No specific reference was made in the minutes of Blood Transfusion Service Board (BTSB) meetings to the discovery in mid-1986 that a number of haemophiliacs had contracted HIV from a clotting agent manufactured by the blood bank, the tribunal was told.
Mr Ted Keyes, former executive consultant of the board, said there was no particular reason for this and he assumed all board members would have been aware of the problem.
At a board meeting in June 1986 Mr Keyes was recorded as saying the situation with the BTSB's Factor 9 clotting agent was being examined as a matter of urgency and that Dr Terry Walsh, a consultant haematologist at Pelican House, had been asked to meet Prof Ian Temperley, former director of the National Haemophilia Treatment Centre, to review standards.
Counsel for the tribunal, Mr John Finlay SC, asked Mr Keyes if this was a "coded" reference to the fact that Prof Temperley had expressed concern that a number of haemophilia B patients had tested HIV positive. He further asked if this was the only information given to board members.
Mr Keyes said he believed board members were told but this was the field of the chief medical consultant, Dr Vincent Barry.
Mr Finlay put it to him that the record in the board minutes was a very significant understatement of the reality that people had tested HIV positive from BTSB product. "I would accept that," Mr Keyes said.
At two further meetings in July no reference was made to the infections. When counsel asked why, Mr Keyes said it was possible he just did not record it in the minutes. "Maybe they were just told off-board what happened. The chairman would have been told by phone because it was a serious issue," he said.
Mr Keyes also said that in a review of structures in 1986 he noted that the board's chief medical consultant (CMC), Dr Barry, was spending all his time in the Cork centre and that Dr Terry Walsh was the consultant in charge at Pelican House. He said Dr Walsh was CMC on an ad-hoc basis but did not have access to board meetings. This was a weakness in the system, he said.