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QUESTION: The general public sessions would take place in village halls and community centres and the like; i s that correct? ANSWER: That was the usual arrangement, yes.
46,001
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QUESTION: Prior to the new centre opening in 1985, were blood donor sessions ever held in the old centre? ANSWER: I don't think so. I don't think there was a facili ty, 168 a room in the old Centre that would take it but, no , I don't recall it.
46,002
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QUESTION: Then once you had the new Centre, is it right that there were some blood donor sessions that together place in the new Centre but it wasn't a major part of the Centre's use? ANSWER: No, it wasn't. The drawing has been shown as a don or facility, a donor room was given over to plasmapheresis, so we al...
46,003
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QUESTION: In terms of the geographical reach of the donor sessions, is it right that the sessions took place all over the area but there were fewer sessions in Cumb ria because of, I think, transport and road links? ANSWER: Yes, yes. The road link from Newcastle into the Cumbria area, even to Carlisle, remained...
46,004
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QUESTION: You told us in your addendum statement that there w as a satellite office in Middlesbrough, known as the Teesside office. Did the donor sessions in that ar ea take place at the Teesside office or was it a quest ion of mobile questions going out from the Teesside office? ANSWER: No, it was mobile sess...
46,005
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QUESTION: Then you told us in your main statement that you thought there was an area just north of the Scottis h border which was supplied by the Regional Transfusi on Centre and you didn't recall any blood donor sessio ns being held there but, in your addendum statement, I think your recollection now is that you...
46,006
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QUESTION: Then, in terms of the general public sessions, were they based upon donors being called up from the pan el or were they drop-in sessions or was it a mixture o f both? ANSWER: We called people to the general public sessions so they were invited by letter. And so, you know, we had statistics that showed...
46,007
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QUESTION: Then, if I can just ask you to look at one document from 1988, NHBT0059596_001. So this is a meeting, 12 January 1988 at which you were present and this is from the point in time at which you were a consulta nt haematologist at the centre but not the director. If we just go to page 5 and pick it up under...
46,008
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QUESTION: Do you know what consideration was given when the general public sessions were being held to creating opportunities for privacy, so that donors could spe ak in confidence perhaps to the medical officer, especially if they're being asked questions about high-risk activities? ANSWER: No, it wasn't good. ...
46,009
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QUESTION: In terms of the workplace or industrial sessions on which you've already told us the region was very heavily reliant, was any consideration given to concerns that a workplace donor might not be a trul y voluntary donor because they may feel pressured to give blood if their employers had arranged a sessio...
46,010
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QUESTION: Do you know whether, in the workplace sessions, aga in, whether there were opportunities for donors to be a ble to speak confidentially, again in the context of discussions about high-risk activities in particula r, it may be particularly problematic for a donor if their colleagues are within earshot, t...
46,011
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QUESTION: Then I'm just going to ask you to look at couple of the graphs you've exhibited to your statement on th e donor numbers. If we start with WITN6935008, pleas e. Oh no, sorry, my fault, Sully. I've given you the wrong reference. WITN6935006, I meant to start 176 with, sorry. So this gives an overall pi...
46,012
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QUESTION: Do you have any recollection as to what caused that particular drop? ANSWER: Yes, I think there's another chart I've produced wh ich shows employment rates. If you knew the north east at that time, the number of shipyards closing down, yo u know, steelworks closing down, steel fabricators, i t was a ...
46,013
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QUESTION: Then I won't go to the charts but there are two cha rts which look at registered donors and industrial dono rs and then the employment rates, and for the transcri pt they're WITN6935008 and WITN6935009. Can I then ask you little about the process for donor screening. I'm going to start by asking you to...
46,014
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QUESTION: Okay, let's try a different version. DHSC0046337. Okay, so this is the 1985 version of the "National Blood Transfusion Service Guidance for th e Selection, Medical Examination and Care of Blood Donors", and if we go over the page, we can see the re it starts with a section on the "Selection of Donor s"...
