Around 100 patients had surgery cancelled today after hospital consultants stepped up industrial action over concerns about their medical insurance.
The senior doctors withdrew co-operation from the National Treatment Purchase Fund in the second phase of industrial action that could see all services bar emergency cover withdrawn at the State's hospitals next week.
The action could lead to up to 40,000 patients having elective surgery and appointments cancelled.
The consultants have already withdrawn from administrative duties in hospitals.
Consultants are angry at the Minster for Health, Mr Martin, over his decision to introduce a new insurance scheme without their agreement.
The British-based Medical Defence Union (MDU) has traditionally indemnified consultants against malpractice claims. But they are now refusing to cover historic claims because of the size of compensation pay-outs in Ireland.
They want to transfer liability for claims which have not yet been made to the Department of Health, but Mr Martin has not accepted the €60 million offered to cover a bill which he believes could expose the State to a €400 million liability.
A series of talks involving the Department of Health and the MDU began today and are ongoing. The Irish Hospital Consultants Association is likely to await progress before becoming involved.
In the meantime, the Irish Patients Association, said patients would be the real victims of the action.
"We understand their [consultants] concerns and, indeed, we share them but at the end of the day we cannot sit by and let patients be affected" the association's chairman Mr Stephen McMahon said.
And Fianna Fáil TD, Mr Batt O'Keeffe accused consultants of favouring private patients during the action by referring them to public hospitals while appointments for public patients were canceled indefinitely.
Mr O'Keeffe said: "This is yet another outrageous example of Irish consultants favouring their private patients over those who cannot afford to pay for private care."