It is 1986. A blood test to screen for non A, non B Hepatitis, costing just 5 cents per test, has been shown to significantly reduce the amount of contaminated blood being collected and given to people needing transfusions. It is not a specific test, so it also rules out a small percentage of healthy donors due to occasional false positive results. Blood banks throughout the US are using the test for medical, ethical and legal reasons. What was Australia to do? Queensland’s Blood Service started using the test but no other Australian blood service did so. Many thousands of people were infected as a result. Elizabeth Minter reports in this third of her series on Australia’s infected blood scandal.
During a hip operation in 1987, Clara Hickey required a blood transfusion. It was infected and Clara was diagnosed with Hepatitis C.
March 1988. David Callard, who had haemophilia, was given Factor VIII in preparation for dental work. Two weeks later he became very ill and was diagnosed with Hepatitis C.
December 1988. Robin Newman was infected with Hepatitis C when she required a blood transfusion following surgery. Gordon Land was infected in 1989 and became “a total invalid” as a result.
What Clara, David, Robin, Gordon and so many other Australians infected with Hepatitis C between 1987 and 1990 had in common was that their devastating illness could have been avoided if the screening test had been used by all Australian blood services.
As stated by medical experts who testified at Scotland’s Penrose Inquiry (2015), all the evidence available from at least 1978, and certainly from 1985, was that non A, non B hepatitis (later known as Hepatitis C) was not a benign condition, as had been previously thought, but was a potentially severe and even fatal disease. As a result:
“There should have been a significantly greater degree of urgency about doing something to protect patients exposed to potentially infected blood.”
Evidence for the test
Non A, non B hepatitis, which had been known about since the 1960s, was widely recognised as a common side effect of blood transfusions. (It was officially discovered as Hepatitis C in 1989.)
Since 1970, blood banks in Germany and Austria had been using a liver enzyme test (the Alanine Aminotransferase (ALT)) to screen blood for hepatitis. This test could check for liver damage – caused by disease or drug use, for example.
By 1974, due to concerns over the high rates of hepatitis infection after transfusions, the US National Heart, Lung and Blood Institute began a study into the effectiveness of using the ALT test (also known as surrogate testing) to make the pool of donated blood safer. By 1978 it was clear that “screening donors for ALT activity could make the blood supply much safer”. The study was published in 1981 in the world-leading New England Journal of Medicine.
In 1978, the study’s co-ordinator, Dr James Mosley was invited to Australia to give lectures on hepatitis, as he explained in his submission to the 2004 Senate inquiry.
In one lecture, attended by senior Australian blood bankers, Dr Mosley gave a preliminary summary of the study, including the conclusion that: “(It was already very clear) that ALT screening could lower the incidence of non-A, non-B Hepatitis.”
Dr Mosley noted that at the end of his lecture, the “blood bankers huddled at the back of the room … talk(ing) in low voices. I distinctly recall they looked apprehensive.”
In 1981 the data was also presented to American Red Cross executives who were discussing ways to limit the spread of Hepatitis C through blood transfusions. They concluded that the evidence for the ALT test was so strong that blood banks should start using it.
They added that:
“It would be unethical to continue to conduct studies where patients received blood known to have high ALT levels.”
Industry groups pushed back, but eventually blood banks across the US introduced the test in 1986.
Queensland goes it alone
In the mid 1980s, each state/territory ran its own Blood Transfusion Service. The director of Queensland’s service, Dr Ian Young, was a strong advocate of the ALT test. He had written numerous submissions to the Australian Red Cross pushing for the test to be implemented, to no avail.
So in July 1987, Queensland went it alone with testing. The other state and territory services decided to wait for a specific Hepatitis C test, which became available in 1990.
However, FoI documents reveal that representatives of the state/territory blood services had acknowledged in 1986 that the test would make the blood supply safer. A meeting of the National Blood Transfusion Committee in September 1986 noted that:
“Indications are that the exclusion of donors with elevated ALT or anti-core antibody might prevent 30-40% of cases of transfusion-associated hepatitis.”