46,015
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QUESTION: We've got later versions from '87 and 1990. Until you introduced your own selection booklet, was this the guidance that was used, do you think, some form of -- one of the -- ANSWER: Oh yes, yeah.
46,016
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QUESTION: -- versions of this? ANSWER: I mean, this document is very familiar to me. I me an, you could pull up several from different years and they don't change a lot, but this was the base for the selection of donors that we used. I mean, we didn' t deviate particularly from this, it's just that we tried to...
46,017
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QUESTION: And if we go to the next page, please, this sets ou t the questions that the donor session clerk should a sk about medical history. And then we've got a number of conditions listed. We can see AIDS would lead to disqualification. Blood transfusion in last six months is referred to the medical office...
46,018
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QUESTION: Yes, if we go then to the bottom of page 6 because you'll see it says, "See note ix", and then -- ANSWER: Okay.
46,019
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QUESTION: -- note ix is at the bottom of page 6: "Transfusion of blood or blood products received in the last six months." Then it says: "6 months minimum depending on nature of disease or injury." ANSWER: Yeah.
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QUESTION: In any event, if we then go back to page 4, please, I just want to pick up a couple of other conditions or situations. So the third item down here is "Drug abuse ... Disqualify." Can you recall what procedures were t o try to assess whether somebody fell into that category? Were there specific questi...
46,021
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QUESTION: Then if we look further down the page, we've got: "Hepatitis ... Refer to MO ... See appendix 1" And we see the same at the top of the next page, it says, "Jaundice ... Refer to MO ... See appendix 1". If we just go to appendix 1, page 12, please. So we can see it's the fifth paragraph down, headed "Hepat...
46,022
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QUESTION: "Individuals who give a history of jaundice or hepatitis or in whose blood anti-HBs is present may be accepted as donors providing they have not suffered from jaundice or hepatitis in the previous twelve months, have not been in close contact with hepatitis or received a blood transfusion of blood or b...
46,023
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QUESTION: Then if we come to guidance produced by the Norther n Region itself, if we start with NHBT0007497, we can see a letter from you to Dr Gunson, January 1994 saying: "I know you are now getting reasonably close to producing the Selection of Donors booklet. I thoug ht you might like to see the version we h...
46,024
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QUESTION: -- so probably what you were referring to in your letter to Dr Gunson? ANSWER: Yes.
46,025
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QUESTION: If we go to page 5, we can see, under the heading "Introduction", it provides: "... the information required to assist staff of the Northern Region Blood Transfusion Service in th e process of selecting Blood Donors and Donations wit h regard to both the safety of the donor and the safe ty of the donat...
46,026
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QUESTION: Then if we look towards the bottom half of this pag e, "Rationale": "There are two major considerations with regard to donating blood. These are: "(i) That all care should be taken to protect the voluntary donor from harm, and. "(ii) That the blood or plasma collected should be safe for its intended ...
46,027
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QUESTION: I'm sorry, Dr Lloyd -- ANSWER: -- remember we had -- sorry?
46,028
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QUESTION: You froze there for a moment. Sometimes when you 184 freeze I don't think we're losing what you're sayin g but I think we might have done there. ANSWER: Okay.
46,029
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QUESTION: So the last we heard was you said, "But we did collect", and then we lost you. ANSWER: Okay, yes. We did collect donations that we couldn 't use. Our statistics, as we gradually built up our information systems in the centre, we realised that we were taking a lot of donations that weren't either be...
46,030
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QUESTION: Then if we go to page 7, we've got the heading "Medical Assessment": "In practice it is impossible to perform a complete medical and physical examination of every prospective donor. A significant part of the assessment procedure will usually rely on answers t o ...
46,031
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QUESTION: The paragraph which begins "Where doubt exists, the donor should be deferred" -- ANSWER: Yes.
46,032
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QUESTION: -- was that a shift in policy at this time? ANSWER: I think we were moving more to excluding, if we wer e in doubt, rather than collecting the donation and perhaps following up afterwards. Now, in terms of the safety of the blood we collect, you might argue tha t 186 that doesn't make a big differenc...
