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QUESTION: Then a much broader question next. Following the 82publication of the Lindsay Tribunal report, has that had any broader effect in terms of culture change in Ireland in terms of the approach to treatment and patient safety? ANSWER: Absolutely. I think when you look at the recommendations from the Linds...
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QUESTION: Just -- ANSWER: Sorry, just again to expand, I mean I think the culture has changed. I think everybody realised that this can't be allowed to happen again, so, you know, there is a co-designed approach to the Haemophilia Service, major decisions were taken in 84consultation with the patient organisatio...
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QUESTION: Do you have any sense of the extent to which that culture change has extended beyond the haemophilia community? For example, the other bodies, organisations you mentioned, those involved with the -- advocating on behalf of those who were infected through transfusion or infected through anti-D, would they, d...
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QUESTION: Then just going back to the work of the Compensation Tribunal. Do you know what approach is taken to the assessment of compensation if there is a dispute between family members? So there may have been -- there may be competing claims in terms of care or dependency. Do you know whether that's arisen at all...
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QUESTION: Then the awards made by the Tribunal, are they taken 86into account for the purposes of any applications for welfare benefits? ANSWER: No, they're not, they're specifically excluded. And in fact, because of the arrangements we've made with the Revenue Confidential Service, they can't even know about th...
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QUESTION: And in relation to taxation, you've explained the position in your statement, but for the benefit of those who may not have been able to read through your statement, what in short is the position in terms of taxation and the compensation awards? ANSWER: The compensation awards are tax-free. That's clear. Bu...
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QUESTION: And then last question arises from your involvement internationally, you've been involved both in terms of 87the World Federation and the European Consortium. Do you know to what extent the measures that you've been describing in Ireland, in particular in relation to the insurance scheme and the HAA car...
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QUESTION: 1 Closing statement by MS MONAGHAN KC on behalf of 4 individual Core Participants ANSWER: Yes, Ms Monaghan.
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QUESTION: Good morning, Sir. Good morning. Sir, I speak a behalf of four Core Participants, Mr AK, Paul, Robert James -- whom I shall refer to as Robert -- and Mr AH, all of whom gave evidence before you, Sir. They have asked me first, please, to thank you, sir and the whole of the Inquiry team for the way in which...
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QUESTION: Precisely, Sir. That's precisely the point we make and, indeed, the UK has agreed to adopt those human rights norms but it is right to say, as well, that these are broad international covenants, certainly the UN Covenant is one that's 1966 and widely adopted -- a large number of states are signatories to ...
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QUESTION: Yes, thank you, sir. So, consequently, the rights that -- health must be understood as the right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realisation of the highest attainable standards of health. In fact, it will be as well -- certainly I would invite ...
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QUESTION: Thank you. Sir, if I can ask you, please, to look firstly at the "Preamble", simply to observe again that this is a convention inspired by the UN's foundational documents, the Charter, we see that referred to at paragraph (a), and at paragraph (b) The Universal Declaration that I took you to a moment ago ...
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QUESTION: I'm sorry. I'm not quite used to this, Sir, and you told me about hurrying or somebody did, so I'm terribly sorry. Are we there now? ANSWER: We are. If you want to check ever it is on the screen to your right, the big screen.
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QUESTION: I think it is here but I was concentrating on my notes and not the screen, but there you are. Apologies. ANSWER: You may want to start Article 1 again.
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QUESTION: Thank you. So Article 1 identifies the "Purpose", and: "The purpose of the ... Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity." Persons with disabili...
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QUESTION: Yes. ANSWER: But non-A, non-B might be thought, unless there is evidence that it is an actual late comer, which evidence isn't apparent, I think, in the document, but I will listen to any submissions to the contrary, was always there, it was always part of the viruses that were causing hepatitis. So it...
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QUESTION: Yes. 35ANSWER: So that is what you are submitting to me, is it?
