Doctors did not discuss patients' options

Doctors 15 years ago did not discuss with patients the relative merits of blood products or treatment options, a leading British haematologist told the Lindsay tribunal yesterday.

Prof Christine Lee, director of the London Royal Free Hospital's haemophilia centre, said it was not the policy in the mid-1980s to discuss the treatments with patients. She stressed, however, "times have changed".

She was being questioned by Mr Raymond Bradley, solicitor for the Irish Haemophilia Society, about the centre's policy from 1983 onwards of "always" treating children with locally produced Factor 8 instead of commercial concentrates. Asked whether doctors would have discussed the merits of National Health Service versus commercial concentrates, Prof Lee replied, "no".

She said: "In those days and indeed even today the determination of the clotting factor concentrate used in a centre is not a matter of choice." Her evidence echoes that of Prof Ian Temperley, former medical director of the National Haemophilia Treatment Centre, when he spoke of the different doctor-patient relationship which prevailed in previous years.

Asked about his failure to inform a parent in 1983 about the infection risks associated with concentrates, Prof Temperley said "now" they were entitled to be given information but "then, in the context of the times . . . it was much less likely that I would have done that".

Explaining the practice in London at the time, Prof Lee - who did not have clinical responsibility, having become director in 1991 - said there was a "very strict policy" of treating mild haemophilia A patients with a synthetic drug, DDAVP.

Adult haemophiliacs received either commercial or NHS Factor 8 with a preference for the latter for "purely historical" - rather than safety - reasons.

She said cryoprecipitate was not widely used and the only severe haemophilia A patient who got it was "a kind of conscientious objector" to concentrates.

The London hospital, in contrast to practice in the Republic, also adopted a policy of deferring elective surgery between 1984 and 1985 after knowledge began to emerge of the problem of HIV transmission, she said.

About 10 per cent of patients at the hospital with bleeding disorders were infected with HIV. This compared to an infection rate of about 30 per cent in the Republic's haemophilia population.

Of an estimated 397 severe haemophilia A patients at the Royal Free, 101 were infected. Of an estimated 360 mild-to-moderate haemophilia A patients, seven were infected.

Prof Lee also described how she was involved in an early study into the threat of hepatitis C transmission. Findings published in 1985 showed that 100 per cent of people got the virus following their first transfusion and that there was no difference in this regardless of whether concentrates were sourced from American or local donors.

She noted there was "a general ignorance" of the virus at the time as doctors were much more preoccupied with HIV. She recalled one senior figure in the field "completely rubbished" her findings and said the then new strain of hepatitis did people no harm.

The tribunal was adjourned until tomorrow when the chairwoman, Judge Alison Lindsay, will give her ruling on last week's IHS submission on broadening the inquiry to investigate the actions of certain drugs companies.

The tribunal is then due to be adjourned for the summer.