THE Blood Transfusion Service Board (BTSB) knew a great deal, at several levels, about the circumstances surrounding the infected anti D product in 1976-1977, Mrs John Rogers, counsel for Positive Action and the McCole family, said.
He said it would be his clients' position that a great deal was known by more than certain named individuals. He had seen no documents that would tend to indicate that responsibility lay only with Dr Terry Walsh, who became chief medical consultant, and Dr John P. O'Riordan, who was his predecessor. "Matters go far beyond that," he said.
A person engaged in transfusion medicine would never normally use a multiple transfused patient as a donor. However, during the last 20 years the BTSB "certainly used two such donors", said Mr Rogers. He added that papers available to him showed that it used no fewer than 14 plasma exchange patients as donors.
"Since 1962 it has been established that the risk of hepatitis in a recipient of blood increases with the number of transfusions," he said.
As early as 1976, he said, it was clear the BTSB was "in breach of a basic precept of transfusion medicine". Mrs Brigid McCole had received batch No. 250 of anti D which had been manufactured on June 20th, 1977, and dispatched in September.
"In September of 1977 the BTSB knew everything that we know now. Notwithstanding that they knew everything, Mrs McCole was infused with that batch. That is how appalling the tragedy is and how far reaching the wrong doing is. The same could be said of many other women who received anti D from batches after mid August to September 1977."
He said their evidence would show the BTSB was aware of at least 10 patients who had been infected by early 1978. He said it knew it was dealing with "something very serious indeed" in August 1977 when it sent samples to a doctor in Middlesex Hospital in London for testing. He asked why it had specifically sent samples from patient X. "The reason that they did so is that they suspected themselves they [the samples] were infected," he said.
There had been a clear opportunity then to shout "stop". Anti D could have been purchased in Britain and the US at that time. Mr Rogers said he suspected that route was not followed because the BTSB knew the reasons would have to be disclosed.
He asked who were all the people down the years who knew "at all times".
On at least three occasions "misleading and false" information was delivered to experts outside the State who were studying the bad reactions to anti D.
"But nothing was said here. Why was that?" Mr Rogers asked. He also questioned why the responsible public authority was not notified that the BTSB was a source of infection.
Mr Rogers said there was a "distinct difference" between the report of the expert group and what Mr James Nugent SC, for the tribunal, revealed in his opening statement.
It was never disclosed to the expert group that patient X had been diagnosed with infective hepatitis in November/ December 1976. It was only discovered in the course of Mrs Brigid McCole's court case this year. It was a cause of serious concern that the code which appeared to be applicable to the licensing of anti D under the 1932 Therapeutic Substances Act was not used until 1984 by the BTSB and the Department of Health. It appeared the National Drugs Advisory Board (NDAB) took no steps to advise them, he added.