Patient's consultant shocked at BTSB denial

PATIENT X's consultant obstetrician said he was so shocked when the head of the BTSB denied knowing she had been jaundiced in…

PATIENT X's consultant obstetrician said he was so shocked when the head of the BTSB denied knowing she had been jaundiced in 1976 he was asked to "keep down his voice". He was brought upstairs at Pelican House and given a cup of tea.

Dr Eamon McGuinness told the tribunal he had visited there in February 24th, 1994, to meet Dr Terry Walsh, chief medical consultant. However, at the arranged time, Dr Walsh was at a press conference. When Dr Walsh rang to explain his absence they had a heated exchange.

"He said he was not aware of her jaundice," said Dr McGuinness. "I was quite shocked about this.

Dr McGuinness also told the inquiry that he did not recall ever being told that his patient's plasma was being used in the production of anti-D until 1994.

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Patient X became jaundiced following a transfusion in 1976. However, the BTSB continued to use her plasma after this to make anti-D.

Dr McGuinness said he told Dr Walsh in February 1994 on the telephone that he had an obligation to go to the Minister for Health and tell him what had happened. However, Dr Walsh did not respond "one way or the other", he told Mr Rory Brady SC, counsel for the tribunal.

Dr McGuinness told Dr Walsh that two samples were definitely taken from patient X in 1976, one was sent to the BTSB laboratory and the other to the Virus Reference Laboratory in UCD with "query hepatitis" written on them both.

He had sent the two blood sampIes because he was concerned patient X may have been suffering from hepatitis B and wanted to exclude it. They had stopped her exchange programme when she got jaundice while awaiting the results of the test. Five days later they recommenced it when the tests were negative for hepatitis B. They then assumed it must be hepatitis A.

During the 1994 telephone conversation at Pelican House Dr Walsh said he was not aware that patient X had suffered jaundice and subsequently what her medical team believed was hepatitis A.

"I was quite upset by this and taken upstairs and given tea. I was asked to contain my voice. I said I did not need to, I was happy for anyone to know the situation," said Dr McGuinness.

During a second call later that evening Dr Walsh rang and apologised to Dr McGuinness for their "somewhat argumentative discussion" on the telephone. He informed him then that the BTSB did know of patient X's jaundice.

"I think what he said was that he was aware of the jaundice in patient X," said Dr McGuinness adding that he had been "greatly relieved" by this.

He suggested that patient X should be contacted and screened. But Dr Walsh insisted that he was not her personal physician and neither he nor the blood bank had any obligation to test her.

Patient X had moved address at that stage and there was difficulty contacting her. Dr McGuinness said he had known her well during her treatment but only recently met her for the first time in 20 years.

Dr McGuinness said that there had been a discussion between himself, Dr Denis Reen, senior biochemist at Crumlin Hospital, and Dr Walsh prior to patient X's treatment, about making anti-D from her plasma.

He said they knew she had a high concentration of anti-D and he had some interest in trying to offset the £5,000 cost of her plasma exchange treatment.

Patient X had already had one miscarriage, Dr McGuinness said, and they decided to start the plasma exchange programme in her eighth week of pregnancy to try and correct a haemolytic disease.

However, at the time of the discussion, Dr Walsh said, it was a much more economic proposition to continue to extract anti-D from male donors.

During questioning by Mr John Rogers SC, Dr McGuinness said he was "sure" he had told Dr Walsh about patient X's jaundice since they were in "fairly regular communication".

At the time that patient X fell ill she told her medical team that children in the area of Dublin where she lived had had hepatitis A and they then assumed that she may have picked that virus up there. She had tested negative for hepatitis B.

Dr Ciaran Craven BL, counsel for patient X and Transfusion Positive, said that patient X has a "vivid recollection" of the plasma exchange programme. She remembers that Dr McGuinness once called to her home to carry out a blood test and she felt that was unusual as she was due to see him in the hospital. However, Dr McGuinness said he had no recollection of this.

Later, Dr McGuinness said that "in fairness" he had not had a row with Dr Walsh on the day he received the call at Pelican House.

"I was quite shocked by the revelations and his lack of knowledge," he said, adding that "anyone that knows Dr Walsh would know that he is not that type of person."