Emergency physician Dr John Chambers said, when contacted, while positive things were happening in the emergency department, it was difficult to see how matters could improve when the board and its senior managers had real concerns about the financial operation of the hospital.
Despite the fact the board was funded for hundreds of millions of dollars each year, concerns about an annual deficit of a few million dominated all discussions, Dr Chambers said.
"Plans which require investment seem to be on hold and something has to give. I see people in the emergency department who are existing on painkillers with conditions like gallstones, who are just waiting because they don't have enough points [to get on to waiting lists]."
There was talk of lack of capacity, but this really meant "resourced capacity" as there were empty beds, operating theatres sitting idle and frustrated surgeons working below capability in many hospitals around the country, Dr Chambers said.
"For whatever reason, bureaucratic systems have resulted in blocking access to utilising these resources.
"It is no exaggeration to state that there are more doctors and nurses living in Dunedin than some African countries. It should be possible to do things better to deliver care to patients and next year looks hopeful for the emergency department and our patients."
Some small gains had already been made under the "optimising the patient journey" project, which is being piloted in the emergency department under the leadership of emergency department specialist Tim Kerruish.
The project aims to reduce waste, increase efficiency and improve patient flow, using the lean thinking method used by car manufacturer Toyota.
At a national level, Dr Chambers said he and the Emergency Medicine College welcomed recent comments from new Health Minister Tony Ryall to improve the quality and timeliness of care in emergency departments around the country.
It was revealed earlier this month the board's budgeted $9.3 million deficit had ballooned to an expected $13 million deficit, and board chairman Richard Thomson has said the board will have to debate with the community what services it could continue to provide, as it has to break even in the next three years.
