A doctor yesterday defended her decision more than 20 years ago to give an imported concentrate to a haemophiliac with a nosebleed rather than wait an hour to find enough sterile water to allow a safer product be used.
Dr Emer Lawlor, a former haematology registrar at St James's Hospital, Dublin, told the Lindsay tribunal she believed she made the right decision in treating Mr John Berry with Haemofil on the basis of a balance of risks.
The product, made by the drugs company Baxter Travenol, infected him with hepatitis C, which caused his death from liver disease last year.
Dr Lawlor, who is currently deputy medical director of the Irish Blood Transfusion Service, said no doctor could be happy with prescribing a treatment which led to such an unfortunate outcome. However, she said, "what was right was to stop the bleeding" which was occurring at the time.
Mr Berry, a mild haemophiliac and father of three children from Athy, Co Kildare, gave evidence to the tribunal before he died. He described how he was admitted to the hospital in 1979 with what he regarded as a relatively minor bleed.
Medical records show his nosebleed had stopped by the time he arrived at the hospital but an admitting doctor recommended he be kept in overnight and treated with cryoprecipitate if bleeding restarted. When this happened in the middle of the night, however, a junior doctor on duty found there was insufficient sterile water to prepare a treatment of cryo.
At 6.45 a.m., the doctor phoned Dr Lawlor, who was on call, and she instructed him to give Mr Berry two bottles of Haemofil to stop the bleed.
Dr Lawlor said there would have been a preference for using cryo, partly because it was "the national product", i.e., sourced from voluntary donors in the Republic. She added it was known there would be "a higher risk" with concentrate.
However, she said, she was also concerned Mr Berry could have collapsed and died.
"From a nosebleed?" asked Mr Martin Hayden SC, counsel for the Irish Haemophilia Society.
"Yes," replied Dr Lawlor. She said a patient like Mr Berry could have collapsed very quickly. She added if he had collapsed within the hour it took to get enough sterile water she would not have liked to have had to explain the situation to either his relatives or Prof Ian Temperley, the head of haemophilia treatment at the hospital.
She said doctors always had to balance risks and the balance at that time meant her treatment was the appropriate one. She admitted, however, if you were talking about 1984 - when fears about viral infectivity were much greater - the balance might have been different.
She added she did not know if sterile water shortages were a common problem at the time but she though it "unlikely" this was the first occasion such an incident occurred. It showed, she said, the need for a proper system to be in place to ensure sufficient quantities were always available.
In other evidence, Dr Lawlor rejected an allegation that the blood transfusion service may have "dumped" large quantities of unsafe, non-heat-treated Factor 9 into hospitals in August 1985.
Giving evidence from a review of documents, she agreed more Factor 9 than normal was sent out by Pelican House in that month. Furthermore, she said, "in retrospect" it clearly was not wise for hospitals to be building up stocks of untreated material at a time when HIV-safe heat-treated Factor 9 was shortly to come on stream.
However, she said, the orders were driven by what each hospital requested, and the people doing the ordering may not have appreciated the situation. Of the suggestion the blood bank was dumping the product, she said, "I don't think there is any evidence of that, and I don't think it makes sense."
The tribunal continues today with the start of a new phase of personal testimony from haemophiliacs and their next-of-kin.
