The Pamphlet

Former Canadian health minister Monique Begin says her willingness to take the blame for the country's tainted-blood scandal is a matter of "personal morality and integrity" as well as a demonstration of "ministerial responsibility."

Begin, who served as the minister of health and welfare from 1976 to 1984, accepted the blame in a letter to the Commission on Inquiry on the Blood System in Canada writing that "politicians must definitely be accountable, and I am therefore prepared to join the 'named' people to answer the inquiries of your commission."

Blame Me for Blood Scandal Begin Says
Toronto Globe and Mail (08/21/96)

Five Years In The Making

The Pamphlet is the story about how the Red Cross took almost five years to develop and distribute a simple pamphlet that correctly identified those who should not give blood because of the risk that they were carriers of the AIDS and Hepatitis C virus.

I chose this simple example, as opposed to a slightly more complicated issue such as: why the Red Cross took six months to test for the HIV virus in the blood system when a test was readily available from the United States (the province of Québec took even longer, about five months more, wanting to wait until a French test, that is a test from France was available), or why the Canadian Red Cross was one of the last to acknowledge that the AIDS virus was transmitted via blood transfusions and blood components and therefore did very little to protect the blood supply.

The report by the Commission of Inquiry on the Blood System in Canada (Krever Commission) on which The Pamphlet is based, contains many examples of collective ignorance and stupidity on the part of politicians and official guardians of the nation’s health, too many, the story of the pamphlet is just one of these.

I began The Pamphlet with Monique Begin acknowledging her role in the contamination of the Canadian blood supply to remind Canadians that to my knowledge, she has been the only individual to publicly acknowledge her role in the tragedy that was the contamination of the Canadian blood supply.

In the heartbreaking story of how AIDS and Hepatitis C came to Canada, the Minister of Health at the time (1976 to 1984) was the only public official courageous and perhaps decent enough to admit that she made some mistakes. Her biggest mistake: allowing a small but vocal group of her constituents to dictate public health policy.

Considering what was known about AIDS at the time, the Haitian protest against being asked to refrain from donating blood was understandable, but the Minister of Health should have known better.

Monique Begin should have been aware that the Center for Disease Control (CDC) in Atlanta had identified Haitians as members of a group judged high-risk as carriers of the AIDS virus, (the other high-risk groups identified by the CDC being homosexuals and intravenous drug users) and should have let science dictate public health policy not her fear of offending high-risk donors/voters.

There are many lessons to be learned from the careless contamination of the Canadian blood supply, being aware of the inherent danger in labeling a person or an organization racist when that person or that organization is just trying to do the right thing is one of them.

How It All began

It’s the seventies, Quebec has been given the right to choose its own immigrants and for Quebec, the main consideration is that immigrants speak French. For the French-speaking people of a poor, over-populated island in the Caribbean this is a call for a mass migration northward. It is the beginning of large-scale immigration of Haitians to Canada, 90 percent of all Haitian immigrants choosing to live in the province of Quebec, with Montreal becoming the home base by far for the largest Haitian community in Canada. Smaller communities are established in Ottawa and Toronto.

Unbeknownst to their would-be benefactors, the new arrivals carry with them the seeds of a new disease that will have a devastating impact on the society that welcomes them.

In 1981, the Center for Disease Control (CDC) in Atlanta notices an alarming rate of a rare cancer (Kaposi's Sarcoma) in otherwise healthy gay men. They first call the disease "gay cancer" but soon rename it GRID ("gay-related immune deficiency"). The next year, as more is learned about this new disease it is renamed AIDS for Acquired Immune Deficiency Syndrome

In March 1983, the American Red Cross, the American Association of Blood Banks, and the Council of Community Blood Centers endorse a recommendation made three days earlier by the United States Department of Health and Human Services that urges members of groups at high risk of contracting AIDS to refrain from donating blood or selling plasma.

High-risk groups were identified as persons with AIDS, sexual partners of persons with AIDS, persons with symptoms and signs suggestive of AIDS, sexually active homosexual or bisexual men with multiple partners, Haitian entrants to the United States, present or past users of intravenous drugs, and sexual partners of individuals at high risk of contracting AIDS.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 193. Commission of Inquiry on the Blood System in Canada

That same year 4,749 cases of AIDS are confirmed in the U.S.; 2,122 of those who contracted the virus are dead. The American Red Cross and the American Association of Blood Banks begin a vigorous campaign to inform donors and to stop members of the high-risk groups from donating blood.

