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46,500 | 344 | QUESTION:
Can we turn, then, to the article that appeared on
1 May 1983 on the front page of the Mail.
PRSE0000199, please.
I'm sorry, sir, we had a difficulty with redaction
earlier today and -- but this isn't the article we had
the difficulty with, so I think we are just being e xtra
cautious before we put something up. There it is.
Apologies, Ms Douglas.
This is the article that -- the Inquiry has seen
it before, with the heading "Hospitals using killer
blood", and there are just three parts I want to re ad
out and then I want to ask you a series of question s
about it.
ANSWER:
Sure.
|
46,501 | 344 | QUESTION:
We can see that you wrote it and you were the medic al
correspondent, and the first paragraph:
"Blood imported by the NHS from America could be
threatening the lives of thousands of British peopl e."
Then a little further down:
"Experts revealed exclusively to The Mail on
Sunday that two men in hospital in London and Cardi ff
are suspected to be suffering from the disease [AID S]
after routine transfusions for haemophilia."
And we'll pick up another part in a moment.
Can you tell us how you came to write this
article?
ANSWER:
Yeah. I intimated earlier that I'd always had an
interest in medicine, so I'd worked at junior level
amongst doctors on a medical magazine which was for
doctors in an earlier part of my career. So I was
surrounded by people who were interested in medicin e,
that's kind of my tribe. And there was always the buzz
particularly as AIDS became such a big story and ho w was
AIDS transmitted? Because of course we've all forg otten
but with hindsight we didn't know in the beginning,
a bit like we didn't know about Covid. And there w as
a lots of talk about that.
One of my best friends, who again comes from that
medical journalism background but was still working on
a medical magazine for doctors, so a limited commun ity,
said to me one night over cocktails -- many journal istic
stories are -- "Have you thought about the fact tha t" --
so it was her asking me this question -- "in blood
transfusions, for example we're already worried tha t
hepatitis is being transmitted through blood
transfusions, that maybe AIDS could be transmitted in
routine blood transfusions or when people and patie nts
require blood products?"
|
46,502 | 344 | QUESTION:
Can I just ask you to pause for a moment, Ms Dougla s.
10 I'm asked by the stenographers if you could sit a l ittle
closer to the microphone and speak a little more sl owly
for them. We have wonderful stenographers keeping track
of everything you say and they're just finding it
a little difficult to keep up.
ANSWER:
Is that any better?
|
46,503 | 344 | QUESTION:
Let's keep going and I suspect I'll get a note if t here
are difficulties.
ANSWER:
Okay, I can move that if that helps. Is that bette r?
I've got an echo now. So it might be.
|
46,504 | 344 | QUESTION:
Thank you.
ANSWER:
Sorry, would you like me to --
|
46,505 | 344 | QUESTION:
Can you remember whether the doctor was directly
treating any haemophilia patients himself?
ANSWER:
No, he wasn't. He was a scientist rather than
a white-coated doctor who'd walk on ward rounds.
|
46,506 | 344 | QUESTION:
In that context, can you remember whether the docto r you
spoke with was Arthur Bloom?
ANSWER:
Categorically it wasn't.
|
46,507 | 344 | QUESTION:
When you spoke to that doctor, do you recall what t hat
conversation consisted of? Can you tell us about t he
conversation with him?
ANSWER:
Absolutely. The first -- the reason why I even tar geted
that doctor was, again, back to my friend Lorraine. She
had heard of his name through a very -- haematologi sts
are a small group. Medicine: we're all tribal, the
haematologists are one tribe, medics are a bigger t ribe,
the journalists are a tribe, so she'd heard --
|
46,508 | 344 | QUESTION:
If we then look at the second column of the article just
a little bit further down than where we are, we see
a reference to the Swiss Red Cross:
"The Swiss Red Cross, chief producer in
Switzerland of the anti-clotting factor needed by
haemophiliacs, said this weekend they would welcome
requests from Britain for clean plasma."
A letter from the General Editor, which we'll come
back to later, refers to a Dr Ernst Staempfli from the
Swiss Red Cross. Can you help us with how you foun d
this Swiss Red Cross information? Was it from
Dr Staempfli that you --
ANSWER:
Obviously, I don't -- forgive me -- I don't remembe r the
name -- but whoever the head of the Red Cross in
Switzerland would have been, again, I was doing my
homework and diligently probably also encouraged by the
newsdesk, because you would keep reporting and sayi ng
"I've done this, I've done that", and they would he lp,
and that's how you get to a story like this.
18 I found the telephone number, phoned them up, said
what I was doing from a newspaper and we were very
concerned, and what were they doing in Switzerland? How
were they treating the blood that they were collect ing?
Was that going to sift out AIDS? And, of course, a gain,
relevant to say no one was certain whether heat
treatments or filtering would actually get rid of t he
threat of a virus that we didn't really fully
understand.
However, whoever I spoke to, who was the head then
of the Swiss blood products availability, told me t hat
they were doing all they could with heat treatment and
filtering to remove the risk of AIDS transmission, and
that they were pretty sure there were no incidences
using their blood or blood products.
Whereupon I said "Well, would it be possible, and
do you have enough supply?" Because we didn't have any
blood supply, which I know we're going to come on t o
later here, because we weren't self-sufficient, we were
dependent on imported blood. "Would you be able to
supply the UK instead of the American resource?"
And he said, "Yes".
|
46,509 | 344 | QUESTION:
Was your understanding that the Swiss Red Cross cou ld
supply the UK's entire needs or just some of them?
ANSWER:
From memory, the entire need, but the cost would ha ve
19 been very high.
|
46,510 | 344 | QUESTION:
If we look then at the headline that the article wa s
given, what involvement did you have in the headlin e?
ANSWER:
Journalists -- the humble reporter, sadly, never ha s any
influence whatsoever on the headline or pictures th at
are used. You, if you're lucky, are consulted. An d
because of the importance of this story, I do recal l
being summoned to what was called the backbench, so it
would be like the front bench here, and so the powe rs
that be would say, "This is the likely headline, wh at do
you think?"
At this point I've had no contact with the editor
and I said (sucked in breath) because it is
sensationalist and I thought this was quite scary,
because for me, don't forget I've said, I was quite
a young reporter trying to prove my worth to this
newspaper and validate that I could get great scoop s but
this was quite a shocking headline, and I registere d
that, and I remember thinking "Ooh", but I thought
fundamentally, no one is going to take any notice u nless
we do do something that goes (sucked in breath) "Ooh!"
And that's what you kind of want, that intake of br eath
factor.
|
46,511 | 344 | QUESTION:
When you were speaking to your Cardiff doctor and o ther
sources for this article, did any of them express
20 concerns that publishing the story would lead to pa nic
and to patients refusing Factor VIII?
ANSWER:
Before I wrote that article, no, they were voicing
genuine concerns. And we did discuss, and in my he ad
certainly -- whether or not that comes out from the
piece -- I realised that there was a counterbalance and
a weighing of the risk of infection versus the risk of
people being put off taking their Factor VIII, in
particular for haemophiliacs, and that balance had to be
addressed by doctors who would be advising those
patients with honesty and transparency.
And I don't think anyone at that point questioned
the role of a doctor being honest and transparent w ith
patients, and that wasn't an issue for me, writing that
piece at the time. Obviously later, and again with
hindsight, that became a major factor.
|
46,512 | 344 | QUESTION:
Before the article was published, you think you had
dinner with Norman Fowler. How did that come about ?
ANSWER:
As a medical correspondent, your job was to know th e
Department of Health and the ministers in question and,
actually, if you were any good even higher up, thei r
bosses too. And because I'm a baby at this stage,
age 26, I was busy climbing that ladder and later, later
obviously knew the Prime Ministers of the day and h ad
important relationships, as any national newspaper
1 editor would have.
So as a correspondent, a specialist, you would
absolutely cultivate all the people that you needed to
know and have under your wing.
So it wasn't surprising that I'd worked very hard
to find Health ministers, health advisers, even the
research assistants for those ministers. And I wou ld
cultivate those contacts in the old days, it would be
lunch or drinks, or just chitter chatter and you're
picking up what they care about. And I definitely would
have had lunch and dinner regularly and that still
happens between specialists and ministers.
|
46,513 | 344 | QUESTION:
Do you think that you discussed the article with hi m
before it was published?
ANSWER:
I would definitely have discussed with him the conc erns
because this was in my head and something I really cared
about and would definitely have had that conversati on.
|
46,514 | 344 | QUESTION:
Do you recall anything of his response or any more
detail of the conversation?
ANSWER:
With Norman Fowler, at that point, I don't remember him
flagging up that he was concerned in any way.
|
46,515 | 344 | QUESTION:
You say in your statement that, prior to the public ation
of the watershed article, you would have had to pho ne
someone at the Department of Health to check the fa cts.
Do you have any recollection of who you phoned or w hat
22 was said?
ANSWER:
It wasn't just you would phone someone; you would h ave
been, in the process of writing it, checking all th e
time. And the only person that I would have read t he
story to -- because it was none of the business --
otherwise it would be a press release handout from the
Department of Health -- was my source, and I did re ad it
but I did not read him what the headline was likely to
be, because probably, at that point, I wouldn't hav e
known until, on a Sunday paper, quite late on Satur day
that they were definitely doing, on the front page --
I wouldn't have known it was going to be that -- an d in
such bold, large capitals, which of course is on th e
newsstand what you want as a newspaper editor, peop le to
go (sucked in breath) "Ooh, I've got to read that".
|
46,516 | 344 | QUESTION:
Before we move to another facet of the article did you
have any sources who discussed Scottish medical mat ters
with you or was this article and subsequent article s
primarily England focused?
ANSWER:
I don't recall it being any kind of divisive Englan d,
Wales, Scotland or Northern Irish. It would have b een
UK. So if we talked about British hospitals, which we
don't, we just say, "hospitals", by the same token, the
newspaper's circulation, the first edition of
a newspaper would boringly have to catch the first
23 trains and first planes. So it went what we used t o
call "off stone" at 6.30. You could then update th e
story through subsequent editions and the main edit ion
would be the London edition in the small hours of t he
morning.
So no, in terms of were there any changes made for
different editions that I knew about? No. Did I s peak
to different people within the Department of Health
about any of the regions within the UK? No. But i f you
remember, the story originated from Wales. But I d idn't
even think about that.
|
46,517 | 344 | QUESTION:
Just to go back to a specific question I've been as ked
to ask you, whether you had any sources who discuss ed
specifically Scottish matters?
ANSWER:
No.
|
46,518 | 344 | QUESTION:
On the 6 May 1983, Dr Peter Jones wrote a complaint to
the Press Council and I want to take you to that.
PJON0000001_100, please. Thank you. It's the firs t and
second paragraphs I want to pick up, and I will jus t
read a little bit of it out, and then ask you about it.
He flags the article and the headline and then says
this:
"As an experienced doctor deeply concerned with
the care of patients requiring blood transfusion, a nd in
particular families with haemophilia, I take the gr avest
24 possible exception to this approach to reporting ab out
illness. This sensational and highly exaggerated
article has, not unnaturally, started a chain react ion
involving other newspapers and radio and television , not
only in this country, but abroad. As a result, thi s
Haemophilia Centre and others throughout the countr y
have been inundated with calls from worried familie s.
"I have no objection whatsoever to the press
taking an interest in health and in objective repor ting
of disease and its causes. However, the Mail artic le is
neither objective nor accurate."
Then he sets out a series of bullet points of
critiques.
When you heard about this complaint, what was your
immediate reaction?
ANSWER:
Fear and concern, that maybe I'd got it wrong, even
though I was very sure I'd done as much checking,
through the processes we've discussed, to make sure that
the story was really accurate. I was scared. I wa s
a new, young reporter. This was the biggest story I'd
ever done and I thought this was a very serious
complaint that went through the processes within th e
newspaper and I would be called in, ultimately,
possibly, to explain myself being sensationalist or
over-egging the story or getting it wrong. So I wa s
5 worried.
|
46,519 | 344 | QUESTION:
You then worked on a response to the complaint with
Mr Steven the Editor, which was ultimately sent out by
George Woodhouse, the Managing Editor.
ANSWER:
Mm-hm.
|
46,520 | 344 | QUESTION:
Could we turn to that, PJON0000001_104, please.
The letter responds in detail to each point and
I just want to take you to them and ask you about t hem.
The first point:
"You say the word 'virus' is used but there is no
proof that a virus even exists as a cause of the
acquired immune deficiency syndrome.
"The word virus was used only in the strap-line.
It is true that nobody has yet identified or isolat ed
the agent causing AIDS but specialists for the last
two years have been pointing a finger at a virus.
