Change in blood-processing system deferred due to need for extra staff

The former chief executive of the Blood Transfusion Service Board said his sanity would have been in question had he asked the…

The former chief executive of the Blood Transfusion Service Board said his sanity would have been in question had he asked the Department of Health for an extra 10 staff in 1987.

Mr Ted Keyes told the tribunal that 1987 was a year of extensive cutbacks, the blood bank had lost approximately 50 staff and "everybody was under pressure".

The contents of a letter written by Mr Keyes to the Department of Health in June 1990, in which funding was sought for a proposed change in the BTSB's blood-processing system, was opened to the tribunal.

It said: "We have had this under consideration for some years and we deferred action simply because we would have needed 10 extra staff to deal manually with the change required, including the addition of a nutrient solution called SAGM to red cells."

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Counsel for the Irish Haemophilia Society, Mr John Trainor, pointed out that in February 1987 the board had learnt about the use of SAG-M, to increase the amount of plasma it could extract from blood to make clotting agents for haemophiliacs.

Mr Trainor put it to Mr Keyes that the BTSB had not opted for a change to newer viral inactivation techniques in the late 1980s because they would have required more plasma, which the board could not collect. However, if it had used SAG-M, it could have met requirements, he suggested.

Counsel for the tribunal, Mr John Finlay, interjected that there was no evidence that the board was short of plasma.

Mr Keyes said the employment of 10 extra staff would have been grossly inefficient. "What we wanted to do was improve efficiency," he said.

The board could not opt for monoclate or pasteurisation as newer viral inactivation techniques because they would have to be carried out in the US, where Irish plasma was unacceptable because the HIV test it used was not recognised there.

Mr Keyes said demand for clotting agents and plasma was growing, and in 1990 the board bought new equipment which increased the level of plasma which could be taken off blood.

"If we hadn't done that I suspect you would have been hanging me high for not doing it," Mr Keyes said.

The tribunal heard that the board opted to continue ordering heat-treated products, rather than ones which had undergone newer viral-inactivation techniques, up to the end of 1989, and the company supplying them would only do so on condition that the board indemnified it against the consequences of anyone becoming infected by the products.

Mr Keyes said this company, Armour, had a "clouded" reputation even before the indemnity was sought. In 1997 its Factor 8 product was associated with HIV infection in haemophiliacs in the UK. However, he said the BTSB would never have done business with Armour if its products had not been approved by the National Drugs Advisory Board (NDAB).

He said he did not particularly like the idea of an indemnity. Mr Trainor asked why then the BTSB didn't immediately drop Armour as a supplier. Mr Keyes said this would have meant leaving patients without products. Counsel suggested their needs could have been met by commercial clotting agents.

Mr Keyes replied that the BTSB had to comply with government policy on self-sufficiency, which meant providing products sourced from Irish plasma. He said he had never seen the government requirement in writing.

Counsel asked if it was the existence of this government policy which bound the board to continue getting product from Armour, despite misgivings about the company.

Mr Keyes reiterated that the NDAB did not have a problem with the Armour product but, asked if he told the NDAB about the letter of indemnity, he said this was not his job.