Two senior doctors responsible for care at the Royal Free’s haemophilia centre have been quizzed as to why patients were given blood product treatments doctors knew risked transmitting viruses such as hepatitis C and HIV.
Professor Christine Lee was heckled during two days of testimony at the Infected Blood Inquiry, in particular when she suggested patients would have been told in the early 1980s that they had hep C - then as non-A, non-B hepatitis.
Professor Edward Tuddenham reiterated a view he first shared in a 1987 letter advising the Haemophilia Society about liability for the infection of hundreds of patients with HIV: that the government’s failure to produce all of its own blood products meant it was “responsible for at least half of our antibody positive cases” of HIV.
The contaminated blood scandal saw thousands of haemophiliacs, and others who received blood transfusions, given blood products containing deadly viruses. More than 2,000 people died as a result in the UK.
Prof Lee was a senior registrar at the Royal Free’s haemophilia centre in 1983 and 1984, before returning as a consultant in 1987 and becoming centre director in 1992. Prof Tuddenham was co-director of the centre between 1978 and 1986, before returning to take over when Prof Lee retired in 2005.
At the Infected Blood Inquiry, led by former High Court judge Sir Brian Langstaff, both were quizzed last week by Jenni Richards QC.
READ MORE: Contaminated blood scandal victims prepare for top doctors to give evidence at public inquiryProf Lee admitted to testing blood samples from patients and even patients’ partners for HIV and hepatitis C. She said that as “consent for HIV testing came in quite early”, she thought the people in question would have given consent for that test, but added “the partners weren’t asked, I don’t think” for consent for hepatitis C testing. She confirmed when hepatitis C testing did take place, patients were only informed after the fact.
The now-retired Prof Lee rejected suggestions victims should receive compensation, saying she supported hardship funds but adding: “I think that compensation is the wrong thing to do because it suggests liability.”
Prof Lee was hired in 1983 to complete a study of patients who had not been treated with factor concentrates to observe whether they too became infected with non-A, non-B hepatitis.
Those involved in this study were not told samples were being used for this purpose. One participant, Camden Town’s Mark Stewart, only had his involvement and that of his brother confirmed in a statement Prof Lee submitted to the inquiry.
During two days of evidence she was heckled by campaigners in the audience at the central London inquiry when she said concerns about the risks of non-A, non-B hepatitis “had been discussed over many years” with patients and their families.
READ MORE: Contaminated blood scandal victims slam top medic – “We were treated like lab rats”Prof Lee frequently referred to the “balancing the risk” of giving blood products which were known to carry dangers, with those of being unable to treat bleeding episodes in haemophiacs effectively. She said: “When you’re talking about risk, it may not just be stopping a cerebral bleed; it may be giving somebody a better quality of life.”
She also discussed how it had been accurate to tell patients in a information document that there was a one in 1000 risk of contracting HIV from a factor concentrate blood product as at the time there had been two documented cases our of 2,000 UK individuals receiving the treatment.
Sir Brian Langstaff and Ms Richards questioned both Prof Lee about whether this was an appropriate way of assessing the risk, given information available, in particular in America, about HIV cases in haemophiliac.
The now-retired Prof Lee was also confronted with several statements she has made about being “irritated” by campaigners demanding compensation for life-threatening illnesses received through NHS treatment.
She said: “I think perhaps the word ‘irritated’ is strong, and I think what I was really trying to express there was frustration.”
Prof Lee added: “I really supported and continue to support the idea of the Macfarlane Trust and Skipton Fund which is giving support for hardship, but I think that compensation is the wrong thing to do because it suggests liability.”
Discussing risk with Prof Tuddenham, Ms Richards quoted an 1982 New England Journal of Medicine article to him and he confirmed he had been aware of the risk of transmitting HIV to haemophiliacs through blood products as early as 1982 – when this was first reported by the Centre for Disease Control in the US.
Prof Tuddenham said: “This particular editorial piece is putting very starkly a balance between which takes precedence: complications of haemophilia, or complications of treatment, which would be a hard thing to do when not knowing the prevalence of the appeared complication of AIDS. But it’s prescient, and it certainly brings to attention that choice.”
Shown a letter sent by a British epidemiologist to the Department of Health in 1982 recommending use of US manufactured factor concentrate blood products be paused, he said such a message had not been passed on. “With hindsight if it had had wider exposure, I’m sure it would have had some effect [in limiting exposure to HIV].”
Prof Tuddenham said he stood by comments made in 1987 blaming the scale of the crisis on the “bureaucratic discretion” of the government of the day – who he said had not met promises to ensure the UK did not have to import blood products from countries with poorer standards of donor screening like the US..
Shown a letter sent by a British epidemiologist to the Department of Health in 1982 recommending use of US manufactured factor concentrate blood products be paused, he said such a message had not been passed on.
Prof Tuddenham said: “Until you brought it to my attention, I’ve never seen this letter or was aware of this view having been promoted.” He agreed that: “With hindsight if it had had wider exposure, I’m sure it would have had some effect [in limiting exposure to HIV].”
Discussing hepatitis C, he said the risk of its transmission through blood products was known by clinicians by at least 1978, but that “our understanding of the longer-term consequences evolved over time”.
He said: “That was something that those who were using the concentrates had become aware of by 1978. Certainly, Peter Kernoff was already aware of that from the research he was doing with Dr Nossel in New York. So he came in with the knowledge of that and the intention to study it in detail.”
Dr Kernoff was co-director of the Royal Free’s haemophilia centre from 1978 and led on clinical matters until health reasons saw him forced to retire in 1991. He died in 2006.
In response to Prof Lee and Prof Tuddenham’s evidence, former Royal Free patient Mark Ward said he had not be surprised by what was said. Mark, who contracted HIV and hepatitis C from blood factor problems as a child, told the Ham&High: “She didn’t answer anything properly. There was no remorse. She always reminded me of Margaret Thatcher. Of course, as time went on we saw her temper and the attitude. It brought it al back.”
Mark said he felt Prof Tuddenham’s evidence was very different, saying: “Ted Tuddenham was always pleasant with us and it showed.”
Bruce Norval – another ex-Royal Free patient who was given hepatitis C through blood products, told this newspaper: “I’m happy that the progress so far and the narrative coming out of the inquiry is one I feel familiar with.”
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