"Most recent evidence from France and America
shows conclusively AIDS is linked to a cancer virus
[then there's a reference to two journals].
"Also on 17th May Reuters, the international news
agency, put out a story from Paris stating conclusi vely
that researchers at the Pasteur Institute working o n
AIDS had isolated a virus that they claim could be
linked with the disease."
Is it right that you had obtained some of your
26 information, indeed this part of the information, f rom
medical journals?
ANSWER:
Absolutely, and those journals in particular, that' s why
we cited them.
|
46,521 | 344 | QUESTION:
The letter continues:
"You state that even if a transmissible agent is
eventually proven there is no proof that it has bee n
imported from the US."
The letter addresses that, particularly if we turn
over the page, with the paragraph "Finally":
"Finally, leading experts in the UK consulted by
us were prepared to admit the very real threat Amer ican
blood products constitute. Health Minister,
Norman Fowler and Junior Minister, Kenneth Clarke h ave
both been warned some time ago of this risk. There is
no dispute that it exists."
Had that information come from your Cardiff
source?
ANSWER:
No, it had been -- well, yes, first my Cardiff sour ce.
But all the others were talking about the same thin g.
There was no question at that point that the most l ikely
candidate for AIDS transmission was a virus, it was in
all of the scientific journals. At that point, not
100 per cent proven but that was absolutely what me dical
opinion throughout the world was. And in Cardiff m y
27 original source would definitely have been talking to me
about those fears, that's why he was worried in the
first place, in his community. And there was a tra ck
record for this.
This is how other diseases were being transmitted
and this disease -- suddenly AIDS was becoming -- m aybe
we've forgotten -- but an epidemic that was very
frightening, and its transmission was something tha t we
prioritised to work out what was happening. And as soon
as we were identifying it as a blood-borne disease, the
natural thing was to say, well, we now have to seri ously
question how we filter that out of the blood that w e
routinely use and need in medical treatments. And lots
of people were telling me that.
|
46,522 | 344 | QUESTION:
Then at 4 there is reference to the two men and thi s
letter indicates that Dr Jones had said that at the time
the article was written this was untrue. Then it s ays
this:
"Sue Douglas says the two cases with suspected
AIDS which we reported were in fact confirming a we ek
later by doctors we had previously spoken to. Thes e
doctors notified the watchdog Communicable Disease
Surveillance Centre in London. Our information cam e
from the patients' own doctors who understandably a sked
for anonymity for both themselves and their patient s.
28 It is our belief that they felt obliged to notify t he
Centre after our story. The statement was definite ly
true at the time of printing."
So again, in relation to the two men, the
information, as noted here, had come from your sour ces,
referred to as the patients' own doctors?
ANSWER:
Indeed.
|
46,523 | 344 | QUESTION:
Just over the page, in relation to the Swiss blood
point, we pick this up in relation to the article b ut,
for completeness, towards the bottom of the page po int 8
deals with Switzerland and we see there:
"Dr Ernst Staempfli of the Swiss Red Cross in
Bern -- the central laboratories producing most of
Switzerland's Factor VIII -- said his country had b een
aware of the problems facing Britain following the
appearance of AIDS in the USANSWER:
"The Swiss Red Cross Society would readily receive
any requests from Britain for 'clean' plasma."
Dr Jones responded to that letter. We won't go to
it but for the transcript the reference is
PJON0000001_108.
Before we leave this complaint, and the response,
can you tell us a little bit about what the effect of
the complaint and the response was on you in terms of
your confidence as a journalist?
9 |
46,524 | 344 | QUESTION:
And so in terms of those other reporters for other
newspapers, what was your understanding of what the y
were doing in relation to this story?
ANSWER:
I knew that -- because we all worked in a pack in F leet
Street in the old days, and I knew that people were
interested in the story because it was really big a nd
really mattered, and I knew there were dead ends al ready
and people were finding it very difficult to talk t o
other people and to get that story validated.
31 So that added to my doubts, and their crowing,
"She got it wrong", but at the same time, lots of p eople
had known little bits about the story, and I think, to
be brutally honest, although we'd done it as big sp lash
and a big sensationalist story on the front page,
there'd been little drip-drip feeds of that concern .
Often -- I think The Guardian had done a story befo re
even I had done -- little tiny reports with no real
impact and nobody complaining. So it was a questio n of
that peer group actually knowing that there was
something good and, in old journalistic parlance,
sniffing a story, and then you go off like hunting
hounds, hunting for the truth and the bigger story
within.
So half of me was: they were interested, then
there's the pack, as we used to be called, going fo r
this story because it was so important. And part o f me
is thinking [sucks in breath], did I get something wrong
and what's going to happen? Am I going to be censu red
and is the new newspaper going to be censured? Wha t's
going to happen?
|
46,525 | 344 | QUESTION:
You wrote an article on 8 May 1983, and if we can p ut
that up.
PJON0000001_101.
It notes that the Government is taking emergency
32 action following the first article, and under the
heading "Factory" we see this:
"Mr Geoffrey Finsberg, junior Health Minister with
special responsibility for the blood transfusion
service, said yesterday that a ban on the blood
[products], imported from America, is being conside red.
"In the meantime, plans to make Britain totally
self-sufficient in blood products have been pushed
ahead. Mr Finsberg is demanding a change in buildi ng
plans of a new £20 million blood separation factory at
Elstree, Herts, so production can start long before the
official date in 1986."
Then on the continuation of the article, there is
a quote from:
"Dr Anthony Pinching, one of Britain's leading
immunologists researching AIDS at St Mary's Hospita l,
London, said: 'I wouldn't dream of giving a patient
American blood products. We have to find an altern ative
immediately'."
With regard to Mr Finsberg and Dr Pinching, where
would that information have come from?
ANSWER:
I would have been talking to them from the very
beginning, so that first what we used to call splas h,
the front page story, "Hospitals using killer blood ",
I would have been talking to both of them at that t ime.
3 So again, as I've indicated, that is a conversation
ongoing, with a specialist, that you're talking to all
the people within your community that are relevant, and
building a story from the fears and detractions, as well
as the people saying, "Yes, this is right and this is
what we're doing."
|
46,526 | 344 | QUESTION:
When there's a direct quote from someone, it may se em an
obvious question, but where does that come from?
ANSWER:
Probably a phone call or possibly a meeting. And
I should add, sorry, that you would always read, in
those days, the quote back that you were using, tha t was
going to be published. And I would assiduously do that.
|
46,527 | 344 | QUESTION:
Having had a letter of complaint to the Press Counc il,
you're now publishing a further article which may b e
controversial again. What process was followed wit hin
the newspaper in relation to this article in relati on to
making sure it was accurate?
ANSWER:
So the same process. And particularly now, because
we've had an official complaint, of being so rigoro us
about checking and fact checking, and checking agai n.
And we would have lawyers and we would have other
people -- so the News Editor would almost always so rt of
rather de haut en bas say, "Right, well, I'm making
sure, you know, because on my head be it". So ther e was
a chain of command, and other people would be actua lly
34 helping me, and at that point I would obviously hav e
been engaged in a direct conversation with the edit or of
the newspaper because at that point the newspaper i s
making a stand to continue that coverage.
So by then I'd been almost promoted to be talking
directly to the editor, who was like a god in those
days, and actually telling him what further evidenc e
I had and how important this was. And he, by the t ime
this piece was published, was not just thinking thi s is
a great story, but thinking this is a campaign.
|
46,528 | 344 | QUESTION:
There was then a further article about the death of
a man which was described as a scandal.
If we could have HSOC0016002.
If we pick it up on the first column, we see that
his death is recorded and the article then says thi s:
"[Mr X's] death certificate will say that he died
of renal failure at Bristol Royal Infirmary. Becau se of
that there will be no need for an inquest, accordin g to
the city's Coroner's Office. Yet everyone who know s
about [Mr X], his doctors as well as the Government 's
watchdog committee, the Communicable Disease
Surveillance Centre, knows that the real cause of h is
death was that he was given blood infected by AIDS ..."
And it's recorded that he was someone who suffered
from haemophilia.
35 Again, the information that was used for this
article came from sources who were doctors; is that
right?
ANSWER:
Correct.
|
46,529 | 344 | QUESTION:
If we then pick it up in the editorial box, with th e
heading "Why there must be action", who would have
written this editorial element?
ANSWER:
The editor would write that with the journalist in
question, me, sat by his side. And he would be tap ping
away with what he wanted the paper to say. The edi tor
always was the voice of the newspaper. And he woul d be
deferring to me, because obviously he didn't know t he
facts of the story, but by then probably Stewart St even
did know all the facts of the story because we'd al so
been taken to task by the complaint, and would be v ery
careful to make sure that everything he said within this
editorial piece we're looking at now was correct.
|
46,530 | 344 | QUESTION:
The editorial piece says in the first paragraph -- let
me read a couple of paragraphs out for those who ar e
listening to the Inquiry today:
"The suppression of the facts of [Mr X's] tragic
death and the lack of an inquest point towards
a conspiracy of silence.
"It may be that in withholding information,
[Mr X's] family, the Haemophilia Society, and the
36 doctors who treated him were all acting with the mo st
honourable of intentions.
"All have stressed the need to avoid panic among
Britain's 4,500 haemophiliacs. However, they are
mistaken.
"Only by revealing all the details of this
scandalous and unnecessary death can we protect oth er
individuals from a similar fate. Only public press ure
can stop other haemophiliacs from dying."
If we just pause there, why did you consider that
there was a conspiracy of silence?
ANSWER:
Because the doctors I'd spoken to, including the do ctors
looking after the patient who died, were very conce rned,
and quite clearly the cause of death was that the
infection of AIDS was what killed that patient. An d yet
the death certificate said something else. Just as in
Covid, quite often you died of respiratory failure or
another thing, that would be on your death certific ate,
but everyone knew it was Covid.
So the problem there is that nobody wanted to take
up that baton and say, "This is important, other pe ople
are going to die of AIDS, and we should to a someth ing."
So it was just sublimating the fact that he'd died
of AIDS, or had died because he was infected with A IDS,
wasn't going to be talked about and wasn't going to be
7 raised as a possible risk for other patients, and i t was
just putting a lid on it again.
|
46,531 | 344 | QUESTION:
I'm asked to ask whether you considered that Govern ment
officials and ministers were party to the conspirac y of
silence, particularly -- sorry, yes -- whether they were
party to the silence.
ANSWER:
I felt that they were, and my continued conversatio ns
with ministers, as we discussed, and their underlin gs,
right down to research assistants, there was that
concern very definitely: why wasn't it being voiced ?
Why wasn't anyone allowed to say, "Yes, we're very
concerned and we're looking into it"?
|
46,532 | 344 | QUESTION:
The editorial then goes on:
"In May, I pointed out the dangers of importing
blood from a country with an AIDS epidemic. And I was
viciously attacked for panic-mongering. Must anoth er
innocent man die before action is taken?
"However, while Britain continues to accept
American blood supplies, our advice to all haemophi liacs
is:
"Continue to take your Factor VIII treatment. The
risk of bleeding without treatment is infinitely gr eater
than the risk from AIDS."
In terms of that note of advice, effectively, to
haemophiliacs, who did you speak to know what advic e to
38 give?
ANSWER:
The Haemophilia Society and various people who I'd
obviously talked to by now with some months of
a relationship, and families and people who were ve ry
concerned about what was happening. And at no poin t did
I think I had the right, as a reporter, to tell peo ple
what to do. But what I was trying to encourage the m to
do, in my own way as a messenger, was to encourage
doctors, who were asking real questions, to be hone st
and open with their patients, who were alarmed, and they
were right to be alarmed, and actually be a little bit
more transparent with the risks instead of denying them.
And that balance of the risk, we didn't know at
that stage what the risk was. There were
4,500 haemophiliacs in the UK at that time. We now know
that over 3,000 of them died. That's huge. At tha t
time, we didn't know how dangerous it was, or how
likely -- if they were receiving infected Factor VI II,
how likely it would be that they would get a potent ially
fatal disease. So we had to say -- and we would sa y it
to our own families infected with something like th is,
or with Covid or anything else that's happened -- w e
would be open about the risks. And of course, a do ctor
is there to reassure you about what those risks are ,
what actions one can take, and how to be sensible a bout
39 this.
But again, to continue with what we knew to be
a really dangerous risk was profoundly wrong not to be
enquiring about alternatives after already several
months of those concerns being broached.
|
46,533 | 344 | QUESTION:
We can take that down now, Lawrence, thank you.
Just staying with the question of conspiracy of
silence and thinking about it a little bit more bro adly,
you speak in your witness statement about the medic al
community being divided between those who wanted to act
and those who didn't.
