After an explosive start, the cross-examination of the Blood Transfusion Service Board's chief medical witness, Dr Emer Lawlor, seems to be running out of steam. Little new ground was covered yesterday - Dr Lawlor's 15th day in the box - as the tribunal returned to the BTSB's decision to continue using a locally made Factor 9 blood product which was not heat-treated months after clinicians had deemed it unsafe.
The product has been identified as causing infections to seven sufferers of haemophilia B, or "Christmas disease", between July 1985 and August 1986. Five have since died.
Dr Lawlor conceded there was "undue complacency" within the board regarding AIDS and the safety of the Irish blood supply. There was "an unrealistic view that Ireland of the saints and scholars did not have HIV in its donor population".
She said the board also feared side-effects from heat-treating Factor 9, namely an increased risk of contracting thrombosis. She stressed it "was not a theoretical risk". Some 72 cases of thrombosis caused by heat-treatment were recorded in international studies, she said. Seven of the cases were fatal.
While all this might help explain why the board only began heat-treating Factor 9 in August 1985, it sheds little light on why it continued to use the untreated product for up to a year after that.
Astonishingly, in September 1985, a month after haemophilia treaters informed the board they would no longer accept untreated product, the BTSB produced 70,000 units of untreated Factor 9. Moreover, between October and December, equal amounts of heat-treated and untreated product were issued to hospitals. Dr Lawlor said the policy initially was to send the heattreated product to Dublin's St James's Hospital and untreated Factor 9 to other hospitals. She described the period as one of "clinical assessment".
But the board's apparent slowness in withdrawing untreated Factor 9 did not end there. In January 1986, it decided to stop issuing untreated products and wrote to hospitals informing them of the decision.
The letter, however, did not seem to have the desired effect and a second recall notice was issued in June 1986. While this appeared to have been more effective, it, too, did not reach all its targets.
The tribunal has heard that the regional haemophilia treatment director for Galway, Prof Ernest Egan, wrote to the board in September 1986 complaining he had only just heard of the recall from a third party. He said he was "very disappointed" not to have learnt of the risk directly from the board, adding: "I feel that it is your responsibility to communicate this sort of information to the likes of myself so that appropriate action can be taken at our end."
Prof Egan is due to take the stand with other treaters after Dr Lawlor concludes her evidence which, at the current pace, might not be for another week.