Blood clotting agents which were known to carry a risk of transmitting hepatitis C were given to haemophiliacs in the late 1980s because it was felt virtually all of them had the virus already, the tribunal heard.
The then leading treater of haemophiliacs in the State, Prof Ian Temperley, told the tribunal yesterday it was believed at the time that patients would not be exposed to any additional risk if they had the virus already. However, with hindsight this wasn't "a sound philosophy", he said.
Counsel for the tribunal, Mr John Finlay SC, put it to him that there was no way of knowing at the time if all patients were infected with non-A, non-B hepatitis (as hepatitis C was then known) because there was no test available for this form of hepatitis until 1989.
Prof Temperley said it was believed in the UK that all those who had been treated many times would have been infected. "Everybody assumed that at the time," he said.
Counsel put it to him that UK haemophilia reference centre directors, in recommendations they issued in May 1988, said that "it is not known whether re-exposure to HIV or hepatitis viruses in an already infected patient causes any additional hazard".
Prof Temperley said he had followed their recommendations in offering advice to the Blood Transfusion Service Board in June 1988 on what products should be used. Prof Temperley wrote to the BTSB stating that newer products decreased the risk of non-A, non-B hepatitis (NANBH) transmission but were more costly. He said hospitals could not be expected to meet a doubling of the cost of concentrates in 1989.
Questioned by Mr Finlay on this statement, he said he did not speak to the Department of Health about what costs hospitals could bear before offering this advice to the BTSB.
In his letter, Prof Temperley added that when products were ordered special provision should be made for "virgin" haemophilia A patients, those deficient in factor 8 who had not previously been treated, in order to protect them from the risk of NANBH.
However, he saw no difficulty with continuing to give patients who had previously been treated products manufactured by the Armour pharmaceutical company in West Germany, although the company wanted to be indemnified against any infections which might result from the use of its product.
Mr Finlay asked what provision was made for haemophilia B patients, those deficient in factor 9, who had never been treated before. Prof Temperley admitted that no similar provision was made for these "virgin patients". He said he did not know of any product at the time which would have met their need.
Mr Finlay suggested they could have bought NHS factor 9 from the UK, which was known to be "super-heat treated", eliminating the risk of NANBH transmission. "That was one that escaped us at the time," Prof Temperley said.
The tribunal has heard that a failure to make this provision resulted in the infection of four persons, including three children, with hepatitis C.