Senior doctors differ over evidence

A serious conflict of evidence between a senior doctor and a former consultant with the Blood Transfusion Service Board (BTSB) emerged at the tribunal yesterday.

Prof Ernest Egan, consultant haematologist at University College Hospital, Galway, told the tribunal last April that it was "inconceivable" he did not inform Dr Terry Walsh in January 1986 about the infection of one of his patients with BTSB-made cryoprecipitate.

Yesterday, however, Dr Walsh said he did not believe he was told about the case.

Had he known about it, he said, he would have informed the BTSB's chief medical consultant and asked Prof Egan for the batch number involved.

Dr Walsh, who was recalled to the tribunal to give evidence on the matter, said the first time he made note of a case of cryo infection was when he compiled a report for the Council of Europe in March 1986, using information from the National Haemophilia Treatment Centre (NHTC) and "no other source".

He said Prof Egan's request, in a letter of January 14th, 1986, that all unscreened cryo be replaced with screened material, would not have been a surprise as HIV screening had been in place for three months by then. The letter referred to a telephone conversation between the two doctors the previous day. It was during this conversation Prof Egan said he believed he discussed the HIV case with Dr Walsh.

Asked by Mr Gerry Durcan SC, for the tribunal, what he had been told about the case, Dr Walsh replied: "I don't believe I knew about that."

If he had been told it would have caused concern, he said, although in the overall context of the devastation caused by HIV at the time, it would have been "just another alarm bell".

Mr Durcan put it to him that it was a very important alarm bell because it was the first time BTSB product was implicated in the infection of a haemophiliac. Dr Walsh agreed but said all product was being screened at that point. In addition, he said, BTSB factor 9 was being heat-treated and untreated material had been recalled.

The tribunal has heard that, while a recall notice was sent out in January 1986, untreated product remained on the market and was used by a haemophiliac the following month. The patient, one of seven people infected with HIV through BTSB factor 9, has since died.

Dr Walsh agreed that had he known about the Galway case it would have been "all the more important" to have untreated stocks of factor 9 returned but, he said, that should have happened anyway. Pressed further, Dr Walsh said Prof Egan may have mentioned "in passing" a case he was worried about but Dr Walsh did not recall a specific mention of cryo. From reading the letter, it seemed Prof Egan was not certain cryo had caused the infection, he said.

Dr Walsh added that when he was told later by the NHTC of a cryo infection case it had not been ruled out that the patient received other products overseas.

He accepted, however, it was "probably" the first indication that a patient had been infected with BTSB product. Despite this, he said, he did nothing further to follow it up.

Cross-examining, Mr Jim McCullough, for the Irish Haemophilia Society, asked Dr Walsh how his knowledge of the matter in 1986 stood with subsequent BTSB statements up to 1990 that there were no infections caused by Irish products. Dr Walsh replied he was not going to speak for the BTSB.