ANSWER:
Yes.
|
46,534 | 344 | QUESTION:
What do you think differentiated those who wanted t o act
from those who didn't?
ANSWER:
Partly fear. Again. Like I'd experienced. What d o we
do? Our job as a doctor, if we're -- as we said in that
newspaper editorial, you are responsible and, up to
a point, the expert in charge of life and death for your
patients. And if there is no choice at that stage,
which a number of doctors voiced at that time to me , and
I remember it very well, "There isn't a choice, Sue ",
I can't say to these patients, "Don't do this becau se
there's a very real risk of you getting AIDS", beca use
they have to take their Factor VIII. Otherwise the y
could die of the slightest injury and just bleed to
40 death. So what do I do? I'm frightened. Literall y
scared that there is no choice.
So I don't know if that answers your question.
I think for a lot of the doctors they were genuinel y
worried rather than being -- trying to play god. S ome
of them, perhaps like any other profession, weren't
honourable and thought: I'm in charge, this is what you
do, carry on taking the treatment.
But I doubt it, otherwise you'd never have been
a doctor in the first place.
And others were so concerned, and perhaps had
delved even deeper, to say -- but we didn't know,
remember -- "The risk of you getting AIDS is greate r
than the risk of you bleeding to death."
|
46,535 | 344 | QUESTION:
In your discussion with sources, were you aware of
doctors being sanctioned or facing any repercussion s
if -- when they did speak out?
ANSWER:
Yes, because all the time I was talking to doctors
saying, "But don't quote me". They might lose thei r
jobs.
|
46,536 | 344 | QUESTION:
Are you aware of anybody in fact losing their jobs or
was it a fear expressed to you that they might?
ANSWER:
I think my original source had faced some really ba d
backlashes at work, and others were very keen, who
I spoke to totally separately, particularly doctors
1 looking after patients, that they had been counsell ed,
"Under no circumstances should you be a panic monge rer,
and fuel that panic."
|
46,537 | 344 | QUESTION:
In a much later letter to the Press Council in 1988 , the
managing editor said that the article had generated one
of the heaviest postbags from readers, largely from
grassroot doctors and nurses congratulating the pap er
for speaking out. Just for the transcript, the
reference is PJON0000001_062. Was that your experi ence
as well?
ANSWER:
Yes. And don't forget, again, it's so different fr om
today. You don't get "likes" but there was rafts o f
what we used to call the green biro brigade, people who
actually bothered to write in to a newspaper. In t hose
days you'd have to bother to write a letter and sen d it
or phone up. But we were getting switchboards in t hose
days jammed with calls saying, "We're worried". An d
particularly from my point of view, as the named wr iter
of the stories, The Haemophilia Society and individ uals,
who to this day continue to contact me, were saying ,
"Please do something. Help us."
|
46,538 | 344 | QUESTION:
From your conversations with your sources, do you h ave
any sense of why there was that fear for doctors ab out
being frank on such an urgent public health issue?
ANSWER:
Yes, they had no choice. There was nothing else th ey
42 could give them apart from advising that they went
privately, perhaps.
|
46,539 | 344 | QUESTION:
And you speak in your statement of the hierarchy of the
medical community was responsible for covering up t he
issues. What were you referring to there, what do you
mean by that?
ANSWER:
The hierarchy right to the top in Government terms, and
to ministerial levels, but it was both that and tha t
seniority ladder, that if you haven't got a choice and
you're a junior doctor or even a middle ranking doc tor,
or holding high position, that you might know that these
things were true, but if there was nothing that you
could do about that other than talk about it, the a dvice
would be "Shut up."
|
46,540 | 344 | QUESTION:
Dr Jones wrote another complaint to the Press Counc il
about this other article. The reference is
PJON0000001_126. But this wasn't pursued because t here
was also legal action threatened and resolved betwe en
the paper and The Haemophilia Society, and in your
statement you said you had no involvement in that a spect
of this second complaint and the legal action?
ANSWER:
I didn't, but there again obviously it's part of th e
ongoing campaign, which I had said it's -- rather t han
one article and then another, the paper had at that
point very much identified this as something that w e
43 would see all the way through. So I was aware of i t but
not involved.
|
46,541 | 344 | QUESTION:
Another of those articles was in November 1984.
DHSC0000352. We won't particularly go there today.
The Press Council initially upheld Dr Jones's
first complaint. What was the impact of that on yo u?
ANSWER:
Appalling. The Press Council basically was the
council -- with phone hacking later and all the oth er
things -- that's our body of approval/disapproval, and
if you've been actually warned by the Press Council , and
particularly in the terms that the warning articula ted,
it's very damning for a journalist's career.
|
46,542 | 344 | QUESTION:
-- and whether you saw their publications?
ANSWER:
The Haemophilia Society's publications, of course.
|
46,543 | 344 | QUESTION:
The Press Council refused to withdraw their adjudic ation
but did reconsider it in 1987. By that time you we re
the Daily Mail and you weren't involved, but were y ou
aware of the withdrawal of it?
ANSWER:
Of course, and although I was at the Daily Mail, Th e
Mail on Sunday was the sister paper of the Daily Ma il,
5 and those two newspapers didn't work in concert, ha d
entirely separate staff, but Stewart Steven continu ed to
be the Editor and the Daily Mail had picked up the
cudgels and also was not exactly campaigning but it was
one of those stories -- I mean, this is now three y ears
after -- four years after the original story and st ill
nothing has been resolved, and, yes, of course I wa s
aware of these things. But not in a position to be
writing about it as a medical expert any more.
|
46,544 | 344 | QUESTION:
Thinking about your original May 1983 article, in t erms
of other journalists other media outlets, if there
hadn't been a press complaint or a backlash about t hat
article, what difference do you think that might ha ve
made in the actions of other journalists and other media
outlets?
ANSWER:
It's like -- with any big story, it's like a tsunam i.
There's little tiny bits of the wind blowing, and i t
gathers momentum, gathers momentum. If something i s
then going to stop or warn journalists and particul arly
newspapers "No, don't go there, don't do that", the re
will be a hesitation. And I think that was very mu ch
what happened, and although that pack, as I've said
before, hunt as a pack, and a good story would be
a story that would run and run, that intervention
stopped it running and running and there were littl e
46 sporadic outbursts and little sporadic reports, but
nothing as significant as the story warranted.
|
46,545 | 344 | QUESTION:
When you say you had understood that he knew there was
a problem, where had you obtained that information from?
ANSWER:
Again, if you recall, this was a sort of cloud of
opinion. I can't identify one particular nay-sayer or
one person who worked for him or with him. It woul d be
haemophiliacs who were obviously asking those quest ions
who'd perhaps even seen this. It was the doctors'
community that were already concerned, and Dr Jones was,
you know, someone who knew, an intelligent person w ho's
written this in The Lancet.
|
46,546 | 344 | QUESTION:
I'm not going to put this document up, but we have
a letter from the Managing Editor that was sent to
Dr Jones on 1 July 1983, responding to his complain t.
One of the paragraphs I'm asked to read out is this :
"I must say that I am concerned at your extremely
strong criticism of Sue Douglas and would suggest t hat
it is unwise to reference to anyone as showing appa lling
ineptitude. Any form of attack on individuals is r eally
counter-productive to resolving this disagreement
9 between us."
Were you aware that that was the stance your
Managing Editor was taking?
ANSWER:
Absolutely, and it had become very personal and it would
be something that was discussed with the Editor, me , and
the Managing Editor, so that I was very aware of ex actly
what we were saying on my behalf.
|
46,547 | 344 | QUESTION:
Apologies, I didn't give the reference for that let ter,
PJON0000001_112, just for the transcript.
ANSWER:
So yes, I mean, George Woodhouse and I would have
discussed it but only in the presence with the Edit or.
I mean, you know, it would normally be with the Edi tor
that I was talking, from management's point of view .
|
46,548 | 344 | QUESTION:
Was it your understanding, in making his complaint,
whether Dr Jones was acting independently or did yo u
understand others to be involved or encouraging his
actions?
ANSWER:
It was very much my view then -- it's difficult to
discern now with hindsight -- that he was almost ha ving
a crusade against me, and that it was very much "sh oot
the messenger". And, in the light of this particul ar
letter that he'd already written, I would have know n at
that time that he knew there was a problem. Why wa s he
picking on me -- and anybody else -- the climate of fear
of actually saying anything further -- about we sho uld
50 do something?
|
46,549 | 344 | QUESTION:
If we can then turn to HSOC0016112, please.
In the column furthest to the right, there are
these two paragraphs:
"Although The Mail on Sunday highlighted the
problem five months ago, Health Minister Kenneth Cl arke
was still saying yesterday that there was little th at
could be done.
"'We will make every effort to find a risk-free
source of blood. If we find such a country we will
certainly stop imports from America where AIDS is
prevalent'."
I'm asked to ask you what your source of that
information is, including the quote?
ANSWER:
Ken Clarke direct, who I would have been talking to , and
had seen it in person on a number of occasions.
|
46,550 | 344 | QUESTION:
Also in this article, if we just come out to the ma in
article, we were discussing the issue of the conspi racy
silence, and I asked you whether you had spoken to
The Haemophilia Society, and you indicated that you had.
ANSWER:
Yes.
|
46,551 | 344 | QUESTION:
I'm invited to ask you who at the Society you spoke to?
ANSWER:
I can't remember. That was a dialogue and there wo uld
have been several people, not just one.
|
46,552 | 344 | QUESTION:
Your Cardiff source, that was not Arthur Bloom, app eared
51 to be giving different information to you than what
Bloom was giving to the Society. I'm asked to ask you
whether you told the Society that your understandin g was
that Arthur Bloom had got it wrong?
ANSWER:
I don't think it was ever my position to tell anyon e
anything, beyond -- within articles or properly
researched -- our readership. So the medical
establishment I wouldn't be telling any more than w ould
be voicing "I have been told these opinions and wha t do
you say about it?"
So I would ask questions.
|
46,553 | 344 | QUESTION:
Can you tell us any more about what you said to
The Society before this article was published?
ANSWER:
This particular one?
|
46,554 | 344 | QUESTION:
In relation to the conspiracy of silence.
ANSWER:
Again, it's taxing my memory but, as a code for
journalists, I would always have questioned their
response, probed deeper, tried to find points of
difference, looked at weakness in argument and just
said, "Why do you think that? And what do you thin k of
this?" It would be very much questions rather than ever
telling them anything other than things they'd alre ady
known.
|
46,555 | 344 | QUESTION:
In relation to your earlier clarity, your first art icle,
we discussed the Swiss Red Cross.
52 ANSWER:
Yes.
|
46,556 | 344 | QUESTION:
In our discussion you mentioned that you were aware of
the risks of the transmission of hepatitis through blood
and blood products. Do you recall this being an is sue
of concern to you or others in the medical communit y?
ANSWER:
Yes. Anything that was transmitted that caused
unnecessary disease would be an issue, and we would seek
to flag that issue. The whole point of journalism is to
ask questions, and hopefully get solutions. So the fact
that hepatitis -- and presumably there are other
diseases and possibly I'd cited other possibilities ,
through blood transmission, and the point was alway s
then: what is the risk versus the benefit of taking that
treatment?
Normally, one would think, in the medical
community that there would be clinical trials and t hings
3 like that. None of that ever happen, and neither w as
anyone really addressing the evidence of one agains t the
other. That just wasn't happening. When one posed
those questions there was nobody actually picking u p the
baton and running with it to explore what was the r isk
of transmission of even hepatitis?
|
46,557 | 344 | QUESTION:
You mentioned doctors' views, people you were talki ng
to: there was no option but to treat patients with
Factor VIII. Do you recall any discussion about wh ether
a different approach could be taken in relation to mild
or moderate haemophiliacs?
ANSWER:
No, and I do think when I say there was no other
treatment, that was something that I was obviously
trying to explore, as a journalist. What else are other
countries doing? The whole heat treatment and filt ering
of blood, was that successful, wasn't it? This was such
an early stage and we didn't know in the beginning
whether that actually did filter out any potentiall y
harmful bacteria, infection or viruses. We just di dn't
know. And, as we've heard at the very beginning, A IDS
went even actually confirmed as a virus until quite
early on in all of this.
So I think the point of this is exploration,
encouraging the scientific community, which it's
perfectly capable of, to actually explore other opt ions.
54 |
46,558 | 344 | QUESTION:
-- do you recall?
55 ANSWER:
There was. And, again, it was so early on that whe n
people were voicing alternatives like heat treatmen ts,
like all the other -- the changes in T cell behavio ur,
none of this was definitive. These were all just: this
is what's happening. The only evidence that we kne w at
that time in '83 is that haemophiliacs were getting
AIDS. How were they getting AIDS?
|
46,559 | 344 | QUESTION:
To what extent did you research the safety of blood and
blood products collected in the UK, as opposed to t he
American imports?
