The Gift of Death

Confronting Canada's Tainted Blood Tragedy

André Picard

• Publisher: HarperCollins Publishers
• Year: 2019
• Print ISBN: 9780006385752
• eBook ISBN: 9781443460224
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

Few Canadians know of "Mr. L," an auto worker in Ontario who gave "the gift of life" in 1984 as part of a company blood donor drive. Many more will remember Kenneth Pittman, a 53-year-old heart patient, who died after being infected with AIDS -- from Mr. L's blood. They will also remember Mr. Pittman's wife, Rochelle, who contracted the virus from her husband because his doctor decided not to inform them of Mr. Pittman's fatal disease.

This tragic story is a microcosm of Canada's blood scandal. For over a decade, bureaucratic dithering, profits-over-protection responses, a paternalistic medical establishment and uninformed victims combined to create the worst health-care disaster in Canadian history. More than 1,200 people have contracted AIDS from tainted blood -- and the dying continues.

André Picard has produced the definitive analysis of this complex tragedy. All of the players are here -- public health officials who refused to take the "homosexual plague" seriously; the Red Cross, which worried about bad publicity and the bottom line; the too-little-too-late government that offered inadequate compensation for victims; and the arrogant medical establishment which sometimes took years to inform HIV patients of their condition; and most of all, the victims, who are paying for this betrayal with their lives.

The Gift of Death is a call for a serious re-evaluation of an outdated blood system to ensure that a similar tragedy never occurs.

1

Gift of Life: Kiss of Death

Mr. L. and Mr. P.

When desperate ills demand a speedy cure, Distrust is cowardice, and prudence folly.

Samuel Johnson

Irene

Rose Marie Gillis, New Waterford, Nova Scotia

A coal miner’s wife with three young boys, Rose Marie was devastated when her eldest, Everett, was diagnosed with leukemia in 1982, at age five. On Christmas Eve 1985, the family doctor phoned to say Everett was in remission, but a week later called back to say the boy had likely contracted AIDS from tainted blood. As part of his leukemia treatment, Everett had been injected with about two tablespoons of platelets. The boy died in 1988, just days after his eleventh birthday. Before going to the hospital for the last time, Everett insisted on a party and invited singing star Rita MacNeil, whom he had befriended when he was a cancer patient.

“Everett was very, very sick. He was sicker with AIDS than he was when he had cancer. . . . He wanted a birthday party, but I was kind of hesitant. I was saying, I should wait until he comes home again. It’s a good job I didn’t because he didn’t come home.

I had a party for him, and [MacNeil] came. She bought him a stereo, and she just made his day. She was fantastic to Everett, and I often thanked her for that because she’s a busy lady and she took the time out of her busy schedule to spend a little time with Everett, and that made him very happy. . . .

Her Christmas album says: ‘This album is dedicated to the memory of Everett Gillis who at the young age of 11 taught me the meaning of the words strength and courage.’”

(August 2, 1994)

THE BOYS ON THE CHRYSLER ASSEMBLY LINE were in a good mood; not only were they cutting out of work early, with the boss’s permission, but they were off to do a good deed. As the thirteen of them scrambled aboard the minibus, they joked that the blood would flow not only that afternoon at the clinic in Ajax but at the hockey game in Oshawa later in the evening. When they bounded up the steps to the second floor of the Royal Canadian Legion Hall on November 13, 1984, Mr. L.^* and his co-workers were welcomed by a smiling Red Cross volunteer still sporting a Remembrance Day poppy. With the greeting came an offer of juice and a pamphlet entitled “An Important Message to Blood Donors”, the first step of the bureaucratic shuffle that is blood donation. First-time donors were shown to the registration table, asked a few stock questions and given donor cards. At the next table, technician Dolores Beaven pricked Mr. L.’s finger to type his blood and test his hemoglobin level. She also handed him a questionnaire and asked some follow-up medical questions, including whether he had read the pamphlet. Mr. L. nodded, even though he could barely read. The veterans, those who had already earned their stripes as donors, were by now lying back on the “bleeding beds” with needles in their arms, flirting with the nurses. Mr. L., a strapping 32-year-old who had recently emigrated from Montreal, joined them. After giving 450 millilitres of blood, he moved to a recovery bed and, after a few minutes, into the refreshment area for Peek Freans and orange juice. The blood donor clinic operated according to a finely honed system: the donors moved in clockwise fashion, with military precision.