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QUESTION: That's what I'm submitting. So when I talk about an "unknown virus", I'm talking about a virus that hadn't been identified, and the significance for us of drawing attention to that is it was plain, therefore, by then that viruses generally were able to move through blood, blood products and the fact that ...
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QUESTION: Yes. ANSWER: So A simple example, you press a button over there and a light comes on over there, you press a light switch, you know that if you do that, that happens. You hope, as long as the bulb is working. But you do not know how, you don't have to understand electronic theory or electricity or any...
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QUESTION: Yes. 36ANSWER: On a simple level, is disease, do you submit, like that, that if you know you do this that may happen?
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QUESTION: Yes, precisely, and the fact that one can't identify the virus at a particular time doesn't mean that one can't identify the risk factors associated with the transmission of viruses: large pools, commercial blood products, and so on. So it is emphasising the importance, we say, of understanding that HIV d...
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QUESTION: I beg your pardon. I had seen two things and that's why I was -- adviser to, thank you. Adviser to the Chief Medical Officer. 40ANSWER: I think the Chief Medical Officer at the time was Sir Henry Yellowlees.
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QUESTION: Thank you. Just then to re-wind. You will recall the Department of Health minute, I think, in which his observations were recorded. He was consultant adviser, as you have just reminded me, to the CMO. When giving evidence in the HIV Litigation, you may recall he said he first suspected -- and there was ...
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QUESTION: Thank you, sir. 44ANSWER: Yes.
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QUESTION: I was about to say -- I started by observing a moment ago or before the break that no steps were taken centrally to address risk and instead much was left to the judgement of individual doctors. Sir, we heard from Dr Winter as you may recall, that the absence of centralised guidance meant that there were m...
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QUESTION: Sorry, I'm not sure I'm understanding that, Sir. ANSWER: Yes. There wasn't a test for the presence of HIV until the HIV virus had been identified and isolated. That was done at least definitively in 1984, in April it was announced in the US. It was very shortly after that that there was a test for th...
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QUESTION: I see. ANSWER: It supports your argument that he didn't know that his blood was going to be tested.
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QUESTION: Yes, I understand the distinction. Yes, I'm sorry. Yes. So the blood had been retained, so they were able to test it presumably having identified the date on which it was taken -- and I have got lots of nodding from the members of the public, thank you. They are giving me a lesson on testing. Thank yo...
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QUESTION: No, no, as you have said, there was no consent given to testing at all. No consent given to the retention of samples. These were all done without the not only or consent of indeed all of my client group. This was a feature of the treatment afforded people with haemophilia and the transmission of viruses....
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QUESTION: Thank you, sir. Thank you. ANSWER: Ms Richards.
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QUESTION: Professor Franklin, I'm going to ask you first for an overview of your career. You undertoo k, 96 I think, various house officer and senior house officer roles in Leeds between 1974 and 1976? ANSWER: Yes, I did.
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QUESTION: And then between I think 1977 and 1980 you were a research training fellow for the Medical Research Council? ANSWER: Yes.
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QUESTION: Your work then, I think, was predominantly related to sickle cell anaemia? ANSWER: Yes, the research was, yes.
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QUESTION: Did you undertake any clinical work during that period? ANSWER: I did nothing for the first year and then I used to attend a sickle cell anaemia clinic at The London School of Hygiene and at University College about a couple of times a month, and that carried on for those -- the last two years, and in t...
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QUESTION: Then from 1980 to 1982, you were a senior registrar in haematology at University College Hospital? ANSWER: Yes, based there, yes.
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QUESTION: That was your specialist haematology training to achieve membership of the Royal College of Pathologists? ANSWER: Yes.
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QUESTION: Your statement and your CV tells us that between October 1980 and February 1981, you worked for approximately three months at Great Ormond Street Hospital under Professor Hardisty? ANSWER: That's right, yes.