ANSWER:
From memory, I was told that we had no self-suffici ency.
Possibly we did, in the private sector, and that yo u
could even --
|
46,560 | 344 | QUESTION:
I'm sorry, not in relation to self-sufficiency.
ANSWER:
Sorry.
|
46,561 | 344 | QUESTION:
But just in relation to the supply of plasma and bl ood.
Did you investigate anything about the sources of t he UK
supply?
ANSWER:
Well, we were getting the American supply. Is that what
you mean? We were getting only the American supply
because as I understood it, that was cost effective .
|
46,562 | 344 | QUESTION:
So you didn't undertake any investigation about sou rces
of blood and plasma collected domestically?
ANSWER:
Oh, I see what you mean. Sorry. Yes, I knew that --
I mean, obviously, the first question is why can't we
56 get the blood that we're collecting from donors in this
country? And, at that point, we were actually
preprogramed to get our Elstree laboratories up and
running but it was like four years from when I was
reporting. But we didn't have central blood banks.
And so what Government policy was and health
policy was that we would find a reliable and mass s ource
cheaply, which we did from America.
|
46,563 | 344 | QUESTION:
The question is slightly different, I think we are
almost there.
ANSWER:
Sorry.
|
46,564 | 344 | QUESTION:
No, it's my fault for not framing this adequately. Did
you uncover anything about where the UK blood and p lasma
was coming from, in terms of whether it was the sam e as
the US, places like prisons?
ANSWER:
Oh, I see what you mean. Sorry, I completely -- ye s.
Because in this country it's a volunteer thing and in
America it was paid for and largely sourced from
communities that needed that money and particularly from
prisoners and drug addicts and vagrants, and that t here
was a tradition of that blood being harvested, whic h we
don't have in this country.
|
46,565 | 345 | QUESTION:
Sir, we
are
turning
today
to Scottish
Government decision making focusing on the period from
the 1970s to about the early 1990s. I am going to start
with a handful of introductory points, most of which
will be familiar to those who have followed previous
Inquiry presentations, this oral presentation
accompanies a written note which has now been disclosed
on the Inquiry website. The written note, as will be
obvious to those who have seen it, is lengthy
and
it
covers a large number of documents which were available
on Relativity. I certainly won't be covering every
document or issue that are contained in the written note
today
.
I should also say
,
as I have said before in
presentations
,
that whilst the written
note
is lengthy
,
it doesn't purport to
address
every
relevant
document
.
No
doubt there will be
further documents and points
brought to your attention by
core participants and legal
representatives
in
due course.
The Inquiry team also intends to disclose a much
2
shorter addendum note on a particular issue that I'll
touch on later
today
. It relates to the hepatitis
waiver or the waiver that
applied
in Scotland in the
context of the HIV Haemophilia Litigation and
,
in
particular
,
whether that waiver covered only
hepatitis
--
sorry, only HIV or both HIV and hepatitis.
I'll come back to that later on
today
, sir, but we also
intend to disclose a short addendum note addressing it.
In terms of witness evidence
on Scottish
Government decision making, the Inquiry has already
heard from Duncan Macniven and Lord Forsyth
, but
the
Inquiry is also obtaining a further witness statement
from a further Scottish Government official,
Mr
John
Davi
e
s
,
who was
a senior official in the
Scottish Home and Health Department between 1983 and
1985
.
We will see his name appear on
a
number of
documents relating to AIDS in particular during the
course of
today
.
The
Inquiry
is in the process of
obtaining that statement and it should be available
shortly, both a written note
and
what I say orally will
fall to be considered alongside that statement and
Mr Davi
e
s'
s
evidence.
Now
,
the structure of the rest of
today
will
broadly follow the structure of the written note
for
those
who are following it. I should flag that one
3
topic I
in
tend to miss out more or less completely
today
is self-sufficiency and supply of blood products.
Now
,
that topic was of course considered in some
detail in the March hearings
.
The written note add
s
some further detail on the involvement
of
Scottish
Government decision-makers
.
They look
ed at
very similar
issues and a similar chronology to
the
material
considered in March. The evidence that's available is
in the written notes and I'll be focusing on other
topics
today
.
Finally
,
on terminology, much of the material that
we're going to be looking at
today
concerns the Scottish
Home and Health Department, the SHHD, which is a bit of
a mouth
ful
sometimes
.
I'll occasionally refer
to
it
as
the
HHD, occasionally as "the Department
".
I
wi
ll try
to make it clear when I'm contrasting it with the
equivalent department in England and Wales, the
DHSS
or
the D
epartment
o
f
H
ealth
.
I'm going to move now, sir, to the structure and
organisation of the HHD and the Scottish Office
relatively briefly and its relationship with other
bodies
.
It will be apparent from the written note that the
sources we rely on to outline the structure and
organisation of the HHD and its position within the
4
Scottish Office mainly involved witness evidence. That
includes witnesses who gave evidence to the
Penrose
Inquiry
and witnesses to this Inquiry
,
such as
Duncan Macniven
.
The note also makes reference to
a document created during the course of the
Penrose
Inquiry which summarises
the
structure of
the
HHD in the 1980s, lists the names and titles of
number of officials and ministers, and that's a document
which is set out in the written note.
Now
,
that and a significant part of the
available
witness evidence focuses on the 1980s but many of the
key features
of the way
in
which
the Department was
structured also apply to the 1970s.
Now
,
as the witnesses we have heard from in this
Inquiry have noted, during the 1970s and 1980s,
the
Scottish Office was of course part of the wider
UK
Government. It was headed by a Secretary of State
for Scotland, beneath whom were a number of more junior
ministers.
Now
,
that Secretary of State for Scotland was
a member of Cabinet, but there were a number of areas in
which decision making, policy and decision making, was
devolved and fell to Scottish Office ministers and
officials. Health
,
including blood services
,
was one of
them. One of the issues we'll look at further during
21 September 2022
5
the course of
today
is the relationship between those
decisions taken in Scotland and the wider UK Government.
Now
,
the Scottish Office itself was divid
ed
into
a number of departments, one of which was the HHD. Each
department reported to one or more junior ministers and
through the junior minister to the Secretary of State.
The junior minister with responsibility for Health could
be a parliamentary under-secretary of state or
a Minister of State. The ministerial responsibilities
were allocated by the Secretary of State for Scotland.
As with the DHSS, the HHD had a dual hierarchy of
officials, on one
side
were administrative officials, on
the other were medical officials. Both contributed to
advice to ministers.
A very brief summary of the administrative
structure
:
the hierarchy of administrative officials in
the HHD was headed by the HHD secretary
,
who reported to
the Scottish Office Permanent Secretary. Beneath
the
HHD Secretary were under-secretaries, then an
assistant
secretary
,
occasionally called
the
senior principal,
underneath the assistant secretary, senior executive
officers, sometimes referred to as principals.
Departments
in the Scottish Office were divided
into groups, each
one was headed by an under-secretary.
Each
group was
divided
into several divisions
.
At the
6
head of the division was an assistant secretary and
,
generally speaking, groups were referred to by a Roman
numeral,
followed by a letter, sometimes
the
particular
Roman
numeral
and the particular letter changed over the
course of years
.
D
ivisions
were then generally divided
into branches and at the head of a branch was a Senior
Executive Officer.
On the medical side
,
the hierarchy of medical
officials was headed by the Chief Medical Officer for
Scotland, the CMO, beneath whom were deputy chief
medical officers, DCMOs, principal medical officer
s
,
senior medical officers and medical officers.
Until 1974 the HHD
had
one DCMO to whom principal
medical officer reported. In 1974 a second DCMO post
was created and the two individuals who were in post
from the mid-1970s in that period were
Dr Iain
Macdonald, Dr Graham Scott
.
We'll see their
names appear in a number of documents
we
look at
today
.
In 1985, Dr Macdonald was appointed CMO and the
hierarchy beneath him reverted to just one
DCMO
.
Now
,
the principal medical officer from 19
7
7 to
the early
1990s was Dr Archibald McIntyre
.
That's
a name that will appear
a
number of times
today
. The
senior medical officer with responsibility for blood
services from around 1973 to 1985 was Dr Albert Bell.
7
We'll see him appear a number of times
today
, as we will
with Dr John Forrester who replaced Dr Bell in 1985
until
1988.
Now
,
the CMO in Scotland and DCMOs had a wide
range of responsibilities. Dr Macdonald
,
in giving
evidence to the Penrose Inquiry
,
described two practices
which he said were intended to keep the CMO and the DCMO
aware of the work of the medical staff beneath
the
m.
The first one was a meeting every Monday morning, which
was chaired by the CMO or a DCMO
,
attended by PMOs
heading each of the groups
,
principal medical officers
.
He said these were quite
in
formal meetings
.
No
notes
were taken
.
The
second mechanism was a monthly report written
by senior medical officers and medical officers which
were generally known
I think as
PMO reports, principal
medical officer reports, which set out the issues and
the activities medical officials had been involved in
during that month. Dr Macdonald's evidence by the time
of
the Penrose Inquiry
is
unfortunately those reports
were
no
longer available
.
That remains the case
today
,
although we will occasionally see documents which seem
to have been intended to contribute to PMO reports.
One of the issues that was explored in witness
evidence we've heard previously in this Inquiry with
8
Mr Macniven and
L
ord Forsyth was the relationship
between ministers and officials in the HHD
and the wider
Scottish Office, in particular how it was decided
whether or not an issue should be put to a minister
f
or
a decision or to inform them about an issue.
I'm not going to repeat that evidence that's
already been given. The thrust of it was there were
n
o
set criteria and it was a
matter
of judgment for the
officials to decide when to put the issue to ministers.
I am going to highlight a paragraph in written
evidence to the Penrose Inquiry which casts some further
light on this evidence, it
comes
from the statement of
Alexander
Murray
and
,
Lawrence
,
if we could please have
PRSE0002440.
This is the statement of Alexander Murray
for
the
Penrose Inquiry
. It was
on the topic of HIV testing.
Mr Murray was a senior executive officer in the HHD
between 1983 and 1987. This statement was considering
in particular the introduction of HIV testing but
there's a section that's of more general relevance for
our purposes
.
So if we could go to page 4, please.
Then
the
third paragraph
.
That's great, thank you.
So the first sentence refers to the evaluation
programme relating to the introduction of HIV testing,
21 September 2022
9
but Mr Murray goes on to describe --
ANSWER:
Well,
can you help with that, because
much depends on timing in respect
of this
,
what is meant
by "at this stage"? Can you link that back for us,
please, to what he says earlier.
|
46,566 | 345 | QUESTION:
I believe
he's
referring to the timing of the
decision to put this issue to Scottish Office ministers
in the first few months of 1985, and how officials went
about deciding --
ANSWER:
Well,
can you be any more precise
about that?
|
46,567 | 345 | QUESTION:
That's --
sir,
I will
--
if I may, I might come
back to being a bit more precise about that.
ANSWER:
The reason for my asking is this: the
idea of evaluating appears to have arisen initially in
January 1985 with the DHSS. It is not entirely clear
when it was taken forward, but it would have been some
time between mid-January and early February, in the
DHSS.
It would appear from what is said in this
statement that the Scottish ministers were not notified
in advance that there would be an evaluation programme
and therefore weren't in a position
,
if they had wished
to do so
,
to challenge it and say, "W
ell, w
hy
are
we
evaluating? Why don't we get on with it?" Or whatever
10
might have crossed their minds
.
And that's why I'm so
interested in the precise date
.
|
46,568 | 345 | QUESTION:
Sir,
I can quite see why you're interested in
the precise date. I'm going to come back to the
introduction of HIV screening
--
ANSWER:
It's not -- if you can't answer it off
the top then better a considered
answer
in due course
.
|
46,569 | 345 | QUESTION:
Thank you, sir. I
could
try to give
you
an
answer off
the top but it would be a bit
too
rough and
ready and I will
make sure that I have a more precise
date to give you linking to this paragraph
when we get
to
the introduction
of HIV screening later
on
today
.
ANSWER:
Thank you.
|
46,570 | 345 | QUESTION:
Sir,
we can see
,
in this paragraph that's
highlighted here
,
Mr Murray describing the sorts of
factors which might lead to a minister being involved
directly in an issue
,
and he says:
"An issue like this would normally be brought to
Ministers' attention in the following circumstances: to
keep Ministers aware of important current developments
;
if something was going to appear in the media
;
if
a decision had to be made which officials considered
only Ministers can make
;
if an interdepartmental dispute
needed to be resolved
;
to bring together
,
in an overview
submission
,
a number of issues affecting multiple
11
divisions within a Department
,
or multiple Departments
;
or where developments in Scotland affected UK
Departments and vice versa. When a Department
considered an issue was of such importance that the
final
decision required to be made by the Secretary of
State, the submission would be in the form of going
first to the junior Minister concerned and then to the
Secretary of State."
