The doctor who treated haemophiliacs in Munster admitted yesterday she should have looked for a safer clotting agent for some of her patients in 1985.
Dr Paule Cotter, the consultant haematologist at Cork University Hospital, told the tribunal she knew by late 1984 that heat-treated products appeared to be considerably safer and less likely to transmit HIV.
Together with Prof Ian Temperley, former director of the National Haemophilia Treatment Centre in Dublin, she decided that patients should be given only heat-treated clotting agents. She sought heat-treated commercial products for her factor 8 patients and urged the Blood Transfusion Service Board to begin heat-treating its factor 9 product.
However, the BTSB did not produce a heat-treated factor 9 until the autumn of 1985. Counsel for the tribunal, Mr Gerard Durcan SC, asked if she took any steps to get a heat-treated commercial factor 9 product for her patients in the early months of 1985 while waiting for the BTSB to heat-treat its product.
"Looking back now, perhaps I certainly should have done," Dr Cotter said.
Dr Cotter explained that she was paying attention to "the riskiest product" first (imported factor 8). She said BTSB products were considered to carry a lesser risk because they were made from the blood of voluntary Irish donors. However, she was aware they still carried a small risk.
Earlier, she said she became concerned in the autumn of 1985 when she discovered that heat-treated factor 9 had been provided by the BTSB to St James's Hospital, Dublin, but not to her hospital.
Dr Cotter took up her position in Cork in 1979 and advised patients to go on imported concentrates so that they could treat themselves for bleeds at home. She said she would have informed them of the increased risk of non-A, non-B hepatitis (later known as hepatitis C) from the concentrates.
She became aware of the HIV virus around 1983. It caused her concern and she looked to doctors treating haemophiliacs in the UK for guidance, she said. They recommended the use of cryo, a clotting agent made by the BTSB from small plasma pools, for mild haemophiliacs to lessen their risk of viral infection.
However, records of her patients with mild haemophilia showed they were not always given cryo. Dr Cotter said mild patients sometimes bled so often and so heavily they had to be given concentrates.