The Blood Transfusion Service Board's (BTSB) initial reaction to the discovery of AIDS in the early 1980s, and to fears over the possible contamination of haemophiliacs, was portrayed yesterday as lacking urgency and blighted by indecision.
A "very tortuous" process of "toing and froing" was how counsel for the tribunal, Mr John Finlay SC, characterised the board's internal discussions in the four years up to the end of 1984. Most worryingly, he said, "no concrete advancement" had been made in that period in developing alternative blood products to those imported from the United States and other countries, over which there were growing safety fears.
It was a verdict with which Dr Emer Lawlor agreed. On her second day giving evidence, the BTSB's deputy medical director, conceded the pace of decision-making was disturbingly slow.
The period under examination was crucial as a window of opportunity then existed to keep the HIV virus out of the domestic blood supply.
The first case of haemophiliacs being infected with HIV was reported in the United States in mid-1982. Two years later, the first of some 260 Irish cases was reported - a haemophiliac patient in St James's had become infected with the AIDS virus.
According to Dr Lawlor, the board probably had until 1983 to come up with a solution which would have stopped the domestic supply becoming infected.
Internal documentation from the period showed the board had initially pinned its hopes on becoming self-sufficient in the provision of blood products for haemophiliacs. The idea, spelt out in a January 1981 document, "Future Development of the BTSB", was to produce a concentrated blood clotting agent from Irish donations.
The report listed a number of advantages to "home-production", including the fact that it would lower the board's reliability on outside agencies and help reduce the risk of transmittable diseases. Moreover, it said "it is likely that the cost of production will be appreciably lower than that of [imported] commercial products".
However, Dr Lawlor said the idea was ultimately shown not to work. She said the BTSB had neither the expertise nor the resources to become self-sufficient, particularly at a time when embargoes on Government expenditure on health services "started biting".
Even if the board had become self-sufficient, she said, there was no guarantee that infection would not have taken place. Other countries which had built production facilities costing up to £60 million still had cases of infection.
However, she admitted while self-sufficiency might not have eliminated the risk it would have reduced it.
Documentation from the period showed a great deal of optimism initially in the "homeproduction" method. By January 1982, Mr Sean Hanratty, a senior technical officer with the board, reported that trials would be completed within three months and concentrates produced for patients within six months. The test product was said to have had "an excellent clinical response" with immediate arresting of bleeding and no adverse reaction.
Mr Finlay noted that around this time concern about the AIDS virus was increasing. He cited an Irish Times article in May 1983 quoting board officials commenting on the issue. He also cited minutes of a conversation between Mr Hanratty and Mr Brian O'Mahony, secretary of the Irish Haemophilia Society, in which Mr O'Mahony expressed concerns about the virus and the use of imported American blood products.
In July 1993 the BTSB issued a press statement in which it claimed to be "on the point of making a big breakthrough" with regard to the home production of factor 8.
But there was a change in policy to finding overseas companies to produce factor 8 from plasma collected in Ireland.
Asked did she agree it took a "troubling" length of time for the board to come to this conclusion, Dr Lawlor agreed "it was quite long".
She will resume her evidence today.
