The sight of Prof Ian Temperley being questioned at the Lindsay tribunal this week will have created mixed emotions in the haemophilia community.

To some, he remains the trusted doctor, someone who championed better services and treatments for haemophiliacs that helped to ease the pain of their condition. To others, he was a "cold" and "arrogant" figure - to quote two witnesses to the inquiry - who kept patients in the dark about HIV and hepatitis C infection risks and who could have done more to have stopped the tragedy which engulfed a vulnerable group of individuals.

Either way, there was a strange irony to his presence at the tribunal, given the only reason for its existence was the persistent campaigning of the Irish Haemophilia Society, an organisation which Prof Temperley helped to establish 30 years ago.

The clock this week was turned back not quite so far with inquiries centring on the period from 1983 onwards when Prof Temperley said he first became concerned about AIDS.

Evidence was starting to emerge at the time that the then unidentified AIDS virus, HIV, was blood-borne, and throughout the world treating doctors were beginning to look at precautionary measures which would help to avoid the infection of their patients.

Prof Temperley was no different and, in October 1983, he met the directors of haemophilia centres in the UK to examine what was best practice there. He subsequently drew up guidelines on product use which were circulated in December that year to staff at the National Haemophilia Treatment Centre, of which he was medical director.

The guidelines stipulated that under various circumstances cryoprecipitate, a clotting agent made locally by the BTSB, should be used in preference to commercial concentrates. The latter were associated with a higher risk of viral infection because they were sourced from large pools of blood taken from paid, "skid row" donors in the US. In line with UK advice, Prof Temperley recommended that cryo be used in preference for mild haemophiliacs and for patients not previously exposed to concentrates. He stressed this policy was "only to be disregarded in a serious emergency".

All this was to Prof Temperley's credit. The only problem was the guidelines were not enforced. As the tribunal heard, even their author may have breached them.

Jackie, the mother of a haemophiliac who died from AIDS in 1995, told the tribunal at a previous sitting how Prof Temperley persuaded her to switch the treatment for her son, Rory, from cryo to factor 8 concentrate in August 1983. She said "we managed for nine years on cryo" and would have continued using it had she been told about the risk of HIV infection from concentrates. But, she said, she was never told - evidence which Prof Temperley accepted this week.

The doctor agreed the UK treaters, from whom he said he took his lead, had recommended as early as June 1983 to keep previously unexposed patients on cryo. Prof Temperley said, clearly, he did not support the UK policy from the evidence available. But, he said, Rory's was a "rather unique" case. His condition was deteriorating on the existing treatment and Prof Temperley thought it "fairly essential" to change. Rory contracted both HIV and hepatitis C from factor 8 concentrates and died aged just 22.

A more clear-cut breach of guidelines came in May 1984 when a mild haemophiliac admitted to hospital for a minor operation had his treatment inexplicably changed from cryo to concentrate three days after surgery. The switch caused the man, referred to by the pseudonym Declan, to be infected with both HIV and hepatitis C. The decision was made by a subordinate doctor without reference to Prof Temperley.

For children, the tribunal heard, there seemed to be a further diminution of the guidelines.

Prof Temperley said it would nearly have been a "toss up" as to what to give a patient like Bernard, a one-year-old boy who received treatment in April 1983 for a head injury. The doctor admitted the bleed probably could have been dealt appropriately with cryo. Yet concentrate was used.

The boy tested positive for HIV the following year.

Whether Prof Temperley followed the correct policy in these matters will be decided upon by Judge Alison Lindsay. What is clear, however, is that the doctor cannot stick to the defence that he bowed to the superior expertise of treaters in the UK when, in certain cases, he plainly ignored their advice.

On a related topic, Prof Temperley conceded this week there was a lack of communication between treating doctors on product selection and safety matters. Such lapses gave rise to a situation in late 1984 when haemophiliacs in Dublin and Cork were tested for HIV but patients from other parts of the country were not.

A sore point for many haemophiliacs and their next-of-kin, in this regard, was they were allegedly never told the tests were taking place. Worse still was the fact they were not informed of the results immediately.

In Rory's case, the tribunal heard yesterday, signs of HIV antibodies were discovered in one of his blood samples in January 1985. Yet his mother was not informed he was HIV positive until the following year when he was admitted to hospital for a knee operation.

A nurse came up to her and said, "You know we don't treat Rory any different because he is HIV positive", said Jackie. Prof Temperley later confirmed Rory had the virus, said Jackie, and then "he just disappeared down the corridor and we were left to deal with it then the best we could".

Prof Temperley said yesterday he understood the boy had been retested six months earlier and, presumably, he believed his parents were informed then.

THE DOCTOR will continue his evidence next week when attention will turn to the question whether he moved quick enough to use virally-deactivated products, including factor 8 and factor 9 which had been heat-treated to guard against HIV, and concentrates made with solvent detergent technology which removed the hepatitis C risk.

On Thursday, the doctor admitted he should have stopped using untreated BTSB factor 9 in August 1985 and switched to heat-treated commercial factor 9 instead. At the time, however, he regarded the abandoning of Irish product as a "draconian" step and he put his efforts instead, he said, into persuading Pelican House to begin heat treatment.

This it did but only on a phased basis from October 1985, and not before seven haemophilia B patients were infected with HIV through untreated BTSB factor 9.

More than 220 haemophiliacs were infected with HIV and/or hepatitis C, mostly through imported concentrates. Of that total, 76 have died.