By evening, when Mr. L. and his buddies had knocked back a few beers — one of the unspoken benefits of giving blood, the assembly-line workers knew, was that it was a lot easier to get drunk after giving a pint — and laced up their skates for the weekly hockey game, their blood was safely on ice in the freezer at the Toronto headquarters of the Canadian Red Cross Society, ready to save lives during the busy holiday season.

Voluntary blood donation is as archetypically Canadian as the pick-up hockey game, and the red cross has been as enduring a symbol as the maple leaf since Canadians were first asked to “make a date with a wounded soldier” during the Second World War. The annual drive by Chrysler workers was just one of hundreds of corporate blood challenges held every month across Canada — feel-good competitions in which everyone from students to factory workers to company presidents willingly rolled up their sleeves and gave a pint to save a stranger.

Kenneth Pittman, a 53-year-old manager at The Bay and self-described “best hardware man in Canada”, would have loved to share a few beers with the Chrysler workers that cold November day, but his health didn’t allow it. Since his triple bypass in October 1982 he had curtailed his smoking and drinking, but his heart problems had persisted. In September of 1984 he had gone under the knife for another bypass, but months of illness had followed, so the doctors decided to open him up again in December 1984. The surgery was a disaster; Mr. Pittman suffered a heart attack on the operating table, and bleeding that threatened his life. The next morning he was infused with cryoprecipitate,^* a fluffy white protein mass that is extracted from blood and helps clotting.

One week after the cryo injection, Kenneth Pittman sat up in his hospital bed and looked at the clock grumpily. Rochelle, his wife, couldn’t help but laugh. After all he had been through, Ken was scolding her and the children for being a few minutes late for Christmas dinner. It was strange to be having dinner in the intensive care unit of the Toronto General Hospital instead of at home, but the family was ecstatic to see Ken Pittman looking and sounding so good. They knew he was feeling better because he had mentioned, more than once, how a stiff drink and a smoke would round off the meal nicely. But he would have to settle for singing Christmas carols and telling stories about the holiday fun he had had as a boy in Nova Scotia.

For decades, blood transfusions have been instrumental in bringing people back from the edge of death. That’s why they’re called the Gift of Life. That Ken Pittman’s life-saving operation took place just days before Christmas made it all the more special.

Unfortunately for Mr. Pittman, Mr. L.’s blood was infected with the AIDS virus. This gift of life was a kiss of death.

* * *

The single unit of blood Mr. L. donated at the Legion Hall was broken down into three parts. Mr. Pittman received component number A96490, the cryoprecipitate. Two other surgery patients also received parts of Mr. L.’s blood during the busy holiday season, the red cells and the platelets. By the time the Chrysler crew boarded the minibus to attend the same Ajax blood clinic in November 1985, two recipients of Mr. L.’s first donation had already died. Mr. Pittman’s fate was to suffer a slower death.

Once again the illiterate auto worker breezed through the screening procedure, despite a new pamphlet and questioning about specific symptoms. Luckily for others awaiting surgery, universal testing of blood for the AIDS virus had finally begun two weeks earlier — after lengthy delays — on November 1, 1985. Mr. L. would be one of the first blood donors who tested positive for HIV.

Mr. L. seemed physically quite healthy, just as he had a year earlier. Right before his first donation, in November 1984, he had been discharged from hospital after a hernia operation with a clean bill of health. He had also received high marks on the company physical. His emotional health, however, was wanting. Far away from his hometown of Montreal and his girlfriend, he was lonely and often drowned his sorrows in alcohol and anonymous sex, with prostitutes or women — and men — he met in local strip clubs. Like most Canadians, Mr. L. was unaware that the AIDS era had begun. The Red Cross had done little to warn him; its medical experts insisted that the odds of blood being infected with the AIDS virus were about one in a million, about the same as getting cancer after smoking a single cigarette.

