The revelations are in one of a series of draft briefing papers prepared on the Tuam and Bessborough mother and baby homes by Declan McKeown, a consultant public health physician and medical epidemiologist of HSE Medical Intelligence.

The drafts date to October 2012, two years before the Tuam babies scandal. They were completed as part of the HSE’s examination of the State’s role in the Magdalene Laundries, under the McAleese inquiry.

In one draft, from October 18 of that year, Dr McKeown noted the Tuam archive contained evidence that one child was sent to a US couple in 1957 for a price.

“Some of the records are well-kept, however, and show that, in one case of an infant being sent to a family in Louisiana, in 1957, a sum of approximately £50 was paid to the order by both the adoptive parents and by the natural [birth] parents,” wrote Dr McKeown.

Under the Adoption Act, 1952, it was illegal for an “adopter, parent, or guardian of a child” to receive any payment in return for the adoption of a child, unless the payments were towards the maintenance of the child or to a solicitor.

Dr McKeown said the adoption records contained in the Tuam archive showed multiple illegal adoptions, which were not processed by the Adoption Board.

The adoption records are scanty, but a number of records do exist, which appear not to have gone through the Adoption Board. Processing an adoption through the Adoption Board would have been the accepted practice at the time.

Dr McKeown’s drafts also revealed that there were letters from “senior Church figures, requesting the nuns to identify babies for adoption to the USA” — indicating that the Catholic Church hierarchy was also directing this practice.

In one case, the child of a named woman is suggested for transfer to American adoptive parents, a briefing paper states.

Dr McKeown concluded by suggesting the archive needed to be fully examined for possible “criminal issues”, but noted “an enormous amount of work” remained to be done.

“The archives need to be examined for clinical, accounting, and ethical irregularities, of which there are numerous clues in the material already uncovered.

“Additionally, there may be legal or criminal issues underlying the documentation, and it is critical that these potentials are out ruled as soon as possible, given the increased public interest in the issue of adoption practice in Ireland, particularly in the 1950s.”

A final draft of the briefing paper, containing concerns about adoption and infant mortality at Tuam and Bessborough, and citing the 1957 case, was sent to the national director of the HSE’s quality and patient safety division, Philip Crowley, and to the then national director of HSE children and family services, Gordon Jeyes, the following day.

The briefing paper had been sent one week after a note of a teleconference with the then assistant director of children and family service, Phil Garland, and then head of the medical intelligence unit, David De La Harpe, expressed concern that what was being discovered in Tuam “may prove to be a scandal that dwarfs other, more recent issues with the Church and State”.

This note was revealed by the Irish Examiner in 2015.

A series of questions were put to the HSE, including whether any of the evidence discovered in 2012 was ever reported to a government minister or to the gardaí.

It declined to answer the questions, stating it did not wish to “inappropriately encroach” upon the work of the Mother and Baby Homes Commission.

“The HSE is currently liaising with the commission, in relation to the disclosure of all documentation relevant to their work,” a statement said.