Tania Corcoran McCabe was a fit, 34-year-old garda sergeant and the mother of a three-yearold boy. She was almost seven months pregnant with twins on 6 March last when she attended the Lourdes Hospital believing that her waters had broken. Though some hospital staff had the same opinion, a test was negative. She was told she had an infection and was sent home with antibiotics. She returned to the hospital two days later complaining of pain, and had an emergency caesarean section. One child, Zach, died and the other baby survived. But Tania bled heavily after the delivery and she too died the next day, 9 March.

Culture of the solo-run consultant The Health Service Executive has appointed a committee, chaired by Dr Seosamh O Coighligh, a consultant obstetrician at the Lourdes, to examine the circumstances in which the mother and her child died. Privately, colleagues of the medical workers who attended Tania argue that the performance of the HSE itself should also be put under the microscope. They are frustrated that major recommendations made by judge Maureen Harding Clark in her acclaimed report on the hospital have still not been implemented, a year and a half since it was published.

"If anything, we should be made a special case. A particular spotlight was put on this hospital because things happened that were not acceptable, " says one doctor. "There has been a cultural change in that, after Tania Corcoran's death, there was a major inhouse discussion over a number of days about her care. The culture of the solo-run consultant is gone and change is happening but it's been an uphill battle and things are being achieved very slowly."

Another doctor questions the wisdom of appointing a locally-recruited committee to inquire into the deaths of the mother and child, after the controversy that arose from the disastrous peer investigation of Michael Neary.

Three consultants exonerated the former obstetrician and gynaecologist in a review of his practice in 1998, at which time, according to the Harding Clark report, the number of hysterectomies being performed in the Lourdes was "truly shocking".

Maureen Harding Clark was a judge of the International Criminal Court when she began her inquiry into the Lourdes hospital, and specifically its maternity unit, in April 2004. She completed the inquiry at a cost of 3m in January 2006, was appointed a High Court judge last year and is chairing the redress board for victims of Michael Neary.

In May last year, four months after submitting her report to the minister for health, Harding Clark spoke scathingly to a conference in Dublin on regulation of healthcare professionals about the HSE's lack of action on her recommendations. She said she had returned to the hospital to check on progress and found that, while senior midwives and consultants had "embraced" many of her recommendations, there had been "no follow through by the HSE".

On paper, some progress has been made in the 13 months since then. An executive management board . . . one of the report's main proposals . . . has been established, comprising the general manager, three consultants and the chairman of the Lourdes' medical board. But hospital staff complain it is little more than "a talking shop" with "a very circumscribed role". In her report, Harding Clark advocated a devolution of responsibility from the HSE to the hospital as a general principle.

One significant recommendation that has not yet been adopted is the provision of a dedicated round-the-clock on-call team for the maternity unit. The number of consultants has increased in the unit and the HSE is committed to recruiting another 22 midwives (the announcement was made after Tania Corcoran McCabe's death), but there are not enough people to staff the 24hour emergency obstetrics team.

Massive population growth As well as the remedies necessitated by Neary's orgy of hysterectomies, the Drogheda hospital and its maternity unit more than any other has to cope with a massive growth in its workload.

The number of annual births at the Lourdes has more than doubled since the turn of the millennium, rising from about 2,000 to about 4,500.

The ending of maternity services in Monaghan and Dundalk hospitals, the population explosion around the north Dublin border and the opening of a "reception centre" for asylum seekers at the old Mosney camp are the reasons why the Lourdes is "bursting at the seams", according to one consultant. The hospital's client population of 350,000 is almost as big as those served by the major Dublin hospitals. Admissions to the paediatric unit were up 15% last year.

Harding Clark's report emphasised the urgent need for a new hospital in the northeast and a political commitment has been made to this, but workers in the Lourdes fear it could take 20 years to complete, in light of a target of 15 years.

The report catalogued severe management deficits, personality problems, internal conflicts, no transparency at any level, no discussion, no analysis, no audit, no handover meetings or questioning of outcomes, no agreed protocols, gross under-manning, great under-resourcing, gross overwork, questionable training of some consultants, and flawed judgements in one consultant in particular.

Reputation hinders recruitment While improvements have been made in terms of clinical incident reporting, handover meetings and outcome assessment, staff say not enough resources have been provided to enhance the hospital's appeal to potential employees in an under-supplied market. Its reputation, they say, rebounds on it when it is recruiting staff. Harding Clark's report pointed to a high turnover of managers at the Lourdes and there have been three managers, including an acting manager, since the report was published.

"Our increased workload hasn't been matched by resources, " complains a doctor. "There have been regular meetings in the past three months where these concerns would have been put to the HSE. The hospital is under pressure but these problems have been evident in the region for 20 years. Morale is very low and there's a feeling of what more can one do to highlight the deficiencies? There's a feeling that we're completely snowed under with the volume of work. Consultants have red-flagged their concerns to the HSE. There is still a lot of anxiety in the hospital in general at the failure to implement many of Harding Clark's recommendations. Nobody here would say things have significantly improved."