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Mark Kennedy
A U.S. firm with links to U.S. President Bill Clinton collected HIV-tainted blood from Arkansas prison inmates in the 1980s and shipped it to Canada, newly uncovered documents reveal.
The contaminated plasma -- used to create special blood products for hemophiliacs -- is believed to have been infected with HIV, the virus that causes AIDS. As well, it's likely the prisoners' blood was contaminated with hepatitis C.
The story of how that plasma was collected and found its way into the bloodstreams of unsuspecting Canadians stands as one of the most shocking -- yet least explored -- aspects of the tainted-blood tragedy.
Its significance is magnified by the fact that Mr. Clinton's name is associated with the story.
Mr. Clinton was governor of Arkansas when the Canadian blood supply was contaminated in the mid-'80s. He was generally familiar with the operations of now-defunct Health Management Associates (HMA), the Arkansas firm that was given a contract by Mr. Clinton's own state administration to provide medical care to prisoners.
In the process, HMA was also permitted to collect prisoners' blood and sell it elsewhere.
HMA's president in the mid-1980s was Leonard Dunn, a personal friend and political ally of Mr. Clinton. Later, Mr. Dunn was a Clinton appointee to the Arkansas Industrial Development Commission, and he headed Mr. Clinton's 1990 gubernatorial re-election finance committee.
It's not known how many Canadians contracted HIV from the plasma of Arkansas prisoners, who were paid $7 a unit, although it's likely that several hundred, perhaps thousands, were infected by the tainted products.
At the time, U.S. companies that fractionate blood products had stopped buying prison blood because it was widely understood that, since many inmates practised unsafe sex or were intravenous drug addicts, their blood posed a high risk of carrying the AIDS virus.
However, HMA found a willing buyer in a Montreal blood broker, who then sold the plasma to Toronto-based blood fractionator Connaught Laboratories. Connaught apparently didn't realize the plasma had come from prisoners.
Canadians learned of the prison connection in 1995, when Justice Horace Krever's inquiry on the tainted-blood scandal unearthed some aspects of the story. In his voluminous report last November, Judge Krever chronicled what he knew of the prison plasma contract.
But nowhere before now has any mention been made of Mr. Clinton's name, even though the facility in question -- Cummins prison in Grady, Arkansas -- was located in his state during an era when the governor's office was active in overseeing many aspects of public administration.
Two new developments are bound to focus public attention on Mr. Clinton's knowledge of the prison-blood collection system -- all this at a time when the president is bracing himself for the fallout over independent counsel Kenneth Starr's report on the Monica Lewinsky affair.
This month, a new book, Blood Trail, is being released in Canada and the U.S. It is a novel, and its Illinois publisher is carefully taking the usual legal precaution to declare in the book that if any characters in this "work of fiction" bear resemblance to real people, it is "purely coincidental."
However, the book is a thinly veiled account of how an Arkansas governor gets caught up in a prison-blood scheme gone bad, becomes U.S. president, and tries to cover up his past.
What adds to the book's mystique is that it is written under a pseudonym, "Michael Sullivan," to temporarily hide the author's true identity. The Citizen is aware of the author's real name, and has agreed to keep it confidential.
The author is a medical practitioner in Arkansas who has direct knowledge of how the prison system worked when Mr. Clinton was governor. He wishes to remain anonymous temporarily because he fears retribution in his home state, but acknowledges that he will be willing to reveal his name once the media have reported details of the prison-blood collection program. At that point, he says, he won't feel as vulnerable.
In another development, the Citizen has obtained copies of internal Arkansas state police documents written by investigators who were examining HMA in the mid-'80s. The investigators were following up on complaints the company supplied poor medical service to the prisoners (some had died, and one had lost a leg) and were probing rumours that the Clinton appointees on the prison board had demanded a bribe in return for renewing HMA's $3-million health-care contract in 1985.
In the end, the investigators accepted the explanation supplied by the board and HMA: Mr. Clinton was "deeply concerned about HMA's past performance" and it was decided that as a condition of getting the contract renewed, Little Rock lawyer Richard Mays should be paid $25,000 by the firm to act as an "ombudsman" for the prisoners. Mr. Mays was a Clinton friend who had been appointed to the Arkansas Supreme Court in 1980-81 by the governor.
The state police asked HMA and Mr. Mays for a copy of the "letter of agreement" outlining what was expected of him as ombudsman, but one could not be found.
Years later, Mr. Mays became entangled in the Whitewater scandal. His name also cropped up as one of an exclusive group of Clinton friends and supporters who the president rewarded with unusual access to the White House. In fact, Mr. Mays was one of more than 300 loyalists who were allowed to sleep in the Lincoln bedroom of the White House -- a well-kept secret until word of the reward system leaked out, sparking a controversy in the U.S.
But what is perhaps most striking about the state troopers' notes -- based on interviews -- was the propensity of HMA's president, Mr. Dunn, to boast of his political ties and the fact he was a "friend of Gov. Clinton."
"Mr. Dunn spoke openly and freely and explained to these investigators that he was the financial portion of the corporation as well as the political arm," wrote investigator Sam Probasco.
"Dunn advised that ... he was close to Gov. Clinton as well as the majority of state politicians presently in office."
Also in the police files, Dr. Francis Henderson, HMA's medical director, described how the market for prison blood had dried up in the early '80s, the period when AIDS emerged.
One U.S. company, Cutter Laboratories, had in 1980 cancelled its contract to purchase prisoners' plasma, he said, adding that it was "historically" the worst possible time to sell.