A later study that compared patients who had been given ALT screened blood with patients given non-screened blood showed the test reduced the incidence of Hepatitis C by 84%.
While Australian executives had raised concerns that the test would rule out some healthy blood donors, Alfred J Katz, who became the executive director of America’s Red Cross Blood Services, wrote that such concerns:
“did not outweigh the medical, scientific, ethical, legal, and public relations judgment that it was incumbent upon us to prepare to implement ALT as a donor screening procedure to decrease (non-A, non-B) hepatitis in recipients”.
In 1988, Dr Catherine Hyland, who worked alongside Dr Young at Queensland’s blood service, wrote a letter that was published in the medical journal Pathology explaining the reasons for using the test.
“A transfusion service (must) maintain a safe blood supply that has been tested according to the highest acceptable professional standard, and to be able to defend a claim of negligence.”
Dr Hyland noted that the test was also cheap and convenient, at a “total cost [of] less than $0.05 (Australian) per test”. She added that it was “intriguing” why the other states did not follow suit regarding testing “given that the Queensland Red Cross had already published that the failure to implement appropriate testing could result in negligence at law”.
Canada’s Krever Royal Commission found that Canada’s Red Cross had been negligent in not introducing surrogate testing.
Similarly, the ACT, which put in place a minimal compensation scheme in 1999. As Health Minister Michael Moore told ACT’s parliament in March 1999:
“The failure of all Australian states, except Queensland, to introduce ALT testing for all blood donors may have created a situation where the Red Cross Blood Service in those states is legally liable to pay compensation.”
Michael West Media put a number of questions to Health Minister Greg Hunt. The Health Department responded:
“The ALT surrogate marker debate was thoroughly reviewed and considered as it evolved internationally, where inconsistent approaches were taken as evidence at the time did not justify universal surrogate testing.
The Government is also investing over $1 billion to provide access to curative direct acting antiviral (DAA) medicines through the Pharmaceutical Benefits Scheme, to all eligible Australians regardless of how they acquired hepatitis C or their current circumstances.”
Red Cross taking high-risk blood
There was also a belief that blood donated voluntarily, as in Australia, was much safer than paid-for blood, as occurred in the US.
However, documents obtained by the law firm Turner Freeman Solicitors revealed that not only was the Red Cross taking blood from high-risk donors, it was taking blood from donors it had supposedly barred from donating.
Turner Freeman Solicitors took legal action against the Red Cross on behalf of a number of victims infected between 1984 and 1989. The firm obtained donor cards and Red Cross attendance records of donors.
Despite donor cards clearly stating blood was not to be collected, the Red Cross continued to take blood from them and use it in transfusions. The attendance record of Donor A, for example, stated:
“Donor had B(lood) T(ransfusion) August 1984. Do not call til August 1989.”
Yet blood was collected from this donor on 7 November 1985, which infected one of the firm’s clients.
The Red Cross also continued to take blood from donors with the following medical history:
- Donor B “admitted to using heroin, sharing needles and admission to hospital for drug overdose”
- Donor C “had Hep B in 1980 and was ill for 6 weeks with jaundice”
- D’s donor card and a letter sent to the donor’s doctor stated that: “The medical history indicates the donor was an IV heroin user sharing a needle in 1982 … [with] approximately 7o sexual partners.”
2004 Senate report
The report from the Senate Committee into “Hepatitis C and the blood supply in Australia” concluded that based on all the evidence provided, the decision of the Australian Blood Transfusion Services not to introduce ALT testing was reasonable and that “due consideration was given to pertinent evidence”. The Senate inquiry maintained that was best practice was followed.
And still ignored are calls by victims’ groups for a judicial inquiry to get to the bottom of what is one of Australia’s worst public health treatment scandals and to bring some closure for so many thousands of Australian victims.
Editor’s note: Michael West Media last week put a number of detailed questions to Australian Red Cross Lifeblood but is yet to receive a response.