The evidence of Dr. Anna Pettigrew was heard on the 7th December 2020. She began by providing an overview of her career working as a Registration House Officer in Medical Paediatrics at the Royal Hospital for Sick Children in Glasgow until 1977 and thereafter as a Haemophilia Senior House Officer at the Royal Infirmary in Glasgow before commencing her training in 1989 to go into general practice. Dr. Pettigrew had previously given evidence at the Penrose Inquiry.
Dr. Pettigrew spoke of her time during 1980/1989 working as a clinical Assistant at Yorkhill where she worked alongside Dr. Willoughby who treated cancer patients as well as providing haemophilia care. Dr. Pettigrew explained there had not been a bleeding clinic or special unit for haemophilia care until Dr. Hann joined the department at Yorkhill in 1983. Prior to that, patients were seen in the day care area or casualty department when they attended with bleeds.
Dr. Pettigrew was asked about the treatment policy at Yorkhill and whether there were any written policies. She was not aware of any and explained in the 1970s Cryoprecipitate had mostly been used until Dr. Willoughby developed the home treatment program, providing prophylaxis treatment and treatment with SNBTS Factor VIII. She explained the supply of SNBTS became poor and unreliable and so Dr. Willoughby transferred to the use of the commercial product Armour Factor VIII for home therapy.
She explained this treatment had been preferred by parents because of the convenience. However, in 1983 Dr. Hann reverted to the SNBTS product for home treatment as Scotland was expected to achieve self-sufficiency. Untreated patients in the 1980s would probably have had treatment with Cryoprecipitate. In the early 1980s DDAVP had been used for treating mild haemophiliacs, patients with Von Willebrands Disease and non-serious bleeds. She could not say however, that patients with Von Willebrands Disease did not ever receive commercial concentrate. Dr. Pettigrew explained how she introduced routine liver function testing at Yorkhill in the mid-1980s, having previously carried these out at the Royal Edinburgh Infirmary. As a junior doctor during this time, she was not consulted on the decision making concerning the use of treatments.
Dr. Pettigrew said that in the 1980s, hepatitis B had been a considered a serious condition and there was much concern of transmission of this virus to other family members whilst using home therapy. Parents were informed that all blood products carried risks, screening could not be relied on 100% and hepatitis B was potentially a fatal illness. However, she had been unaware of NANB being a serious condition until 1984. Dr. Pettigrew was asked about the sharing of up to date information and clinical developments between clinicians. She explained the internet had not been an option in those days, so she had been reliant on her seniors, colleagues and attending meetings.
Dr. Pettigrew was questioned on the safety of products. She said she had been aware in early 1980 that the US commercial products carried more risk as this came from paid donors and were more likely to transfer viruses. She spoke about the advice and information that was provided to parents and that more parents began to ask questions when the HIV virus became a threat to haemophiliac patients. She spoke about the stigma and the reaction of hospital staff refusing to transport bleeding disorder patients. Parents had been encouraged to join the Haemophilia Society who could supply information to them.
Dr. Pettigrew was questioned on her knowledge of AIDS treatment in the early 1980s. She explained parents of patients were advised of the of likely progression to liver disease but also of another virus which was not hepatitis C. As it was considered there was insufficient proof of the agent, treatment with blood products was not withdrawn.
When asked whether parents had a right to know about the risks of Factor VIII and had the choice to revert to Cryoprecipitate, Dr. Pettigrew considered there should have been a policy in place and that in hindsight, they could have dealt with the situation much better but that it had been a time of confusion.
Dr. Pettigrew was asked about HTLVIII testing on stored samples at Yorkhill by Dr. Follett in 1984/85. She said she had only become aware of this when Dr. Hann showed her a letter from Dr. Follett which listed the names of patients who had become infected with HTLVIII. Dr. Pettigrew went on to explain how parents were informed of the results of the tests and how difficult and upsetting it had been to break the news to parents that their child had tested positive for HTLVIII. Dr. Pettigrew talked about the importance of the social worker and her liaison with parents. The negative effects on children attending the Ruchill Hospital for AIDS treatment was highlighted by Inquiry Counsel. Dr. Pettigrew explained the process of informing GPs of a patient’s infected status. Dr. Pettigrew explained the approach to patients’ consent in the 1980s and the common practice of ‘implied’ consent.