"I called all over the world and finally got one group in Canada who would take the contract," Dr. Henderson told the state police.
The state police documents even contain statements which, if true, raise troubling questions about how HMA was able to sell its plasma during that period.
The report, written by Sgt. King of the criminal investigation division, stated: "H.M.A. licence was pulled in 1982 for Falsifying Records and shipping hot blood. Their licence was pulled (for) 13 months."
In a related document entitled "case synopsis," Dr. King also wrote that in August 1983, the prison plasma centre was "suspended after an investigation by department of Health and Human Services, an agency with the Food and Drug Administration."
"The suspension was for collecting and shipping plasma which had been collected from donors with a history of positive tests for (hepatitis B) ... The violations were directly related to using inmate labour in the record and donor reject list."
It wasn't until the Krever inquiry in 1995 that some limited aspects of the prison blood fiasco began to emerge.
In the early '80s, the Canadian Red Cross had contracts with three U.S. companies (Cutter, Hyland and Armour) and one Canadian firm (Connaught) to produce blood products. But not enough plasma was collected from Canadian donors to produce the products, so some plasma had to come from U.S. donors.
In December 1982, at a meeting with the U.S. Food and Drug Administration, the U.S. companies agreed not to use plasma from high-risk donors, such as prison inmates. But Connaught, because of its Canadian origins, was not at the meeting and was unaware of the new policy.
To make matters worse, Connaught had decided it was "impracticable" to inspect all of the plasma-collection sites itself and decided to rely on FDA reports. Judge Krever discovered that those reports were obtained but not reviewed by Connaught.
The first publicly known signs of trouble came in mid-June of 1983, when HMA told the FDA that 38 units of plasma it collected earlier in the year from four inmates at the Grady prison should not have been collected.
The inmates had tested positive for hepatitis B and it was well understood by specialists by 1983 that anyone with this disease ran a high risk of also having AIDS. Thus, as Judge Krever noted, there was a "greater-than-average risk that the 38 units of plasma from the four inmates could transmit AIDS."
On June 17, 1983, HMA told its Montreal blood broker, Continental Pharma, of the problem. Four of the 38 units had already been sent to Connaught in Toronto, and the other 34 units had been sold to fractionators in Switzerland, Spain, Japan, and Italy.
Continental Pharma did not immediately warn Connaught of the danger. Indeed, Connaught didn't learn until Aug. 18 of the problem from the Canadian Health department, which had been told by the U.S. FDA.
The next day, Aug. 19, a Continental Pharma official told Connaught of the problem. According to a Connaught memo of the conversation about the four donors with hepatitis B: "They were from a prison population and had not been truthful when their history was taken."
Until this conversation, Connaught had been unaware of the fact that it had been processing plasma collected from prison inmates. The shipping papers accompanying the plasma had not revealed the centre was located in a prison. They simply referred to the source as the "ADC Plasma Centre, Grady, Arkansas," without any indication that "ADC" stood for Arkansas Department of Corrections.
Connaught had received, in February 1983, an FDA inspection report that revealed the centre was in a prison. But, as Judge Krever noted of the report: "It had not been reviewed (by Connaught)."
By the time Connaught learned of the concerns about the four prisoners' plasma, it was virtually too late. It had mixed the plasma in with huge pools of other units, meaning just one contaminated unit would taint the whole batch.
Connaught had already sent the Canadian Red Cross 2,409 vials of blood products made, in part, from the four prisoners' plasma. On Aug. 23, Connaught telephoned the Red Cross and declared that it wanted to withdraw those vials of Factor VIII, a blood product used by hemophiliacs to help make their blood clot properly.
However, the Red Cross had already sent out the product to its blood centres in Toronto, London, Hamilton and Ottawa. Officials scrambled to pull the product from the shelves. But in the end, only 417 vials -- about one-sixth of the total -- was retrieved.
Soon after, there was another warning from HMA about potentially infected plasma from the Grady prison. Again, it was too late. Connaught asked the Red Cross on Sept. 6 to retrieve 1,968 vials. Only 27 were recovered.
On Sept. 7, Connaught's vice-president told the Red Cross that the plasma that had led to the two withdrawals had been collected from prison inmates. The Red Cross immediately cancelled its contract with Connaught, writing that although the company was "not directly responsible for the circumstances" and had "acted in good faith," the problem with the plasma "leaves us with no confidence in the quality and safety of the material."
When Connaught conducted an internal review of the embarrassing mishap, it discovered it had also collected plasma in 1982-83 from inmates at four Louisiana prisons. A company there, Community Plasma Centre Inc., had sold the plasma to HMA in Arkansas. Again, just as it did with the plasma from the Grady prison, HMA sold the product to Continental Pharma, which sold it to Connaught.
"There is no doubt that Canada's dependence on commercial concentrates made from U.S. plasma increased the risk that Canadians with hemophilia would be infected with HIV," wrote Judge Krever. The AIDS epidemic had hit the U.S. earlier, and that country's practice of paying donors increased the risk that high-risk donors (such as drug addicts) would donate because they needed the money.
"The U.S. practice of collecting plasma in prisons also increased the risk." Unfortunately, by early 1983, however, Canada's was facing that risk itself. American hemophiliacs were getting their products from U.S. fractionators that had closed the door on prison blood.
"Connaught, without knowing it, became the only fractionator in North American that was using plasma collected in prisons," observed Judge Krever.
Almost all of that plasma, it seems, was coming from HMA in Arkansas, where Mr. Clinton had been re-elected after being once turfed from office.
He was on his way to being known as the Comeback Kid.