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QUESTION: So you would, in the course of that period, have se en children with bleeding disorders. You said you did n't have a decision-making role in terms of what treatm ent to provide to them? ANSWER: No, I didn't. It was observational, I would say.
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QUESTION: Can you recall anything about what the treatment policies were at Great Ormond Street at that stage? ANSWER: I can't really. I remember they had Lister Factor VIII. I think that was the first time I had heard of Lister Factor VIII. I don't remember whet her they had commercial product and I don't reme...
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QUESTION: Then from March to September 1981 you were training in blood transfusion medicine under Dr Barbara at the North London Regional Transfusion Centre in Edgware ? ANSWER: Well, I didn't work with him. He taught me about transfusion virology but also Dr Marcela, now Dame -- Professor Dame Marcela Contrera...
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QUESTION: You said in your statement that the focus in terms of what you recall learning there was on hepatitis B. It would seem likely that there must have been some discussion of non-A, non-B hepatitis and its risks at that time. Can you -- ANSWER: I think there was some. I mean, I have to say outs ide the...
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QUESTION: Then you moved to St Albans City Hospital, where yo u spent, I think, around three months doing general haematology work? ANSWER: Yes, yes.
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QUESTION: Then January to August 1982 you were at UCH. You'v e said in your statement you were mainly concerned wi th the development of a bone marrow transplant program me? ANSWER: Well, my boss, Professor Tony Goldstone, was settin g 99 out the programme there. He had been doing that fo r a year or so. I wa...
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QUESTION: You have said there was no involvement with the car e of those with bleeding disorders, save for the odd patient? ANSWER: Well, yes. I mean, I remember seeing the occasiona l person with haemophilia on the wards but, really, i t was a haemophilia centre but couldn't have had many patients, I think.
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QUESTION: Did you have any involvement in decisions as to how to treat those occasional patients? ANSWER: Don't remember having any such role, no.
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QUESTION: Do you have any recollection of what treatment was routinely provided? ANSWER: No, I'm afraid not, no.
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QUESTION: Then on completion of that specialist training you gained membership of the Royal College of Pathologists? ANSWER: Yes.
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QUESTION: Then in September 1982, you took up your post as a consultant at the Queen Elizabeth Hospital in 100 Birmingham? ANSWER: Yes.
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QUESTION: You were around 33 years old at the time? ANSWER: Just about, yes.
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QUESTION: Your statement suggests that your appointment was principally to develop a bone marrow programme beca use of your sickle cell experience; is that correct? ANSWER: Yes. I mean, they had quite a large sickle cell population, which I think made me attractive but th ey particularly wanted to start doing --...
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QUESTION: So in terms of haemophilia care, Professor Stuart w as still the director of the haemophilia centre at tha t point? ANSWER: He was.
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QUESTION: For that first 12 months, your statement describes you only dealing with the care of patients with bleedin g disorders when you were on call? ANSWER: Yes, so if we had haemophilia patients in the ward, you would see them on the ward, the ward round, dur ing the day and then if there were any issues deal ...
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QUESTION: I will ask you a little more about that in a few minutes. You then took over as the director of the haemophilia centre after approximately a year, so September 1983 or thereabouts? ANSWER: Yes.
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QUESTION: Did Professor Stuart continue as a consultant or di d he retire completely? ANSWER: No, he -- obviously, he was a professor. He had a research interest and he continued to provide out-of-hours cover on a one-in-three rota and at weekends, but he largely retained responsibility fo r the laboratory and...
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QUESTION: So is it fair to say that at the point at which you became a director of the Haemophilia Centre at the Queen Elizabeth Hospital your direct experience relating to the treatment of patients with bleeding disorders had been largely limited to those three months at Great Ormond Street and then the first 12 ...
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QUESTION: You remained consultant haematologist and director of 102 the Haemophilia Centre at the Queen Elizabeth Hospi tal until the end of July 1992 -- ANSWER: Yes.
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QUESTION: -- and then moved to Glasgow -- ANSWER: Yes.
