He began by providing an overview of his medical background which included Sheffield Hospitals medical rotation (General Medicine Training Scheme) during the years 1970-1973, Registrar in Haematology at University Hospital of Wales (UHW) (working with Professor Bloom) and Llandough Hospital during 1973-1975 before becoming Senior Registrar at the Sheffield Royal Infirmary 1975-1978.
His duties included laboratory haematology and care of in-patients and out-patients mainly at Sheffield Royal Infirmary but also at the General Northern Hospital and Sheffield BTS. From 1979 to 2003 Dr. Mitchell worked as a Consultant Haematologist and Director at the University Hospitals of Leicester and was a member of the UKHCDO until 2003.
Dr. Mitchell was questioned by Jenni Richards QC about his involvement in the study of DDAVP treatment, performed in 1978 at the Sheffield Royal Infirmary. He explained it was during this study that he noted progressive and non-progressive hepatitis and liver disease in patients undergoing biopsies. Ms Richards went on to ask about the types of treatment being used in the 1970s, for haemophilia A, namely Cryoprecipitate, Armour FVIII, Kryobulin and Factor IX for haemophilia B. He said it was recognised at that time that large pool concentrates were connected to progressive liver disease and therefore multifactor concentrate treatment was reduced. Dr. Mitchell said he was unaware that BPL were making small pool concentrates, and would have used these, rather than the large pool concentrates if he had been made aware.
In 1980 when the new Haemophilia Centre was built at Leicester, Dr. Mitchell took responsibility for haematosis and bleeding disorders. He recalled that resources were limited, only having two consultants. In 1981 a specialist nurse was appointed to the Centre, (the first in the UK) and assisted greatly with home treatment and in other areas. He explained how there was no treatment policy in place on his appointment at the Centre, and so he formulated his own. The Centre tried to stick to the same batch of product when treating patients with haemophilia A and B. He said it took a year or so to implement his policy. He explained being isolated at Sheffield, and having little or no support from other reference centres.
Dr. Mitchell was questioned on his awareness of the association of factor concentrates to the AIDS virus. He said he had become aware of the virus in or around 1983. Questioned on whether his patients were informed of the possible risk of factor concentrates, he confirmed they were. He said he did not think suspension of home treatment of Factor VIII was a good idea at that time, because he did not want to return his patients to an inadequate treatment such as Cryoprecipitate. Risk of exposure to patients was reduced by deferring non-urgent surgery. Supplies of NHS factor concentrates were rationed amongst the five centres in the Trent area.
Dr. Mitchell was asked about his policy on the use of heat-treated products and the use of Koate in 1985. His preference was to use NHS heat treated Factor VIII and Factor IX for severe haemophiliacs. Dr Mitchell said patients were informed when changing treatment. Heat treated Factor IX was also used for the treatment of Parvovirus.
Dr. Mitchell explained the process of HTLV3 testing and how patients were informed of the risk before being tested and how they were advised of their infection after they had tested positive. He explained how advice on general care and sexual transmission was provided to those patients and how they would be carefully monitored. He spoke about counselling and how steps were taken to provide help to patients by an appointed social worker. Funding, however, was subsequently withdrawn for this counselling.
Dr. Mitchell was questioned on his association with the UKHCDO in the 1990s. He explained how members were not encouraged to “have a voice” and that meetings mainly tended to consist of brief reports of working parties.
Dr. Mitchell spoke about how he secured the funding for a look-back exercise carried out in around 1995 to trace 100 donations of people to be found positive for hepatitis C.
Ms Richards asked Dr. Mitchell about his involvement with representatives of pharmaceutical companies and lavish hospitality. Dr. Mitchell said he was unaware of any ‘lavish’ hospitality but that the pharmaceutical companies did assist in funding trips for educational meetings abroad and this assistance was welcomed by the Committee as they had a limited budget.