Health Minister Jonathan Coleman has refused to apologise for calling the Southern District Health Board's urology department "toxic", despite complaints from doctors.
The DHB is embroiled in controversy over excessive waiting times for prostate cancer checks and pressures on cardiac services and intensive care beds.
Mr Coleman told Checkpoint on Friday the DHB received adequate funding, but described its urology department as "toxic".
Dunedin Hospital surgeons yesterday demanded that he apologise for the remark, saying the comment was inappropriate.
But at Question Time in Parliament today, Mr Coleman defended his remarks, saying he used the word 'toxic' because "that's how matters have been described to me".
He added that the reason he had to put a commissioner into the Southern District Health Board was because it had been called a "cot case".
DHB chief executive Chris Fleming said its urology service faced major challenges, but he did not say it was toxic.
"I told Doctor Coleman that there were challenges within the urology service, I'm aware that there are challenges both internally within the service and between management and clinicians, and we need to address it."
Southern DHB issues 'won't be quick fixes'
Mr Fleming today emailed all staff, responding in detail to the past weeks' claims about pressures and failings at the deeply indebted DHB.
In his email, Mr Fleming conceded that the DHB, which was formed about a decade ago from a merger of the Otago and Southland DHBs, had "failed to take actions to address many significant issues".
"And we now find ourselves in the position of having huge challenges which at times can seem insurmountable".
He said the picture was not completely negative, but the issues had not surfaced overnight and "they won't necessarily be quick fixes to address".
The DHB was "absolutely committed" to addressing the challenges, he said.
Mr Fleming said on the surface - measured by standardised intervention rates - access to surgery at the DHB appeared reasonable.
"We excel in some areas and we are falling behind in others.
"Presently access is variable with the former Otago and Southland DHB catchments having different levels of access (in some services Otago has better access and others Southland)."
But he said the DHB must do more to ensure that wherever people lived, they received fair access.
Mr Fleming said increasing theatre space was crucial, but the DHB was limited by the number of physical theatres it had to operate in. He said it was addressing this by adding an acute Sunday list to alleviate pressure during the week.
Surgeries have also been taking place at Mercy Private Hospital on an opportunistic basis, and the DHB was in discussions about how to make greater use of that under changes at that facility.
Mr Fleming said statements had been made in the media that the DHB has employed surgeons and not necessarily provided them with adequate theatre time to allow them to operate on patients.
"Unfortunately this is indeed the case in some services. This goes back over many years and I am at a loss to understand how this practice has been allowed to occur."
He said unfortunately the same things had occurred elsewhere, including the employment of extra medical specialists without matching it with other extra "matched" staffing, such as nurse specialist roles.
Urology, Cardiac surgery and ICU beds
Mr Fleming acknowledged there were major issues, adding: "The service is largely operating as two separate services between Dunedin and Invercargill, processes and practices across the service are variable, and there is concern as to whether we have invested adequately in the service in recent years.
"Overall, intervention rates in urology indicate that we are providing this service at around the national intervention rate levels. However, there are significant numbers of patient referrals we have accepted and are failing to see within the expected timeframes.
"There are also a number of patients awaiting significant surgical procedures for whom we are falling short of meeting their expectations."
He said the DHB was committed to sharing the results of an external review into its urology services when it was available, but offered no timeframe.
Mr Fleming said intervention rates for cardiac surgery were "amongst the highest... in the country", but added that access to intensive care beds was the single biggest limiting factor for these rates.
He said there were eight ICU and eight HDU beds today and they had approved adding an extra ICU bed from Tuesday to Sunday to support more cardiac surgery.
"This extra bed will open just as soon as we are able to appoint the additional nursing staff signed off."
Mr Fleming said there was no evidence to support the suggestion made by some media that patients were dying because their cardiac surgery was delayed by constraint in ICU beds.
"I do however acknowledge that the delays for elective surgery have resulted in some patients needing to be treated acutely, which is unacceptable."
He said bed pressure had been intense over the past couple of months and this was expected to continue for the next few weeks until winter pressures eased. Work was under way to encourage primary care to improve access there as "there are too many people accessing [hospital] emergency department services instead of primary care".
A Medical Assessment Unit was also expected to be open this month but had been delayed by "the recruiting of resources to staff it". It was now scheduled to open from 4 September.