Treatment switched without risks spelled out

Medical practice has changed, it seems, and for the better.

Medical practice has changed, it seems, and for the better.

Today, one might find it hard to imagine a patient not being informed of a serious safety risk associated with a medical treatment.

But 20 years ago it was a different matter. Or, at least, so Prof Ian Temperley seemed to say yesterday.

The tribunal was revisiting the case of Rory, a haemophiliac who died from AIDS in 1995 and whose mother gave evidence to the inquiry under the pseudonym Jackie. She described how her son had been treated with locally made cryoprecipitate until August 1983 when Prof Temperley persuaded her to switch to commercial concentrate, a product associated with a higher risk of viral infection.

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AIDS was beginning to loom as a threat to the haemophilia community and because of a fear she had of needles, Jackie said, she "only wanted an excuse" not to switch to the patient-administered concentrates. Yet, she said, Prof Temperley said nothing about AIDS.

"She could well be correct," the retired doctor conceded yesterday. Asked whether Jackie was entitled to such information, he replied "now, yes" but in the context of the time it was much less likely that he would have given it.

Rory was subsequently diagnosed with HIV, which he received through imported concentrates. He died aged 22.

Prof Temperley stressed that the decision to switch treatments was not a question of being "thoughtless". It was a clinical decision based on the perceived risk at the time, and on what was considered best for Rory.

He said he felt it was a "fairly essential" move as Rory had not been benefiting from existing treatments and his condition was deteriorating.

Arguably, however, Prof Temperley breached his own guidelines on the use of concentrates by switching treatments in the case.

The tribunal heard yesterday how the doctor drew up a policy document in late 1983 recommending that cryo should be used in preference to commercial concentrates, even in "clinically quite threatening situations".

The guidelines, prepared for the National Haemophilia Treatment Centre, of which he was medical director, stated that for day-to-day hospital therapy patients should be given only cryo, and that this plan "should only be disregarded in a serious emergency".

For home therapy, however, on to which Rory was switched, the guidelines stated that the present policy of using commercial concentrate "will be maintained".

This was in line with a recommendation at the time of the UK directors of haemophilia services, to which Prof Temperley said he looked for advice, given the relative lack of expertise in Ireland.

Prof Temperley's guidelines were not finalised until December 1983, although the issues involved were being considered by him at the time of his decision in Rory's case.

Prof Temperley stressed the guidelines were "evolving" at the time as knowledge of the HIV virus was in its infancy. He added that, while the policy was maintained "as best as we possibly could", his word "wasn't law completely".

Whether Prof Temperley did breach his own guidelines is, however, not as important as whether he should have switched treatments. Only Judge Alison Lindsay can provide an answer to that.

Earlier yesterday, the inquiry witnessed some heated argument between legal representatives of the Irish Haemophilia Society and the tribunal.

Counsel for the IHS, Mr Martin Giblin SC. submitted that he was subjected to "unwarranted and fallacious" interruptions at a recent sitting, a claim which was rejected by counsel for the tribunal, Mr John Finlay.