The chief executive of the North Eastern Health Board, Mr Paul Robinson, has made a strong attack on the Royal College of Surgeons.
He has described it as "unacceptable" that the college, which is not accountable to the public, can make decisions which influence the health board, which has a statutory role to provide acute hospital services.
These comments were made at a meeting of the health board which was dominated by the decision of the college not to recognise the Louth County Hospital in Dundalk for training purposes. This effectively leaves it without surgical or A&E services from January 1st because it does not have full-time consultants in both departments.
However, it has emerged that the college has agreed to give temporary recognition to two non-consultant hospital doctor posts for six months from January 1st.
In the same letter, Prof Arthur Tanner said if the board failed to appoint a permanent fully trained A&E consultant to the hospital before July 1st next year, the recognition of the two posts would be withdrawn and "the matter will not be debated again".
The RCSI decision has ignited fears the hospital will eventually lose the normal services available at acute hospitals which would instead be transferred to the Lourdes hospital in Drogheda.
The same letter warned that Our Lady's Hospital in Navan, Co Meath, would lose temporary recognition for its three posts in A&E on June 30th next unless a permanent consultant was appointed.
The RCSI stand has provoked the ire of many health board members as well as that of its chief executive. Mr Robinson said the medium-term implications for both hospitals "are very serious" and described the six-month deadline within which the board must recruit consultants or lose recognition as "completely unachievable".
The RCSI was a body "that has no accountability to the public" and he said it was effectively determining how services should be provided by the health board which is the statutory body appointed to provide those services.
The threat of non-recognition for training of non-EU junior doctors also hangs over A&E in Cavan General Hospital and "the impact on acute hospital services right across the board would be little short of catastrophic were accident & emergency and/or surgical services were to be interrupted or suspended at either of the hospitals", he added.
The lengthy debate which followed Mr Robinson's remarks heard from board member and consultant Dr Alf Nicolson that while Ireland was moving towards the British model of consultant-led care, "it is clearly impossible to get a consultant within six months and we must challenge that dictate."
Another board member, Dr Maurice Stokes, warned that the NEHB was not alone in this dilemma and listed a number of regional hospitals elsewhere in the State which were facing into the same problem of non-recognition by the RCSI.
Meanwhile. the Department of Health has approved funding for two full-time consultant surgeons in the Louth hospital and these must now get the approval of Comhairle na nOispidéal before the positions can be advertised.