How did this woman get hepatitis C?

Catherine Shanahan tells the story of a 76-year-old woman who went to hospital for an operation. Now she has hep C.

EILEEN KELLY went into hospital in August 2004 for a fairly innocuous operation on her foot. She was, according to her son Dennis, a relatively healthy woman, who, despite having rheumatoid arthritis, was well able to get out and about and enjoy life.

The previous July she was hearty enough to travel to New Jersey under her own steam to visit her sister.

A year-and-a-half later, she is a shadow of her former self; fatigued, short of breath and sickly.

The 76-year-old from Killarney has had to contend with the potentially fatal MRSA superbug and has been diagnosed with hepatitis C. Her life now oscillates between GP visits, hospital stays and being largely confined, because of her illness, within the walls of her own home. Dennis Kelly wants answers.

“My mother went into St Mary’s Orthopaedic Hospital in Cork on August 2 for a corrective procedure on a bone which had grown crooked in her foot. Part of the procedure required a cast being put on her foot and leg. She was in pain while the cast was on but she was of a generation that offers things up.”

In a letter to the infection control team at St Mary’s Hospital on December 13, 2004, Dennis’s wife, Mary Kelly writes: “When the cast was removed, Mrs Kelly suffered a pressure sore on the back of her foot. Some weeks later and [with] the pressure sore now measuring approximately two inches by one-and-a-half, and three-quarters of an inch deep, Mrs Kelly was informed that she had the MRSA bug in the wound and that it would be better if she moved into an isolation ward.”

According to the Kellys, the room Ms Kelly was moved into was appalling.

“It was filthy. There was vomit on the walls. The floor was filthy. My wife offered to clean it but the nurse said if she (the nurse) picked up a vacuum cleaner, there would be a strike,” Dennis says.

In a reply to the Kellys’ letter of complaint on December 13, the hospital manager at St Mary’s wrote on January 7, 2005: “I can find no confirmation that there was dried vomit on the wall. However, I am aware that there was an ongoing problem with roof leaks in that block which led to discolouration of the walls in certain places. I also know that the block in general was in need of refurbishment.”

The hospital manager apologised “that the conditions were sub-optimal when Mrs Kelly was a patient”.

Dennis says his mother was eventually discharged from St Mary’s in November 2004, 11 weeks after being admitted for a straightforward procedure, “in a very weakened condition”. The infection in her foot required a painful skin graft.

“To this day she cannot wear normal shoes, but has to wear an open sandal, regardless of the cold, as a result of the skin graft,” Dennis says.

To add to her woes, while in hospital, Ms Kelly had to have a blood transfusion. This took place on September 2, 2004, according to a letter from Dr Joan Power, regional director of the Irish Blood Transfusion Service (IBTS) to Dennis on December 13, 2005. In the letter Dr Power states: “on the 02/09/2004 we issued two units of red cell preparations cross-matched for Ms Eileen Kelly.” Dennis says his mother was not happy about being transfused with someone else’s blood.

Following discharge from hospital, his mother’s health did not improve, and by February 2005, she was back in hospital, this time in Kerry General, where she remained for approximately three weeks.

“She was very weak, her breathing was poor. They gave her two more blood transfusions,” Dennis says. According to Dr Power’s letter of December 13, these took place on February 18 and February 19, 2005.

The three blood transfusions his mother received are at the core of Dennis’s concerns for his mother. She subsequently tested positive for hepatitis C, a virus carried in the blood, primarily spread through contact with infected blood, and which can eventually cause liver failure. A chronic carrier state occurs in some individuals and may result in life-threatening liver damage, cirrhosis, and/or liver cancer. There is no standard treatment or vaccine.

MS KELLY’S hep C status was discovered while attending the outpatients’ clinic of Kerry General in the summer of 2005, around four months after the final blood transfusion.

Dennis says his mother was by now suffering from chronic fatigue and breathlessness.

“They ran tests on her checking her liver function and totally unexpectedly they found she had hep C,” he says.

This is confirmed in a letter from Dr Power to Dr Barry Moynihan, Kerry General Hospital, dated August 25, 2005.

The letter reads: “She (Mrs Kelly) presented to out-patients on June 27 with a history of icterus (jaundice), of recent onset, and on further investigation, was found to have abnormal liver function together with an anti-HCV antibody.”

Dennis says his mother’s GP in Killarney was asked by the hospital on July 8 to carry out a second blood test. It confirmed the results of the first.

“On August 9, my mother was in with her GP who told her he had bad news for her - that she had hep C.”

Dennis believes the development of jaundice in June 2005 coupled with the discovery of hep C “indicates a strong suggestion of connection to the previous blood transfusions”.

The IBTS denies this.

It has ruled out any recent transmission of hep C by blood transfusion. A statement from the IBTS said: “All cases referred to us in the recent past have been investigated and transmission through blood transfusion has been ruled out.”

