Doctors based at University Hospital Limerick have written an open letter outlining the serious challenges faced by the hospital in providing enough in-patient beds for acutely ill patients.
They say it has led to unacceptable numbers of elderly and frail patients waiting too long in the emergency department for a bed.
They say the experience of some of these patients has been very bad and they profoundly regret that.
The letter, which was signed by five doctors, is addressed to "the people of the Mid West from the Clinical Directors of UL Hospitals Group".
It says no matter how excellent an emergency department is "and the new one at UHL is a superb modern facility", serious problems arise if there are not enough beds and enough access to doctors, nurses, diagnostics staff and step down facilities.
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The doctors compared UHL with Beaumont Hospital in Dublin, which they say serves a catchment area of 290,000 people, compared with the Mid West catchment area which serves 385,000; Beaumont has 630 in-patient beds, while UHL has 454.
The letter states that there were 63,850 new ED presentations at UHL last year as opposed to 52,856 at Beaumont, a 21% difference.
Beaumont has a "whole-time staff" equivalent figure of 3,728 compared to UHL at 2,851.
The open letter was sent to the Limerick Leader newspaper after it began a campaign about overcrowding at UHL.
The letter has also been sent to local newspapers in Clare and Tipperary as they are also in the hospital’s catchment area.
Meanwhile, the Irish Nurses and Midwives Organisation has said there are 426 patients on trolleys in emergency departments or wards waiting admission to a hospital bed, with UHL the worst affected with 58 patients waiting.
Beaumont Hospital has 33 patients waiting.