As we go during the course of
today
to submissions
which were put to ministers in the HHD, we will come
across some of those circumstances.
ANSWER:
There's an element of circularity, is
there, about those reasons.
As
you
say
,
it's a matter
of judgment, but keeping ministers aware of important
current developments demands someone considering that
there is, first of all, a development. Secondly
,
it's
a current development
.
But
,
thirdly, it's important.
Those are all matters which each of them in turn
,
to
a greater or lesser extent
,
involve a judgment. Then if
something is going to appear in the media, that speaks
for itself.
But a decision had
to
-- the next one
:
"...
if a decision had to be made which officials
considered only Ministers could make
...
"
It's exactly the same, isn't it? You are sending
12
something
to
a
minister which a minister should decide.
Well,
that's a question of judgment again, isn't it
?
|
46,571 | 345 | QUESTION:
That's exactly right, sir, yes.
Yes
.
A
number of these factors come back
,
as you just
said
,
to a question of judgment
.
They're consistent
with what,
for
example
, Mr Macniven said
.
They don't
give us a precise answer
.
They don't give us a set
of
criteria by which that judgment was evaluated
.
Some of
them
are perhaps
a bit more
hard
edged
,
like something
appearing in the media
,
but you're absolutely right,
sir
, that
many of them come back to the matter of the
official's
judgement
.
ANSWER:
I mean, I suspect
that
,
as
with
most
matters of judgment
,
generally most people would agree
,
but it doesn't answer the point, really
, it
doesn't
provide a specific objective
criterion
beyond what is
set out.
|
46,572 | 345 | QUESTION:
That's absolutely right, sir, yes.
ANSWER:
Thank you.
|
46,573 | 345 | QUESTION:
We can take that down now. Thanks, Lawrence.
Now
,
the nature of the relationship between the
Scottish Office and the wider UK Government
,
more
particularly between the HHD and the DHSS
,
or later the
Department of Health, is an important aspect of our
understanding of HHD decision making in this period.
21 September 2022
13
The written note records at a more general level
some of the different ways in which that relationship
has been described by witnesses both to this Inquiry and
to the Penrose Inquiry. There might be said to be
contrasts that can be drawn between those descriptions
or at least differences in emphasis between them.
For
example
, the note records Dr Macdonald's evidence to
the Penrose Inquiry, when Dr Macdonald said that on
major policy matters the DHSS will have been expected to
take the lead, and other departments
,
such as the HHD
,
will have been expected to fit their policy around the
lead of the DHSS.
He put it another way
when
he said that the DHSS
would be expected to take the lead and then other
departments would implement a common policy, subject to
a modest degree of adaptation
in
formed by local
circumstances.
Now
,
those comments should be considered alongside
other evidence
,
such as that of Mr Macniven.
Mr Macniven commented
that
,
as a matter of good
administration, the HHD and the DHSS will have kept each
other in touch with developments in one country that
might affect the other, but he described the
Health Service in Scotland as being entirely devolved to
the Secretary of State for Scotland and
through him
to
14
the HHD, emphasised that the DHSS had
no
oversight role.
Similarly, Lord Forsyth, whilst stating that there
were occasions on which he felt that the DHSS or the
wider UK Government
hadn't
consulted sufficiently with
the Scottish Office, said that
,
broadly speaking, every
Secretary of State for Scotland used to say that they
were Scotland's
person in the
Cabinet, not the Cabinet
's
person in Scotland.
Now
,
that
is
really just a broad
brush overview
picture of this issue. Sir, you may wish to consider it
and may
well
hear submissions on how that relationship
operated in the context of particular issues, for
example the introduction of hepatitis C screening.
Now
,
the written
note
also seeks to summarise
evidence relating to the HHD's relationships with other
bodies such as the Common Services Agency and the SNBTS.
I'm not going to go very much further into that now.
One of the issues that arises in that context is the
extent to which there were difficulties or tension in
the relationship between the HHD and the SNBTS,
particularly Professor Cash, the extent to which such
difficulties may have affected decision making. It was
explored in witness evidence to some extent,
for
example
, with Mr Macniven. The written note contains
some documents, some of which suggest strains in the
15
relationship at points
but
there is more detail
,
as
I say, in the written note
.
I'm going to turn now, sir, to a different topic
,
which is Home and Health Department knowledge and
decision making in relation to hepatitis B
and
,
in
particular
,
issues relating to the screening of blood
donations
for the virus.
Most of the available documents on this issue
relate to the position in the 1970s. There was some
evidence available of the HHD's understanding of
hepatitis B in the 1960s. I'm going to highlight one of
those documents now.
Lawrence, could we please have SCGV0000279_165.
Now, this is a letter that we can see
,
from the
date in the top right-hand corner
,
that was sent on
27
September 1968. The letter heading at the top is the
Scottish Home and Health Department
.
If we could just go through, please, Lawrence
,
to
the second page for a moment
,
we can see the signature
at the bottom of the page
.
It comes from the Chief
Medical Officer in Scotland at that time,
Dr Brotherston.
If we go back, please, to the top of the letter,
it's addressed to "Dear Doctor".
If we go, please, Lawrence to the
bottom
of this
16
page
,
we can see who Dr Brotherston meant
,
"Medical
Officers of Health, General Medical Practitioners
"
.
Back up, please, again to the first paragraph. We
can see the reason why this letter was being
sent
.
Dr Brotherston says
that
:
"
From 1st October
,
1968 effective jaundice and
measles will be generally notif
iable
the Public Health
(Infectious Diseases
)(
Scotland) Amendment Regulations
1968"
.
The third paragraph makes it a little bit clearer
why this letter is being
sent
:
"The principal object of
making
all forms of
infective jaundice
generally notifiable is to enable
Medical Officers of Health to
enquire into the
epidemiological background."
ANSWER:
Infective jaundice was not serum
--
necessarily serum hepatitis
.
|
46,574 | 345 | QUESTION:
What we see in the next
two
paragraphs
I'm
going to take you to, sir,
is Dr Brotherston seems to
use the term
"
infective jaundice
"
to cover both what we
understand
becomes
hepatitis A and
also
serum hepatitis
,
hepatitis B.
So in the fourth paragraph that begins "The
majority
",
it says:
"The majority
of
cases of infective jaundice
21 September 2022
17
notified under
the
new Regulations are likely to be due
to
infective
hepatitis, which is a common condition
believed to be of increasing" --
ANSWER:
That's what he deals with above.
That's not serum hepatitis.
|
46,575 | 345 | QUESTION:
It's not, sir, no.
ANSWER:
Then if we go to
--
what is of
interest to us is the last paragraph, is it?
|
46,576 | 345 | QUESTION:
It's
the
next paragraph,
ye
s. It's
not quite
the last one because there are more below that. So he
starts with what becomes hepatitis A
. He
then moves to
serum hepatitis, which is what
is
of interest to us
,
and
he says this
--
I just wanted to highlight the first few
sentences in this:
"Serum hepatitis occurs less frequently than
infective
hepatitis. It's potentially a more serious
condition with a longer incubation period of usually
,
60-160 days. Transmission is almost invariably by
a
parenteral
route and a history of a blood transfusion
,
or
of an injection by any parenteral route, within the
incubation
period
may suggest this
diagnosis
."
Then in the last sentence of this paragraph he
refers to
:
"
Outbreaks both of infective hepatitis and serum
hepatitis
have been reported
from
a number of units
18
undertak
ing
intermittent haemodialysis for the treatment
of chronic renal failure."
We'll come back to points at which that sort of
issue comes up in the early 1970s.
So that's a document -- relatively brief but at
least makes some reference to the HHD's understanding of
serum hepatitis in the late 1960s.
We move forward to the early 1970s
,
and what we
see in the available documents is the HHD becoming
involved in debates amongst regional transfusion
directors in Scotland over the introduction of screening
of blood donations for Australia antigen
,
for serum
hepatitis, what becomes known as hepatitis B screening.
We can see evidence of the debate that takes place
around this time
.
In June 1970 a meeting takes place on
that date to discuss a policy which might be recommended
on the use of Australia antigen screening of blood
donations
.
The detail is in the written note.
That meeting took place at around the same time as
an outbreak of hepatitis in Edinburgh
,
which was in
a renal unit,
a
haemodialysis
unit
.
That meeting at which th
is
issue was
discussed
was
attended by transfusion directors and the HHD
,
including
Dr Macdonald.
The note of the meeting which we have records that
19
prior to the Edinburgh outbreak, Scottish transfusion
directors had felt that the time was not yet right for
the
screening of blood. Their position begins to change
around this time, and there seems to be a view that
screening should be introduced
,
at least for high risk
patients
,
such as those undergoing dialysis
,
but they
say it wouldn't yet be feasible to screen larger
quantities of blood for other emergency use.
We do see in the documents around this time,
mid-1970, certain Regional Transfusion Directors in
Scotland emphasising the risk posed by serum hepatitis
and pressing the HHD to support a more general
introduction of screening at an earlier date. We see
that in particular in correspondence from the director
of the Glasgow and West of Scotland RTC, Dr Wallace, and
we're going to come back at various points to
correspondence involving Dr Wallace.
One of those, which is just summarised in the
written note
,
which I won't go to now, but is of
interest, is a
16
July 1970
letter written by Dr Wallace
to Dr Macdonald at the HHD, which attached a paper on
serum hepatitis and the Blood Transfusion
S
ervice
.
Now
,
it was directed in particular at issues
relat
ing
to renal dialysis and it contains some material
that
is of wider relevance for our purposes.
20
A couple of points to highlight in particular from
that document -- and we can take that down now, please,
Lawrence -- that paper provided by Dr Wallace said that
for the past 30 years, so this is 1970, for the past
30 years, homologous serum jaundice, serum hepatitis,
has been recognised as a delayed complication of the
transfusion of blood and blood products.
Dr Wallace also recorded that the highest
incidence
of serum hepatitis ha
d
been observed in
recipients of plasma prepared during World War II. He
said that was not surprising because it was not uncommon
to prepare a plasma pool from 500 donations of blood.
So we see there Dr Wallace making a link between
hepatitis risks and pool sizes and providing that
information to the
HH
D.
There was a further letter from Dr Wallace to the
HHD in August of 1970 in which he begins to press more
strongly
for the screening of all donations
for
Australia antigen. One of the comments he makes is that
even if this mass screening only reduces the inciden
ce
of serum hepatitis by 25%, it would still be
a significant reduction in the inciden
ce
of what can be
a serious illness
:
"
In the present climate, I think the
SNBT
S
must be
seen to be doing everything possible to reduce this
21 September 2022
21
serious transfusion risk
.
"
Now
,
by this time
, which is
around mid-197
0,
the
introduction of Australia antigen was also being
considered by the DHSS.
In September 1970, a new group
was
set up
,
the
advisory group on testing for the presence of Australia
hepatitis associated antigen and its antibody, chaired
by Dr Maycock, becomes known as the Maycock Advisory
Group
.
It was appointed jointly by the DHSS, the HHD
,
and the Welsh Office. Dr Wallace was one of its
members.
Now, the work of that group has been considered by
the Inquiry on previous occasions
.
I'm not going to go
in detail into its development and what it found, but
its work relates to
the HHD's
understanding and response
to hepatitis risks during this period.
It seems that the HHD was aware in the early
1970s, so around 1970, 1971, that Scottish RTCs,
Regional Transfusion Centres
,
were taking different
approaches to screening
,
both in the extent of screening
they were
under
taking and
in
the technique they were
using for screening
.
If
we move forward to May 1972, the Maycock Group
publishes
,
issues a report, which recommends the
introduction of routine testing of all blood donations
22
for Australia antigen
and
its antibody, recommend
s
a
number of different testing methods
.
I'm going to keep moving forward to 1973, when the
HHD becomes more closely involved in discussions about
the appropriateness of different screening techniques
for
serum hepatitis. So rather than the principle of
whether or not to screen or have mass screening
,
the
appropriateness of different techniques.
Now
,
this was an issue being considered by the
Maycock Group
--
ANSWER:
By now, by 1973, there was general
screening.
|
46,577 | 345 | QUESTION:
Yes
.
ANSWER:
So the question then is
:
what form of
screening are you having?
|
46,578 | 345 | QUESTION:
Exactly, sir
,
yes
. When I refer to screening
techniques
,
what I mean is the debates about exactly
that, sir, the form of screening technique which is --
ANSWER:
Yes
.
|
46,579 | 345 | QUESTION:
-- appropriate.