The Canadian Red Cross does not take the American recommendations seriously and believes that the problem to be solved is a public relations one. It will not even put information about high-risk groups in the pamphlet given to all potential blood donors informing them under what conditions they should not give blood.

The Red Cross recognized that it was facing a difficult public relations problem. In response, an ad hoc meeting of senior personnel was held at the national office on 10 March 1983. In attendance were Dr Perrault, Dr Davey, Dr Derrick, a senior person from the blood donor recruitment service, and several members of the public relations department. They decided that the Red Cross would promote a policy of voluntary self-exclusion: the voluntary withdrawal of those at high risk, as opposed to active exclusion of members of high-risk groups. In particular it would inform persons at high risk of contracting AIDS, through their community leaders, that they should not donate blood. The meeting also decided that the donor questionnaire would include only questions about health, including questions about the signs and symptoms of AIDS, and none about membership in risk groups.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

Following the meeting of March 10 and in response to the American actions to stop members of high risk groups from giving blood, the Canadian Red Cross on March 10, 1983 issues a mixed-message press release.

In its press release the Red Cross asks members of high risks groups not to give blood while maintaining that AIDS is not transmitted via blood transfusions. If high risk donors still want to give blood, the Red Cross assures them that they can do so without fear of being challenged.

"The Canadian Red Cross Society advises members of groups identified as high risk of carrying Acquired Immunodeficiency Syndrome (AIDS) not to give blood … to date there is no conclusive evidence that AIDS is transmitted though (sic) the blood or blood products and no cases of AIDS in Canada can be linked to blood transfusions … The Red Cross is not considering questioning potential donors at blood clinics concerning their sexual preference or their racial origins…"

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

Even this timid approach to weeding out potential carriers of the AIDS virus does not sit well with Canada’s Haitian community or Haitian diplomats. Here is what the Krever Commission had to say about the Haitian protest:

Members of the Haitian community, particularly in Montreal, resented the implicit stigma and discrimination in being described as at high risk. Canadians of Haitian descent denounced the Red Cross’s position as racist. A complaint was lodged with the Quebec Human Rights Commission. The Haitian Red Cross complained to the League of Red Cross Societies about the actions of the Canadian Red Cross and the American Red Cross. The Haitian embassy in Ottawa and the Haitian consulates in Toronto and Montreal protested to the Red Cross. Haitians picketed the Ottawa blood centre. Blood donor clinics in Montreal lost support. The Red Cross was particularly sensitive to the accusation that it was acting in a racist manner, an accusation that struck at the heart of its identity as a humanitarian and non-discriminatory organization. The accusation was also potentially damaging to efforts to recruit voluntary donors. All of this came at a time when the Red Cross was already facing criticism for shortages of blood in major cities.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

Community leaders meet with officials from the Red Cross and the federal government to discuss the reference to recent Haitian immigrants as being high-risk as carriers of the AIDS virus. Blood donations from people from the country that would soon be revealed as having the highest proportion of HIV-infected men in the Western hemisphere, perhaps the world, are received without a question being asked.

As fear grow that the epidemic will spread, pressure is put on the Red Cross to be more specific as to potential carriers of the AIDS virus in its self-exclusion pamphlet. The Red Cross, like the proverbial scalded cat, won’t budge. In a meeting with city of Toronto public health officials on May 26, here is what William Mindell, the city’s coordinator of community health reported to his colleagues about his meeting with a Dr. John Derrick.

"The CRC BTS [Canadian Red Cross Blood Transfusion Service] medical advisory committee is very conservative and won’t threaten the system they’ve developed. John Derrick feels public pressure may yet force more overt precautionary measures on the part of the donor clinics within the next few months (confidential opinion) ..."

"They were still reeling from their public statements regarding Haitian donors and the clamour it had caused re: defending against charges of racism. It had occupied a tremendous amount of their time and they had little interest in going through it again … They noted that the situation had calmed, but they were still not able to agree on a joint statement to be issued with the Haitian community."

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

The Question Is Finally Asked

Did the Red Cross eventually get around to identifying groups that had a high-risk of being infected with the AIDS virus in its self-exclusion pamphlet? Yes and no!

