10. Deputy Clare Daly asked the Taoiseach and Minister for Defence further to the fact that the Attorney General is examining the possibility of settling pending cervical smear claims following the successful legal action of a person (details supplied), if a similar approach is being taken regarding outstanding Lariam cases in view of the successful legal action in the first Lariam case before the courts in 2017. (Question 20410/18 asked on 10 May 2018)

Deputy Clare Daly: The Minister of State is aware that in December last year the State settled the first case for Lariam damage brought by a member of the Defence Forces. No witnesses were called and there was no evidence to defend the case. The man was attacked and it took him four long years before he got the settlement. In light of the decision of the Taoiseach to request the Attorney General to consider withdrawing from the legal actions in the cervical cancer cases, has the Minister of State requested a similar intervention with the Lariam cases, given the successful case taken by the first Defence Forces member? If he has not, why has he not done so?

Deputy Paul Kehoe: The Deputy will be aware that the State Claims Agency manages personal injury claims on behalf of the Department of Defence. The Lariam case referred to by the Deputy was settled on 30 November 2017 without admission of liability. The plaintiff withdrew any part of his claim relating to the choice by the defendants of Lariam as a chemoprophylactic. All other matters are settled and the case was struck out. The Deputy will appreciate that it would be inappropriate for me to discuss legal strategy in respect of ongoing litigation.

I assure the Deputy that the health, safety and welfare of the men and women of the Defence Forces are key priorities for me and military management. Three anti-malarial drugs, namely, Lariam, Malarone and doxycycline, continue to be used by the Defence Forces. The selection by a medical officer of the most appropriate drug for use is complex and depends on several factors. All of these anti-malaria drugs have contraindications and side effects. Significant precautions are taken by the Defence Forces medical officers in accessing the medical suitability of the members of the Defence Forces to take any anti-malarial medications. It is the policy of the Defence Forces that personnel are individually screened for fitness for service overseas and medical suitability.

A range of support services, including medical and non-medical, are available to all Defence Forces personnel who may require them for whatever reason. These include access to Defence Forces medical officers, psychological and social work services and psychiatry. In addition, the Defence Forces personnel support services provide a confidential information, education, support and referral service designed to give Defence Forces personnel and their families access to information and services from within the military community and outside it.

Additional information not given on the floor of the House

A 24-hour confidential helpline is also available.

A working group was re-convened to review developments arising with regard to malaria chemoprophylaxis and the use of Lariam, especially in the context of the current and potential litigation. The working group has produced its second report, which has been provided to me. It has made a total of 12 recommendations, many of which focus on areas including planning, training and education or information sharing as well as the establishment of a new medical advisory group. This will formalise the provision of ongoing expert medical advice, including external expert medical advice, to the Defence Forces on a range of medical matters, including chemoprophylaxis. Preliminary work has commenced in this regard.

Deputy Clare Daly: That has to rank as one of the most pathetic answers I have ever come across in this House, and it is up against some pretty stiff competition. The reality is that the State settled the case before the courts in December. It is a fact that many more Defence Forces personnel who have been similarly affected are lined up. It is a fact that this House passed a motion urging the Defence Forces to stop prescribing Lariam in line with best practice. That decision has been brazenly ignored by the Defence Forces, presumably on the basis of legal advice. If the Defence Forces stopped prescribing it, in effect they would be admitting liability.

We can drag this out and cause these people further injury and damage by fighting their claims or we can deal with the matter responsibly, as suggested in the cervical cancer situation. We should possibly consider a redress scenario.

The Minister of State knows that Roche has withdrawn Lariam from sale in Ireland. I presume the Defence Forces have a stockpile that they are trying to get through first. Is that the case? The company has made the decision for the Government. Will the Minister of State get the Defence Forces to cop on, grow up and deal with the reality that exists now? The Defence Forces should take responsibility for their actions.

Deputy Paul Kehoe: As I have outlined to the Deputy previously, Roche withdrew from Ireland for commercial reasons. They were the reasons the company withdrew from Ireland. The case to which the Deputy refers was settled without any admission of liability. I am not going any further into the circumstances of any one case.

As I have stated previously in the House to the Deputy and to many others, the decision for the prescribing of medication is a matter for the medical professionals in the Defence Forces and for any other medical professional. I do not imagine many people in this House are qualified to prescribe any form of medication. We have been told that Lariam is one of a range of medications available. It is on the register for the World Health Organization. It is the medicine prescribed by medical professionals within the Defence Forces. That is the advice I have been given. For as long as they are happy to prescribe it on medical advice, I will accept it.

Deputy Clare Daly: The Minister of State, Deputy Kehoe, would not be the first Minister of State to flounder on advice given to him by officials. I will put it to the Minister of State again. In light of the withdrawal by Roche of the drug from sale, the Cole case, the ending in 2016 by the UK Government of the use of Lariam in the armed forces except in restricted cases and its status as a drug of last resort in Britain, USA, Australia and Canada because of the damage it does and the evidence of the harmful side effects, will the Minister of State not now go to the Attorney General with regard to the multiple cases outstanding and request that we address this responsibility in some different way?

The Defence Forces should stop prescribing Lariam now. The decision to continue is only adding to the numbers who will be taking cases in future. The Defence Forces should also deal with the cases in the pipeline. Rather than aggressively contesting court cases, the Defence Forces should sit down and possibly address some form of redress. That would be the right thing to do for the people the Minister of State has said he wishes to defend, that is to say, the members of the Defence Forces.

Deputy Aengus Ó Snodaigh: Why is it the default position of the State, in particular, the State Claims Agency, to close ranks? Will the Minister of State ask the State Claims Agency to cease its prevarication and delay in the cases before the courts?

If Roche has withdrawn Lariam from sale in Ireland, then where do the Defence Forces source Lariam tablets now? Does it happen on the black market? The information I have is that in most European countries, if not all, Lariam is no longer available or not for sale by Roche anymore.

Deputy Paul Kehoe: I will come back to Deputy Ó Snodaigh on from where we get the Lariam medication.

I know that Roche pulled out of Ireland in 2015 or 2016 for commercial reasons and for no other reasons. I wish to repeat to Deputy Clare Daly, as I have already indicated, that the use of anti-malarial drugs is a medical matter and should be decided by a medical officer. I am not given the advice by any official. I have been given this advice by a medical officer based in the Defence Forces. The medical officer has informed me that Lariam is the most suitable drug available. I am not going into any of the legal cases that are before the legal system at the moment. I hope the Deputy understands why I cannot go into any of the legal cases.