Kenneth Pittman wasn’t a gambling man, but his odds were nowhere near as good as the Red Cross scientists predicted. Of the one million blood donations the Red Cross had in 1984, Mr. L.’s was far from the only one infected with the AIDS virus. During a lawsuit many years later, it would be advanced by one of the world’s foremost experts on infectious disease that Mr. Pittman’s odds of being transfused with AIDS-tainted blood when he lay down on the operating table that day might have been as high as one in four¹ — worse than a game of Russian roulette.

Ironically, on the first roll of the dice during surgery, Kenneth Pittman beat the odds. But the next day, when an intern prescribed the cryoprecipitate to help stem the bleeding in his battered heart, a nurse injected unit A96490.

About two months after Mr. L.’s second blood donation, he received a letter from the Red Cross urging him to see his doctor. He and his common-law wife were tested for the human immunodeficiency virus on January 12, 1986. Mr. L. tested positive; his partner was negative.

Mr. and Mrs. Pittman were not so lucky. It took the Red Cross another eighteen months to contact Toronto General Hospital — now called the Toronto Hospital — to tell them that Mr. L.’s blood had been infected. The hospital, in turn, took from June 12, 1987, until February 24, 1989, to link Mr. Pittman’s name to the cryoprecipitate unit number A96490. Mr. L. had actually made the donation forty months earlier.

Sometime in April 1989, Dr. William Francombe, the hematologist in charge of the blood transfusion laboratory at Toronto General, phoned Dr. Stanley Bain to inform him that his patient Kenneth Pittman had received a transfusion that was likely contaminated with AIDS. The North York family physician took note of the information on a Post-it note that he placed on the inside cover of Mr. Pittman’s voluminous medical file, and awaited a letter of confirmation. None ever came, nor did he receive any information on how important it was to have his patient tested. Meanwhile, Dr. Francombe wrote to the Red Cross, telling them that the recipient’s physician had been contacted. The agency that had collected the tainted blood took no more follow-up action than the hospital that had transfused it.

Dr. Bain had been treating Kenneth Pittman for more than twenty-five years. He had seen him transformed from a healthy bon vivant to someone incapacitated by chronic heart disease and depressed about his fate. The doctor decided his patient was too emotionally fragile to be told of his transfusion of bad blood, so he simply kept him in the dark. Dr. Bain says he examined Mr. Pittman during a routine physical and saw no obvious signs of infection — just as Mr. L. had had no signs of infection when he had donated the poisoned blood. Given that the incubation period of the AIDS virus was known at the time to be as long as a decade, dismissing the possibility because of a lack of symptoms was a dangerously erroneous assumption for a physician to make. General practitioners can’t be expected to be up to date on every disease — even one of epidemic proportions — but failure to consult specialists is, at best, sheer arrogance. Dr. Bain not only violated basic ethics by withholding the news from Mr. Pittman, he was also in clear violation of his professional code of conduct. A second violation was failing to report the patient’s possible infection to the Medical Officer of Health.

There is no doubt that Mr. Pittman’s quality of life would have been improved by a swift diagnosis of AIDS, even though many treatments were still in the experimental stage: he never had the benefit of drugs like zidovudine (AZT); he wasn’t given the opportunity to make lifestyle changes that would reduce the chance of contracting an infection; and when he contracted Pneumocystis carinii pneumonia (PCP), often a sign that a person with AIDS is on his last legs, he didn’t get the chance to say his final goodbyes.

His three weeks in North York Hospital in March 1990 were excruciating. His body, deprived of all immune responses, was racked by infections, including the pneumonia that was ultimately listed as his cause of death. As inexplicable as his own doctor’s paternalism was the ignorance of the hospital staff. By then more than four hundred Canadians had contracted AIDS and half of them had died. The symptoms were widely known even to casual readers of newspapers. Months earlier, the federal government had announced a humanitarian assistance package for transfusion patients infected with HIV — hundreds of whom had already been identified and twenty of whom were already known to have died of AIDS. Yet a man with an obvious history of multiple transfusions, who was suffering total collapse of his immune system in a major metropolitan hospital, wasn’t diagnosed until his daughter, a nurse, insisted that he be tested for HIV.

