Anti-D scandal was a bloody disgrace

It’s been 20 years since the country first heard of the anti-D scandal. Initial alarm has now been joined by anger and grief, and the story isn’t finished yet, writes Caroline O’Doherty

Anti-D scandal was a bloody disgrace

NO need for alarm, Brendan Howlin, the health minister declared, doing his best to sound reassuring about the Hepatitis C scare gripping the mothers of the country.

But the numbers involved were huge — as many as 100,000 women were feared to be at risk. The time period was extensive — the potentially lethal virus could have been lurking inside them for almost 20 years. And the uncertainties were vast — nobody could say how the virus would affect any individual woman, what her prognosis might be, what needs might arise for her, or what the State would do to meet them.

In the circumstances, alarm was a natural response. In the 20 years since, it has been joined by anger, frustration, and grief, and the story isn’t finished yet.

It was on February 21, 1994, that the country was introduced to what would become known as the anti-D scandal. The Blood Transfusion Service Board, as the Irish Blood Transfusion Service was then known, called a press conference and set out a scenario that had journalists running for medical dictionaries.

Anti-D immunoglobulin, a product made from donated blood, was given to new mothers whose own blood type was Rhesus Negative but who gave birth to Rhesus Positive babies.

It was administered to safeguard the health of future babies the woman might have as some of the Rhesus Positive could have passed through the placenta into her bloodstream and she would have developed antibodies to it.

Those antibodies, left in her system, could seriously damage or kill the foetus in a future pregnancy. In the 1960s, around 40 babies a year died in this way so the development of the anti-D treatment was considered a welcome breakthrough and its use became normal practice in maternity hospitals in the 1970s.

In 1991, however, the BTSB was alerted by a British hospital that a batch of anti-D produced in 1977 may be contaminated. It would later emerge the blood donor whose plasma was used to make the anti-D had jaundice and hepatitis but these facts had slipped through a sloppy screening process.

Despite the alert, no alarm was raised and no action was taken to trace the women who received doses from that batch or to ensure the screening slip-ups were not repeated. They were, and in 1992, plasma from another infected donor was used to make anti-D, creating another potentially lethal treatment batch.

Still no action was taken, and no alarm was raised. But within the BTSB, some staff were seeing patterns between donors and disease that they could not keep quiet about.

Dr Joan Power, then working for the BTSB’s Cork centre, linked contaminated anti-D to a number of female donors with Hepatitis C, an insidious strain of hepatitis only identified in 1989, that could hide without producing symptoms for years while preparing an onslaught on a carrier’s liver. Ruling out coincidence and environmental factors, she became convinced these women could only have contracted the virus from the anti-D. She also knew she had only found these women because they happened to sign up to be blood donors, oblivious to the virus they carried.

That meant many, many more women could be carrying it with little likelihood that it would be discovered unless they were tracked down and called in for specific testing.

That was what the media was told at the press conference on February 21, 1994 and that was when the alarm began.

In the months that followed, a national screening exercise took place and around 1,200 women were found to have been exposed to the virus.

For some, the finding made perfect sense. They had suffered vague symptoms of fatigue and general ill-health for years without being able to find a cause. For others, the test results were shocking and plunged them into anxiety for their own future and that of their families.

The Government was immediately aware of the potential for compensation claims and moved to emphasise that the medical needs of affected women would be taken care of.

But individually, many women were not reassured by their dealings with the health authorities.

Jane O’Brien, from Co Kildare, was concerned by the lack of detail pertaining to her own case and bothered that no-one in charge would put her in touch with other women in her situation. As a journalist, she knew how to get the word out about an issue, and before long she had gathered together a group of women who formed the Positive Action organisation which became pivotal in the fight for answers about how the scandal happened and compensation for the suffering and loss it brought.

As a result of their campaigning, a Tribunal of Inquiry was set up in 1996 which found serious failings in the way the BTSB operated and concluded the contamination of the anti-D batches could have been prevented.

The Hepatitis-C Compensation Tribunal, set up on a transitional basis in 1995, was formally established in 1997 as a result of the findings.

In the meantime, a number of women had sued the State, the best known being Brigid McCole, a mother of 12 from Co Donegal, already in the advanced stages of liver disease, whose case was fought by a frigid State all the way to an unspectacular settlement which she accepted under threat of proceedings dragging out long beyond what her frail form could take. She died the next day.

On foot of the tribunal report, a Garda investigation began into the BTSB. Three senior employees were arrested in 2003 and two were charged with causing grievous bodily harm to Anti-D recipients, but one died before his case could come to court and the other, who instigated lengthy legal challenges to her arrest, finally had all charges against her withdrawn in 2009 due to the death of witnesses.

The Hepatitis-C Compensation Tribunal paid out around €310m in 1,539 awards to women, their spouses, and children in its first seven years. It then also became responsible for compensating people infected with HIV through other BTSB blunders.

In total it has paid out almost €1bn in awards and legal costs associated with more than 4,500 claims.

There are still around 800 claims to be dealt with and more could yet arise as women infected by the second batch of anti-D may only begin to see the consequences now.

In the meantime, almost 80 members of Positive Action have died and hundreds of others who should be enjoying life as grandmothers, great- aunts and active retirees, struggle daily to find the energy and strength to match those modest dreams.

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