The idea of heat-treating blood products for haemophiliacs which would have inactivated the HIV virus was not considered by the Blood Transfusion Service Board (BTSB) until nearly two years after it was first informed of the procedure, the tribunal heard yesterday.
It was only after a patient was diagnosed with AIDS at St James's Hospital, Dublin, in November 1984 that things moved with "commendable speed", counsel for the tribunal Mr John Finlay SC said.
Evidence was presented that the former director of the BTSB, Dr Jack O'Riordan, now deceased, was written to by Travenol - a company supplying blood products for Irish hameophiliacs - in May 1983 advising him of actions the company was taking in response to the threat of AIDS, the cause of which was not then known. The company offered heat-treated products at a small additional cost.
The company wrote to him again in June 1983 saying the Food and Drug Administration (FDA) in the US had given it a licence to produce heat-treated clotting agents which would protect against hepatitis and "possibly AIDS". It said scientists had theorised that haemophiliacs, first diagnosed with AIDS in the US in 1982, were contracting HIV from Factor 8 clotting agents.
Counsel put it to Dr Emer Lawlor, deputy medical director of the board, giving evidence for the third day, that there was no evidence Dr O'Riordan considered the question of heat-treatment until December 1984.
Dr Lawlor said there was considerable debate at the time on the effectiveness of heat-treatment. There was a danger that patients getting heat-treated factor 8 would develop inhibitors to it which were difficult to treat and when, in time, the question turned to heat-treating factor 9, doctors were worried that it would result in thrombosis.
It was not until August 1984 that it was proven that heat-treatment would inactivate the HIV virus, she said.
She agreed doctors did not seem to consider the threat of AIDS when deciding which companies they should buy clotting agent from each year up to late 1984, despite reports in journals linking blood products to AIDS and suggestions heat treatment might eliminate the risk.
She said cost was also a factor in purchasing clotting factors from foreign companies. "While people might not like to think about it, cost is a factor throughout the whole health service and people do have to watch it," she said.
Mr Finlay also referred to a letter Prof Ian Temperley, director of the National Haemophilia Treatment Centre, wrote to Dr O'Riordan on December 17th, 1984, saying he and his colleagues would only purchase commercially produced heat-treated blood products in 1985 and urging the BTSB to heat-treat its own products.
There was no evidence Dr O'Riordan considered switching to heat treated products before this, he said.
Counsel noted things changed after this letter and the diagnosis of a patient in a Dublin hospital with HIV.
The first heat-treated factor 8 came into the State on December 21st and on Christmas Eve the BTSB's chief biochemist, Ms Cecily Cunningham, wrote to two doctors at a fractionation laboratory in Oxford to inquire about how the BTSB might heat-treat its products.