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The Inquiry heard evidence from Dr Janet Shirley.

Dr Shirley began working as a registrar of haematology at Kingston Hospital and later at St Thomas’s Hospital. From 1980-1997 she was a consultant of haematology at Frimley Park Hospital, where she developed an Associate Haemophilia Centre. She later worked as a consultant haematologist at King Edward VII Hospital and Royal Surrey Council Hospital, until she retired in 2011. Her evidence to the enquiry focused on her time at Frimley Park.

Dr Shirley described the functions of the Associate Haemophilia Centre she set up at Frimley Park, which was running by 1981. Patients seen at the Frimley Park Centre would be also registered at a Reference Centre. Patients would be locals who would attend for regular treatment and possible emergency treatment. However, they also had appointments at their Reference Centre. An 1983 annual return saw that patients were being treated with a mixture of Cryoprecipitate, NHS Factor VIII and Armour Factor VIII products.  Dr Shirley said for supply of products, she relied on what was provided by the Tooting Regional Transfusion Centre. Dr Shirley said she was dependent on the Tooting supply and did not recall any discussions of NHS product shortages. For patients who used home treatment, the products would be provided by their Reference Centre and either delivered directly to the patient picked up from Frimley Park. Dr Shirley said for  severe hemophiliacs, the patient would have a  programme of treatment mapped out by their Reference Centre and Dr Shirley would endeavour to get what was written down.

Dr Shirley did make treatment decisions for mild haemophiliacs. She would generally give Cryoprecipitate initially and if that did not lead to a sufficient level of factor, she would turn to concentrate products. As soon as DDAVP became a recommended treatment, she used this. Dr Shirely said in terms of risks of concentrate products she held the view the NHS concentrate was safer to use because it came from voluntary donors, not paid donors. She clarified by safety, she meant in regards to risk of hepatitis, it was not until 1983-84 that she had knowledge of the HIV risk. She also believed Cryoprecipitate had fewer risks of transmitting viruses because each pack was made from individual donors, not a large pool of donors. Despite views of risk, Dr Shirley would accept what was provided by Tooting as she believed they provided what they had available.

Dr Shirley said in terms of knowledge about hepatitis risks in Haemophiliacs, she could not recall when she became aware of the risks of Non-A, Non-B hepatitis, although she was certainly aware by 1984. She told the Inquiry that she always understood it could cause chronic liver disease. Dr Shirley agreed that on principle and with the benefit of hindsight, patients should have been informed of the risk of chronic liver disease. She said she had the view it was the responsibility of the patient’s Reference Centre to inform them of the risks. However, she did not have discussions with the Reference Centres to confirm her assumptions that they would inform patients of the risks. Dr Shirley said she accepts that patients receiving treatment did not have knowledge of risks.

Dr Shirley also spoke of the 8Y Factor trial she put patients on to get them heat-treated 8Y products. She told patients that they would have liver function tests to check if Non-A, Non-B hepatitis was being transmitted. She could not recall if she gave patients information about what hepatitis would entail if it was transmitted. She said on principle, if patients had asked about risks or information about hepatitis, she would have informed them.

Regarding when she became aware of the transmission of HIV in haemophiliacs, Dr Shirley said she could not recall when exactly she became informed, although it would have been around 1983 or 1984. She did attend an October 1983 UKHCDO meeting where a discussion of AIDS in haemophiliacs took place, although she did not recollect the discussion. Dr Shirley confirmed that in 1983 a connection between blood products and HIV had been made, she did not recall informing patients of this connection. Dr Shirley agreed that not informing patients was wrong; she clarified that it is wrong by today’s standards but there was a more paternalistic view at the time.

Dr Shirley said she became more fully informed about the HIV risk when her own patient, Mr AJ, a mild sufferer of haemophilia, became infected in late 1984. She said as Cryoprecipitate was not proving to be effective for Mr AJ’s bleed, he was treated with NHS Factor concentrate. A June 1983 letter was referred to which had suggested that NHS products were safer than commercial products. Dr Shirley said she believes this could be why MR AJ was treated with NHS products. After Mr AJ’s treatment, in December 1984, Dr Shirley had received an AIDS advisory document which was the first time she had received firm guidance on recommended products to be used. The guidance said that heat-treated products should be used. She agreed that if she had been in receipt of this advice earlier, she would have endeavoured to use heat-treated products. She said she did not have the benefit of knowledge Reference Centres had earlier.

In further discussion on choosing products for use, Dr Shirley emphasised her reliance on what was provided to her by Tooting. Sir Brian posed the question that if a visiting patient requiring treatment for a bleed requested a particular product,  would she ask Tooting to provide it?  Dr Shirley confirmed that she could have asked for products for certain cases.

Sir Brian commented that Dr Shirley’s evidence painted a picture of what it was like in a very small Haemophilia Centre during this period.

 

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