The A&E departments of hospitals in Monaghan and Dundalk are due to close next year, and the A&E unit at Our Lady's Hospital in Navan will close next year or the year after, it has emerged.
Their A&E services are to be transferred to Our Lady of Lourdes Hospital in Drogheda and Cavan General Hospital.
The changes are included in an internal Health Service Executive report, which says the changes "present major opportunities for savings, efficiencies and staff redeployment".
It estimates savings of €7.2 million over the next two years and that the changes will also result in the loss of 48 jobs by July 2009.
Last year the HSE asked Teamwork consultants in Britain to provide a plan to develop the best possible acute care for people in the northeast region, covering Louth, Cavan, Meath and Monaghan.
Its main recommendation was that a new regional hospital be provided and the process of selecting a location for it is under way. It is due to be built by 2012.
The internal HSE report deals with how elements of the Teamwork plan could be implemented in the short term. It was obtained by Sinn Féin, which released it to the media yesterday.
It is clearly proposed that the A&E units in Monaghan and Dundalk should close next year and be replaced with minor injury units, which would be open from 8am to 8pm. In one place the document also refers to the Navan A&E unit closing in 2008, but in another place it suggests it may not close until 2009.
Around the clock emergency services will be centralised in Our Lady of Lourdes Hospital in Drogheda and at Cavan General Hospital. The report says a new A&E department is being provided in Drogheda to cope.
It also proposes that Monaghan hospital transfer its acute medicine to Cavan General in 2008 and that the Louth County Hospital in Dundalk transfer its acute medicine to Drogheda in the same timeframe.
An extra 21 beds are to be provided in Cavan.
Emergency surgery is also to be transferred from Our Lady's Hospital in Navan to Drogheda next year.
It also says critical care patients from both Monaghan hospital and the Louth County Hospital will be transferred to Drogheda. The target date for closure of Monaghan's critical care unit is July this year.
Under the plan, the cardiac care unit in Dundalk would also be transferred to Drogheda.
The HSE said it believed the document might concern draft proposals which were being prepared in a bid to secure funding for the initial phase of the reconfiguration that is necessary to improve services in the region.
"It is unfortunate that this document is being politicised in the way that it has been leaked today, in the heat of a general election debate. It serves only to cause confusion and unnecessary anxiety to staff and service users," it said.
Arthur Morgan, the Sinn Féin TD for Louth, said the contents of the report were "scandalous" and that the Government parties had "misled and misrepresented" the health situation in the region to the people.
In particular, he said that to close the A&E unit in Dundalk would have "dire" consequences.
Sinn Féin health spokesman Caoimhghín Ó Caoláin said the HSE and the FF/PD Government did not want the document to enter the public arena before the election. "They have sought to conceal the facts, the full facts, regarding their plans," he said.
Minister for Finance Brian Cowen said Fianna Fáil would not stand over any service reductions in the northeast.
The HSE said the Teamwork report found "the current system of five local acute hospitals has exposed patients to increased risks."
In the future it said all local hospitals would work in tandem with the new regional hospital and community health centres.
"Each local hospital will continue to provide the majority of the community's health needs, such as speedier access to day procedures and minor injury units that can treat the majority of emergencies (sprains, burns, cuts, stitches, eye injuries, etc)."
It added the HSE was committed to providing "the most modern, integrated, safe, patient-focused health service that has ever been devised in this country."