A Monaghan obstetrician has said it was "made clear" to him by the North Eastern Health Board that he should not have acted to safely deliver a premature baby at Monaghan General Hospital earlier this year "in the middle of the night".
The incident, involving a Romanian national, occurred "in March or April", said Dr Rommel El Madanny. Maternity services had been withdrawn from the hospital at the time of the incident. Gynaecological services, however, were still being offered.
After the successful delivery, the woman and her baby were transferred by ambulance to Cavan General Hospital.
Dr El Madanny told The Irish Times that he did not receive censure in writing.
"But the health board was in contact by phone asking lots of questions, asking why it happened and saying they were a bit concerned that delivering babies was continuing at the hospital."
This was despite the board's protocols stating that delivery should happen when "inevitable prior to transfer" to another hospital.
Dr El Madanny said a Romanian woman had arrived at the hospital "in the middle of the night with labour pains".
"The porter called me and a nurse and we realised the lady was fully dilated. The baby was coming. There was no option but that she had to be delivered."
The hospital matron was also present, he said. The woman was admitted and a baby girl was successfully delivered, "very premature - about 26 or 27 weeks".
Medical staff ventilated the baby, suctioned her upper airways and treated the mother before transferring both in an ambulance to Cavan General Hospital. The baby was transferred in an incubator and a midwife accompanied them on the 25 mile journey over bumpy, winding roads to Cavan.
"The baby is perfect now, the mother is healthy and happy. The health bord implied we had created the situation or something to try and prove we needed a maternity service," said Dr El Madanny.
"When they found out about this case they started asking why we hadn't sent her straight to Cavan. 'Did we know she was coming?' 'Did we tell her to come to the hospital?'"
The board, he said, "made it clear they were not happy about it".
"But the problem is much bigger than just maternity. The board always says it is concerned with safety and they use the excuse of insurance. It doesn't take a genius to work out that it is safer to provide a doctor and a midwife than provide nothing."
Dr El Madanny, an Egyptian national, is an Irish citizen and has been practising here for 12 years.
However, he says that were he to tell his Egyptian colleagues that there was no maternity service for 40 miles in a rural area, they would be "shocked".
"Even in the poorest parts of Egypt," he said, "there would be a doctor and a midwife available nearer." He said he believed in the 'Good Samaritan' approach to medicine.
"If someone is in need you help them," he said, "especially if they have come to a hospital for help and you have all the equipment there. It is bad enough when someone comes for emergency help during the day, but in the middle of the night - we had to help."
