A considerable number of questions will have to be addressed by doctors on how seven haemophiliacs in the State became infected with HIV after 1985, counsel for the tribunal said at the beginning of the inquiry's third phase yesterday.
Mr John Finlay SC, in his opening statement, said issues arising out of these infections, which occurred after the risks of HIV were known, included why doctors continued to use products made by the BTSB which had not been heat-treated to inactivate the HIV virus.
He said heat-treated commercial factor 9 for these patients became available in February 1985 but some doctors continued to use both heated and non-heat-treated products. One patient had continued to use non-heat-treated product up to February 1986, he said.
The tribunal has already heard that five of the seven haemophilia B patients who became infected with BTSB factor 9 have died.
Mr Finlay said it could be suggested that as soon as treating doctors became aware of the first of these infections they ought to have tried to establish if the infection had been caused by BTSB factor 9 or a commercial heat-treated product and have reviewed their policy in respect of the use of both.
Counsel added that the tribunal would also examine whether there was sufficient communication between the various doctors and institutions treating persons with haemophilia.
He said they would also have to look at whether the use of imported concentrates was "justified" before 1982 when a BTSB product known as cryoprecipitate, which was made from voluntary blood donations, was available.
"It also seems necessary to examine whether the treating doctors made information available to persons with haemophilia about the balance of risk and benefit between commercial concentrates and cryo and factor 9 produced by the BTSB either at an individual or at a more general level," he added.
Counsel said the tribunal would also examine whether doctors adopted appropriate policies to prevent hepatitis C transmission from the mid1980s onwards. They would look in particular at the infection of four children, and whether they should have been offered a safer product.