The hospital doctors' dispute worsened yesterday as an indefinite work-to-rule began at Waterford Regional Hospital and many outpatient and surgical appointments were cancelled.
With a ballot for a national dispute under way, there was no immediate prospect of talks on the rostering issue.
Next Tuesday, a three-day dispute begins at Tullamore General Hospital.
One of the key issues in the dispute, concerning when the basic working week of non-consultant hospital doctors (NCHDs) ends and when overtime begins, is already due to be adjudicated on by the Labour Court in September - but it seems likely that by then doctors in the Irish Medical Organisation will have voted for nationwide industrial action.
The South Eastern Health Board yesterday accused the Irish Medical Organisation of "resisting" its proposal for immediate talks at the Labour Relations Commission.
The IMO said there is "no need" for such talks. The matter will be resolved, it says, if the Health Service Employers' Agency (HSEA)acts in accordance with previous agreements reached at the LRC.
The HSEA says it is disappointed that the IMO did not agree to talks on the current dispute. It argues that the rosters introduced in Waterford do not differ from those in effect in some other hospitals.
Meanwhile the Irish Patients' Association says it fears the acute health sector "would effectively be shut down" in the event of a national strike.
It says that so far this week, 275 patients have had appointments cancelled at Tullamore and Waterford because of the dispute.
The Minister for Health and Children, Mr Martin, should personally intervene in the dispute, it said. "The Irish Patients' Association supported and assisted the junior doctors in their early protests for safer working hours," the IPA said. "We restate our view, expressed at their protest outside Leinster House, that people in essential services should not strike and patients should not be used as leverage in any dispute by any party."
The South Eastern Health Board yesterday cancelled today's outpatient appointments and non-emergency surgery with some exceptions. All cancer services, including the administration of chemotherapy, breast clinics and outpatient cancer services, will proceed as normal. Scheduled dialysis and maternity outpatient clinics will not be affected. Accident & Emergency, intensive care units and the coronary care unit are also operating as normal.
One of the difficulties facing the public in understanding the dispute is that the two sides do not agree on what it is about.
The IMO says new rosters mean part of a doctor's basic week would be worked outside normal daytime hours. This would take the doctor out of the hospital at a time when training and professional development opportunities are at their greatest and would therefore result in a poorer service for patients.
The HSEA denies this, saying training days are scheduled into the NCHD roster and this will continue. It says NCHDs in the dispute are really seeking to protect overtime payments and that they want to be paid overtime for any work done after 5p.m. Monday to Thursday or 4p.m. Friday, regardless of how many hours they have worked before these times. It says it has to introduce new rosters to comply with an EU Directive on reducing hospital doctors' working hours.
The IMO says overtime payments have "absolutely nothing" to do with the dispute and that the method of reducing NCHDs' working hours is a matter to be agreed by the separate Manpower Task Force.