Kenneth Pittman was tested for AIDS just days before he died of the disease, although it had taken more than five years to kill him. Rochelle Pittman, his wife and sexual partner of thirty-two years, didn’t learn of the diagnosis until three weeks after the funeral.

Her immediate reaction was, “How long do I have to live?”

Dr. Bain responded, “You weren’t having sexual relations with him, were you?”

The question, like so many in the tainted-blood saga, came years too late. Dr. Bain had assumed that Mr. Pittman wasn’t having sex because he was a cardiac patient (some heart medications dampen sexual drive, but the drug he was taking didn’t interfere with erection) married for more than three decades, and depressed. Governments were asking doctors to promote safe sex, but Dr. Bain was too embarrassed even to ask his long-time patient if he was having sex. He just assumed he wasn’t.

In fact, the Pittmans had made love just two weeks before Kenneth entered hospital for the last time, in March 1990, by which time he had full-blown AIDS. There is no way of knowing exactly when Mrs. Pittman was infected, but it was almost certainly during this period. Research has shown that HIV carriers are most likely to transmit the disease to their sexual partners when their CD4² count is low (an indication of high immunodeficiency); this indicator reaches its lowest levels in the first six weeks after infection, and again just before opportunistic infections develop. It was well known at the time that using a condom would dramatically reduce the risk of transmission of the virus, but the family doctor never broached the topic. As a result, Rochelle Pittman, mother of four and grandmother of six, died of AIDS.

For failing to tell Mr. Pittman that he was infected with a deadly disease, and for failing to refer him to a specialist who could have treated and counselled him, conduct judged by the Ontario College of Physicians and Surgeons to be “disgraceful, dishonourable and unprofessional”, on March 11, 1993, Dr. Stanley Bain was handed down a two-month suspension — a meaningless penalty to a man who had already retired — and ordered to complete a course in bioethics. This slap on the wrist is typical of the medical profession’s lack of self-criticism concerning tainted blood and AIDS. At the very time he committed the offences against his patient and his profession, Dr. Bain was president of the Ontario College of Physicians and Surgeons. At the height of his profession he was, sadly, leading by example.

Later, in a lawsuit, Dr. Bain would be found negligent for failing to tell Mr. Pittman that he was likely HIV-positive, and assessed 40 per cent liability, while the Toronto Hospital and the Red Cross would share a 60 per cent liability for failing to notify him promptly of the infection. (But the judge found the Red Cross not negligent in its efforts to screen blood and the hospital not negligent in administering it to a patient in need.) The court judged that the lack of diagnosis h...

Table of contents

• Cover
• Title Page
• Dedication
• Epigraph
• Contents
• Preface
• 1. Gift of Life: Kiss of Death: Mr. L. and Mr. P.
• 2. Blood Ties: Red Cross and Connaught
• 3. Boys Who Bleed: Hemophilia and Transfusion
• 4. Death Touches Down: AIDS in Canada
• 5. Lethal Indifference: “How Many Deaths Do We Need?”
• 6. Blood Money: The Fractionation Débâcle
• 7. Consensus for Inaction: Heat-Treated Concentrate
• 8. One in a Million: AIDS Testing Begins
• 9. Through the Looking-Glass: Look-Back and Trace-Back
• 10. Money Can’t Buy Me Life: The Fight for Compensation
• 11. Under the Microscope: Inquiries, Lawsuits and Justice
• 12. Global Connections: Tainted Blood Around the World
• 13. Call to Action: Rebuilding the System
• Epilogue
• Acknowledgments
• Appendix
• Glossary
• Chronology
• Endnotes
• Sources
• Index
• About the Author
• Copyright
• About the Publisher