Commenting on the impasse over southern neurosurgery services, Mr Hunter said he believed some Canterbury health professionals had been actively working to make it impossible for the Otago District Health Board to employ neurosurgeons.
They were creating a situation for which they then had the solution, he said.
Mr Hunter has written a series of articles for the Otago Daily Times, beginning on Monday, giving his views on the issue.
He had decided to go public with his opinions because he felt the community needed to understand some of the background issues and that Dunedin was "on a hiding to nothing trying to keep the unit going and to employ people".
The issue was not only about neurosurgery, but also about finding a satisfactory solution to the delivery of all specialist surgical services in the South.
People needed to know that the issues were "not just squeaky clean" with everyone motivated by concern for the public good.
He alleged some Canterbury health professionals had been "actively undermining" the Dunedin service "for their own ends - for lifestyle".
Canterbury wanted a one-site service with six consultants and three or four registrars. This meant the consultants would never have to get out of bed in the early hours to attend patients, he said.
If that meant that people in the southern part of the South Island had no service when they were "acutely unwell and dying, it's not good enough", he said.
A request to discuss issues raised by Mr Hunter was declined by Canterbury neurosurgery unit clinical leader Martin MacFarlane and former Otago neurosurgeon Suzanne Jackson (who now works in Canterbury) yesterday.
In the articles, Mr Hunter said if trainees who might have come as newly qualified consultants were discouraged from applying for positions, before long, the only applicants were those who could not get a job anywhere else.
He believed this was "exactly what has been happening in neurosurgery", although he said head of neurosurgery in Auckland, Ed Mee, had insisted this was not the case.
In his articles Mr Hunter says that in late 2008 the South Island district health boards noted Otago was having trouble recruiting a second neurosurgeon and that the position of Ms Jackson as sole surgeon was untenable unless this occurred.
It was determined that the chief executives' forum would "help" the board to solve this issue, from which the discussion turned to support for a single regional service.
"It must have sounded like motherhood with bells on, but it soon became clear that the meaning to each party in the room was radically different."
He described it as the opportunity the Canterbury neurosurgeons had been waiting for - "the moment to deliver the coup de grace to Dunedin and consolidate the position of the Christchurch unit as the sole centre of neurosurgery in the South Island".
Mr Hunter said that the Otago board's recruitment of British neurosurgeon Irfan Malik was brought to a " sudden standstill" when Ms Jackson refused to supply the supervision required by the medical council.
Efforts were made to get supervision from the North Island, but Mr Hunter alleged that during this period, Mr Malik received a competing offer and Ms Jackson rang him and advised him against taking up employment in Dunedin.
Mr MacFarlane and Ms Jackson advised, through the Canterbury board's communication office, that they did not want to discuss any such neurosurgery issues through the newspaper.
Mr Malik, who is working in the United Kingdom, did not respond to ODT requests for contact over issues related to his recruitment earlier this week.
Southern chief executive Brian Rousseau also declined to comment.
Mr Hunter's articles are also strongly critical of the influence of the Royal Australasian College of Surgeons and the Neurosurgical Society of Australasia and the requirements posed on applicants for specialist registration.
If the NSA wanted to make it difficult for a board to employ foreign doctors then "they most certainly can, either by withholding a recommendation for vocational registration, or by refusing to supervise them in their initial period of practice, or both".
It could be very difficult to distinguish between a genuine concern for the safety of the public as a motivation for stringent standards and the operation of a "closed shop" for other ends, he said.
"In my view, the nickname of 'neurosurgical mafia' is not undeserved."
He called for the New Zealand Medical Council to break away from the influence of Australia and develop training and qualifications and employment arrangements that suited New Zealand, rather than go along with the urban view being expressed from Australia.
He referred to neurosurgery as "a small club" with the fraternity in Australia and New Zealand dominated by the views of the Australian majority and attitudes were "metro-centric".
Within New Zealand "the club is even smaller, there being only 15-20 surgeons, and a small group of strong personalities can easily dominate it".
In response to questions raised by the ODT , NSA executive director Stacie Gull said in an email that the NSA had no involvement, formal or informal, in the employment, assessment or supervision of international medical graduates in New Zealand.
This was undertaken by the Royal Australasian College of Surgeons, in conjunction with the Medical Council of New Zealand.
"If there are instances where individual neurosurgeons have refused to provide supervision for international medical graduates, noting that I am not aware of such instances, this has not been an action instigated by the NSA."
However, the society did respect individual member's rights to determine their own personal involvement in supervision of any third party, she said.
The Medical Council declined to comment on any of the issues raised by Mr Hunter.
Mr Hunter said he expected he would be "very unpopular in some circles", but he believed that there would be much support for his views from provincial surgeons around New Zealand who would recognise that his views applied to more than neurosurgery services.
In a section in the articles on air transport, Mr Hunter said intensive care staff at Dunedin Hospital were of the unanimous view that having acute neurosurgery only at Christchurch was unacceptably dangerous and consultants could not support, encourage or condone the proposal, as it was clinically unsafe.
In his view, there was no reason to believe that treatment outcomes in a four or six-surgeon unit in Christchurch would necessarily be better than in a two or three-surgeon unit in Dunedin.
• Since Ms Jackson left at the beginning of last year, the Dunedin service has been staffed by locums with back-up from Canterbury, when required.
Mike Hunter: passionate about public health system
> Born in London in 1956, one of five children, to New Zealand parents; arrived in Dunedin aged 6 months.
> His father, John Hunter, was Dean of the Otago Medical School and Professor of Medicine.
> Graduated from University of Otago in 1980.
> Worked for two years as a house surgeon in Nelson
> Undertook surgical training in Dunedin and Invercargill and subsequently undertook further training in anaesthesia and intensive care.
> Worked in England at Portsmouth and Cambridge.
> Trauma fellow and intensive care senior registrar at Westmead Hospital, Sydney, in 1992. Wrote first edition of the hospital's trauma guidelines.
> Returned to Dunedin in 1993; worked as a consultant general surgeon and consultant intensivist since. Clinical leader of the intensive-care unit and head of the helicopter retrieval service for the Southern region. Was sole surgeon managing burns in region until the arrival of two plastic surgeons in recent years.
> Unique in Australia and New Zealand as the only general surgeon who is also an intensive-care specialist.
> Recently resigned from 34 years of military service in the NZ Defence Force.
> Professional practice fellow in medical and surgical sciences at the Dunedin School of Medicine; also serves on a variety of professional groups.
> Passionate about public health system; "philosophically uncomfortable" about private practice and does not do any.
> Married with three children; interests include running, biking, hunting, fishing and cooking.