Now this issue which is being considered by the
Maycock Group, the form of screening which is
appropriate, is also being raised in correspondence
again between Dr Wallace and the HHD
,
which provides us
some insight into what the HHD -- what information it
23
had and what its thinking was at the time.
There's a series of documents
,
which I'm not going
to go into the detail of now, which is summarised in the
written note
,
which begin in February 1973. The
y are
about
a trial that Dr Wallace began
of a newer
technique, radioimmunoassay, sometimes referred to as
RIA
,
which was more sensitive and
more
expensive than
the method then being used by his RTC, the
electrophoretic method.
We can see that Dr Wallace writes to the HHD
effectively to say that in order to be able to undertake
this trial, he would get some equipment loaned free of
charge from Abbott Laboratories
.
He would need to
purchase some reagents
in
order
to undertake the trial
.
He asks for the HHD's agreement, the additional funding
that would be necessary for that trial to take place.
The HHD agrees.
I mention that correspondence
,
which is from
February 1973
,
because it forms the background to some
later developments and
,
in particular
,
to disagreements
which emerge later on between the HHD and Dr Wallace
about the appropriateness of different screening
methods.
Now
we're moving closer to that by going forward
to
the mid-1970s
,
the period
from
1975
.
The HHD's
24
involvement in debates over screening techniques
intensifies. That debate is taking place in the context
of the Maycock Group preparing a further report.
The
documents show that the
HH
D received a draft version
of the Maycock Group's updated report in around
February 1975. It discussed that draft report
internally
,
discussed it with the SNBTS over subsequent
months
,
and provided comments to the Maycock Group
.
I want to highlight two internal HHD documents
from around this time which touch briefly on the
Department's understanding of its role in this issue,
and also its views on screening
.
The first, please,
Lawrence, is
SCGV0000205_085.
Now
,
if we can -- if you could
zoom
out slightly
so we can see the whole document, we can see that this
is an internal minute which is from Dr Scott
. It's
dated 1 May 1975. It's addressed to Mr Roberts and
Dr McIntyre in the HHD
.
The subject is
"
Hepatitis B
surface antigen testing
"
.
Now
if you could
please
zoom
in on the top half of
the page, thank you.
Dr Scott says this, he refers to the
NMD, the
National Medical Director
,
which at the time was
Major General Jeffrey,
has asked if Dr Wallace and
presumably the other R
T
Ds who wish to use
R
PH, reverse
21 September 2022
25
passive
haemagglutination
, one of the screening methods
for screening hepatitis, can go ahead now in
anticipation of Maycock to introduce the
test in
place
a
C
IE
O
P which was the technique then generally in use,
counterimmunoelectrophoresis
.
ANSWER:
Osmophoresis.
|
46,580 | 345 | QUESTION:
Osmophoresis, thank you, sir.
If we move down to the paragraph that begins
"I have
no
qualms" Dr Scott says:
"I have
no
qualms about anticipating the Maycock
report
as I wonder if we could in any case stop
a
[
Regional Transfusion Director
]
who 50 to do RPH now or
indeed RIANSWER:
It is to a great extent a clinical matter
;
similarly, we cannot force Dr Cash and the others to
adopt RPH in place of PH
.
"
PH is passive haemagglutination
.
Dr Cash
,
in the
Edinburgh Regional Transfusion Centre
,
was using
a version of passive haemagglutination at the time
.
He then goes on to say
:
"
There
is
a question of money but that would be up
top the
NMD.
However this is a matter of such
importance
I should have thought that the money must be
found."
Now that's one perspective from Dr Scott at the
time on what the Department's role was in decisions
26
around the introduction of different screening
techniques in RTCs in Scotland.
If we go next, please, to PRSE0000704.
This is Dr McIntyre in the same series of minutes
providing his perspective.
So we can see it is dated
13
May 1975
. It's
from
Dr McIntyre to Dr Scott on the same issue.
I'll just read out the first sentence.
Dr McIntyre says:
"There
is
no
doubt
that
the Advisory Group will
recommend reverse passive
haemagglutination
(RPH) for
routine screening of blood
for HBsAg. It is
also likely
that following representation
from
this
Department the
passive inhibition
agglutination test will
be accepted
as being perfectly satisfactory for the detection of the
antigen."
What that sentence provides us some insight into
is the Department's role in commenting on the draft
Maycock report before it was circulated more widely.
Dr McIntyre says
:
"
From the draft text of the report it would appear
that they are approximately equally sensitive. There
would seem
,
therefore
,
to be
no
reason why a gradual
change should not be made
at
an
early date to one or
other of the more sensitive methods."
27
Now on to the next paragraph
,
Dr McIntyre says
that:
"This subject will be sure to come up at the
Scottish Transfusion Directors
'
meeting on
11
June and
if the
NMD
[
National Medical Director
]
k
new in advance
that we were agreeable in principle to the introduction
of
a
more sensitive test he could perhaps ask the
Directors to come prepared to discuss at that meeting
the test they were likely to adopt and the financial
implications thereof. I agree that the question of
money will be up to the NMD but I
feel
sure that he will
eventually come to us for additional money for this
purpose."
So we can see there officials discussing the
different screening tests they consider to be
acceptable, also linking decisions around the
introduction of those tests to the question of funding
which ultimately comes from the Department.
Now
,
the updated Maycock report which is discussed
in these minutes is eventually finalised in
September 1975. That report says that the
C
IEOP method
is
no
longer recommended.
It
recommends replacing it
with RPH or P
H
. It also
discusses
the RIA method
,
which
it says has some
extra
sensitivity, but that
advantage
is outweighed by
disadvantages
, in particular that it is
28
more expensive and
more
difficult to perform.
Now
,
those recommendations come to be discussed at
a December 1975 meeting of SNBTS directors. Important
to note when looking at the minutes of that meeting that
Dr Wallace who is there emphasises that the
recommendations in the Maycock updated report were
drafted in early 1975. In other words, suggesting that
there was a possibility that they were becoming out of
date by the time we get to directors considering and
accepting them.
Now, by the
time
we
get to March 1976 it seems
that
recommendations in the Maycock updated report had
been implemented in Scottish RTCs and that the HHD was
aware of that.
T
hen
we
get to the summer of 1976 and by
this time differences have begun to emerge between
Dr Wallace and the HHD about the appropriateness of the
different techniques which had been covered by the
Maycock report.
Those differences related in particular to whether
funding should be provided for RIA screening
,
which is
a more sensitive method. I'm going to quickly go to
a document in which Dr Wallace
set
out his position in
this issue to the Department
.
It's PRSE0000964.
That's
a 22
June 1976 letter to Dr McIntyre at the
21 September 2022
29
Home and Health Department
.
We
can see
at the top of
this document
it comes from the
Glasgow and the West of
Scotland Blood Transfusion Service
.
On the left-hand
side at the top
,
the regional director is Dr Wallace
.
And if we go just very briefly to the end of the
document, we'll see that it's signed by the Regional
Director
,
in other words Dr Wallace.
If we could go back, please, Lawrence
,
to the
first page. This letter is headed "Total Screening of
Donations for
HBsAg
".
I'm not going to read them out, but in the first
paragraph Dr Wallace describes some of the work
undertaken by the Maycock Group. In the second
paragraph he says to Dr McIntyre:
"You attended meetings of the Central Advisory
Group under the chairmanship of Dr Maycock on the
testing of donations for
HBsAg
. The views of the
members of the Advisory Group were similar to those
reported by the special WHO group on the same subject.
It was acknowledged that radioimmunoassay
(
RIA
)
was the
most sensitive method available for the detection of
HBsAg
but in practical terms both expert groups
recommended the reverse passive
haemagglutination
(
R
P
HA
)
should be introduced as
the
method of total screening
because RPHA could be introduced much more rapidly than
30
the
more sophisticated RIA technique."
So that's Dr Wallace describing the reasons as he
understood them for the Maycock Group's recommendations.
He then goes on at the bottom of this page to
describe some of his own involvement. He says:
"As a member of the Advisory Group I was aware of
the views of the members and I decided to continue my
original work within the limits of the finance
available."
So that's the work
he's
undertaking to test
different screening methods and to compare their
sensitivity. He says:
"I
discussed the possibility of a further
evaluation of RIA with Abbott Laboratories which is the
only firm currently producing reliable reagents for the
performance of RIA testing for
HBsAg
.
I
had sufficient
money available to produce reagents for RPHA testing and
Abbott Laboratories agreed to provide me with all the
facilities for
RIA
testing for a period of
one
year at
the same cost as would have been incurred by producing
reagents for the RPH |
46,581 | 345 | QUESTION:
This one
?
Of course, sir, yes. It's
SCGV0000079_013.
S
ir,
we can see at the top of this document that
it's a meeting of the Scottish Health Service Planning
Council Blood Transfusion Advisory Group. In attendance
at the meeting is Dr McIntyre from the HHD as well as
number of
trans
fusion directors, and we can see
Dr Wallace is one of the individuals present at that
meeting.
We can see the discussion which I was just
referring to over the page
.
ANSWER:
Lawrence, could
you just go back to
the top of the page
.
|
46,582 | 345 | QUESTION:
Of course.
ANSWER:
Thank you.
9
November -- sorry,
9
March 1977.
|
46,583 | 345 | QUESTION:
9
March 1977.
ANSWER:
Thank you.
|
46,584 | 345 | QUESTION:
While we've got that date, sir,
9
March 1977,
21 September 2022
41
earlier on I described the Maycock Advisory Group draft
report being circulated to the
HHD
in around
February 1975. The report seems to be finalised
September 1975, discussed by directors in Scotland
towards the end of that
year
.
Then there seems to be a period over about the
following year
until around this time
,
in March 1977,
before the Department
circulates
it more widely in
Scotland
,
with a covering
circular,
so it's that timing
which
seems to prompt
some of
the discussions we see in
these minutes.
If we go over the page, please, Lawrence
.
Thank
you.
It's the top half of this page, the entry
paragraph that begins "Report of the Advisory Group
on
the
Testing for
HBsAg
and its Antibody"
.
We can see in the second sentence Dr Wallace
emphasising the point he'd made in the previous meeting
,
that the information in the report was based on 1974
data and was now substantially out of date.
He says:
"In view of the considerable advances which
had
been made in the meantime
he and most members of the
Maycock Group would
no
longer agree with the main
recommendations of the Report."
42
Refers
to
a further report that's been prepared by
the WHO
,
and then the entry which I had started to read
out earlier:
"Rapid progress was being made in the use of
various blood products
with
a consequent increase in the
risk of the spread of hepatitis."
ANSWER:
Yes
, he introduces it by saying
:
"
In
view of the considerable advances which
had
been made in the meantime
[
ie
since the drafting of the
report
] he and most members of the Maycock Group would
no longer agree with the main recommendations of the
Report."
|
46,585 | 345 | QUESTION:
That's exactly right, sir, yes, that's
Dr Wallace's contribution at this time, March
1977.
ANSWER:
Then he goes on to the bit you're now
quoting. Let's have a look at that.
|
46,586 | 345 | QUESTION:
Yes,
that's right sir, yes.
"
Regional Directors
were concerned at this
increasing risk and would be considering the entire
question in the near future. The situation whereby
Reports of this kind had to be widely circulated for
approval prior to publication invariably resulted in the
document being somewhat dated,
particularly in the
developing situation."
There's then a suggestion about how to deal with
43
this issue:
"However
,
a suggestion that this situation could
be overcome by the issue of updating information sheets
was thought to have considerable merit
. It
would also
avoid having to go over old ground again.
"
It
was
intimated that the report was initially
a report to the Health Department for consideration of
any financial implications, although tests
recommended
in the report had been in use for some considerable
time
,
and there's a reference at the end there to
apprehension amongst staff working in the centres
.
While we've still got this
paragraph
up,
sir,
the
first sentence at the beginning
:
"
The second report of the Advisory Group had now
been circulated under cover of NHS Circular 1977(GEN)2
.
"
It was that
recent development
that I was
describing earlier
,
which is wide circulation of this
Maycock September 1975 report, not taking place until
1977, though regional directors were aware of its
recommendations earlier
.
ANSWER:
So the concern which
he
is expressing,
and begins "Rapid progress" is the use of blood
products, which would include presumably clotting
factors, would lead to a consequent risk -- increase in
the risk of the spread of hepatitis, and it's that risk
44
which they think is now more concerning and therefore
there's a greater case for effective screening. That's
what
he's
saying, is it?
|
46,587 | 345 | QUESTION:
That's exactly right
,
sir, yes
.
