Last May, the brother of the first haemophiliac in the State to die of AIDS from a contaminated blood product asserted that the Blood Transfusion Service Board treated haemophiliacs as guinea pigs rather than humans. "Somebody, somewhere decided haemophiliacs were expendable people and did not spend the proper money to ensure their safety," said the young man, using the pseudonym Gary.
His view seems almost overly generous in light of yesterday's evidence which suggested the BTSB did not simply refrain from spending money which could have reduced the risk of infection, but consciously exposed haemophiliacs to a greater risk in order to make money.
The revelation came on the first day of the cross-examination of Dr Emer Lawlor, the deputy medical director of the Irish Blood Transfusion Service (as the BTSB is now known) by counsel for the Irish Haemophilia Society, Mr John Trainor SC.
The tribunal heard the board had a sudden change of heart in 1974 over a blood product made from plasma donated by professional donors in the United States and Third World countries over which, until then, it had serious concerns.
The previous year the then national director of the board, the late Dr Jack O'Riordan, had unsuccessfully lobbied the Department of Health urging it to refuse a licence for the product. In a memo from February 1974, he further warned of the "Skid Row-types" in the United States whose blood was being used to make it.
Two months later, however, he received a letter from the product's manufacturers, Travenol, which suggested the BTSB might act as the company's distributor within the State. Travenol offered the board a "service fee" of 10 per cent on all sales, based on a selling price of 12p per unit of product.
Dr Lawlor confirmed the board took up the offer. However, she said no written contract could be found which would confirm exactly what price was agreed.
Whatever price it was, Mr Trainor said the "irresistible conclusion" to be drawn was that the profit motive had swung the board's opinion.
Dr Lawlor conceded the board did make a profit on the imports by selling them on to hospitals and treaters of haemophiliacs with a mark-up of at least 3p on the purchase price, earned along with the service fee from Travenol. However, she stressed the money was put towards developing the board's other services and did not compromise its not-for-profit character.
She also said the risk associated with commercial products was regarded as "acceptable" at the time by both treaters and haemophiliacs themselves. She said the products were easier to use than domestically sourced alternatives and everyone agreed these advantages outweighed the disadvantages.
This assertion is expected to be contested by the IHS. Correspondence already shown to the tribunal indicated the society had an ongoing concern with the sourcing of products from overseas and particularly from paid donors.
A crucial fact to be established is whether the haemophiliacs themselves were made aware of the risks, or given any choice over which product they could use.
A further question arises over whether the BTSB may have been breaking the law by distributing the product without a licence. A document shown to the tribunal yesterday suggested the BTSB did not receive a wholesale licence to distribute such products until 1979. However, Mr Trainor was prevented from exploring this issue further, as it is due to be dealt with at a later stage of the inquiry.
In addition, it appears the BTSB may have been overcharging hospitals for the Travenol product. In September 1978, Prof Ian Temperley, medical director of the National Haemophila Treatment Centre, complained that he was being charged 18p per unit, 8p more than his counterparts in Northern Ireland.
After threatening to purchase another product, which he did not wish to do as it would have meant a fragmentation of treatment services, the BTSB agreed to reduce the price in June 1979 to 14p.
Mr Trainor pointed out that in distributing the product, the BTSB was in breach of a 1966 Council of Europe directive on blood products on two counts, first, by using a product sourced from paid donors, and, second, by seeking to make a profit on it.
Dr Lawlor repeatedly played down the significance of such directives, describing them as purely aspirational. In doing so, she appeared to roll back from her position last month when, under questioning from the tribunal's legal team, she agreed it would be an understatement to describe such directives as purely aspirational but, rather, they represented expressions of best practice which blood boards were working towards.