Serious concern has been expressed about the running of the accident and emergency unit at Our Lady's Hospital in Navan both by the Royal College of Physicians of Ireland (RCPI) and the Medical Council.
The RCPI conducted "an emergency inspection" of the hospital recently after learning of the Medical Council's concerns for patient safety in the A&E unit.
These stem mainly from the fact that the unit does not have a full-time A&E consultant and therefore has to be run most days of the week by junior doctors without consultant supervision.
"There is no A&E consultant on site except between the hours of 9am-5pm Tuesday and Thursday. The use of a locum does not compensate for this shortfall," the Medical Council's report of last April said.
It added that GPs' letters seemed to be the basis for assigning patients - by clerical staff - to the medical or surgical team which was on call.
Valuable time was sometimes wasted by inappropriate assignments.
The Medical Council informed the RCPI of its concerns and the RCPI conducted an inspection.
In a letter to hospital management following its inspection, which has been seen by The Irish Times, the RCPI said it found substantial structural deficits which required prompt action. It said "the major area of concern is the emergency department arrangements and in particular the lack of continuous supervisory consultant cover". It said this "must be addressed immediately".
It added that two more consultants were required in the medical department and that more junior doctors were also needed.
"The on-call arrangements at night are not adequate. There are at present only two senior doctors on call, one medical registrar and one senior house officer," it said. And it found arrangements for CT scanning to diagnose patients with certain conditions out of hours unsatisfactory. At present CT scanning in Navan is "a nine-to-five service" and outside these hours patients needing scans have to be taken by ambulance to Drogheda and must be accompanied by a junior doctor on their journey.
Furthermore the RCPI, whose mission is to develop and maintain high professional standards in specialist medical practice, warned that the deficits it had identified were serious and "potentially could terminate training arrangements at the hospital if not addressed in a timely manner".
A HSE spokeswoman said it was in constant informal discussions with the RCPI on how best to address the issues raised.
"And we are working on a number of proposals to address these issues," she said.
The RCPI inspected the department of medicine at Our Lady of Lourdes Hospital, Drogheda, recently and found there were insufficient numbers of doctors in the department to ensure patients were not put at risk.