26 July 2022: Keel - D
Core participant questions (an endeavour of hope over experience):
On the issue of the Better Blood Transfusion, was there resistance to this initiative; she said she did not recollect any resistance.
On the internal investigation and specifically if any consent would be recorded related to testing to investigate if infection from treatment had occurred; she said in the case of HIV then yes, certainly since explicit consent was required, but she could not say for sure in the case of HCV.
On the internal investigation acceptance of consultants’ evidence, so did that mean they disbelieved the patients; she said they “certainly didn’t disbelieve them … but … I know where you are heading with the question …”, then there was some lame reference to a lack of confirmatory evidence. (So, unless you also sought confirmatory evidence about what the clinicians said, then in effect, yes, you did disbelieve patients.)
On her time in Glasgow with Forbes and Lowe and if there was testing for immune deficiencies; she said no she was not involved in that.
On the Look-back and D-fix, and in particular in relation to what were the timescales involved; she said it was over many years in the 1990s, “I guess”.
On SNBTS having records on D-Fix to refer to; she said they would, but it might not link the treatment to a particular patient.
On the possibility of there being tens of thousands of D-Fix patients (which was a pooled product) and therefore there may by thousands of unidentified HCV and HIV patients; she said it is a possibility. (WHAT? Seriously?)
On the line to take on the best available treatment, what might have been the origin of that statement; she said she did not know.
On commercial products being given to Yorkhill patients (children) as standard and whether it was still reasonable to call it “the best treatment available”; she said “in hindsight” it may not have been but there were other factors such as ease of administration. It would really be a question for Dr Willoughby (… oh right, he’s dead).
On NY being “the best treatment” option when it was used; she said, “in hindsight” (again) it might not have been since everyone who got it automatically was infected, but she stoically maintained the line (it must be programmed in) that the benefits outweighed the risks. (Her loyalty to the cause in the face of overwhelming odds might be viewed as endearing. It wasn’t.)
On 35 years being the mean age of death prior to concentrates and the source; she said it related to severe and maybe some moderate patients, but she did not know where the stat had come from.
On there being no really effective alternative to factor; she talked about severe and intercranial cases again … blah, blah, blah. (Is that really all you’ve got, madam?)
On surrogate testing and the advice being giving, and specifically whether ALT was the only possibility, or what about the option of Anti-H; she said ALT was the main consideration and more current, but the option of Anti-H might have been around.
On not doing a test that might be positive, why would telling the patient be a bad thing if they were at risk of a compromised liver; she said it would be unsatisfactory if someone was not actually infected, and anyway the point was not to identify sick patients but to ensure the purity of the blood supply. (So, the opportunity to catch early onset viral damage was foregone because the purpose was not clinical for the donor didn’t matter? In Scotland, with its internationally infamous problems with drinking, smoking, obesity, and drug misuse, that door was closed. Someone was having a laugh.)
On the realisation that 100% of exposed haemophiliacs were exposed, and if it was told to Ministers; she said it might have come up, but without anything else to say on the subject, the witness gave an impromptu mini-lesson on the risks of pooled products … to an audience of virally infected people, no less. The inverted irony must have gone over her head.
On a 1983 paper by Fletcher and others about infection risks; she said she was not aware or it.
On the assessment criteria of Stage 1/Stage 2, contact with Peter Hayes, and if there would be a Scotland-specific scheme or not; she said she did not see the relevance of linking Stages and the Scotland context.
On natural clearers and the exclusion of acute clearers, including when and who decided these cases; she said it was fairly early on that anyone cleared, and within 6 months they would not be affected by it, so did not need support. She did not recall the origin or timing. Natural clearers she said did not know they had it, were asymptomatic, so they would not need psychological support. (What about the poor souls who were told they were infected, not told about clearing, so lived their lives as if they were a chronic case, limiting their lives in the genuine belief that they had to minimise social and intimate contacts, restrict their educational and career choices, declare their believed status, and all the other party tricks of being infected, even when they were not but that didn’t matter?)
On clearers, how to prove they had cleared at what stage; she said it would have been very difficult to say.
On linking to the insurance industry and what happened; she said she could only remember one meeting but has no recollection of any outcome or follow-up.
On the rationale of it having to be a UK Look-back, including who might pay for it, did that consideration influence the desire for a UK approach (so Westminster paid for it all); she said she did not recall that as a factor, but more importantly it was to not confuse people.
On the infection of people by the State being described by Lord Winston as “the worst treatment disaster in the history of the NHS”, and whether she disagree with that; she said there were other disasters such as Thalidomide, but she was not in a position to say.
On any other victim groups pressing for financial support who might have pointed to the HIV/HCV example to justify their cause; she said did not know of any, and especially after having been seconded out of the Scottish Government for 7 years. (Really? That’s interesting, so she is really just “out on loan” but remains contracted to Holyrood.) She added that she is not totally against a scheme, but in her view it was put in the “too difficult” box (ie. too much effort to set up), plus other countries had much smaller schemes (ie. stingy). Does this mean she would consider doing all that work so long as it only gave out a pittance, but when it looked like people were due a considerable level of recompense the she didn’t want to play? Would that have taken the fun out of it?
On the setting up of the schemes, and whether it resulted in any floodgates being opened; she said no, but it was still a valid concern, and they were right to raise it. (Ha-ha! The taste of the sour grapes was visible on the visage.)
The Chair asked about the Look-back exercise and what was meant by the risk of people being confused, in particular, why would Scottish doctors have been confused by a Scottish Government directive? She mentioned how patients crossed borders and (anyway) it would just have been more desirable. The nations were at were different timeframes, but when it started it was generally done together. Sir Brian drilled down, “Was it really concern about confusion or was there a fear people would ask, ‘Why there and not here?’, to which he added, “You’ve not really explained it to me so far”. She replied by talking utter nonsense, including how English doctors would become “bemused”. (Not half as bemused as your audience, Prof Keel.)
The Chair then mentioned the pilot schemes and why their existence did not cause confusion. She said those examples were not generally publicised. He reflected back on the answer, “So, it was simply a matter of the degree of publicity?” The witness agreed, oblivious to the level of her reputational public denuding.
The witness did not have anything to add. (For which we were all very grateful, even by the lack of any statement of regret.)
The Chair noted the considerable degree of interest and the longer than usual time for the witness to give evidence. He said it was clearly entirely justified. (Who writes this man’s material?)
And as the remote screen unhooked from the scene, the background level of hubris returned to just a nominal trace level.
Comments
Post a Comment