Minister for Health Jennifer Carroll MacNeill has said that three members of the board of Children's Health Ireland have resigned, while another board member resigned last week.
"We have had three resignations from the board this morning," the minister said. The three people who resigned held voluntary positions on the board.
Speaking on RTÉ's News at One, Ms Carroll MacNeill said she had made it clear that she had "strong questions about the governance of CHI and its direction towards the future".
"We've had three resignations from the board this morning. These would be individuals who have worked on the board, worked in [a] volunteer capacity on the board since 2018," she said.
The three members are Dr Gavin Lavery, Brigid McManus and Catherine Guy.
A fourth member, Mary Cryan, resigned last week.
"I have said that very clearly we need to have a functional governance structure to enable us to get to the opening of the Children's Hospital and to deal with the very many issues in children's health," Ms Carroll MacNeill said.
She said that she had not asked the board members to resign, as she did not have the authority to.
"I have a different relationship with the CHI board in statute than any other minister really has with most other boards. It is an unusual structure and I don't have the authority to ask people to step down in the way that you normally might expect," she said.
"I want to thank those people for the service that they have given to the public because we recognise that these are voluntary positions, and we are asking people to step out of their other lives to perform a public service in this measure," she added.
The minister said that she would be looking to fill the three vacant spots on the board in the coming days.
Read more: HSE chief 'shocked' by details of internal CHI report
Fundamental reform at CHI 'critical'
The Taoiseach said it is "absolutely critical" that there is fundamental reform at the CHI, to ensure there is a multi-disciplinary approach across all areas of medicine which it is responsible for.
Speaking in the Dáil, Micheál Martin said there will be an external and independent clinical audit to give assurances to both family and patients.
He said there had to be "accountability", given that recent revelations were "deeply deeply worrying".
The Taoiseach said it was clear that the environment was "not optimal for safety".
He said there is a "clear need to find out how and why so many children got surgery when they didn't need it".
The Taoiseach was responding to Labour leader Ivana Bacik, who said that instead of focusing on children, CHI had engaged in a "chaotic string of failures," and that breaches of trust are "clearly evident too".
The Dublin Bay South TD asked: "What is going on? Who is in charge?"
She said the failures of culture and clinical care and management are "systemic and endemic".
Ms Bacik said that while there was a clear need for accountability, it also requires "decisive action from Government".
She called for the CHI to come under the "direct control and oversight" of the HSE, saying it was not acceptable for the HSE to be giving answers to questions about the CHI for which it does not have any responsibility".
We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
'Toxic behaviours' developed at CHI - Carroll MacNeill
Separately, Ms Carroll MacNeill said "toxic behaviours" had developed within CHI over time, as individuals had not got along with its board and executive.
She told RTÉ News at One: "Over time, there have been pockets of very toxic behaviour.
"There have been pockets of individuals who have been very defiant and who have not gone along with what the board and the executive and the broader thrust of public policy has been.
"I think that has made it very difficult for CHI to get to the point that we want to get to."
Ms Carroll MacNeill added that such behaviours were not tolerable.
"It is now 2025 and we are moving towards a new Children's Hospital. These behaviours where they exist, these toxic behaviours or decisions that are not made in line with international best practice, they were never tolerable.
"We are in a totally different era of health now as we move towards a world class hospital," she said.
Read more: Difficult to see CHI emerge from current crisis intact
Full action plan sought over public patient referral report
Minister Carroll MacNeill has also written to the CHI board looking for a full action plan in relation to an internal unpublished report concerning a consultant who it is alleged referred public patients to his private clinics.
Details of the report were published by The Sunday Times at the weekend.
The surgeries were paid for by the National Treatment Purchase Fund.
The minister has now received the 2021 report of this investigation and it is understood that advice is being sought by CHI on what can be published.
Ms Carroll MacNeill said that there was no process in place to make the Department of Health aware of the report, and that it should also have been brought to the attention of the National Patient Safety Office.
She said: "I believe it should have been the attention of the national Patient Safety Office, even more importantly than the minister, because these issues are very, very serious.
"There was no process in place to bring this to my attention and it should be at my attention."
Ms Carroll MacNeill added that she only became aware that the consultant in question was now retired upon receipt of the report.
Minister has not yet received spinal surgery report
Separately, another report into spinal operations by Surgeon A at Temple Street, the Nayagam report, has not yet been received by the minister.
Meanwhile, the heads of the terms of reference for an expert panel to review dysplasia of the hip operations in children was due before the Cabinet.
It follows the report into hip surgery last week which found that almost 80% of surgeries were not necessary at National Orthopaedic Hospital Cappagh and 60% were not necessary at CHI Temple Street.
That audit covered 2021-2023, and as a result parents of children who had these operations going back to 2010 are also being offered reviews.
A helpline has been operating since last week to assist parents and has received several hundred calls.
The expert panel will be chaired by an international expert and will have a range of specialists in radiology, orthopaedics, paediatrics and other areas.
Parental consent will be needed in order for the panel to review if the surgery conducted on a child was necessary.
Ms Carroll MacNeill has written to the Royal College of Surgeons for its assistance in the matter.
The full details of the terms of reference are be completed at a later stage.
