Sweating Blood

Though blood transfusions have saved thousands of lives, the procedure can be risky for patients and doctors alike. In the past five years, more than 20,000 Americans have contracted serum hepatitis, many from blood transfusions, and several have sued as a result. A number of courts have rejected their claims. But last week an Illinois housewife won one round in a legal battle and touched off a scare that has hospitals sweating blood.

Mrs. Frances Cunningham entered MacNeal Memorial Hospital in Berwyn, Ill., for treatment of anemia in 1960. During her stay, she received several pints of blood, and when she came down with a severe case of serum hepatitis a few months later, she sued the hospital for $50,000.

A lower court threw out the suit, but Mrs. Cunningham did better on appeal. Citing decisions holding sellers responsible for the safety of their products, her lawyer argued that blood is a product, not a service as the hospital alleged. Thus he had only to show that it was defective in order to win his case. Now the Illinois Supreme Court has accepted the argument and sent the case back to the lower court for trial.

Disastrous Dilemma. Though it affects only Illinois, the decision has profound implications that may influence courts in other states as well. By extending the doctrine of strict liability to blood, it leaves hospitals open to damage suits from patients who contract hepatitis from blood transfusions. It also confronts them with a disastrous dilemma: the choice between a necessary but possibly infectious transfusion and a malpractice suit for failure to perform a life-saving procedure. "The thing that scares me most," says David Stickney, associate director of the Illinois Hospital Association, "is that some doctors and hospitals may be reluctant to prescribe transfusions even though they may be needed, because they don't want to risk being sued."

Economic Impact. The impact may be economic as well as medical. Dr. James Hartney, a pathologist, who serves as chairman of the Chicago Medical Society's blood-bank committee, estimates that transfusions are responsible for as many as 750 cases of hepatitis in the Chicago area each year. He figures that if each patient sued successfully for $50,000, it could add as much as $14 a day to local hospital charges. Others feel that the decision will raise the costs of malpractice insurance, which will be passed on to the patient in increased charges.

To avoid these increased costs, Illinois hospital and medical associations are pressuring the state legislature to follow two dozen other states and enact legislation exempting blood from the doctrine of strict liability. Such a measure would go far toward lightening the liability of hospitals that administer blood transfusions. It would do little, however, to reduce the substantial risk of hepatitis for those receiving the blood.

Dangerous Donors. U.S. hospitals transfuse about 6,500,000 units of blood a year. Though blood banks in Seattle, Portland and San Francisco have been able to meet local needs with volunteer donors, Chicago depends upon professional donors for a good proportion of its blood, New York for a lesser proportion. The quality of the blood is as varied as the sources. Volunteer donors are generally healthy and willing to discuss their medical histories with blood officials. But commercial donors are another matter. Often Skid Row derelicts or drug addicts selling their blood for the price of a bottle or a fix, they are twelve times more likely to carry hepatitis than a volunteer.

Current tests--only 30% to 50% accurate--often cannot determine what the donors are unwilling to acknowledge. For this reason, an increasing number of hospitals are avoiding commercial blood entirely, and trying to rely solely on volunteer donors or members of the patient's family. Some hospitals have gone even further. In cases of prescheduled surgery, they ask the patient himself to come in a month or so before the operation and donate a supply of his own blood.

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