30 March 2022: Snape - C

The session started by clarifying an apparent anomaly about fractionators' risk assessment attitudes between those applied to AIDS and those applied to non-A-non-B Hepatitis. Dr Snape clarified that those fractionators to whom he was referring was the UK-wide cohort.

The crucial value of retaining accurate meeting minutes was seen from the small group discussion in April 1983 about responding to viral transmission risks in factor concentrates, particularly AIDS and non-A-non-B Hepatitis. As might be expected, the considerations included the costs involved in the various ways of responding, including all the possible options for viral inactivation, and sourcing/pooling issues. The relative candour of this group's deliberations compare favourably with those of many meetings of contemporary haematologists where the approach seemed to involve a toxic mix of denial, deferring, and digging in along the party line. The fractionators were at least working through the legitimate possibility of resorting back to the relative safety of very small pool cryo, although the lack of investment in facilities and personnel was a critical limiting factor in responding to the emerging threats.

Even the opportunity to carry out lab research into pathogen carrying blood could not be safely performed in either Building 25 or Building 27. Neither facility were suitable for that type of research. There had been calls for developing a separate capacity for such a specialist facility, but the money had never been allocated. So, if the cryo switch option had achieved momentum, it would have exposed the inherent problems with the under developed available facilities. Maybe that explains, at least in part, for the almost universal emphasis by clinicians on sticking with factor concentrates. Further, the apparent preference of factor treatments among patients and their representative organisations, was facilitated by persuasive promotion of the previously touted wonder-drug, while under-playing or more likely not even mentioning, the increasingly emerging risks. And this does not begin to include the profit motives for factor products. What a bunch of charlatans and a parcel of rogues (allegedly).

The case of the HTLV.III infected donor from Bournemouth Hospital was the subject of an "In Confidence" memo written by Dr Snape. The infamous batch of vials was HL3186. The witness described in useful detail the efforts to trace, isolate, and recall the suspect vials. Dr Craske's first response was to want to know what Haemophilia Centres received vials from the batch so that the UKHCDO could follow up on those patients who had received the vials.

It also flagged up the lack of coordination in tracking donors since this donor, it was eventually discovered, had donated blood in three different centres. Dr Snape saw this as an opportunity to promote the idea of having an extended, six-month "quarantine period", which would have maintained the value of the quantity of donated plasma, and would have allowed the donation to be excluded before release for use as a product. He also asserted the usefulness of having a centrally coordinated record system for donors, particularly in light of the donor in question having been to three centres within two years.

There was a very unusual toothy smile moment from a witness when Dr Snape acknowledged the very probing questions from Counsel.

Given the gravity of the matter, it is perhaps surprising that Dr Craske had a poor response to his request from Haemophilia Centre Directors to follow up on patients who had received the implicated batch. A fairly strong reminder was sent out, but it too did not produce much more compliance. One Dr Green took exception to the reminder and highlighted in response how long Dr Craske was taking to return test results to him. So one of our professional clinicians produced a "handbags" response to what was a very urgent and life-threatening issue. I don't know what is worse, the stroppiness of Green, or the beige inaction of so many of his peers.