A few weeks ago, the Food and Drug Administration hit the American Red Cross with a nearly $10 million fine for safety violations, lax oversight and faulty testing of its blood services. The fine is just the latest of more than a dozen the Red Cross has racked up in the last decade.
In 2003, a federal court, frustrated by repeated blood safety violations by the Red Cross, gave the FDA the power to fine the organization. Forty-six million dollars in penalties later, many of the same violations -- understaffing, ineffective screening of donors, failure to recall infected blood -- are outlined in the recent letter the FDA sent to the executive vice president of Biomedical Services for the Red Cross.
The 32-page letter describes hundreds of violations over several months in 2010 at 16 Red Cross facilities across the country, and details how the Red Cross repeatedly failed to properly track and record information about donors and blood units. (To see the actual document and others like it, go to our timeline of Red Cross fines.)
For example, the agency failed to notify health departments when donors had infectious diseases such as HIV and syphilis, failed to add new donors with infected blood to a national list of people who aren't allowed to donate, and failed to review records of donors who had bad reactions, such as a 16-year-old who lost consciousness and fell to the floor after giving a unit of blood. It also failed to follow written procedures, such as the case of a phlebotomist in Arizona who stuck herself with a needle before sticking a donor with the same needle to draw blood. The case went unreported for a month, because a staff member "was not aware of the need to immediately notify a Medical Director," according to the inspection letter.
In a recent statement, the Red Cross said it was disappointed that the FDA issued the fine for "an inspection conducted so long ago" and noted that it has "already taken corrective steps to address those matters and that improvements in operations have been made."
In an email to ProPublica, a Red Cross spokeswoman also said there is no evidence that these violations endangered any patients, adding that the blood supply is safer than it has ever been. The spokeswoman said the agency has made significant improvements, including reducing the number of problems system-wide by at least 65 percent, and is investing in technology upgrades. For example, the agency recently upgraded software and computer equipment at blood drives to better collect and track donor information.
The FDA's letter laying out the fines says the Red Cross "has known of these continuing problems and has failed to take adequate steps to correct them." The FDA also noted that "many of the violations recounted in this letter are virtually identical to violations charged in previous [letters]." In June 2010 the FDA imposed a $16 million penalty on the Red Cross for the same type of violations.
The chronic problems raise the question of whether penalties are working at all.
The Red Cross has been making promises and failing to keep them for over a decade, according to Sidney Wolfe, who heads the health research group at the consumer watchdog organization Public Citizen. Wolfe said he wrote to head of the FDA in 2000, urging it to hold the Red Cross in contempt of court. A federal court first put the Red Cross under government supervision in 1993 after finding blood safety lapses. A decade later, in 2003, the court empowered the FDA to impose fines.
"But fast-forward nine years ahead, and we have the same violations," Wolfe said.
If the Red Cross disagrees with an assessment, it can ask the FDA to reevaluate the penalty, but in most cases the fine only changes by a few thousand dollars.
Most of the recent problems inspectors cited have to do with managing records and tracking blood donors. The Red Cross says it is unaware of any infections or deaths that stemmed from problems noted in the report, and that "serious problems" account for only three percent of the total problems found.
The FDA doesn't think that's good enough.
"FDA cannot definitively say there was never any danger to the blood supply since the violations can create conditions that could lead to potential safety consequences," said FDA spokeswoman Patricia El-Hinnawy.
The government requires that the Red Cross (like any blood services operation) have multiple safeguards for its blood services. That includes asking a donor questions to identify any risks, checking his or her name against a national list of people who aren't allowed to give blood, testing for infectious diseases, keeping track of blood units so infected blood isn't released, and investigating any deviations from standards.
Because blood transfusions always carry a degree of risk, the FDA considers every step in that process critical to minimizing problems. "Failure of an individual safeguard does not automatically translate into the release of unsafe products," an FDA spokeswoman told ProPublica in an email, "however, it may increase the potential for risk."
In 2008, the Red Cross consolidated its blood work to two facilities: one in Charlotte, N.C., and the other in Philadelphia. The offices are in charge of managing, tracking and, if need be, recalling blood. But according to the inspection letter, both offices have been chronically understaffed, and simply haven't been able to carry out their required functions in a timely or effective manner. As of 2010, the offices had a backlog of about 18,000 donor management cases.