An agreement between private hospitals and the HSE has been described as "bizarre in the extreme" by the Head of ICU at the Beacon Hospital.
Dr Stephen Frohlich insisted the south Dublin private hospital is playing its part in the fight against COVID-19, despite being the only one in the state to refuse to sign over beds to the HSE.
17 of 18 private hospitals have signed up for the deal which would see them provide additional capacity for the public health service.
Yesterday, the CEO of the HSE Paul Reid expressed his "extreme frustration" at the Beacon Hospital's stance, describing it as "beyond belief and comprehension".
Dr Frohlich said the hospital has added additional capacity to facilitate the public sector, which is something they're "expanding out further" this time.
Speaking to On The Record with Gavan Reilly, he said: "We're more than wearing the green jersey, we're wearing every shade of green and we have been doing for a number of months now.
"Since the autumn, we've developed very strong relationships on a clinical level, doctor to doctor relationship, with individual public hospitals that has allowed us to treat a huge number of public patients over the past number of months.
"We propose to continue doing that and grow that further."
These relationships allowed doctors working in the public sector to "seamlessly transfer patients to our facility regardless of whether they're public or private or what their insurance status is but based solely on clinical need"," he said.
"What I'm confident is very clear is that we've been doing this well in advance of any other government agreement.
"The public sector is a mixed bag with different hospitals with different skillsets but given our skillset of high tech oncology and cardiac work and critical care capacity, our facility has been in much greater demand by the public sector for that type of work.
"We're doing a lot more than any other private hospital."
Hospital emptiest since 2005
As of this morning, 63% of people in ICU in the Beacon are public patients, with nine people in the eight-bed unit, said, with the extra added yesterday to increase capacity following the transfer of an urgent case from a public hospital.
None of these patients are in ICU with COVID-19, he added.
"We already have experience working with the HSE on a similar agreement, in fact, an almost identical agreement last spring," he said.
"During that time, 70% of our hospital was empty, so at the time the greatest need for national healthcare capacity, our hospital was the emptiest it has been since 2005.
"In three months, I got one single ICU transfer from the public sector, so putting in place a centralised HSE arrangement that's bureaucratically intense, difficult to administer, that runs to a few hundred pages to us just doesn't work."
Dr Frohlich added that "nearly all the consultant doctors" in the hospital have written to management outlining their "real concerns" that entering the deal would leave them "looking at empty beds again".
He contended that management would be "delighted to formalise" the current arrangement in place with public hospitals which allows for rapid access to the Beacon's capacity.
However, the suggestion that "just because there's demand, the beds will be full and patients will be transferred" is "not how it works", he stated.
Private sector not 'one homogenous entity'
Dr Frohlich said: "That may seem illogical, it's quite hard to square that for three months we left our private hospitals empty despite the State paying for them.
"But that's what happened."
He described the HSE agreement as a centralised very democratic process with "big picture, headline ideology" rather than "getting the buy-in of the individual doctors on the ground".
He added that the private sector is not "one homogenous entity" and so a one size fits all contract cannot be imposed on the 18 different hospitals.
"We propose and we will continue to do exactly as we are, and if the HSE would wish to wrap that into an agreement I have no doubt that our board would be very supportive of that," he said.
"It would be absolutely remiss of me as a doctor to make a mistake for a second time and go into an arrangement that we feel is very flawed and would lead to empty beds.
Dr Frohlich believes the Beacon's board has shown their "absolute commitment" to delivering care and facilitating the HSE's needs.
"I would be very confident that we would be very happy to enter an arrangement that would reflect what we're currently doing, and indeed, more than what we're currently doing and expand more capacity if we can," he said.
"We want to do more, we want to help out the public sector, but we need to do it in a way that we know will work on the ground."
HSE plan 'bizarre in the extreme'
He described some of the detail in the HSE plan is "bizarre in the extreme" with the health service "paying hospitals to keep beds empty".
"Our arrangement where we have local, existing arrangements between clinical teams means we only get paid for work done so if we have an empty bed it's not on the State's head.
"If we were to leave 30% of our capacity aside, if I was to leave two or three or four of our ICU beds empty, and if the HSE didn't send me a patient to put in them, we would be paid for that bed regardless."
It is also a "bizarre arrangement for the taxpayer"," he added.
Dr Frohlich said it was "absolutely incorrect and disingenuous" to suggest that many staff at the hospital had received the COVID-19 vaccine.
"We have an emergency department that saw around 400 people this week, that's 400 people that didn't need to be seen in the local emergency departments," he said.
"A significant proportion of those patients presented with COVID.
"For Paul Reid to suggest that our staff who were seeing those COVID patients should remain unvaccinated while administrative staff, medical students and so on in many of his own hospitals have been vaccinated is frankly bizarre.
"The HSE have received a big tranche of vaccines, they've vaccinated all of their staff, including administrative staff who don't have direct patient-facing contact in many of their hospitals.
"I think it's a real insult to our staff and the patients that attend us that they should be put at risk because only public hospitals should be vaccinated first."
No administrative staff and the vast majority of patient-facing clinical workers in the Beacon have not been inoculated yet, he stated.