The warning is contained in an internal note of a teleconference in October 2012 with then assistant director of Children and Family Service Phil Garland and then head of the Medical Intelligence Unit Davida De La Harpe.

It ends with a recommendation that the then health minister be informed with a view to a state inquiry being launched. This was almost two years before revelations of a mass grave at the home forced the Government into launching a state inquiry into all mother and baby homes.

The note relays the concerns raised by the principal social worker for adoption in HSE West who had found “a large archive of photographs, documentation and correspondence relating to children sent for adoption to the USA” and “documentation in relation to discharges and admissions to psychiatric institutions in the Western area”.

READ MORE: SPECIAL INVESTIGATION: Government already knew of baby deaths .

It notes there were letters from the Tuam mother and baby home to parents asking for money for the upkeep of their children and notes that the duration of stay for children may have been prolonged by the order for financial reasons.

It also uncovered letters to parents asking for money for the upkeep of some children that had already been discharged or had died. The social worker, “working in her own time and on her own dollar”, had compiled a list of “up to 1,000 names”, but said it was “not clear yet whether all of these relate to the ongoing examination of the Magdalene system, or whether they relate to the adoption of children by parents, possibly in the USA”.

At that point, the social worker was assembling a filing system “to enable her to link names to letters and to payments”.

“This may prove to be a scandal that dwarfs other, more recent issues with the Church and State, because of the very emotive sensitivities around adoption of babies, with or without the will of the mother.

“A concern is that, if there is evidence of trafficking babies, that it must have been facilitated by doctors, social workers etc, and a number of these health professionals may still be working in the system.”

The report ends with a recommendation that, due to the gravity of what was being found in relation to the Tuam home, an “early warning” letter be written for the attention of the national director of the HSE’s Quality and Patient Safety Division, Philip Crowley, suggesting “that this goes all the way up to the minister”.

“It is more important to send this up to the minister as soon as possible: with a view to an inter-departmental committee and a fully fledged, fully resourced forensic investigation and State inquiry,” concludes the note.

The Sisters of Bon Secours said it ceased operating the Tuam mother and baby home in 1961 and, at the instructions of the local authority, handed the files on the running of the facility back to them.

“As the Commission of Investigation has now been established the Sisters of Bon Secours do not believe it would be appropriate to comment further except to say that they will co-operate fully with that commission,” said the order.

The Department of Children and Youth Affairs said none of the concerns raised were brought to the attention of the minister at the time, but were discussed in the context of the McAleese inquiry under the auspices of the Department of Justice.

It stated that the minister became involved in the issue once material around infant deaths in Tuam became public in mid-2014.

“The minister was subsequently tasked by government with leading its response to these important matters and the Inter Departmental ReviewGroup was set up to assist deliberations on the terms of reference of a Commission of Investigation,” said the statement.

A request for comment from the Child and Family Agency Tusla was not responded to at the time of going to print.

READ MORE: SPECIAL INVESTIGATION: Government already knew of baby deaths .

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