Health Minister David Clark appears poised to sack the entire Waikato District Health Board over poor finances and governance, and replace it with a commissioner.
The Labour MP has told the embattled DHB he is seriously dissatisfied with its performance and increasingly worried about its growing deficit and instability at a governance and leadership level.
On governance, the DHB is not managing some basics - like getting patients seen in the Emergency Department within the six-hour time frame expected - contributing to dysfunctional relationships with a couple of other hospitals in the DHB's own region.
Board decisions have also reportedly reached the media while the board is still meeting. Senior doctors are worried decisions are not being made, and some GPs are also unhappy.
Waikato DHB also recorded a deficit of $56 million this financial year - the second biggest deficit of all 20 DHBs, after Canterbury - and up from $37 million last financial year.
That followed the scandal of inappropriate spending by its former chief executive Nigel Murray, who resigned after an investigation. He was replaced by a nurse, Derek Wright, who was well liked by clinicians but has now also resigned for personal reasons and leaves at the end of April.
The board advertised the position but then put that process on hold, unhappy about the calibre of the people applying. Potential chief executives could be reluctant to put themselves up for a job that could well result in failure.
Mr Clark said he was not commenting further, and has given the board two weeks to tell him what they think before he makes a final decision.
He offered the same to members of the Counties Manukau DHB after problems at Middlemore Hospital were exposed, before sacking them.
Waikato's board chair Sally Webb, who will be sacked as well if Mr Clark axes the board, backed the minister's action. She said being unable to appoint a suitable new CEO has undermined trust and confidence in the board.
She said the public disagreement throughout the term of the board had been detrimental to it, and a number of board members have considered resigning as a group to enable the minister to appoint a commissioner.
If he goes ahead and sacks the board, Mr Clark would also have to get legislation through Parliament to cancel the October local body DHB elections in Waikato.
The senior doctors' union said senior doctors would be sympathetic to the appointment of a commissioner.