46,033
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QUESTION: We can take that down. Thank you. What systems or processes did you put in place to try and avoid donors whose donation might well e nd up getting rejected from attending in the first pla ce? How did you tackle that issue? ANSWER: I mean, two things. One is with a document like th e selection docume...
46,034
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QUESTION: You talk in your statement about trying to ensure t hat donors were informed about donation criteria before attending, to avoid them wasting their time if they turned out to be ineligible. ANSWER: Mm.
46,035
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QUESTION: Was that done by sending out standard literature wi th the call-up cards, then? ANSWER: Well, in one of my documents that I attached to my witness statement, you'll see a leaflet that we produced. You'll see it stands out. It's white wi th a lot of red lettering on it and most of the text i s blue w...
46,036
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QUESTION: The letter that you referred to that you exhibited to your statement is WITN6935020. ANSWER: Yes.
46,037
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QUESTION: It's not, I think, dated but I think it must be aft er 1989 because, if we just look at the letter on the right-hand side: "Dear Donor, 89 "On behalf of the Blood Transfusion Service in the North East and Cumbria, I would like to take th is...
46,038
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QUESTION: -- "to help us by donating blood. "During 1989 there was an increased demand for blood and blood components and I am very pleased to say that many more donations of blood were given, helping us to meet that need. This year it is clea r that even more blood is being used and still more donors will be nee...
46,039
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QUESTION: I'm sorry -- ANSWER: -- given the timing -- and, oh --
46,040
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QUESTION: We missed a bit there. So you said -- ANSWER: Okay.
46,041
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QUESTION: -- you asked the rhetorical question: did we do it before 1990? Then we lost it for a few seconds. ANSWER: Okay. Looking at the timing and thinking back abou t our thought processes of changing how we, you know, dealt with donors, this is probably the first one w e 191 put out.
46,042
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QUESTION: Then, if I can ask you to look at your statement, WITN6935001, page 10. It'll be the bottom half of the page, please, Sully, when we get to it. So, in that long paragraph at the end, just over halfway down, you say: "In the past many donations were labelled for 'laboratory use' because of limitations i...
46,043
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QUESTION: We can take that down -- ANSWER: It's not fair to the donors.
46,044
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QUESTION: And then what, if any, systems were in place at the Northern Regional service to ensure that a donor wh o 192 had been excluded from giving blood in your region would not give blood in another region? Was there any way of ensuring that? ANSWER: Oh no, no, I don't think so. If we excluded someon e, I ...
46,045
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QUESTION: And do you recall any occasions in which your servi ce was notified by another regional service of a donor who'd been excluded? Or deferred? ANSWER: I do not recall that happening. It's a lot of year s ago, but I don't recall it, no.
46,046
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QUESTION: I just then want to pick up on a couple of what mig ht be regarded as high-risk groups. So prison donatio ns, first of all. If we look at NHBT0008628_001. This is a document that was put up together for a Scottish Transfusion Directors' meeting in September 1983. It says: "Telephoned survey ..." ...
46,047
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QUESTION: "... of England and Wales Transfusion Centres regarding use of prisons as a source of donor blood ." ANSWER: Yes.
46,048
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QUESTION: I think this may have been an exercise undertaken b y Dr Brookes, but I -- 93 ANSWER: I think it probably was.
46,049
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QUESTION: And obviously it sets out the position in relation to a number of regions. But if we go over the page, t he second region is yours, Newcastle. "Long ago stopped holding session is Durham and Northallerton but continued to use an 'Open' prison in West Cumberland which housed 'civil crime' prisoner s (...
46,050
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QUESTION: We lost you for a couple of seconds, a couple of occasions, Dr Lloyd. I'm just going to read back broadly what you said and see whether we caught all of it. So you said it may be "possible that we held sessions at that facility in Cumberland after 1981" . Then you referred to Dr Collins telling you tha...
46,051
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QUESTION: Then you say you can't be sure but it was in that early phase when you first started working there an d you recall her telling you about this. So is it right to understand it's in the 1980/81 period that is your best recollection of when she t old you this? 195 ANSWER: That's my best recollection. I...