On 1 May 1984 (sic), the Red Cross pamphlet, An Important Message to Our Donors, which had been completed two weeks earlier, began to be used in Red Cross blood centres. Every centre was given a three-month supply and instructed to give the pamphlet to prospective donors as part of the pre-donation procedure.

Unlike the American Red Cross’s pamphlet produced in January 1984, the Canadian Red Cross’s pamphlet did not define “multiple partners,” nor did it include persons with symptoms of AIDS in the groups of persons who should not donate blood. There was no requirement that donors acknowledge that they had read the pamphlet, either by signing the pamphlet or by being interviewed by a nurse. There was no statement at the end asking donors to call the blood centre after donating if they believed that their donations should not be used for transfusion.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

Over 14 months too late and even then, as Krever points out, they still could not get it right. They didn’t get it right and it took almost another year and half for the Red Cross to revisit the pamphlet fiasco. Some people did not understand the wording, regular blood donors didn’t bother reading it thinking there was nothing new … and even if the blood collection staff knew the pamphlet wasn’t read or understood they could not intervene by asking the donor if he or she was in a high risk-group.

Knowing that the pamphlet-based self-exclusion system was not working some medical directors and nurses took it upon themselves to exclude contaminated blood from the system.

Some medical directors reported that they had been taking measures of their own to exclude donations from persons believed to be at high risk of transmitting AIDS. In the province of British Columbia, for example, nurses who suspected that a donor belonged to a high-risk group tagged the donation, withdrew it from the system, and later destroyed it. Other medical directors used similar procedures to identify suspect donations for destruction.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 228. Commission of Inquiry on the Blood System in Canada.

When Dr. Perrault heard about this practice, he ordered it stopped as the minutes of a medical directors’ meeting confirms:

Dr. Perrault stated that blood collected from high risk group donors is not to be singled out at the moment. Some Centres had it held in Quality Control testing and others had disposed of it.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231. Commission of Inquiry on the Blood System in Canada.

Some medical directors ignored Dr. Perrault’s directive including Dr Thomas Bowen, the medical director of the Calgary blood centre. 

Dr. Bowen understood that medical directors had been told not to mark suspect donations in any special manner. Nevertheless, from the summer of 1983 to the autumn of 1985 the Calgary blood centre continued to use a “black dot” procedure; if a donor appeared unwell, had new tattoos, or was suspected of being at high risk of contracting AIDS, nurses marked the donation with a black dot to signify that it was not to be used for transfusion. Dr Bowen felt that this ought to be within the discretion of nurses with solid clinical judgment. He did not tell the national office about this practice, which he believed to be sound, because it did not conform to what he believed to be the policy of the national office that donations of persons at high risk who had not self-excluded were to be used (my emphasis). He did not tell the national office of his practice because he did not want to be told to stop.

Measures To Reduce The Risk Of Contamination. Vol. 1 p. 267. Commission of Inquiry on the Blood System in Canada.

A revised pamphlet was sent out in August 1985. It too was found wanting and another revisions was sent out in January 1986.

Of course the pamphlet was not the problem. The problem was always the Red Cross forbidding its blood collection staff from asking a potential donor if he or she was a member of a high-risk group and if so, stopping them from giving blood.

The Red Cross in the autumn of 1988 finally allowed its blood collection staff to do just that. More than five years after the warning about the contamination of the blood supply.

The last word on The Pamphlet I will leave to a lawyer for the Red Cross who had to remind Dr. Perrault about the Red Cross’s obligations when asked by Dr. Perrault “What would be the legal aspects if an issue is made of the right of donors to give blood?”

Mr. Worsoff stated that it is not a matter of the donor having a right to donate blood rather it is a case of the Red Cross having both a moral and legal obligation to assure the safety of the blood it accepts for processing and distribution. The evidence of possible unacceptability of the blood does not have to be conclusive – the decision can be made on a basis of “reasonable doubt” as to its suitability. With reference to the AIDS problem in particular, the premise is not that the CRC [Canadian Red Cross] has to justify beyond any scientific doubt that there is a link between the designated “high risk groups” and the development of AIDS since, if there is even a possibility of transmission via blood, CRC has the moral and legal obligation to protect the blood recipient above all.

Measures To Reduce The Risk Of Contamination Vol. 1 p. 231.Commission of Inquiry on the Blood System in Canada.

To bad Dr. Perrault did not follow his lawyer’s advice.

