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The proposal is to increase day surgeries, and reduce the need for patients to be admitted overnight.
The much-needed modernisation faced a major roadblock because of the Southern District Health Board's dire financial position.
''Southern needs to get into this century. There are some practices going on in Dunedin because it's the way we've always done it,'' Dr Powell said.
Dunedin Hospital was ''isolated'' and had not kept up with changes in other main hospitals.
''Dunedin day surgery tends to turn into an overnight stay, whereas it doesn't elsewhere.''
Managers would take a paper to the board's hospital committee in May, and have been reluctant to disclose information to the Otago Daily Times.
Dr Powell said she believed building work was needed to increase day surgery numbers.
Whether the financially strapped board could secure necessary capital funds was unclear, but the spending would bring significant benefits, she said.
Dr Powell slated the board for a lack of communication.
''Their communication, their engagement, is appalling, absolutely appalling.''
The surgery paper was written by National Health Board senior official Joy Farley, who was seconded to look at surgery issues. Dr Powell said Ms Farley's paper should be released to provide reassurance about what it contained.
''There's nothing in it that couldn't be circulated. It's a discussion document; it raises some issues. Why isn't it out there in the public domain?''Of course staff start to get nervous if they hear of documents and they haven't seen it.''
Patient services director Lexie O'Shea, in a written statement, said the paper was still in draft form, and was being discussed internally.
Chairman Joe Butterfield said when contacted he did not know what was proposed, but it was not simple to build new facilities, because of the need for capital investment of up to $500 million for Dunedin Hospital.
Detailed design plans for the whole project had to be drawn up before any part of it was started, to ensure the hospital was planned in a coherent way.