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Dr John Chambers, speaking as a senior doctors' union representative, said the high number of patients going public with their stories showed the situation was critical.
Chief executive Chris Fleming said the Southern District Health Board was trying to open new beds in some areas, and he described the situation as a ''perfect storm''.
''The difficulty is the state of our infrastructure . . . most of those spaces are no longer fit for purpose for clinical activity and would have to be upgraded.
''It's a perfect storm. It's a storm that shouldn't have been created, but it has.''
''Dunedin Hospital is under significant pressure,'' Mr Fleming said.
It was likely the board would seek extra funding from the Ministry of Health to get the buildings through the next 10 years until the rebuild, to allow for small upgrades or new beds as required, Mr Fleming said.
He feared a sudden critical failure at the hospital caused by the state of the facilities.
''Of course I worry about that.''
Dr Chambers said many beds had closed in Dunedin Hospital, and if they could not be reopened, the board needed to outsource to the likes of Mercy Hospital.
''Someone has to go round Dunedin Hospital ward block and look and see what bits of that building are quite capable of providing patient care that are not used to provide patient care.''
Areas that used to house patients had, in some cases, been turned into offices and storage facilities.
''A whole lot of beds have been shut in Dunedin Hospital over the past 20 years.
''Dunedin Hospital was much bigger. Beds have been closed.
''With a bed comes a nurse, and that costs money,'' Dr Chambers said.
Dr Chambers, who was one of the board members sacked in 2015 over the deficit, said removing the board kept a lid on problems.
As a board member, he would have been vocal at meetings attended by media and other members of the public.
''That's why I got on the board, to try to do something about some of these issues.''
Dr Chambers said a surgeons' letter written earlier this year which came to light in recent days highlighted a serious lack of access to general surgery in Dunedin.
Patients were often bumped off the list by urgent cancer surgery, he said.
Procedures such as major bowel surgery could take all day, meaning the time allocated for elective general surgery each month was completely inadequate.
Dr Chambers called on Mr Fleming and the commissioner team to front up and say if there were other problems being kept hidden from the public.
Mr Fleming said he was
not aware of any issues that had not already been made public.
He agreed the hospital needed to do more outsourcing, as its operating theatres were at capacity.
The review of urology was likely to recommend an extra specialist, which would have a flow-on effect to extra demand for operations.
He said the surgeons' letter of complaint about general surgery mainly reflected disparity between Dunedin and Southland.
It was easier for Southland patients to get surgery than Otago patients.
''We are one DHB, and if I happened to live in one part of the district, I would feel cheated if I get a different level of access.''
Invercargill surgeons were reluctant to lower the service level, arguing more resources should be provided in Otago instead.
'''The part of the district providing a higher level of access says that needs to be
at our level, not the other
''We do live in a rationed health system,'' Mr Fleming said.
Deputy commissioner Richard Thomson, who was a member of the board sacked two years ago, took issue with Dr Chambers' comments.
He called them ''unfair'', and said problems highlighted recently existed while Dr Chambers was a board member.
Mr Thomson said his contact with the community was higher as a deputy commissioner than it had been as a board member.
The commissioner team had shown a willingness to invest in services and listen to clinicians, particularly when designing the new intensive care unit, he said.