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Bloody awful 

How money and politics contaminated Arkansas's prison plasma program.

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Last April, at the Abbey Garden on Great College Street in London, a British widow vented her frustration over a now-defunct state program in Arkansas that may have killed her husband.

She addressed Lord Archer of Sandwell, a former solicitor general, who is leading an independent inquiry into how 4,500 hemophilia patients in the UK were exposed to lethal viruses in blood products in the 1970s and '80s. Two thousand have since died of either Hepatitis C or HIV, in what has been called the worst disaster in the history of the nation's health service.

The widow, 47-year-old Carol Grayson, spoke calmly of the death of her husband, Peter Longstaff, two years ago. She explained that he was one of the patients who were treated with Factor 8, a blood-clotting product manufactured from human plasma.

Grayson and Longstaff had believed that his medicine was safe; that it had been derived from plasma collected in the U.K. from donors who were not paid.

They learned too late that it had been manufactured, not from plasma collected in their own country, but from persons in other parts of the world and that some of those sellers were, in fact, Arkansas prison inmates.

In the U.K., it is illegal to collect plasma from prisoners. That restriction arose in part from a philosophy that considered plasma from unpaid donors to be safer, and partly because collecting human tissue from prisoners — paid or not — was considered exploitative.

When Grayson was called to testify, she recounted the shock she felt when she and Longstaff learned that plasma collected from groups, such as prisoners, who were considered in the U.K. to be high-risk, had been pooled, fractionated and dispensed as medicine to people like her husband.

Shredded records

She described his difficult death and the further difficulty that she and other activists have had in tracking down records from their own and other governments about how the catastrophe occurred. For instance, she said, they learned that many of the files in the U.K. dealing with the scandal were shredded during the 1990s.

In 2000, the British Department of Health conducted an inquiry into the records' destruction, but never published its findings. This spring, as Lord Archer's inquiry was getting underway, the BBC requested the health department's report, but was told that the document was still being withheld at the request of the prime minister's office.

Grayson and other members of the country's Haemophilia Society are pressing their government for full disclosure. They would also like to see records from this side of the plasma transaction, particularly records pertaining to the inmate plasma center run from 1964 to 1991 by the Arkansas Department of Correction.

Grayson is particularly interested in the Arkansas center. With the help of Little Rock documentary filmmaker Kelly Duda, she said, she has tracked batches of the blood-clotting product her husband received to plasma that was drawn from inmates at Arkansas's Cummins Unit.

Duda has become something of a celebrity among hemophiliac victims and their survivors since his film, “Factor 8: The Arkansas Prison Blood Scandal,” was released in 2005. A review that year in the trade magazine Variety called the film “a sturdy, concise, no-nonsense documentary that ... would probably win Peabodys if shown on ‘Frontline,' HBO or any of the several other outlets with social agendas and nerve enough to air the appalling story...”

Factor 8 was seen by relatively small audiences in Little Rock during two recent film festivals. It is receiving greater attention in countries affected by the tainted blood. The film focuses on how the Arkansas plasma program operated during the 1980s, years when Bill Clinton was governor — and when the emergence of the AIDS virus was making all trade in blood a deadly serious business.

In her testimony to Lord Archer, Grayson suggested, “As Clinton now travels the world on AIDS prevention, surely he should be willing to assist with investigations into a past prison plasmapheresis program in his own backyard.”

She added, “Perhaps the Inquiry could write to him officially and ask him to help us secure the relevant documentation relating to Cummins Unit Arkansas Prison.”

‘Why?'

Dan Farthing, communications manager for Britain's Haemophilila Society, echoed Grayson's interest in seeking answers from Arkansas. “We know of three UK cases of HIV that can be directly traced back to Arkansas prison blood,” he wrote in an e-mailed response to questions.

Farthing wrote that members of the society wonder why “high-risk groups like prisoners were not excluded from donating blood.” With reference to Arkansas, he wrote, “The state officials should not have approved such practices, and our government certainly should not have licenced the import of products made from prison blood.”

Since the U.S. Food and Drug Administration had banned prison blood from being sold in the U.S. as early as 1984, Farthing said he wondered, “why blood and blood products not thought fit for U.S. consumption was allowed to be exported rather than destroyed.”

In his film, Duda chronicled his mostly fruitless attempts to obtain documents on the plasma program from Arkansas prison officials and officials of the two companies that contracted with the ADC to run the program during the 1980s. This reporter is shown in one part of the film explaining that records from Clinton's terms as governor were also unavailable, since Clinton took possession of them when he left office to run for president.

