It has been a question of when - rather than if - the chief executive of the State's flagship hospital would resign. Last night, weeks after he had written his letter of resignation, the chief executive of Tallaght Hospital, Dr David McCutcheon, presented it to the board. He believed his position had become untenable.
Apparently, last night's meeting was extremely emotional, with the board reluctantly accepting the resignation. According to sources, it was particularly difficult for chairwoman, Ms Rosemary French, who has backed Dr McCutcheon from the beginning.
But the Minister for Health, Mr Cowen, and his officials are probably viewing matters somewhat differently this morning, jaundiced by being presented with the biggest budgetary over-run in the history of the health services.
Sniping between them and the hospital management has continued for some time and it is not easy to identify what went wrong and who bears the most blame.
The problems were multiple before the hospital opened. It was being built from Department of Health plans drawn up over a decade ago. Even the opening date was a matter of contention.
Those on the Tallaght side argue that the Department's budget allocation was never going to be enough. Not only were they bringing together three hospitals - the Adelaide, the Meath and the National Children's Hospital - but they were supposed to be offering new and enhanced services.
Not only are they unable to open some of the planned services, but other services are being curtailed. Accident and emergency attendances are already up by 30 per cent.
Problems have been compounded by something of a siege mentality arising from the board seeing itself as a protector of the Protestant ethos, which it felt was under threat and not supported by the Department.
However, Mr Cowen was fast losing patience as the independent board continued to over-run its budget, without seeking sanction.
The 211-page Deloitte & Touche report, which he commissioned, found an over-run of £13.3 million and a potential £4.3 million overrun of capital expenditure. The report had identified problems of "serious governance and general management problems". There were also 120 unsanctioned jobs.
One source felt that while Mr Cowen "paid the piper he did not get to select the tune". He also has his eye on the assets of the three base hospitals and the buildings left behind in the city centre.
The Minister took firm action in ordering the Deloitte & Touche report and was ensuring its recommendations would be implemented by appointing his own team to hospital management. It showed the hospital would run out of funds if serious cost over-runs, including £550,000 per month on the payroll, were not tackled. Hospital management is in the process of securing a long-term bank loan of £8.5 million to cover a revenue deficit for 1998.
Last night, the board said in a statement that it wanted to put on record its "profound gratitude" for all that Dr McCutcheon has contributed to the life and work of the hospital since his appointment in October 1996.
"Foremost amongst his contribution has been a compelling vision of patient-centred care. This vision underpinned the process of integrating three significantly different hospitals. The integrating process has been most successfully achieved at both the level of the delivery of patient care and at the level of the operations of the board and undoubtedly was greatly enhanced by the fact that Dr McCutcheon is a qualified medical doctor."
The board also praised his "consensual approach and committee skills" which it said had been greatly admired and appreciated. Outside of the board, however, some felt Dr McCutcheon could have been quicker in taking decisions and should have delegated more.
In its statement, the board said his vision had also carried the "inspirationally successful transfer of services" from the three hospitals with the minimum disruption to patient services. Finally, the board said it was confident that history would record "the very great debt of gratitude that is owed to Dr McCutcheon".
Dr McCutcheon, who is married with two children, worked in Canada for several years before returning to Ireland to take up the job in Tallaght. Earning around £100,000 per year, Dr McCutcheon was the highest paid health administrator in the health services, earning more than the Minister. He is said to be considering a job overseeing the merger of two Canadian hospitals.