25 July 2022: Keel - B

Dr Keel had received a letter from Prof Cash wherein he noted the need for concern in their work, including conflicts of interest, due to problems in France where people were being taken to court over blood infectivity problems. The previously noted stipulation by Prof Cash about confidentiality of their meetings was mentioned. But Dr Keel did not feel constrained when it came to feeding back to colleagues. She recalled correspondence from Prof Cash being cryptic at times.

Dr Keel was asked a series of direct questions about relations with Dr Ludlum. She never did lab work with him. She never did lab work on his patients. She never discussed his patients with him. She never discussed the possibility of a Public Inquiry with him. Once the Penrose Inquiry started, she could not recall discussing this with him. While at Yorkhill she never discussed the possibility of infection with Dr Willoughby, despite saying in her statement that as she was training, she became aware of risks related to blood. Similarly, while at GRI she did not recall any conversations about infections coming from blood. It was only after the emergence of AIDS did these matters become a topic of conversation. Maybe Dr Keel and all her colleagues shared a passion for underwater basket weaving, and that was all they talked about, not the job in hand. HCV was seen as benign, and she said the medical literature confirmed that. Counsel referred to the Eric Preston writings in the later 1970s, but his was not the majority view at the time.

A briefing paper drafted by Dr Keel was written in preparation for a Ministerial meeting with Philip Dolan and Frank McGuire to involve Andy Kerr as the Minister. The topic was to include a call for a Public Inquiry arising from HCV infections. The briefing included the usual bovine by-product assertions of no real scientific consensus, no confirmed links or strong risks, no way of screening and then when it was it was introduced as early as possible, no treatment so no action, plus the unquestionably fandabbydozey benefits of concentrates to patients. Despite being offered the chance to recognise in hindsight the questionable nature of the briefing advice, Dr Keel was resolute in continuing to stick with her having done nothing wrong in any way. She could not cite references for any of her statements due to the time lapse involved. There was comparative reference to the HIV support scheme. She was not involved in its inception, but had a role in authorising, or not, applicants to this for Scottish applicants. It had included criteria to debar people if there was evidence of other lifestyle risk factors at play.

The capacity to study patients, including carrying out a Look-back, was enhanced in Edinburgh due to the nearness of the regional blood transfusion service to the hospital in Edinburgh, compared to Glasgow where it was at Law Hospital. Counsel pointed out the difference between something being difficult and being impossible. The point was made that the duty on the State was to do all it could, even if it was difficult. The previous assertions of the Look-back being impossible were actually impossible to maintain. Counsel listed a host of reasons why it was important to discover and let people know of any infections which might arise out of a Look-back. Sir Brian pointed out the weakness of the different location argument by asking, “What was wrong with picking up the phone?” It was established that the difficulties were not reported from the witness, but she was articulating what others had said. When asked what she would have done if it had been up to her, Dr Keel was forced to accept that the reasonable course was to follow the argument summarised by Counsel.

The idea of a “collective mindset”, which the witness had said in her statement she had followed was raised. Asked to reflect on the issues which might arise from “groupthink” (as the witness said it could sound like), she said it would be important to review any set positions if they were becoming unhelpful. She asserted how she had bucked the trend on a Look-back being too hard to do once she had seen the Dr Gillon presentation which highlighted the do-ability of a Look-back. The worm seemed happy to be seen as having turned on that occasion. The witnesses’ voice was beginning to crack, for some reason. On the point Dr Keel was reviewing at that point, and despite her “no clear recollection” on various previous matters, she was describing in great detail the exacting circumstances of seeking to stop Prof Cash from telling his UK counterpart about the move towards performing a Look-back after all the previous resistance.

On the resistance to Look-back, the main justification seemed to be logistical, so the Chair’s question about the ease with which the telephone would have overcome the problem was salient, unless the telephone had not been available in Scotland back then. After all, as US friends have pointed out, the telephone might have been invented by Alexander Graham-Bell, but he had to go to the US to do it. The close proximity in Edinburgh made a Look-back possible, as demonstrated by Dr Gillon, and that somehow opened it up as possible for the rest of Scotland; messenger pigeons permitting. When asked if the resistance to a Look-back related to a fear of litigation, it was not something the witness could recall (… back to type). A letter to a UK Minister from Scotland (Lord Fraser) highlighted the arguments related to Look-back, including the risk that it might result in raised stress in people because there was no treatment. So, it must have been seen as ok for people to suffer unexplained illness, be seen as work-shy, maybe a junkie, and be at risk of infecting a partner with a life-limiting virus. What about the State’s duty of care, not least in a public health context? Individuals have gone to prison for knowingly infecting others with viruses. Why not the State?