The Blood Transfusion Service Board should have introduced HIV testing and donor screening initiatives earlier than it did, the blood bank's chief medical witness conceded yesterday. However, Dr Emer Lawlor said the board's delaying, in her view, had no impact on the infection of a Kilkenny health worker with HIV in July 1985.
Dr Lawlor, deputy medical director of the Irish Blood Transfusion Service, formerly the BTSB, was giving evidence on the first day of a new phase of the tribunal dealing with the agency's HIV screening, testing and look-back programmes.
An HIV test first became available in the United States in March 1985 and was made mandatory in American blood banks that July. During that time the BTSB considered doing the same but it only got round to introducing a test in October 1985.
Dr Lawlor agreed the board had acted on the HIV threat at a "reasonably casual pace" and did not give it priority, due to a misguided belief that AIDS was "not an Irish problem". For much of 1985 the board was also sceptical about the accuracy of the tests available and had a "genuine concern" about the need for alternative test sites for HIV.
Launching a test without such sites would have been a possible recipe for disaster, said Dr Lawlor, as the test would have had a "magnet effect", attracting people from at-risk groups to give blood so as to find out whether they were HIV positive.
In hindsight, Dr Lawlor said, the board ought to have introduced a test on a trial basis at an earlier stage and if there were problems it could have changed it. However, she stressed the BTSB followed the lead of other blood banks, saying Europe in general was "too slow" in responding to the threat of AIDS.
Documents show that in July 1985 the board first ordered testing kits from suppliers for evaluation.
Dr Lawlor said it might have been able to do this earlier if kits were available. However, she said, as there was a "working-up" period of at least two to three weeks before testing could be introduced, she did not think the board could have had it operational before the Kilkenny nurse became infected through a blood transfusion on July 16th, 1985.
In August 1985 the board first carried out a study of the financial implications of testing, and Dr Lawlor agreed this should have happened earlier, in parallel with the evaluation process.
On September 12th, 1985, the board wrote for the first time to the Department of Health seeking approval for funds and staff for HIV testing.
Counsel for the tribunal, Mr Gerry Durcan SC, described it as "strange" that the board had moved from a "relatively leisurely pace" to regarding the issue as of "extreme urgency".
He put it that the only significant thing which had happened was that Britain was to introduce testing the following month and the board thought it was going to be in trouble if it did not follow suit. Dr Lawlor agreed.
Regarding screening, Dr Lawlor said it was "regrettable" that it took so long for the BTSB to introduce an updated information leaflet for donors, designed to exclude at-risk groups.
The board first introduced a general leaflet, identifying risk groups such as intravenous drug users and sexually active homosexual men, in July 1983. However, this was not updated until December 1985, 13 months after a draft revised leaflet - with a wider definition of risk groups and more specific questions for donors - was circulated by the board's consultant haematologist, Dr Terry Walsh.
Explaining the delay, Dr Lawlor said the board was reluctant to launch the initiative until HIV testing was introduced. This was despite the fact that a revised leaflet was introduced in Britain in May 1985.
Dr Lawlor agreed the delay was unsatisfactory. But she did not believe it had any ill-effect.
In relation to the Kilkenny case, she noted Donor A, the donor whose infected blood the nurse received, had signed the updated information leaflet in September 1986, the month he tested positive for HIV. The donor would not, therefore, have been picked up earlier by the leaflet, Dr Lawlor said.
Meanwhile, it was learnt yesterday the Irish Haemophilia Society has added Mr Martin Giblin SC to its legal team. He replaces Mr John Trainor SC, whose retainer was withdrawn by the society last month.
