In June 1983, a company that bought blood from Arkansas’s prison inmates discovered it had drawn 38 units from four inmates who previously had tested positive for hepatitis B. They had not tested positive at the time their blood was taken. (A fifth inmate who’d also tested positive in the past and had sold blood in 1982 was later identified.)
Within days, the company, Health Management Associates, notified the Food and Drug Administration and the buyer of the plasma, Continental Pharma, but said there was no need to recall the plasma because chances were “very remote” that it posed a health risk.
But during the same time period, health professionals were finding a link between hepatitis B and AIDS, a fatal disease: Most AIDS patients, they now knew, had at one time been infected with hepatitis B. It was already known that AIDS had been transmitted to people via transfusions.
In the years following, more than 1,000 Canadians who received blood products manufactured from pools containing the inmates’ blood were infected with the AIDS-causing virus HIV, and 20,000 with hepatitis C. Some 3,000 deaths had been reported by 1997.
Two weeks ago, on May 30, the Canadian Red Cross — which itself had quit collecting blood from Canadian inmates in 1971 because of the prevalence of hepatitis B in the prison population — pleaded guilty in Ontario Superior Court for its role in the public health disaster. Its CEO publicly apologized. “We could have and should have done more,” Dr. Pierre Duplessis said.
A report issued in 1997 by Canadian Justice Horace Krever noted that Australia, Japan and the United Kingdom provided financial assistance to infected persons — mostly the families of hemophiliacs — and Japan has made a formal and public apology. Of the governments that found fault with their blood product oversight, only the United States has not apologized or made restitution, Krever wrote.
Arkansas has never apologized for its role in the tainted blood distribution either, said Arkansas Department of Correction spokesman Dina Tyler. The Department of Correction has admitted it was possible the inmate blood taken there was to blame for the thousands of infections and deaths that ensued, and “if we’re responsible for anything, we’re sorry,” Tyler said. But, she added, “there were a lot of allegations, but nobody ever tracked anything to us.”
And while a group of Canadians vowed to sue the state Department of Correction, no suit ever materialized.
Arkansas’s prison blood ended up in Canada because the United States had, in 1982, stopped using blood taken from inmates. In 1982, the first cases of transfusion-caused AIDS infections turned up, triggering a public health debate on ways to make the blood supply safer. High risk providers were identified: Homosexuals, Haitians and intravenous drug users.
But prisons in Arkansas, Florida, Mississippi and Louisiana — filled with high-risk individuals — continued inmate blood sales.
Health Management Associates discovered the Arkansas inmates’ health histories in June. In August, it decided blood products that included plasma from Arkansas inmates should be withdrawn after all.
But by then, four units of plasma had been shipped to Canadian plasma processor Connaught, mixed with blood products from other sources, and delivered to the Canadian Red Cross.
Of 2,409 vials fractionated into blood products by Connaught, only 417 were retrieved. Later in August, Connaught learned of a fifth inmate whose blood was sold by HMA to Connaught. Only 27 of 1,968 vials containing plasma factor from that inmate could be withdrawn.
Then-DOC director Art Lockhart reportedly contributed to a 1984 prison association bulletin raising questions of quality control associated with the plasma program. As time went on, plasma centers began to shut down since, ironically, their plasma providers largely came from high-risk groups. What would be described as a public health “calamity” in Canada was erupting.
Why, then, did Arkansas continue to sell blood until 1994, until the last vein ran dry, when the market for inmate blood was finally reduced to zero? “It gave inmates spending money,” Tyler said. She said they were paid $5 to $7 a unit of blood.
She noted that the prison ended its practice of allowing inmates to handle medical records when the problems surfaced in 1983, and in 1985 began checking blood for HIV.
The Canadian Red Cross will pay a $5,000 fine for violating a regulatory charge and will also donate $750,000 to the University of Ottawa for a scholarship fund for families of persons harmed by transfusions of the tainted blood and another $750,000 to establish a National Medical Error Project.
A criminal suit against four Canadian doctors, the former director of blood transfusions for the Red Cross, and a New Jersey plasma broker is pending.