Today, Clinton's governor's papers — some 2,000 boxes of them — are stored on the upper two floors of the Central Arkansas Library System's Main Library, a few blocks west of the Clinton Presidential Center. While the presidential papers have been made public, records of Clinton's years as governor have not; nor does Clinton mention prisons in his autobiography.

The library system's director, Bobby Roberts, says the governor's papers eventually will be moved to the Arkansas Studies Institute, now under construction near the main library. But, Roberts added, the papers will only be released to the institute in batches by topic, with Clinton's approval.

‘A lot of politics'

Besides his current role as the archivist of Clinton's papers, Roberts, a former member of Governor Clinton's staff, also served on the Arkansas Board of Correction during some of the most controversial years of the state-run plasma program. Clinton appointed him to the board in 1986.

It was an era when almost everything about the prisons was contentious, if not dangerous. Problems with the prisons' plasma program were almost totally eclipsed by other serious problems — including suspected murders, rapes, bribery, embezzlement, and substandard medical care. Clinton and his aides were also battling to end an entrenched system of bonuses for high-ranking prison employees.

There were schemes and practices in the prisons that many in the state would prefer to forget. Even the ADC's own website, which chronicles the prison system's history from 1838 to the present, omits the entire the span of years covered by this article.

But Roberts was willing to discuss them, perhaps because he opposed so much of what transpired during the administration of ADC Director A.L. “Art” Lockhart. Roberts went even further than discussing the prisons, the plasma program, and some of the politics that shaped them. He also volunteered that he had placed his own records from his years on the prison board in the library's Butler Center for Arkansas Studies and that they were available for examination.

The papers tell an ugly story of a prison system that was often described in newspapers at the time as a fiefdom controlled by three men: state Sen. Knox Nelson of Pine Bluff, state Rep. William F. “Bill” Foster of England and ADC Director Lockhart. There were allegations — some proven — that some in “the cartel,” as it was also called, used the prisons to enrich themselves, along with a cadre of local businessmen.

Roberts recalled it as a time when Nelson held the upper hand over Clinton with regard to the prison system, which was headquartered in his district. Roberts said Nelson made it clear to Clinton that, as chairman of the Senate Rules Committee, he would prevent legislation the governor wanted in other areas, such as schools, roads, and economic development, from ever reaching a vote if Clinton pressed for changes in the prisons.

“Knox and I got into it about everything under the sun,” Roberts said. “I don't think any governor was going to cross him — and a handful of other senators down there — and think he was going to get anything done.

“There was a lot of politics that went on in those things. You could not do anything with the ADC if you ran afoul of Bill Foster and Knox Nelson. That's just the reality of it.”

Even so, Roberts bridles at the suggestion, made in Duda's film and elsewhere, that responsibility for the problem-riddled plasma program rests with the former governor. He admits that “the management down there was flawed,” that “some inmates were using their position to gain leverage,” and that, “certainly, that bunch that was running it was inept at best.”

But, he insists, “Those mistakes rest with me and the board, not the governor. I think that's what irritates me.”

Roberts said he was a member of the minority on the board that tried to tackle Lockhart, Nelson, Foster, and many of their prison programs. Because there were so many concerns, he says, “We weren't focused on plasma.”

‘A hateful way'

Arkansas is one of the few states that does not pay inmates even minimal amounts for work. Yet most correction experts agree that inmates need money. For years, the justification offered for running a plasma program at all was that it offered inmates a way to make money that was acceptable to the citizens of Arkansas.

Roberts was acutely aware, as he put it, that people in prison “need a source of money.” Some tried to send a bit home to relatives. Others used it to purchase small commissary items such as paper and stamps. “Some of them,” he said, “would only get two apples for Christmas. It was an unfortunate set of circumstances.”

At the same time, Roberts understood public resistance here to allowing inmates to earn even minimal funds. “If we tried to do that in the General Assembly,” he said, “we wouldn't have gotten five votes for it. The only way for inmates in this state to get money — and it's a hateful way — was to sell plasma.”

Throughout most of the years the program endured, inmates who donated plasma were paid $7 a unit. They could participate twice a week.

As a board member, Roberts said he figured: “If we quit this project, who gets hurt? The inmates get hurt. I think I was willing to go along for that reason.”

