Critically ill patients at a Co Cork hospital were put at risk by inadequate out-of-hours staffing levels, a report has found.
The Health Information and Quality Authority (Hiqa) said Mallow General Hospital did not have round-the-clock on-site expertise and facilities to safely manage patients with complex clinical needs.
Jon Billings, Hiqa's director of healthcare quality and safety, said services in Mallow were based on historic practices, with insufficient action at a local, regional or hospital group level to identify and anticipate risks to acutely ill patients.
He said: "The investigation found that the seniority of medical staff available on site outside core hours in Mallow General Hospital was not adequate for a hospital open to emergencies 24 hours a day. This has subsequently been addressed by the Health Service Executive (HSE).
"In short, the safety and quality of the service provided to patients was dependent on the willingness of local clinical staff at MGH, rather than a resilient and reliable system of care."
The authority highlighted a number of immediate patient safety concerns which came to its attention during the course of the investigation and requested the HSE take immediate steps. The HSE has since introduced a mandatory policy for Cork University Hospital to accept critically ill patients from Mallow General Hospital.
The inquiry was launched last August after a tip-off that patients with major or complex conditions were being treated in the emergency department. MGH did not have an intensive care unit, with critically ill patients cared for in a four-bed coronary/high dependency unit.
Hiqa was also informed that acutely ill patients were undergoing major surgery in a hospital with few similar procedures and without round-the-clock critical aftercare.
This went against recommendations published by the watchdog some 14 months earlier after a review of a similar-sized hospital in Ennis, Co Clare. It found such services could pose a serious risk to the health and welfare of acutely ill patients receiving emergency, major surgery and critical care.
Local Labour TD Sean Sherlock said the report showed an under-investment and shortage of resources at the hospital for more than a decade, but that it vindicated doctors and staff.