Brendan Howlin never thought to examine his department's role in the blood scandal, writes Fintan O'Toole.
By FINTAN O'TOOLE
IT is hard to imagine a Minister being faced with a more terrible crisis than that which landed on Brendan Howlin's desk in the Department of Health on February 18th, 1994, when his officials first told him about the hepatitis C scandal.
And it is hard to imagine a response more passive and inadequate than that which Mr Howlin outlined in his evidence to the hepatitis C tribunal yesterday.
Between February and November 1994, when Mr Howlin left for the Department of the Environment, he did three things. He sanctioned the screening for the virus of all women who had received anti-D. He set up an expert group to report on the scandal, which had not yet reported to him by the time he left office.
And when the chairmanship of the BTSB became vacant in September, six months after he learned of the scandal, he appointed a new chairman who he hoped would be able to ensure the blood bank's co-operation with the expert group. But in all that time, he left the State's response to the worst public health crisis in its history in the hands of the very people who had caused it.
Before he took the stand yesterday, the evidence to date at the tribunal had thrown up in essence five questions for Brendan Howlin to answer. It is worth recalling those questions and the answers that can now be given in the light of Mr Howlin's evidence.
1. How was it possible for eight women to receive infected anti-D in the five months after Mr Howlin learned of the scandal?
There is no doubt that Brendan Howlin was told on February 18th that the current stock of anti-D was to be withdrawn immediately and replaced with product imported from Canada.
There is no doubt from his evidence that he believed implicitly that this would happen. But neither is there any doubt that he never tried to discover whether the BTSB bad withdrawn the product efficiently.
His evidence was, in fact, that the first he knew of the continuing infection of women was when he read it in a newspaper article after he had left the Department of Health.
He believed - reasonably - that hospitals should have followed the instructions to withdraw the product.
He referred in particular to the "barrage of publicity" about anti-D at the time. But one of the problems was that this publicity, including his own public statements, indicated to no one - hospitals, GPs, victims, the media - that, crucially, there was reason to believe that the current stock of anti-D was actually infected.
Brendan Howlin accepted yesterday that right at the start he was told of a suspicion that anti-D sourced from Donor Y in 1989, and still in use in 1994, might be infected. This was information of the most urgent import, confirmed the following day to the Department though not, according to his evidence, explicitly to Mr Howlin.
Nevertheless, "over the weekend of February 19th and 20th, I became aware that there was a potential further source of infection".
Subsequently, he could not recall precisely when he was told there was definite evidence that the batches made from 1991 onwards, using Donor Y's plasma, were infected with hepatitis C.
Yet at no time did he, his Department, or the BTSB inform victims, doctors or the Dail of this fact. It is significant in this context that at this time all press releases by the BTSB were cleared with the Department of Health and that Mr Howlin's personal adviser, Dr Tim Collins, was "coordinating" the Department's press relations.
In all statements to the public to GPs and to hospitals, the only specific year of infection mentioned was 1977. In its initial press release, on February 21st 1994, the BTSB said: "Some batches of anti-D produced in 1977 are potentially the cause of this problem." On the same day Mr Howlin told the Dail the same thing. On March 4th, he issued another press release, again saying that "present indications are that the problem mainly relates to 1977".
Even more extraordinarily on March 9th Mr Howlin submitted - an aide-memoire on the crisis to the Cabinet, which again failed to mention what the Department knew - that batches issued after 1991 were also infected.
Even though the BTSB had told the Department this, the aide-memoire states: "The Board maintains that, thus far, there is no definite evidence to suggest that women from years other than 1977 have the antibodies through the administration of anti-D."
On June l4th Brendan Howlin met Positive Action, the group representing the victims of the scandal. One of the many concerns put to him in a document that Brendan Howlin told the tribunal he read was that the BTSB had been implying that women who had received anti-D in years other than 1977 may have got the virus from some other source such as sexual promiscuity, intravenous drug use or tattoos.
At this point, Brendan Howlin knew such women had got the virus from post-1991 batches of anti-D, and he could have helped to remove at least this extra burden of stress from them. He did not do so. Asked if he or any of his officials told Positive Action what they knew, he said: "I don't know.
He agreed that he himself had not told them. Rather oddly his reason for keeping them in ignorance was that "the worst thing I could have done was to give them partial information".
2. Why were the people who caused the crisis left to deal with it?
Brendan Howlin's evidence is that from the early days of the crisis he knew some significant facts about the behaviour of the BTSB's chief medical consultant, Dr Terry Walsh.
He knew he had brushed aside an outbreak of hepatitis among anti-D recipients in 1977, and tests in 1991 that proved the anti-D had been infected with hepatitis C. He knew the BTSB under Dr Walsh was continuing to give him inaccurate information, telling him for instance that the replacement product for anti-D had the approval of the National Drugs Advisory Board and the Food and Drugs Administration in the US, when it had neither.
He knew the BTSB and Dr Walsh were refusing to co-operate with the expert group inquiry. He knew Positive Action felt that, for the victims, counselling provided by the BTSB was a cause of anger and stress rather than comfort or support. He knew the victims, the most important people in the saga, had no confidence in the BTSB.
Yet, for the entire period he remained in office, he made no changes in BTSB's management other than the appointment of a chairman when the position became routinely vacant. He deemed Dr Walsh, who was failing to give frank information to his own Department, the person best fitted to give information to victims and their doctors. He believed, he told the tribunal, that "the people with the greatest degree of information could give the greatest degree of consolation".
The wisdom of that decision can be judged from one simple fact: the "look-back" programme to identify potentially infected donors, which the BTSB promised to finish very quickly, had not even begun when Brendan Howlin left office. He was unaware of this,
3. Why did he not set up a public inquiry? There is no doubt that Mr Howlin made a reasoned decision in February 1994 that the best way to investigate the BTSB was through an expert group rather than a tribunal. Before yesterday, the evidence before the tribunal, not least from his personal adviser Dr Collins, was that Mr Howlin had "an open mind" on the subject and was prepared to reconsider a tribunal if the expert group was not working.
But yesterday Mr Howlin denied this, and insisted he never envisaged replacing the expert group with a tribunal, even when he was told the expert group, which had no powers to compel witnesses or documents, was not getting the co-operation of the BTSB. He had, he said, no "fall-back position". If plan A didn't work, in other words, he was going to try plan A.
4. What did he do to help the Victims?
There was a scheme to help the victims with out-of-pocket medical and travel expenses, but it was administered by the victimiser - the BTSB. Mr Howlin agreed he had told Positive Action when it raised concerns about the scheme in September 1994 that women in financial difficulties could contact their community welfare officers.
This was, he told the tribunal, a "suggestion that was made off the top of the head at the time". Asked if he had told his officials to notify the community welfare officers of the Minister's proposal, he replied: "No. I did not."
5. What did he do about his own Department's failure to enforce the law requiring anti-D to be licensed under the Therapeutic Substances Act?
He told the tribunal that "I don't recall becoming specifically aware" of licensing under the Act being a function of his Department. From his evidence, his Department's role in the scandal never seems to have been an issue for the Minister.