And that would
be consistent with a document that we looked at earlier
from Dr Wallace to the Department and Dr Wallace linked
some of his concerns about the sensitivity of the test
to developments in the use of blood products to Mr Watt
at the PFC, and the use of fractions
.
ANSWER:
Yes
. Thank you.
|
46,588 | 345 | QUESTION:
We're finished with that now, thanks, Lawrence
.
Now
,
in the remainder of the 1970s and early 1980s
we can see in the document
s
further consideration of
screening methods, that includes developments of
,
for
example,
a lower cost RIA, and other methods, trials of
differen
t
techniques were being undertaken at RTCs. I'm
not going to go into the details of those developments
now
.
The Maycock Advisory Group has reconvened under
a
different chair. The written note summarises the
HHD's involvement in those developments.
I'm going to move forward
,
finally
on this topic,
sir, to a last couple of documents in 1981, which is
relevant to how the
HH
D understood its role in relation
to screening and also what transfusion directors'
responsibilities were.
21 September 2022
45
So in May 1981 a further report from the advisory
group on hepatitis B testing
,
by this point under
a different chair
,
had
become
available. That report
was
discussed at a meeting which was attended by the
HHD
.
It considered the merits of different screening
methods which
had
developed by this point beyond those
that we've been looking at, RIA, ELISA tests, and RPHA
tests. That updated report recommended minimum
sensitivity levels for tests used by RTCs.
We can also see from that report a conclusion that
it was only possible to lay down approximate guidelines
for the sensitivity testing.
If we could go to PRSE0003920, we can see
a meeting of SNBTS directors
, 22
September 1981, chaired
by Professor Cash, attended by Dr Bell and also
Mr Finnie for the Department, in which there's
discussion of this report. Can we go to page 5, please.
Thank you.
Down little bit further so we can see the whole of
section 5
.
Thank you
. "
Testing for hepatitis
"
.
Professor Cash introduces the report that I was
just seeking to summarise, and there's a discussion of
that report's recommendations
,
and I just wanted to pick
up Dr Bell's comments here.
Dr Bell is recorded as having advised
:
46
"...
that
the
document was not intended to provide
a legal safety net
but to provide guidelines on the best
procedures to be adopted
,
and
that
Directors' clinical
judgment and adherence to the recommendations
,
within
the finance available
,
was all that could be expected of
them."
So we see here Dr Bell emphasising that the use of
particular screening tests that were available by this
point was a matter of clinical judgment
,
also
recognising that those choices had to be made within the
finance that was available. The finance that was
available ultimately being a matter for the Department.
Sir,
that
was all I intended to say about
hepatitis B screening and hepatitis B for
today
. I'm
going to move on now to another topic. I note the time,
11.10
. I
wonder if this would be a convenient moment
for a break. Alternatively, I can start on our next
topic, which is going to be HIV and AIDS.
ANSWER:
Yes
,
well,
let's do that, then, and
come back to HIV and AIDS at 11.40.
(11.10 am)
(
A short break
)
(11.40 am)
|
46,589 | 345 | QUESTION:
Sir, I'll be moving now to issues relating to
47
which HIV and AIDS
,
the Department's knowledge of
matters relating to HIV and AIDS, and their responses
.
Now
,
the earliest reference to AIDS in documents
involving the Home and Health Department
,
at least in
the material available to the Inquiry
, would
appear to
be a
21 January 1983 meeting of SNBTS and Haemophilia
Centre Directors. It was chaired by Dr Bell and
attended
by Dr McIntyre and
Mr
McBryde. I'm not going
to the minutes of that meeting
,
which have been
considered
before
,
but during the course of it
Professor Cash draws the
meeting's
attention to recent
articles in the United States and some other documents
including an MM
W
R extract relating to AIDS
.
If we move forward to May 1983, by this stage the
SHHD was
receiving information relating to AIDS from
other sources, in particular the DHSS.
Now
,
the Inquiry has previously considered
a 3
May 1983 DHSS minute on this subject which enclosed
a line to take and a background note which had been
prepared for the Prime Minister.
Now
,
those documents were copied to
John Davies,
who was Assistant Secretary at the time at the Home and
Health Department. The Inquiry has looked
at those
documents previously
.
They included a line to take that
there was as yet
no
conclusive proof that AIDS had been
48
transmitted
through
American blood products.
I'll come back to that line later.
There was also a briefing note which described the
risk to haemophilia patients treated with Factor VIII,
said they were at increased risk of AIDS, and described
the risk as follows:
"As yet there
is
no
conclusive proof that AIDS is
transmitted by blood as well as by homosexual contact
but the
evidence is suggestive that this is likely to be
the case."
S
ir,
those are DHSS documents but they are copied
to officials in the Home and Health Department. What
we
see
in the documents
is
,
in the days that follow those
documents being provided, both administrative and
medical officials work on a submission to the Junior
Minister
who
had
responsibility for Health in the
Department at this time, and that was John MacKay
,
and
I'm going to go to the submission in which these issues
are brought to the Minister's attention.
Lawrence
,
it's PRSE0004037.
It's a one-page document
.
We can see at the
bottom it's from
JG
Davies, John Davies
,
dated
6 May 1983.
At the top it is addressed to PS, that's
a
private
secretary
,
to
Mr
MacKay, and copied to
some
another
--
21 September 2022
49
to a number of individuals within the Department.
In the introduction Mr Davies says that:
"Mr MacKay may have seen comment recently in the
media about AIDS. He might find it helpful to see some
briefing
material on the matter prepared earlier in the
week by DHSS for the Prime Minister."
Those are the documents which I've just described.
Mr Davies
said:
"We agree with the general line in the briefing.
There are, however, a few Scottish points to be
made
...
"
The first is about imported Factor VIII.
"Scotland is virtually self-sufficient in
Factor VIII. Occasional purchases of imported
concentrate are made for clinical reasons
:
only a very
few patients
are
involved."
On Scottish cases Mr Davies said that:
"
No
confirmed case of AIDS
has yet
been reported
in Scotland. Any suspected for diagnosed case
will be
reported to the Communicable Disease
s
Unit
at
Ruchill ..."
ANSWER:
As a matter of interest
,
the wording
there is "
No
confirmed case of AIDS". That leaves open
that there may have been a suspected case.
|
46,590 | 345 | QUESTION:
That wording, you're absolutely right, sir,
50
does leave that open. I'm not aware from the documents
that I've seen, and I believe are available to the
Inquiry at the moment, that there were any suspected
cases of AIDS in Scotland at the time of this note
--
of
this minute. It's an issue we might want to investigate
further, but I'm at least not aware of any suspected
cases that ha
d
been brought to Mr Davies's attention or
the attention of Home and Health Department officials
which might lend particular significance to the use of
the word "confirmed" in the submission but
,
as I say
,
it's something we can look
in
further to confirm the
position
.
ANSWER:
Thank you
.
|
46,591 | 345 | QUESTION:
On
"Donation
Policy
",
Mr Davies wrote:
"The Blood Transfusion Directors in Scotland are
very aware of the problem and have it under constant
consideration." They are currently considering
..."
Then he
s
ets out four measures, first
:
"(
a
)
Briefing all frontline blood bank staff to
handle questions from donors
.
"(b)
Preparing a neutral factual leaflet about
AIDS and making this available at donor sessions
-
perhaps drawing attention
to
it
as a follow-up to recent
press and television publicity
;
"(c) In
formal contact with representatives of the
51
relevant gay associations
.
"(d)
Avoiding collection in
high
risk locations
such as prisons or where there
is
known to be
a
high
proportion of homosexuals or drug abusers in the
population."
Now
,
that final sentence there brings with it the
suggestion that collection in certain high risk
locations such as prisons was still taking place in
Scotland at this time
.
There's a later section in the
written note which deals briefly with prisons and what
the Home and Health Department understood to be the
position at this time
,
in May 1983.
ANSWER:
Just as a matter of interest, is there
any -- or what are your submissions as to the force of
the word "neutral" under
(iii)
(b
), "
Preparing a neutral
factual leaflet
"
? It's a word
which
is often used where
there are two rival views. What do you submit the force
of that is? Or is it simply saying
what
we're trying to
be and
give the objective facts without sensationalism?
|
46,592 | 345 | QUESTION:
I think's more likely to
tend
towards that
second characterisation, sir
.
It's perhaps a slightly
unusual word to use in this context. I think it is
likely to reflect officials
'
understanding that already
at this time
,
in May 1983
,
there was what they
considered to be a great deal of sensationalism in the
52
press in particular around any issues relating to AIDS,
that they were keen to avoid adding to that
sensationalism
.
It
might also relate to a desire to avoid causing
any offence amongst blood donors, a neutral leaflet
which tries to present facts about AIDS which doesn't go
beyond presenting matters as neutrally as they could be
at the time, so as to avoid causing offence
.
Those are
two suggestions that come to mind immediately, sir, but
it's a word that might be worth keeping in mind as we
look through the remainder of the documents and when we
consider documents in the written note relating to the
p
reparation of the AIDS leaflet.
What we'll see in my summary of those documents,
sir, and also in the written note, is perhaps less
direct involvement by Scottish officials and certainly
by Scottish ministers in the wording of leaflets
relating to AIDS than might have been seen in England
and Wales when officials and ministers were more
directly involved in the wording.
So we see, sir, from this document a number of
matters which will repeat and
will
form a part of the
pattern of officials' response to the risk of AIDS
.
One
of them in particular is an emphasis on Scotland being
,
as they describe
it
,
virtually self-sufficient in
21 September 2022
53
Factor VIII.
We know that Mr MacKay
,
the Minister,
saw
this
document because we have a response from his Private
Secretary
,
which I won't go to
,
essentially just
expresses the Minister's gratitude for this submission
.
Now
,
around this time
, and certainly
by June 1983
,
Dr Brian McClelland of the South East Scotland Regional
Transfusion Centre had begun work on an AIDS donor
leaflet
.
The steps taken by Dr McClelland in relation
to that leaflet have been explored in evidence
previously heard by the Inquiry, notably Dr McClelland's
own oral and written evidence.
The Home and Health Department's involvement in
that issue is set out in the written note. I'm not
going to go into the detail of
it here for reasons of
time.
The evidence suggests that Dr McClelland's RTC in
Edinburgh began issuing an AIDS donor leaflet in
June 1983, suggests that the Home and Health Department
had very little involvement in the preparation of its
contents
.
When Dr McClelland described orally to this
Inquiry how he went about liaising with the Home and
Health Department, he described essentially asking for
forgiveness rather than permission after taking steps to
54
issue the leaflet.
The documents also show
that
around this time,
so
this is
mid-1983, Home and Health Department officials
were monitoring the
development of a
donor leaflet being
prepared by the DSS and transfusion directors in England
and Wales.
The documents show officials in Scotland liaising
with their counterparts in the DHSS, and emphasising the
need for the Home and Health Department to be consulted
on the development of that UK leaflet.
If we move forward to 1 July 1983, when a DHSS
submission on the publication of an AIDS leaflet was
submitted to ministers in England and Wales, as we've
seen with some of the other documents relating to AIDS,
it was copied to an official at the Home and Health
Department, that was Mr Wastle
.
After that submission is copied to officials in
the Home and Health Department, they begin to discuss it
internally and to prepare a submission to go to their
minister, Mr MacKay
.
I'm going to turn
to that document
now
, which is
dated 11 July 1983
,
so
about ten days after the DHSS
submission.
It's SCGV0000147_157.
Again,
from Mr Davies
,
once
more to the Private
55
Secretary
,
to Mr MacKay
,
and I'm going to highlight the
second paragraph
,
and what Mr Davies says there:
"Regional Transfusion
Directors
in England have
now prepared the attached draft leaflet for printing and
publication by DHSS
(it is
substantially based on an
earlier draft by Dr McClelland at the Edinburgh and
South East
Scotland Blood Transfusion Service
)
.
The
main aim of the leaflet is to discourage practising
homosexuals from donating their blood and
, in
view of
the sensitivity of the issue, DHSS have consulted their
Ministers over its terms.
Our
understanding is that
some reservations have been expressed and that DHSS
officials are toning down the text somewhat, largely to
make clear that, even in the US, only a small number of
cases have been reported. DHSS Ministers have also
asked for a formal statement to be available for use at
the time of publication to diminish any risk of over
reaction
...
"
Mr Davies refers to a possible opportunity for
that statement.
Then in the final paragraph of this page, he said:
"We consider that the leaflet should be issued on
a UK basis, and
are
arranging for the text to be
adjusted accordingly. The main change that
is
required
is to alter references to the 'National' (ie
English and
56
Welsh) Blood Transfusion Service.
