A consultant at St James's Hospital, Dublin, says she has misgivings about a proposal to establish an independent HIV unit for haemophiliacs at their national treatment centre. Dr Fiona Mulcahy, a genito-urinary physician, told the Lindsay tribunal there was a risk that the proposed clinic would become isolated as a stand-alone unit.
Studies showed that services which looked after fewer than 100 patients did worse in respect of patient care than larger services. While an independent service would be "fine", she said, she wished to put it on record that it might not be the best service for patients.
Under the proposal, a consultant who specialised in HIV treatment would be assigned to the main centre for haemophiliacs, the National Centre for Hereditary Coagulation Disorders, at St James's, she said. The move is supported by Dr Owen Smith, the centre's director, and the Irish Haemophilia Society.
Dr Mulcahy said she understood some haemophiliacs would prefer to have their own clinic rather than be seen along with other HIV patients, including prisoners and drug-users.
There was a balance to be struck between having a service which was appropriate or easy to attend and one which provided the best possible level of care. There were advantages to the current set-up in terms of infrastructure and back-up. Consultants benefited from working within a team in which junior doctors and other staff had an input, she said.
Dr Mulcahy, who helped to set up the State's first sexually transmitted diseases unit at St James's in 1987, said the numbers attending had "dramatically escalated". The number of HIV-positive patients had increased 12-fold to 1,200 and the number of annual STD attendances had more than doubled to 20,000.
In the early years, she said, funding was mainly obtained through the National Lottery rather than the Department of Health because of cuts in Exchequer spending. In 1991 additional staff were approved after she wrote with other consultants to the minister for health, Dr Rory O'Hanlon, warning that the government's inactivity "may well be perceived in the future as criminal negligence".
St James's adopted the US approach to HIV treatment which was "hit hard and hit early" with multiple treatments. Triple therapy was introduced routinely at the end of 1995 or early 1996. Since then there had been no death from AIDS in the haemophilia community.
HIV-positive haemophiliacs had fared better than other patients, partly because they had not been exposed to previous treatments and had not built up immunities. Triple therapy had, however, produced significant adverse side-effects.
