Martin fails to end era of bad blood

There is, let us imagine, a car which, because of massive design faults in its engine, belches out poisonous gases. The gases kill some people and do irreparable harm to the health of many others. After a while, the manufacturers discover their mistake, but they do nothing and hope for the best. Eventually, the car is taken off the road.

After a while, it is put back on the road. The engine has been redesigned and it seems to work. This time, however, the steering is askew. The car looks like crashing at any moment.

What would we say about the manufacturers who, having been responsible for one catastrophe, go on to create more dangers? Would we not talk of, at best, gross recklessness and at worst criminal negligence? This is precisely what is happening with the Irish Blood Transfusion Service (IBTS).

The reckless incompetence of the IBTS created the most appalling scandal in the history of the State. It infected hundreds of citizens with HIV, and 1,200 with hepatitis C. Many people have died and many more have had their lives shortened. If you want to know the cost of the fecklessness and irresponsibility which infect our public culture, here it is.

Almost unbelievably, however, having fixed the engine by reforming the IBTS's operations, the Minister for Health, Micheál Martin, has allowed the steering to deteriorate to the point where the chief executive, Martin Hynes, will be in court today, challenging a decision of the board to suspend him from duty.

The civil war which has plunged the most sensitive institution in the entire State apparatus into chaos was entirely predictable. Indeed, I predicted it last September when the widely-respected chairwoman of the IBTS, Prof Patricia Barker, resigned.

I WROTE at the time that Micheál Martin's appointment of five board members from the Cork region, at a time when wrangling between the Dublin and Cork offices at the IBTS was known to be producing chaos, would "cripple the IBTS board by allowing a side issue to dominate its proceedings and distract it from the crucial task of constructing an agency worthy of public trust".

If this was obvious to me, as an outside observer, it ought to have been obvious to the Minister.

At the back of the current row is the independence of the Cork branch of the IBTS, under its director, Dr Joan Power. The immediate issue arises from the shocking experience of a man known to the Finlay tribunal as Donor L. He was a good citizen and a regular blood donor at the blood bank's clinic in Limerick. In December 1991, he gave blood as usual. His blood donation was tested and was found to contain antibodies for the hepatitis C virus.

No one told him.

The blood bank, in fact, kept sending out cards to Donor L, asking him to donate again. As a decent, civic-minded person, he did so on five more occasions in 1992 and 1993. Then, in November 1993, nearly two years after the first test, he finally got a letter from Dr Joan Power telling him that he might have hepatitis C and urging him to go for more tests to the University Hospital in Cork.

By the time he gave evidence to the Finlay tribunal in 1996, Donor L had undergone two liver biopsies and a course of Interferon treatment.

What became clear at the tribunal was that this staggering decision was not accidental. It was a deliberate policy adopted by Joan Power.

Dr Power told the tribunal that she felt the method of screening available in 1991 "was insufficiently precise to warrant the risk of upsetting the donor". This was, as the tribunal report notes, "apparently a decision which she implemented as a general policy and not merely in one case".

It was, moreover, a policy adopted only in the Munster area, which was - and remains - under Dr Power's control. The policy elsewhere was to inform donors immediately of positive tests.

THERE were, as most of the doctors who testified at the Finlay tribunal asserted, two reasons for doing so. One was that the doctor/patient relationship imposed an ethical obligation to give a donor the choice of going for further tests.

The other, more obviously, was the fact that, in the treatment of liver damage caused by hepatitis C, "the earlier intervention took place, the more likely it was to be successful".

Joan Power, as Mr Justice Finlay drily noted, "did not agree with that interpretation of the ethical position". For all the excellent work which she did in tracing the outbreak of hepatitis C in Munster back to anti-D serum manufactured by the blood bank, this is a matter of legitimate public concern. The restoration of public confidence in the institution demands agreement on basic ethical standards.

All of this has been on the public record since March 1997, when Mr Justice Finlay published his report. The need to investigate what happened to blood donors who were not told that they had tested positive was always going to create tensions in the context of a continuing turf war between Dublin and Cork. Yet all that Micheál Martin has done is to exacerbate those tensions by his appointments to the IBTS board.

If this is not a resigning issue, what is?