeling crook most days and many are taking daily and expensive drugs to ameliorate their symptoms - there is no cure. They were founded in 1994 and received 'blood money' from the tax-payer via the HSE for 20 years. This is separate from the compensation awarded to individual anti-D victims. In March 2014, the HSE closed off the tap that kept on giving because they could not sign off on the accounts as a legitimate way of spending tax-dollars. Between 2009 and 2013, PosAct got through €2.3 million. Could Positive Action justify €15,000 to send four members to a 2012 conference in Boston or a budget of €125,000 for away-days, meetings and events in 2013? They could not, to the satisfaction of the HSE auditors. The press had an unpretty spiteful field day cherry-picking other items under Outgoings on the budget: angel-healing, 'gifts', dog-kennels and dry-cleaning. Their web-site is no longer working. The last hurrah was a criminal prosecution against one of PosAct's directors Bernadette Warnock who, in March this year, plead guilty to 71 counts of cheque-kiting, theft and fraud totalling €115,000.
We live in a grossly unequal society, with a tier of upper management at every organ of the state, who are pulling in €100,000+ salaries for being in charge. They draw the paycheck, buy the Summer house, pay their kids through fancy schools & college while attending meetings and signing dockets. But when their management skills are called upon, it turns out that my 20 y.o unschooled daughters could manage the Board, the Quango, the School or the Department better than them. When there is a crisis, they are immediately out of their depth because their only qualification for the salary is time served and increments gained.
Q. What do you call an Irish manager/director/board-member with no arms and no legs in a sea of trouble?
A. Bob . . . except that a bob would float whereas these goons sink without trace clutching a golden handshake.

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