The controversy that ultimately resulted in the closure of the Leas Cross nursing home and the commissioning of the O'Neill report stemmed largely from an investigation carried out by RTÉ's Prime Time programme in May 2005.
The programme featured footage of ill treatment of residents that was filmed by an undercover reporter working at the home.
Two months earlier, a jury at Dublin Coroner's Court had returned a verdict of death by medical misadventure in relation to a woman who had been a resident at Leas Cross.
Dorothy Black (73), died on January 26th, 2004, from septicaemia and complicating extensive bedsores with a background of Alzheimer's disease and immobility.
Ms Black was transferred from St Ita's Hospital, Portrane, to Leas Cross in September 2003. She had become immobile. She developed bedsores and was transferred to Beaumont Hospital on November 16th, 2003, where she died.
Ms Black's daughter, Clodagh Black, was with her mother when she was examined in the A&E at Beaumont and saw the extensive bedsores for the first time.
"There were huge holes in my mother's body, holes the size of melons, with black, green flesh with the bone visible," she said.