A consultant at St James's Hospital, Dublin, has resigned from the hospital board because he is "unable to stand over the mess that presents itself to me on a daily basis" in the emergency department.
One man, aged over 90, spent 24 hours in Accident and Emergency waiting for a bed, Mr Patrick Plunkett, consultant in emergency medicine, has told the Minister for Health and Children in a letter.
"At 9 a.m. today, there were 18 patients in the emergency department of St James's Hospital waiting for admission to the wards," he wrote.
"Of these, 10 had been waiting for a bed since before midnight. Eight of them were over 70 years of age.
"One is over 90 years of age and has been in the emergency department for 24 hours now."
A severe lack of in-patient facilities is at the heart of the problem, he wrote, with the occupancy rate of acute beds running between 95 per cent and 105 per cent (occupancy rates rise above 100 per cent where a patient is moved to another ward or discharged and another patient moves into the same bed on the same day).
Research, he wrote, "would suggest that an occupancy rate of greater than 85 per cent will always lead to queues for emergency admission.
"Go above 90 per cent occupancy and the result is a queue at all times. The lack of physical facilities means that we are trying to get the proverbial quart into a pint pot.
"I cannot reconcile the conflict between my needs to advocate on behalf of my patients, who represent the oldest, most socially and financially deprived and the sickest amongst our community, with my responsibility for running an organisation which is, to all intents and purposes, overstretched to the point of lunacy," he wrote.
A spokesman for St James's yesterday said the management fully accepted that the situation in the emergency department was unsatisfactory but regretted Mr Plunkett's resignation from the board.
Up to 35 extra beds have been redesignated as acute, the "discharge lounge", which is a special ward for people leaving the hospital, has freed up more acute beds and, in the medium term, the planned reorganisation of the emergency department will mean an extra 70 acute beds.
In the longer term, the hospital hopes to get 180 more beds under an Eastern Regional Health Authority plan.
In his letter Mr Plunkett said the planned clinic for minor complaints meant these people would be seen more quickly, but it would not help people waiting for beds.
Just under two-thirds (63 per cent) of the 2,211 elective procedures performed at the South Infirmary-Victoria Hospital in Cork from April to June last year were for public patients, according to figures supplied by the hospital.
At Letterkenny General Hospital, 82 per cent of the 1,376 elective surgical procedures between July and September were for public patients.
At Sligo General Hospital 81 per cent of the 1,165 elective procedures in the period were for public patients.
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