46,052
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QUESTION: You tell us in your statement this, you say: "I recall from informal discussion with staff in the Centre that it was known that prisoners were gi ven privileges for donations such as cigarettes. This went against our policy -- ANSWER: Yes.
46,053
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QUESTION: -- of not offering inducements to donate." ANSWER: Mm-hm.
46,054
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QUESTION: Were you being told or led to understand that that was something that was being given out by the Transfusi on Service or by the prison? ANSWER: I mean, first of all, that was not -- those session s weren't occurring at the time. This was a historic al information. But those -- the cigarettes were giv...
46,055
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QUESTION: And then do you recall whether the Northern Region collected blood from military institutions, barrack s or Air Force bases or the like? ANSWER: Yes, we did. I'm pretty sure that we went to Catterick barracks, near Northallerton, actually in north Yorkshire. And we also went to a small -- I think it ...
46,056
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QUESTION: And were there any US bases where donation sessions were held? ANSWER: No, as far as I -- well, I know we didn't do any sessions at US bases, and I don't know that there w ere any US bases in our region. There might have been an Air Force base and some facilities around the North York Moors, but no, we ...
46,057
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QUESTION: Can you recall whether any active consideration was given to the position of those donating at military sessions, that, again, they may not be truly volunt ary 97 or it may be even more difficult for them to admit to high-risk activities than...
46,058
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QUESTION: And then you referred earlier to the position of people coming along with family members to donate a nd the difficulties that might arise there. ANSWER: Mm-hm.
46,059
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QUESTION: I just want to pick that up by reference to a docum ent you exhibited to your statement, WITN6935018. Some notes, I think authored by you, headed "Transfusion - Do We Have Any Choice?" I'm going t o come back to what you say elsewhere in this documen t tomorrow, but if we just turn to page 4, halfway d...
46,060
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QUESTION: Yes. ANSWER: So it would be nice to -- you know: let's get our 199 family to donate for another family member or for a friend in hospital, so we direct the donations because they must be safer. And I was saying: well , no, there's not really any evidence that they're safer. And in fact they may be ...
46,061
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QUESTION: I want to then pick up the issue of AIDS. How and when, as far as you can recall, did you first becom e aware of AIDS and it's potential transformation through blood or blood products? ANSWER: It's hard to remember when. I mean, you know, duri ng training, you know, you read a lot so you know that th...
46,062
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QUESTION: Again, putting it back in the context of your own career, you were in that period, 1982 through to sa y 1984, that was your I think senior registrar traini ng when you were doing the rotation between the differ ent hospitals? ANSWER: Mm-hm.
46,063
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QUESTION: So do you recall any sense in the haematology community at that time any particular sense of urge ncy or concern about the potential threat that AIDS pos ed? ANSWER: Goodness. Um ... I don't recall that terrific sens e of urgency. I mean, I recall seeing some of the fi rst haemophiliacs who were exhi...
46,064
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QUESTION: And just in terms of seeing haemophiliac patients w ith early signs at the Royal Victoria Infirmary, again, just trying to put that in a chronological context, you told us earlier that you thought your RVI placement was the third of the three. ANSWER: Mm-hm.
46,065
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QUESTION: So would that have been around 1986, then, that you were there? ANSWER: Um ...[frozen screen]... '86, I'm trying to -- I honestly, you know, my -- one of the things I fou nd about this whole business is that I have difficulty putting things into sort of chronological order, an d I do find at times that ...
46,066
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QUESTION: Then perhaps just one more document before we finis h 202 for today, WITN6935027. These are handwritten note s. Are they your handwritten notes? ANSWER: They are indeed.
46,067
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QUESTION: They're remarkably legible, in that case: "The Acquired Immunodeficiency Syndrome and the Human T-Lymphotrophic Leukaemia Viruses. "Notes made at a symposium held at the London School of Hygiene and Tropical Medicine on 3rd April 1985. With some additional material from a Brief review published in Blood...