No
separate Scottish
announcement would be called for, but an important point
for any press inquiries is that Scotland is virtually
self
sufficient in Factor VIII."
Sir,
we can see here officials recommending to
the
Minister that a UK approach to this leaflet would be
appropriate, suggesting that some changes might need to
be made to its wording but really focusing on what might
be considered to be more minor amendments to reflect
that applies to Blood Transfusion Services in the whole
of the UK and not simply England and Wales
.
And what
we
also see in the last sentence of this document is an
emphasis again on
self-sufficiency in Scotland
.
I'm going to go very briefly to the Minister
'
s
response --
ANSWER:
The underlying reason for that
presumably is an appreciation in mid-July 1983 that the
public, or for that matter others, might think that if
the blood is sourced from domestic national sources, it
is safer than blood products imported from the
United States.
|
46,593 | 345 | QUESTION:
That's exactly right, sir, yes.
ANSWER:
And making a virtue of that
.
|
46,594 | 345 | QUESTION:
Absolutely
making a virtue of that, sir,
yes
.
ANSWER:
Yes
. Thank you.
21 September 2022
57
|
46,595 | 345 | QUESTION:
It might be said to be tied not only to the
public perception of the
risk
of domestically produced
blood products but also what officials appear to
understand the relative risks to be. I'll come to
a
document a little later on which lays out -- or which
provides an insight into at least what some officials
understood to be the advantages that were gained from
blood products being produced domestically rather than
relying on importing particularly American sources.
ANSWER:
Yes.
|
46,596 | 345 | QUESTION:
So the Minister's response which comes through
his Private Secretary the following day
.
It's just
a short document
.
SCGV0000147_153.
At the bottom we can see it's from Geoff Pearson
,
Private Secretary to Mr MacKay, directed to Mr Davies.
It
starts by simply noting that the Minister has seen
the minute
:
"
[
The Minister
]
enquired whether the
surplus
capacity at the Protein Fractionation Centre at Liberton
could be used to increase UK production of Factor VIII
-
he believe
s
the current English production is some only
60% of demand."
So that's the Minister taking on board the point
that
is implicit in Mr
Davies
's document, which is that
domestically produced
products
are understood to be of
58
lower risk than imported ones
,
and wondering whether
Scotland could help to pick up additional production and
send some of
it to England and Wales.
Now
,
the response to that enquiry doesn't come
until some months later in October and I'll come
to
it
.
The answer was essentially
no
, but it is perhaps
notable
,
sir
,
that the points that are picked up by the
Minister and the concern with -- or the emphasis placed
on Scotland's self-sufficiency and the relative risks
,
as they
we
re understood at the time
,
between Scottish
and imported blood products
.
Now
,
what the documents shown in the summer of
1983 is HHD officials continuing to be updated about the
DHSS's approach to this donor selection leaflet, this
AIDS leaflet which was still being prepared. It was
eventually agreed to be distributed in Scotland as well
as England and Wales from September 1983.
A separate Scottish press release was prepared at
the time that that leaflet was introduced, and I'm going
to turn
it
to
very briefly. It's PRSE0002778.
So we can see the date of this document,
1 September 1983.
The first paragraph introduces the leaflet that's
been published
.
It says it's by the Health Department
in the UK for distribution in Scotland by the SNBTS.
59
In the second paragraph, AIDS is briefly
described, and then I was going to highlight the third
,
where this press release said this:
"
No
cases of the disease have been confirmed in
Scotland and the Scottish Home and Health Department
emphasised
today
that there
is
no
conclusive proof that
the disease can be transmitted through blood or in blood
products. There is
however
no
screening test the BTS
can use to detect people with
AIDS and donors are asked
not to give blood if they think they may have the
disease or be at risk
from
it."
In the next paragraph:
"Scotland is self-sufficient in whole blood and
virtually so in blood products. Nearly all the
factor VIII issued for the treatment of haemophilia is
produced from blood plasma donated to the SNBTS by blood
donors in Scotland
.
"
ANSWER:
And that links back, does
it, to the
second paragraph
,
the second sentence, where it
described as AIDS as a "
comparatively
new
disease
to
Britain
"
?
|
46,597 | 345 | QUESTION:
That's
exactly
right
,
sir,
yes.
So
we
can see
that link being made, we can see the
emphasis on
self-sufficiency
again
.
We can also see the use of the
"
no
conclusive proof" line without a qualification
60
attached to it
on
whether or not a disease was likely to
be transmitted by blood and blood products.
It was
in
October 1983,
the next month
,
that
Mr Davies provided a response to Mr MacKay's query about
whether the PFC could produce additional Factor VIII for
England and Wales
.
The response is summarised in the
written note. I won't go
to
it
now. The short answer
was no, or rather
,
at least
,
no,
not for the time being.
We move into late 1983 and the first half of 1984,
and the Department's officials
,
based on the documents
,
appear primarily to have been monitoring developments
related to AIDS and blood products, including proposals
for further steps that might be taken in response.
Now
,
that included consideration of updates to the
donor lea
flet,
changes to distribution arrangements.
There's some reference to the possibility of small pool
blood products being prepared, some reference to
surrogate screening for AIDS, monitoring of AIDS cases,
monitoring of the DHSS approach.
HHD officials
'
involvement around this time often
seemed to take place by attendance at different
meetings, in particular attendance at meetings of SNBTS
directors, also attendance as an observer at meetings of
transfusion directors in England and Wales
,
and we've
summarised what we can get from the documents in the
21 September 2022
61
written note.
I'm going to move forward fairly quickly, sir, to
August 1984, when the Home and Health Department became
aware that a haemophilia patient living in Scotland had
contracted AIDS and the Minister was informed
.
Lawrence, could we please go to SCGV0000147_073.
S
ir,
the date of this document
is 29
August 1984,
again from Mr Davi
e
s, and again to the Private
Secretary
,
to Mr MacKay. Mr Davi
e
s wrote this:
"We have recently heard that a Scottish
resident
haemophiliac ... has [contracted] AIDS. We have
hitherto reported that Scotland is virtually
self-sufficient in Factor VIII, the blood product used
in treating haemophiliacs; and therefore that there was
no risk to Scottish haemophiliacs. This case may appear
to provide contrary evidence, and may possibly be so
reported by
the Press.
"
We are informed that the patient concerned has
only recently moved to Scotland
.
He has hitherto been
treated in Newcastle where imported Factor VIII has
probably been used. The disease takes some time to
manifest itself
,
and the Scottish product is not
implicated"
.
Now
,
a number of points which arise from this
document, sir. One of those that's perhaps most notable
62
is the way in which the risk arising from PFC factor
products was described and appears to have been
understood by Mr Davis
:
"
We have
hitherto reported that Scotland is
virtually self-sufficient in Factor VIII
..."
And that
:
"...
therefore there was
no
risk to Scottish
haemophiliacs
.
"
Rather than perhaps a reduced risk compared to
other blood products.
Perhaps also of interest in the final sentence of
this document is
what seem
s
to be a reference to the
incubation period
in AIDS
:
"
The disease takes some time to manifest
itself
..."
which will of course be relevant to an
understanding of the risk posed by factor products.
That's August 1984, and I'm going to turn
now --
and I've moved
fairly
swiftly
through this
period,
of
course there are a lot of fairly important developments
that take place
that are set out
in the notes
.
I'm
going to move forward to the Department's response to
the discovery that group of patients treated PFC
Factor VIII
had
develop
ed
antibodies to
HTLV-III
,
a group of patients sometimes referred
to
as
the
Edinburgh cohort
.
63
Now
,
the Inquiry has already heard evidence on the
timing of this discovery from witnesses,
Professor Ludlam and Dr McClelland. I'm not going to
repeat it, but what that evidence would appear to
suggest is that Scottish haemophilia clinicians and the
SNBTS started to
become
aware of this development around
or by late October 1984.
Now
,
the precise date on which the Department's
officials first became aware of the results of the
Edinburgh patients is not entirely clear from the
documents. The earliest one we have involving the Home
and Health Department is dated
20
November 1984
,
and
it's a minute from officials to the Minister
,
and I'm
going to go to that now.
It's SCGV0000147_058.
We can see the date at the bottom,
20
November 1984. It is from Hugh Morison, who was
Under
-
Secretary at the Home and Health Department at the
time
,
which is a grade higher than Assistant Secretary,
effectively Mr Davi
e
s's superior. Addressed to the
Private Secretary
to
Mr MacKay
,
and we can also see it
is copied to the Private Secretary to the Secretary of
State, so involving the Secretary of State in this
development.
Now
,
in the first two paragraphs Mr Morison gives
64
an update on leaflets in particular in AIDS developments
in relation to the AIDS donor leaflets. I'm going to
draw your attention, sir, to the second half of this
document
,
and in particular the paragraph that begins
"
A
development", and Mr Morison wrote this:
"A development of particular concern in Scotland
is that 16 Scottish haemophiliacs have been identified
as having antibodies to the virus
HTLV
III
, which is
implicated with AIDS. The presence of the antibodies
indicates that the patients have been exposed to the
virus but does not mean that they will necessarily
develop AIDS. A batch of Factor VIII (the blood
clotting agent given to haemophiliacs) produced at the
Protein Fractionation Centre
at Liberton appears to be
implicate
d
.
As
Factor VIII is produced from plasma
recovered from blood donations it must be
assumed
as
probable that the batch was contaminated by
a
Scottish
donor. The batch has been withdrawn and the SNBTS are
taking vigorous steps to identify the source of
infection. This, however, will not be an easy task
since blood from many donors is used to produce a single
batch of Factor VIII. In the meantime, work is urgently
proceeding to introduce heat
-
treatment for Factor VIII
in order to kill the virus
,
and to develop a screening
test for
HTLV
III
antibodies.
No
such test
is,
however,
21 September 2022
65
likely to be readily available in the immediate future."
Then the final paragraph:
"It would not be appropriate at this stage to
issue any statement on the discovery of the antibodies
in the Scottish haemophiliacs. Suitable defensive
briefing has however been given to the S
I
O."
SIO is a reference to the Scottish Information
Office.
If we go over the page, we can see the first page
of the briefing that's referred to in Mr Morison's note.
As you can see
,
it's in the form of a Q&ANSWER:
I'm not
going to go through all of this document
now. I'm going
to highlight, please, the second half of this page which
is of particular relevance to this Inquiry. It says:
"
Antibodies in Scottish Haemophiliacs
"Antibodies to HTLV III, the virus which
it is
believed caused AIDS
,
have been discovered in
16
Scottish haemophiliacs. A batch of Factor VIII
produced at the Protein Fractionation Centre at Liberton
is implicated
."
And then underlined
:
"
No
statement is to be released on this at
present. If
however
there are specific enquiries from
the media on this matter, the following material should
be used."
66
There's then a series of further questions and
answers, and we just go to the last page, and the final
entry which is prefaced with
"
Only
if
press
ed",
so it
appears to be directed at those who may need to answer
press enquiries or enquiries from others and are being
pressed about this issue
:
"What should Scottish haemophiliacs do?
"[
Answer
].
They should make enquiries of the
consultant treating their case."
If we could go back, please, Lawrence
,
to the
first page of this document, and the top manuscript
ad
dition. Now
,
this manuscript
ad
dition would appear to
come from the Minister, Mr MacKay. It says this:
"Thanks:
While I fully appreciate that
a state
ment
would give rise to great concern among
haemophiliacs -- and indeed among recipients of blood
generally -- I do not want us to be accused of
a 'cover-up'. If we are approached we must be perfectly
open."
Then the question
:
"When is heat
-
treatment likely to be ready?"
|
46,598 | 345 | QUESTION:
That is
absolutely
right, sir. That is
a curious feature of this memo.
We'll come
a little
later to look at what
information was provided when to ministers in Scotland
and
,
in particular
,
Mr MacKay about
HTLV-III
screening
68
and when it might be introduced and
,
in doing so, I'll
seek to answer your question from this morning. But
you're right, sir, there's
no
reference to that
information that you've just described from the DHSS
.
ANSWER:
Well,
what that at the moment suggests
to me -- and this is open of course to submission and
may be entirely wrong -- is that those who had come by
some knowledge or developments in England haven't
necessarily been in regular and constant touch with
those in Scotland who were dealing with the same issues
.
|
46,599 | 345 | QUESTION:
That's right, sir. I'll make sure I get the
timing right when we get to
HTLV-III
screening. From
memory, by January 1985, we see information sharing
between the DHSS and the SHHD. It could be that at this
time, November 1984, we weren't quite there yet in terms
of information
sharing.
ANSWER:
Well,
there may
well
have been sharing
of information but it may not have been comprehensive
.
|
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