The haphazard manner in which patient records were managed at the largest hospital in the north-east up to three years ago has been sharply criticised by independent risk assessors.
Their review at Our Lady of Lourdes Hospital in Drogheda found numerous examples of unsigned reports getting into patient records and of reports being filed in the wrong records.
The review by Healthcare Risk Resources International (HRRI) found the results of some investigations "are lost altogether and have to be repeated".
It added: "Difficulties with charts going missing at the rate of several per week . . . were widely reported".
The finding will come as no surprise to some patients who have sought their medical files from the hospital and have been told they are missing. The issue of how files of women who underwent Caesarean hysterectomies at the hospital at the hands of the former obstetrician Dr Michael Neary went missing is to be investigated by the recently established Lourdes Hospital Inquiry, chaired by Judge Maureen Harding Clark.
The HRRI report found there was no policy in the hospital on the making up of patient charts or the management of patient records. There was a lack of clerical support.
That was the picture in 2001 when HRRI filed its report to the North Eastern Health Board management team. It is unclear what the situation is now but a spokesman for the board said last evening the board had "a strong risk-management response which is actively managing the issues identified in the report".
The report also found that management of infection control was not given a high profile and MRSA infection rates were high. MRSA is a hospital-acquired infection which can in some instances prove fatal.
It said bathroom and toilet facilities for patients were inadequate and this could have implications for infection control.
"There were also incidents reported of patients collapsing in toilets or bathrooms and going unnoticed for extended periods of time," it said.
"The use of single rooms by private patients seems to take precedence over providing isolation for the control of MRSA," it added.
Other issues highlighted were the fact that the operating theatres dated from the construction of the hospital in 1957 and that junior staff "were said to perform surgery at night both on orthopaedic patients and children". Audits were ad-hoc.
Furthermore it said surgical lists were very long with inadequate rest periods between shifts for those working in theatre.
The report also pointed to "a piecemeal approach to children's services, not just in the Drogheda site but throughout the programmes operated by the NEHB" and it said "cumulatively the risks to children receiving services could be considerable".
It also stressed the critical care and accident and emergency units were inadequate and that staffing in the hospital pharmacy was so inadequate, nurses were "routinely" dispensing out of hours, often unsupervised by a pharmacist.
"In 1994, the hospital's then insurers, Church and General, were asked to review and report on risk at the hospital but this report was never acted on," the report said.
Former health board member Mr Paudge Connolly, now an Independent TD, said the NEHB was the only board to do such risk-assessments on its hospitals and they had "thrown up a level of practice that is unsafe and has not been properly monitored over the years".
"Our Lady of Lourdes is supposed to be the flagship hospital of the north-east and I was astonished that such practices were ongoing at it up to three years ago," he said.