46,068
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QUESTION: If we go to the second page, there's a heading, nea rly halfway down, "Mode of Transmission", and then the 203 second paragraph under that records: "The transmission by blood or blood products is now well documented, and this includes 'needle stic k' injuries in staff handling infected materials, intra...
46,069
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QUESTION: It does. ANSWER: I didn't attempt to reproduce the whole thing.
46,070
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QUESTION: It says: "Prospects for limiting the spread of the disease including encouraging homosexual men to lim it the number of partners they have, to use condoms, a nd presumably once known to be HTLVIII antibody positi ve, to refrain from sexual contact." Then you go on to talk about the implications 204 f...
46,071
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QUESTION: Now yesterday we had looked at your notes from that April 1985 symposium on AIDS, where you outlin ed some of the measures that might need to be consider ed by the Transfusion Service. Before we look at thos e measures, just one other matter relating to a respo nse to AIDS that I wanted to ask you abou...
46,072
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QUESTION: But as far as you know, and it may be you simply do n't know, was a request -- any particular request for m ore as a response to the threat of AIDS in that early period, do you know whether that was ever made to 5 Dr Collins? ANSWER: I don...
46,073
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QUESTION: Thank you. Now I want to move, then, to the donor leaflets introduced in 1983. Again, I'm very conscious that you were not in post at the Centre at that point in time, but I'm going to ask you to look at a couple of documents in any event. If we start with NHBT0020668. So, Dr Lloyd, this was a letter s...
46,074
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QUESTION: Again, I'm not going to go through the detail of th e leaflet. Now, that was early July 1983. The Inquiry knows from other evidence that the Department of Health became involved and the final leaflet was on ly 66 issued at the beginning of September. And we'll just look briefly at that for the benefi...
46,075
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QUESTION: Whether Newcastle introduced, as some centres did, their own earlier leaflet or whether Newcastle wait ed for this national leaflet to become available in September? ANSWER: I'm certainly not aware that we issued anything earlier. I can't say we didn't, but I personally a m not aware of it.
46,076
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QUESTION: And then I'm again going to ask you to look at a document you wouldn't have seen at the time but i t gives us some information about the method of distribution of the leaflet deployed at Newcastle. ANSWER: Mm-hm.
46,077
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QUESTION: CBLA 0001820, please. This was a table compiled for the Advisory 67 Committee on the National Blood Transfusion Service , "AIDS leaflet - First six months experience". ANSWER: Yes.
46,078
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QUESTION: And we just need to look at the entry for Newcastle at the top of the page: "Distribution Method "With call-up cards "Displayed on industrial sessions. Issued to Citizens Advice Bureaux STD Clinics "No. used 110,000, "Stock 3,000" Then we have: "Donor Response, Effect on Attendance "Nil. 2 or 3 res...
46,079
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QUESTION: "... may be read as 'if you get jaundice you may [g et] AIDS'. Majority don't know what Hepatitis B is." So we can see there, I think -- please let me 68 know if this is your understanding, Dr Lloyd, three methods of distribution there described. In terms of the general public it would appear that the ...
46,080
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QUESTION: And then in relation to the industrial sessions, wh ere presumably the Centre wouldn't know who individuall y would be attending, it was on display. And then Newcastle then took a further step, which is to provide the leaflet to local Citizens Advice Bureaux and STD clinics. Was that still -- ANSWER: ...
46,081
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QUESTION: -- the system of distribution with later versions o f the leaflet when you came back to the Centre full time? ANSWER: Yes, we sent out AIDS leaflets when they were chang ed, so they went out with the call-up cards. They were more like little cards than letters in the earlier days. But yes, we sent ou...
46,082
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QUESTION: Now, we've -- the Inquiry has heard evidence from the North London Regional Transfusion Centre about an additional measure which they introduced, which was the completion of a confidential exclusion questionnaire which enabled the donor to, as it wer e, save face, potentially, by ticking a box which mea...