In addition, it was understood that the ADC made some profit from its contract with the plasma wholesaler. Most news reports from the 1980s that mentioned the contract at all said the ADC took half the proceeds from the plasma operation.

But, as records in Roberts' files reveal, there was more to the plasma deal than consideration of inmates' needs — or even money to help run the state's prisons.

‘A time bomb'

In the early '80s, the ADC contracted with Health Management Associates both to provide medical services in the prisons and to run the plasma program. HMA's president was Leonard Dunn, a Pine Bluff banker, whom Clinton later appointed to the Arkansas Industrial Development Commission. Dunn would eventually chair the finance committee for Clinton's final gubernatorial campaign.

But HMA ran into serious problems, both in delivering the prisons' overall medical services and in running the plasma program. It did not help, in Roberts' view, that Clinton had appointed HMA's attorney, Don Smith, to serve on the seven-member Board of Correction.

In January 1984, Roberts, who was not yet on the prison board, advised Clinton in a letter that he considered it improper for Smith “to be serving on a board that controls a five-million-dollar contract with a firm he represents.” In the same letter, Roberts warned Clinton that HMA was “a time bomb waiting to blow up in somebody's face.”

In fact, by the time Roberts wrote that letter, the time bomb had already exploded. Months earlier, in the summer of 1983, the FDA had learned that HMA had sold 38 units of plasma drawn from inmates who were known to have tested positive for hepatitis. The products were recalled, but not quickly enough.

Almost four thousand vials of product made from the unsafe plasma were sent around the world, many for use by hemophiliacs.

The following year, in 1985, Peter Longstaff in the U.K. tested positive for HIV.

In the wake of that disaster, four U.S. companies that fractionated plasma into blood products stopped accepting prison plasma. Centers such as Arkansas's had to begin looking for new buyers. They contracted with brokers who sold the plasma abroad.

But though state officials were willing to keep pumping inmate plasma onto the global market, problems in its operation were so severe that federal authorities blocked those plans — at least for a few months.

The FDA revoked Arkansas's plasma license in February 1984. The agency cited a litany of problems, including drawing plasma from disqualified donors, altering records and improperly storing plasma. At the same time, the agency issued a warning that prisoners were more likely than the general population to be infected with the AIDS virus.

The National Correctional Association responded to the alert. In 1984, it sent an “information bulletin” to its members, warning about plasma centers. In a section titled “Ethical and Moral Issues,” the bulletin noted that research showed that a higher percentage of prisoners were “illicit drug abusers before their incarceration,” and that, “because of the close living conditions of large groups of inmates, a high incidence of homosexual activity is found.”

The bulletin noted that the consumers of blood products were already concerned about the level of “quality control” in prison centers. Most U.S. prisons stopped operating plasma programs entirely at this time.

In Arkansas, however, plans were being made to restart the plasma program. And they continued, even when HMA's insurer dropped the company's coverage, in the summer of 1986. At that point, the prison board, which now included Roberts, hired an outside body, the Institute for Law and Policy Planning of Berkeley, Calif., to review HMA's performance. The ILPP returned a scathing report.

Though the ILPP report did not focus on the plasma program, it concluded with this note: “HMA originally may have diverted the ADC's payments to support acquiring plasma centers, or to other purposes that may well warrant further inquiry. In any event, it was early in the five-year contract period that HMA established a pattern of contract shortfalls, and ADC accepted them. For HMA, all this must be viewed as profit-motivated business decision making, at best. At worst, it calls for further inquiry.”

Roberts observed, “I don't have a particular problem with contracting, but those guys didn't know what they were doing. I think it was an insider, Pine Bluff deal. Those were companies set up specifically for doing business with the ADC.”

Not surprisingly, further inquiry was not forthcoming. Instead, the ADC negotiated to revive the plasma program, this time with a newly formed company, Pine Bluff Biological Products.

It was clearly a “profit-motivated business.”

The deal

At the time, a unit of plasma could be sold to an international blood broker for at least $50 per liter.

According to Roberts' records, PBBP reported collecting an average of 960 units of plasma a week in fiscal year 1986. Calculated at a conservative selling rate of $50 per unit, that volume of plasma grossed approximately $2.5 million that year.

According to PBBP's contract, the ADC was to receive $5 for every unit of plasma collected. So here's how the numbers looked in a year when the median income in Arkansas was half what it is today — and when the scourge of contaminated blood products was beginning to be felt around the world:

Of PBBP's $2.5 million in annual gross sales, $350,000 went to pay inmates their $7-per-unit fees.

