A team of independent consultants warned the North Eastern Health Board more than three years ago that "lack of clarity and consensus" regarding the future of Monaghan General Hospital was putting staff and patients there at risk.
The report, which was given to the health board in February 2001 but has only now been released under the Freedom of Information Act, expressed concern at various aspects of the running of the hospital, including a disproportionately high level of Caesarean deliveries at its now defunct maternity unit. Outdated surgery conditions, poor record keeping and low staff morale were among the failings cited.
The risk-assessors also expressed shock at discovering surgical instruments being washed in "little more than a sink", and theatre staff walking around the hospital and canteen without changing out if their "blues".
They also warned of the danger of operating with just a single theatre, which was "virtually unmodernised since 1947", when there were competing pressures on its use from different units.
A woman identified for an emergency Caesarean section because of foetal distress had to wait for more than an hour for the operation, the report found.
"This length of time is unacceptable and indicates the potential for mishap due to delay."
The study, carried out by London-based consultants Healthcare Risk Resources International (HRRI) following inspections at the hospital in July 2000, will fuel the debate about whether or not the health board was right to suspend maternity services at Monaghan in March 2001 - a decision which was this week challenged in the High Court by four local women.
The women claim the NEHB exceeded its powers under the Health Act 1970 in suspending the service. But the board said the decision was necessary for reasons of insurance and safety.
A judgment in the case is due on July 23rd.
Uncertainty over the future of the hospital has intensified in recent months with the suspension of emergency admissions at the A&E unit.
Campaigners believe the hospital is being systematically downgraded but this claim is denied by the Minister for Health, Mr Martin, who says services will improve in the region with the implementation of the Hanly report.
A spokesman for the NEHB said no one was available yesterday to give a detailed comment on the HRRI findings but "the board has been actively dealing with the issues in the report".
While the consultants said the health board had responded positively to initial warnings about safety standards, they said it had "suffered severely from a failure to agree a positive future role of the hospital that reflects and supports modern clinical practice".
The managerial problems largely stemmed from a "lack of clarity and consensus regarding the future of Monaghan Hospital, an issue which requires particular attention", the report added.
Louth Fine Gael TD Mr Fergus O'Dowd, who obtained the report through the Freedom of Information Act, said it was important that such documents were made public.
"We need more transparency in all our hospitals, and progress reports on issues like risk management. The public should know how risks have changed and how hospitals have improved."
The suspension of maternity services at Monaghan led to a major controversy in December 2002 when a local woman, Ms Denise Livingstone, was not allowed to deliver her baby there even though she was in an advanced stage of labour.
Instead she was sent by ambulance on a 25-mile journey at night to Cavan General Hospital. On route she gave birth to a premature baby girl who died shortly afterwards.