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QUESTION: -- to take up a role as a consultant focusing on bo ne marrow transplantation? ANSWER: Yes.
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QUESTION: You then worked for a number of years thereafter in the Blood Transfusion Service, initially locally an d then as SNBTS's National Medical and Scientific Director? ANSWER: Yes, I started as National Medical and Scientific Director in early 1997.
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QUESTION: I think you remained a professor of transfusion medicine throughout that period as well. ANSWER: Yes, and I continued to work on the transplant unit s as well.
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QUESTION: Then 2011 to 2014, you had a similar role at the Ir ish Blood Transfusion Service? ANSWER: Yes, that was just solely the medical and scientifi c director, with no other hospital role.
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QUESTION: As I think you know, the questions I ask you today are going to be focused upon your work at Birmingham. ANSWER: Yes. 103
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QUESTION: I'm not going to be asking you about your work in Scotland, although that may be something that the Inquiry will need to ask you about at a later stage of its hearings. In terms of working parties or organisations you belonged to, you were, once you became director of the Queen Elizabeth Hospital Cent...
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QUESTION: I think we've only got a record of you attending tw o meetings, one in 1983 and one in 1984. Does that sound about right? ANSWER: Yes, I don't remember -- well, it was a long time a go. I didn't actually remember many of the West Midland s working parties either, other than the early ones b ut I don't...
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QUESTION: As you just alluded to, you were a member of the Working Party On the Treatment of Haemophiliacs for the West Midlands Regional Health Authority, and we 'll look at some of the minutes of that in the course o f your evidence. You gave evidence to the Archer Inquiry? ANSWER: I did.
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QUESTION: You, I think, had some involvement in some litigati on against the West Midlands Health Authority. You ha d to provide some schedules, I think you said, in 104 relation to patients. Without, obviously, discussi ng any individual case, can you recall the nature of y our involvement? ANSWER: There we...
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QUESTION: Can I ask you just to give us an overview of what t he facilities were at the Haemophilia Centre at QEH wh en you took up your post as director in 1983? ANSWER: Well, first of all, I had a co-director, Dr Frank Hill, who came to the hospital once a week to do the clinic, as I remember, in the morning, a...
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QUESTION: In terms of doctors -- we'll come back to your role and Professor Hill's -- you've mentioned in your statement already, and your evidence relating to Professor Stuart, but there was a Dr Brian Borton . ..? ANSWER: Boughton.
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QUESTION: Boughton. Did he -- ANSWER: I do know he was a senior lecturer. He really only was doing the same as I was doing in the first year , which was one in three nights and one in three weekends covering.
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QUESTION: Were there registrars, senior registrars, who participated in the work of the clinic over the yea rs that followed? ANSWER: Yes, yes, depending on -- they, a bit like me in my training, would rotate through the department. The re were other hospitals in the area, Coventry, the 107 Children's -- Birmi...
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QUESTION: So Professor Hill would come and do clinics jointly with you at the Queen Elizabeth. Did you have any involvement in clinics at the Children's Hospital? ANSWER: No, never.
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QUESTION: Can you recall when you started at Queen Elizabeth Hospital? So first appointed as a consultant but before you took over as director a year later, was there any particular guidance or training that you recall being given by Professor Stuart? ANSWER: You know, I don't remember, to be honest.
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QUESTION: How did the relationship with Professor Hill, and t he fact that you were co-directors, how did that work in practice? ANSWER: I think it worked pretty well. I mean, I had a bit more time to spend than him, but he was a trained a nd experienced haemophilia -- well, I would say, haemophilia expert. He'...
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QUESTION: You said in your statement that you were, to some extent, guided by Professor Hill because he was mor e experienced. You also told the Archer Inquiry that because you were -- I'm not directly quoting from y ou, but you were relatively inexperienced -- ANSWER: Yes, I accept that.
