Proposals to significantly cut services at hospitals across the northeast region have been drawn up by the Health Service Executive.
They include plans to close beds, reduce the number of days on which outpatient clinics will be held and to reduce the amount of elective surgery being carried out.
A leaked memo drawn up by the HSE states that among the cuts proposed are:
reducing orthopaedic elective surgery at Our Lady's Hospital, Navan, by 25 per cent;
reducing elective surgical activity at Louth County Hospital in Dundalk, taking the hospital off call and establishing a shorter working day at the hospital;
closing 10 beds at Monaghan General Hospital;
reducing outpatient clinics at Our Lady of Lourdes Hospital, Drogheda, and at Cavan and Monaghan hospitals from five to four days a week;
reducing elective surgery to four days a week within the Cavan/ Monaghan hospital group;
taking Monaghan General Hospital off call for medical or other emergencies.
The memo is headed Breakeven Plan - Identified Actions January 22nd 2008.
It said the precise date on which Monaghan hospital and its treatment room would be taken off call was to be confirmed, but it noted this would "lead to a reduction in laboratory, radiological, anaesthetics staffing requirements".
It also said the implementation of this proposal was dependent on an additional intensive care bed being provided in Drogheda, additional A&E space being provided in Cavan, additional medical beds being commissioned in Cavan, and the provision of an appropriate number of home care packages within the Cavan/Monaghan hospital geographic area.
The only positive news in the memo is that medical assessment units in Navan and Drogheda are due to open in July.
The document was circulated to hospital managers by Chris Lyons, hospital network manager for the northeast region.
The HSE said yesterday the memo was a draft internal document and no decisions had actually been taken at this stage to reduce services. "We are facing a challenging year and we are exploring how best to deliver services within budget," it said.
"We should be in a position by mid-February to be more definitive about the services we will provide for the year," it added.
Dr Illona Duffy, a GP in Monaghan, said the plan went against everything Minister for Health Mary Harney and HSE chief executive Prof Brendan Drumm had said - that no services would be reduced until better ones were put in place.
Donal Duffy, assistant general secretary of the Irish Hospital Consultants Association, said the proposals were absolutely bizarre, just weeks after the HSE got its 2008 budget. He said it raised fundamental questions about the HSE's budgetary processes.
Fine Gael's health spokesman, Dr James Reilly, said the litany of proposed cuts meant sacrificing patient services to balance the books would continue in 2008, while management and bureaucracy remained untouched.