The state of Arkansas collected $249,600 for prison operations.

PBBP had gross revenues of $1,896,969.

What the company netted is proprietary information. However, Arkansas's contract allowed PBBP to use the ADC's plasmapheresis center at the Cummins unit without charge, while the ADC provided all utilities and janitorial services, as well as “access” to inmates at approved units “desiring to participate in the program.” That included busing some inmates to the center.

For its part, PBBP agreed to “assume responsibility/liability for all plasma product(s) produced.” The company was also required to maintain appropriate licensure and provide necessary professional staff, though the ADC also contributed inmates to work in the operation.

“I think the inmates were looked on sort of as little cows,” Roberts said.

That said, Roberts rejects critics' charges that Arkansas should have abandoned its plasma program as unsafe in the mid-1980s, when most other states did — and that it certainly should not have revived it, handing the contract to PBBP, after the FDA pulled HMA's license.

“At first, there was not much concern about the quality of the blood supply,” Roberts says. “Then the FDA came out with that study that said prison plasma was more likely to be tainted.

“I deny the premise. I disagree that prison plasma blood was more dangerous than what was coming out of the for-profit places in the free world. Out there, anybody could bleed anybody.”

Roberts bases his confidence in the state's plasma program on the fact that, unlike downtown plasma centers, the ADC had medical records on every inmate who participated. It knew who was safe to bleed, he says, and who wasn't.

Yet that defense suffers, even as Roberts offers it. He admits, “We always had problems with medical care. We had particular problems because of our history, because of having been more of a torture chamber, at times, than a prison.”

So, even as Roberts says he disagrees “with the whole damn premise” that prison plasma was riskier than its paid-for free-world counterpart, he acknowledges that, “That does not absolve us from what went on in actual implementation of the program.”

“We did not monitor it well,” he said, “and that's terrible.”

‘A dying program'

PBBP made millions in the late 1980s on its contract with the ADC. But, by 1990, as the scale of the global Hepatitis C and HIV disaster began to be understood, PBBP found it increasingly difficult to find buyers. As a result, prices were plummeting.

An ADC official secretly amended the plasma contract, cutting the share of money the PBBP would pay to inmates and the state. Even so, the plasma center operated at a loss. When the renegotiated contract came to light, officials with the ADC and PBBP begged the board of correction to keep the program going — allegedly for the sake of the inmates.

PBBP's president, Jimmy Lord, told the board, “I think that it's a dying program, but I also think we will be in it as long as anyone else in the country.”

He was right. Arkansas was the last state in the United States to close its prison plasma operation. In March 1991, the board voted not to renew PBBP's contract.

By then, Roberts had been forced off the board. In 1988, he headed the library at the University of Arkansas at Little Rock, and Knox Nelson had found a law forbidding state employees from serving on state boards.

In Roberts' resignation letter to Clinton, he wrote: “There have been days when I was truly proud of the changes that we were able to make, and there were other times when the sadness of not being able to correct the problem was almost overwhelming.”

The “problem” he referred to was Lockhart. As Roberts put it in the letter, “I have only one regret about the whole experience and that is that when I had to leap over the cliff, I did not have Art by the nuts when I went down.”

In 1992, the year after the plasma program closed, Peter Longstaff tested positive for Hepatitis C. In March of that same year, as Clinton was running for president, his former chief of staff, Betsey Wright, sent a memo titled “prison positives.” That memo, a copy of which is in Roberts' files, mentioned four points, including, “education into prison by bc.” But the first point Wright listed was: “Run cheapest system in country.”

In 1994, Longstaff and Grayson began their campaign to expose how tainted blood had been able to make its way into their country.

In a recent interview by email, Grayson wrote, “My husband was so disgusted at the blood-for-money trade he began a very public treatment strike in 2000, refusing human plasma products from paid donors. He believed that paying people for their blood was immoral and exploited impoverished people around the world.

“The most recent example of this is Henan province in China, where many villagers that sold their blood are now infected with HIV, as the blood-heads that collected the plasma re-used equipment. The safety [warnings] echoed those in U.S. prisons 20 years before, showing that lessons still needed to be learnt.”

Noting Clinton's recent efforts to lower the price of AIDS drugs for people in the developing world, Grayson added that she would soon be writing to the former president “to request that he addresses what happened in Arkansas” and to ask that he “calls for a global ban on the use of paid plasma donors.”

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