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QUESTION: -- you needed guidance from more haemophilia expert s and tried to follow a consensus opinion. Is that correct? ANSWER: Yes.
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QUESTION: Let's have a look in terms of a rough idea of numbe rs of patients, Professor Franklin. Could we have UBFT0000252, please, Henry. This is a report prepared jointly by you and Professor Hill in April 1986. It was a request for further resources, and we'll come on to that at a later stage of your evidenc...
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QUESTION: I don't think we need to go to it but in a report t he following year you described Queen Elizabeth Hospit al as effectively the fifth largest haemophilia centre in England and the largest not to receive any bespoke funding as a reference centre? ANSWER: Yes. I don't particularly remember that. In fa...
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QUESTION: I think it's right that during the time you were director, the QEH didn't have the status of a reference centre? ANSWER: No, I think they changed -- they seemed to be quite obsessed with the rules around what a reference cen tre was, the UK Haemophilia Centre Doctors' Organisatio n. I think the Children...
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QUESTION: Yes, in 1989. ANSWER: Yes. So I think they changed the nomenclature, but no, I think the adult centre remained the same stat us.
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QUESTION: Can we look at the annual return for 1983. Again, just to get an idea of what treatments were being u sed at that stage. Henry, it is HCDO0000206_002. So this is for the treatment of patients with haemophilia B, and we can see it's a 1983 return. Director: yourself and Dr Hill. Nine patients with haemo...
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QUESTION: I am looking at the wrong paper document. I am so sorry. Yes, sorry, this is the 1983 return for haemophilia A patients, carriers and von Willebrand 's disease. So we can see 83 patients treated during the year with haemophilia A, three carriers of haemophilia A treated during the year, and 13 with ...
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QUESTION: Then NHS factor concentrate we can see being used b oth in hospital and for home treatment? ANSWER: Yes.
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QUESTION: 338,000-odd in hospital, 569,000-odd for home treatment. But then the predominant product is the Armour Factor VIII, so the commercial product, a smaller amount used in hospital but 1.2 million u sed for home treatment? ANSWER: Yes.
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QUESTION: We will look at some of the contracting arrangement s in a little while. So that's haemophilia A patients. Von Willebrand's we can see treated solely with cryoprecipitate. And then if we go to the document I had been looking at -- sorry, Henry, HCDO0000206_004 -- we c an see there nine patients with ha...
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QUESTION: You've said in your statement that the home treatme nt programme was established before you took up your post. ANSWER: Yes.
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QUESTION: You didn't remember actually starting anyone on hom e treatment yourself; is that correct? ANSWER: No, I don't remember doing that, no.
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QUESTION: Was there any programme of prophylactic treatment a t the time? ANSWER: No, I don't -- well, I don't remember that, and certainly I don't think there was in the adults. Prophylaxis was still -- was talked about and considered to be beyond our ability to afford it, I think, probably.
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QUESTION: One of the treatment policies in operation when you joined was a policy of trying to keep patients on t he same product. Can you explain how that worked. ANSWER: Yes. Well, as taught to me, and I think it does ma ke sense, the idea was that once you were exposed to o ne batch of product, it would be b...
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QUESTION: First of all, it was a policy you inherited? ANSWER: Oh, yes. It wasn't my idea, no.
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QUESTION: The rationale was to reduce the risk of infection? ANSWER: Reduce donor exposures and therefore, hopefully, reduce the risk of infection.
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QUESTION: How did that work in practice? How was a particula r batch secured for a particular patient? ANSWER: I can't actually remember exactly how. I mean, I think once a person was on a particular batch, th at would be on their record in the treatment room. So if 114 they were not on home treatment and wer...
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QUESTION: We'll just look at a couple of documents about this . So could we have UBFT0000156, please. This is a later letter, written in the context of HIV haemophilia litigation, but it's referring t o an earlier letter from March 1984, and we don't hav e the earlier letter, Professor Franklin, which is wh y we...