Almost a year after the surgery unit of Cavan General Hospital became the subject of controversy following the death of a nine-year-old girl, a new report has found it to be in a "dysfunctional" state.
The report from the Royal College of Surgeons in Ireland (RCSI) is highly critical of the ongoing lack of surgical leadership at the unit and its dependence on locum staff.
The Irish Times understands the report refers to a lack of communication between management and consultant staff at the hospital and stresses the current situation cannot continue. Unless the situation is addressed, it says, the entire unit may have to close.
The report, which has been sent to the North Eastern Health Board which runs the hospital, was finalised last month following an inspection of the unit by a high-level RCSI delegation in November. The delegation was led by RCSI president Prof Niall O'Higgins.
The inspection took place after a long list of adverse clinical incidents at the unit, 15 of which were the subject of a report last March which also highlighted the lack of surgical leadership at the unit.
The most high-profile incident at the unit since the suspension in August 2003 of two of the unit's permanent consultant surgeons over "interpersonal difficulties" was the death last February of Frances Sheridan (9) from Cootehill, three weeks after an appendix operation at the hospital. A post-mortem found she died from complications of recent surgery.
The RCSI report criticises management for failing to address problems at the unit and recommends more resources, including dedicated surgical beds, be provided immediately.
It also wants a clinical director appointed to the surgery unit and recommends issues around the suspension of the two surgeons be resolved without delay.
In addition, it states three permanent consultant surgeons should be appointed to the unit.
A spokeswoman for the NEHB said the health board had responded to the RCSI regarding its recommendations.