The former health service boss would have pushed through a plan to downgrade Portlaoise hospital removing round the clock A&E cove in the process, according to an interview published in a Sunday newspaper.
In an extensive three page interview Mr Tony O'Brien with the Sunday Business Post, the former HSE chief executive discusses what he would do he was given the authority to make hard decisions.
While Mr O'Brien is not quoted directly, the newspaper reports that he would have 'pressed ahead' with the controversial plan developed for the Midland Regional Hospital Portlaoise.
While it does not directly quote Mr O'Brien, the paper says: "That was stopped by health minister Simon Harris".
The former HSE boss, who retired early over the handling of the cervical cancer screening scandal, hit out at Minister Harris for behaving like a "frightened little boy" who "runs scared of headlines". Laois TD and Minister Charlie Flanagan subsequently criticised Mr O'Brien for making a 'personalised attack' on Mr Harris.
Mr O'Brien did confirm that he would have made widespread cuts to emergency medicine.
"I would have ended 24-hour emergency department cover in a number of (hospital) locations," he said in the interview with Susan Mitchell.
Mr O'Brien is quoted on Navan hospital as being the 'best example' of the need to remove full A&E services. He said it receives very few presentations overnight but is staff 24/7 relying on expensive locum doctors.
"It's a wasteful use of public resource. And it's not an emergency department. I personally would have a wish to be taken to," he said.
Mr O'Brien said there are also too many emergency departments in Dublin something he said the HSE suggested.
He also highlighted the "enormous implications the quality and sustainability" facing small hospitals like Portlaoise of not being able to recruit staff.
It is almost a year since a report was leaked that recommended the extensive downgrade of Portlaoise hospital with services transferring elsewhere.
The plan was authored by the now retired HSE Dublin Midland Hospital Group ceo, Susan O'Reilly. It remains on the Minister for Health's desk. He has promised consultation on the next steps.
The downgrade plan would see A&E, ICU, maternity, paediatrics and most surgery withdrawn from Portlaoise hospital.
Mr O'Brien had close dealings with the past three health ministers, including Leo Varadkar, involving Portlaoise as a result of the maternity service controversy in which babies died.