Dennis remains unconvinced. Even reassurance from Dr Power that all five donors whose blood was used in his mother’s transfusions have since retested negative for hep C has not allayed his fears.

He was not happy with the delay in tracing the fifth donor. He met Dr Power on October 26, 2005, and says she was at that stage endeavouring to trace the last outstanding donor. It wasn’t until December 13 that Dr Power was able to confirm this person had been traced and retested. The person in question had been abroad for some time.

Dennis says the IBTS knew since June 2005 that his mother had hep C, yet it took six months for the blood bank to be in a position to confirm to him that the final donor had been traced.

He speculates about how long the trace may have taken if he had not maintained pressure on the IBTS to track down that final donor.

Similarly, Dennis is unhappy with some of the references to his mother contained in Dr Power’s letters. He claims some of the statements she made are factually incorrect. He says this begs the question: was Dr Power confusing his mother with another patient?

In her letter of August 25 to Dr Moynihan she says Dr Moynihan had noted “a possible history of transfusion at CUH (Cork University Hospital) in November 2004”.

Dennis says his mother did not receive a transfusion at CUH in November 2004.

In her letter of December 13, 2005, to Dennis, Dr Power says: “In the circumstances of your mother having worked as a public health nurse, I believe we should rule out any inadvertent exposure to BTSB Anti-D immunoglobin.” (This is a reference to the contaminated blood product given to rhesus negative mothers to protect their rhesus positive babies.)

However, Dennis says his mother never worked as a public health nurse and he does not know how Dr Power came to this understanding. At that stage, he had already written to Dr Power (on November 22) saying his mother had confirmed she had never received Anti-D injections.

Although the IBTS claims to have ruled out any recent transmission of hep C by blood transfusion, it has failed to establish just how Ms Kelly did contract the virus. To this end, investigations are ongoing, as confirmed in Dr Power’s letter to Dennis on December 13 last.

In it, she outlines the IBTS plan to send a sample to the University of Edinburgh “where we will compare your mother’s viral strain to that of hepatitis C associated with BTSB Anti-D immunoglobin”.

Dr Power also writes: “It is alternatively possible that your mother may have been exposed to hepatitis C infection during obstetrical and surgical treatments in the United States.” Ms Kelly lived in the US from 1950-1967, and did receive obstetrical and surgical treatments. It is also recognised that someone with the hep C virus may carry it for years without feeling any ill effects.

None of this is any comfort to Dennis. He points out that while the IBTS denies recent blood transfusions are the cause of his mother’s infection, it has not been able to identify an alternative source. He has not received any communication from the IBTS since Dr Power’s letter of December 13 saying they are investigating a link with blood bank Anti-D immunoglobin.

Questions the Irish Blood Transfusion Service needs to answer:

1: Has the IBTS been able to prove conclusively that Eileen Kelly did not contract hepatitis C as the result of a blood transfusion administered on any of the following dates: on September 2, 2004, February 18, 2005, or February 19, 2005?

2: Is the IBTS continuing to investigate a possible link between Ms Kelly contracting hep C and the transfusions she received on the dates mentioned above?

3: Dennis Kelly, the son of Eileen Kelly, says he was told by Dr Joan Power that the IBTS had listed Mrs Kelly’s case as a possible blood-transmitted infection and would remain listed as such until such time as a link between her hep C infection and the blood transfusions she received was fully discounted. Is Ms Kelly’s case still listed as a possible blood transfusion infection? Was it ever listed as such?

4: What is the nature of the investigation into Ms Kelly’s infection and when is it expected to be completed?

5: Why, when a test showed the presence of hep C on June 27, 2005, was she not informed? Dennis Kelly says she was told by her GP in August 2005.

6: A letter from Dr Joan Power to Dennis Kelly on December 13, 2005, states “in the circumstances of your mother having worked as a public health nurse, I believe we should rule out any inadvertent exposure to BTSB Anti-D immunoglobin”. Mr Kelly says his mother was never a public health nurse. What was the basis for this reference?

7: The same letter of December 13, 2005, states Mrs Kelly’s strain of hep C (HCV type 1b) “is the type associated with BTSB Anti-D immunoglobin contaminated with Hep C.” Mr Kelly says his mother never received Anti-D. How does the IBTS explain this reference?

8: A letter dated August 25, 2005, from Dr Power to Dr Barry Moynihan, Kerry General Hospital, states “you noted a possible history of transfusion at Cork University Hospital in November 2004”. Mr Kelly says his mother did not receive a transfusion at CUH in November 2004. What is the basis for this reference?

9: Given the above references which do not seem to relate to Mrs Kelly, is it possible the IBTS is confusing her with another patient?

10: Is the IBTS investigating whether other patient/s may have been infected by hep C, or any other blood-transmitted infection, during the past two years?