Charges are Laid

The Krever Commission doesn’t dwell very long on the link between politics, immigration and the contamination of the Canadian blood supply by the AIDS and Hepatitis C virus and rightly so.

It is the so-called professionals at the Red Cross and the Health Protection Branch of Health Canada that must assume a large share of the blame. They should have known better, including Dr. Perrault who feared more being called racist and losing blood donors than protecting the recipient of that blood from a killer virus contained within. And, of course, the managers of the Health Protection Branch of Health Canada who could have ordered the Red Cross to do be more vigilant. They had the power, but as one manager put it “they had more pressing paperwork on their desk.”

In November 2002, five years after the release of the Krever report on the tainted-blood scandal, the RCMP finally laid charges against four individuals and one company in connection with the scandal.

From Health Canada we have Dr. John Furesz, the former director of the bureau of biologics at the federal government's Health Protection Branch and Dr Wark Boucher former chief of the blood products division of the bureau of biologics in the Health Protection Branch who are charged with three counts of criminal negligence causing bodily harm and one count of common nuisance by endangering the public.

Dr. Perrault, the former director of the Canadian Red Cross Society's blood transfusion service, is charged with three counts of criminal negligence causing bodily harm and seven counts of common nuisance by endangering the public.

One Final Irony

In the 1980’s the Center for Disease Control in Atlanta reported that Montreal had the dubious distinction of having a higher proportion of HIV-infected women than any other metropolitan area in all of North America.

There is a certain morbid irony in the tragic events described here. A separatist government tried to use immigration to increase the number of French speakers in the province of Québec, thinking they would vote for separation.

The newcomers knew about the outside world and wanted to remain part of it and voted overwhelmingly to stay in Canada. They saved Québecquers from themselves and preserved Canadian unity and all it cost was the lives of a few thousand people, mostly women as the statistics from the Center for Disease Control would attest.

Bernard Payeur, March 28, 2005

Crime and Punishment In Canada

In Canada, it would seem, the time it takes to be convicted of a crime is directly proportional to the number of victims. Create enough victims and the chances of never having to step into a Canadian courtroom to answer for your actions, let alone spend any time behind bars, increases dramatically.

It took almost twenty years before some of the perpetrators of the largest terrorist attack on North American (before the attack on the World Trade Center in 2001), were compelled to appear before a judge in a Canadian court.

In took fifty or more years for some NAZI war criminals to be tried for their crimes.

More then twenty years have past (at this writing) since the outbreak of the AIDS epidemic and still those responsible for sending thousands of Canadians to an early grave have yet to answer for their actions in a court of law.

Then again, they did create more victims than the 329 mostly Canadian men, women and children in the Air India bombing so by Canadian justice standards, the time elapsed is not unreasonable.

Post Mortem

Oct. 1 2007, after an 18-month long trial Ontario Superior Court Justice Mary Lou Benotto acquitted the AIDS doctors of any wrongdoing.

More than 1,000 people contracted HIV, and an estimated 20,000 people contracted hepatitis C from contaminated blood and blood products during the mid-1980. More than 3,000 men, women and children are known to have died as a result of receiving tainted blood products courtesy of the AIDS doctors.

Twenty years after this preventable tragedy a Canadian Court ruled that the victims had only themselves to blame.

No Lessons Learned

Canadian Blood Services came out swinging against a union advertising campaign that suggested that proposed contract changes would undermine the safety of Canada’s blood supply and set the stage for a repeat of the 1980s tainted blood scandal ... the dispute revolves around concessions on existing job security provisions to manage expected layoffs and plans to “de-skill” the workforce by replacing trained health-care professionals with casual and part-time workers.

Ottawa Citizen, Jan 6, 2015.

As a money saving measure, the Red Cross, which the Canadian Blood Services replaced as the nation's blood collector, continued using donated blood it knew risked being tainted with the HIV and the Hepatitis C virus thereby contributing to a tragedy which a fear of offending made inevitable.

The ruling infuriated gay rights activists who have fought hard for the elimination of a screening question that obliges gays to specify whether they have engaged in sexual activity since 1977, an attempt to ease concerns about contamination with HIV or other pathogens.

Sep 10, 2010 - Globe and Mail on a court ruling that Canadian Blood Services did not violate a gay man’s rights by asking questions designed to eliminate high risk individuals from donating blood.

If you have read this far you know the deadly consequences of allowing politics and political correctness to influence the way we screen blood donors.