The Irish Medical Council has expressed its concern at the operation of the accident and emergency service at Monaghan General hospital following an inspection visit to the facility last year, The Irish Times has learned.
The Medical Council also found that the hospital was suffering from chronic under-investment in infrastructure, staffing and planning, following its previous assessment in July 2001.
It is believed that in a hard hitting report following the inspection, the council - the statutory authority charged with protecting the public in their dealing with the medical profession - called for a commitment from the North Eastern Health Board that the quality of care available at Monaghan General be equivalent to that available elsewhere.
Medical sources have told The Irish Times that the Medical Council expressed "astonishment" at the absence of consultation by the health board with medical staff about hospital activities between July 2001 and May 2002.
On a follow-up inspection this May specifically to assess whether its previous recommendations had been implemented, the Medical Council found there was no consultant in place to supervise the A&E service.
A number of senior medical sources have told The Irish Times that the accident and emergency facilities at Monaghan Hospital were "unacceptable". The "department" is essentially a single treatment room consisting of two beds and some resuscitation equipment.
Management of serious adult or paediatric emergencies is limited while the ambulance entrance is located close to the A&E treatment room on the ground floor.
On occasion, when the lift access to the wards is out of order, patients have to be carried up stairs for resuscitation or treatment, The Irish Times has learned.
In October 2001, the treatment room began operating on a 24- hour basis. Up to then it had been open between 9 a.m. and 4 p.m., five days a week.
This change occurred following a recommendation by the Medical Council following its initial visit in May 2001 that the NEHB must submit a plan outlining how accident and emergency services be safely delivered at Monaghan General Hospital.
It is understood that the council specifically drew attention to the need for adequate patient assessment, treatment and resuscitation facilities at the hospital.
When a team from the Medical Council reassessed the facility in May 2002, it found that staff at Monaghan were unaware of restrictions introduced by the NEHB on the ambulance delivery of patients suffering from serious trauma.
The council also expressed its concern that the emergency service at the hospital had been extended without an accompanying improvement in the quality of supervision or procedures.
According to reliable sources, the repeat assessment also found no mechanism to introduce protocols or training within the accident department. This reference to a deficiency in the introduction of protocols may have been relevant to the events surrounding the management of the Livingstone baby case at the hospital last week.
One senior medical source said that no meaningful dialogue in relation to implementing guidelines has taken place since they were given to the NEHB last summer.
Asked last night to respond to the issues late yesterday, a spokeswoman for the NEHB said it would do so today.