46,083
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QUESTION: If we then move forward to the point in time or a point in time at which you're at the Centre, if w e go to NHBT0118280, please. So this is a memo from you, Dr Lloyd, dated 22 January 1987 to the session al medical officers and the Regional Transfusion Centr e 70 medical officers? ANSWER: Mm.
46,084
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QUESTION: "It may be necessary to explain the risk group in m ore 71 detail, but every care must be taken not to offend donors. If the donor is suitable to donate, he or she should be shown back to the Clerk. "Donors who are not suitable to donate should be offered further advice through an MO at the RTC." The...
46,085
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QUESTION: We can take that down, thank you, Sully. Can I then move and deal very briefly with the question of the introduction of screening or testin g for HTLV-III or HIV, which was in October -- ANSWER: I'm sorry, I lost you then.
46,086
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QUESTION: Can you hear me again now? ANSWER: I lost you again -- could you say -- yes, if you st art that question again.
46,087
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QUESTION: Of course. I'm going to ask you very briefly about the introduction of HIV screening at the Centre. M y understanding from the documents and from your statement is that you had no involvement, either in the decision making regarding HTLV-III screening or in ...
46,088
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QUESTION: Before I leave the issue of AIDS, Dr Lloyd, and com e on to ask you about hepatitis C screening, I just wanted to ask you about investigation of cases of transfusion-transmitted or possible transfusion-transmitted HIV. I'll do that by reference to a document you've seen and talked abou t in your state...
46,089
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QUESTION: -- October 1992, and it concerned the Department of Health's scheme of payments for those infected with HIV through blood or tissue transfer. You refer to a file relating to the transfusion of a particular individual and, obviously, we're not going to menti on that individual by name. ANSWER: Yes.
46,090
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QUESTION: If I just read the first paragraph: "No new information has come to light since the original investigation. I enclose for your information a copy of the report I wrote in 1986 wh ich identifies the donations originally transfused to [her] and the related investigations. One of the t wo units transfus...
46,091
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QUESTION: Do you recall whether this was the only such investigation which you carried out or were there others? 76 ANSWER: I don't recall any others. You know, the Northern Region didn't -- you know, had a very low incidence of HIV positivity amongst blood donors. I think we're talking perhaps about one in a...
46,092
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QUESTION: Would we be right to understand this case may illustrate the limitations of the investigations wh ich you were able to undertake because, in relation to the second donor, whose donation may have been the infectious donation, you had no samples post the availability of testing and you were unable to trac...
46,093
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QUESTION: Yes. ANSWER: So, no, we certainly didn't keep samples. We weren 't 7 testing for HIV in 1982. And as you've said, we had -- there were definite limitations on how we further explored the possibility of that individual being HIV positive....
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QUESTION: Then if I just ask you to look at a reply from Dr Rejman to you. DHSC0020840_031. So this is a response to you, 4 November 1992, and Dr Rejman sets out in the second paragraph: "It would appear that the donor who failed to re-attend may be the cause of the HIV infection." 78 Then he goes on to set out...
46,095
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QUESTION: Do you know whether anything further was done in th at regard? ANSWER: As far as I know, this donor did not come up on the panel, on the CDSC. I think Dr Rejman would have l et us -- would have let me know, so I had no further follow-up from this. I'm not quite sure how the Department planned to deal...
46,096
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QUESTION: So WITN6935001, please, Sully. Dr Lloyd's witness statement's. And if we go to page 83. So picking it up at the bottom of the page, there's a heading "Surrogate testing for NANB", and you say this in your final paragraph on that page: 80 "I did consider that surrogate testing might have reduced risk, ...
46,097
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QUESTION: But in relation to anti-HBc testing either on its o wn or combined with ALT testing as a surrogate marker for non-A, non-B hepatitis, do you have any views on whether that could or should have been introduced a t some point in the 80s? ANSWER: That, yeah, that's a difficult -- we know from stud ies tha...
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QUESTION: We can still see and hear you, Dr Lloyd. Can you s ee and hear -- ANSWER: You can? 82
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QUESTION: Yes. ANSWER: But I've lost my screen completely. Ah, we're back , I'm sorry. I think an auto switch-off occurred.