A former health board chief executive, whose spending of public money will now be examined by the Ministry of Health, is accused of leading to a culture of dysfunction and embarking on expensive projects at the cost of core services and patient safety, according to a damning letter by doctors.

And the man ultimately responsible for appointing Dr Nigel Murray to the top post at Waikato District Health Board, chairman Bob Simcock, has also come under fire from the senior doctors who say he did not heed warnings and allowed Murray to undermine hospital services.

But Simcock has blamed Murray for part of the situation, saying the CEO was frequently asked to address a growing disjoint between doctors and management, but did not.

Murray resigned on October 5 after an investigation into his expenses found evidence of unauthorised spending, understood by the Herald to include expenses associated with women who were not his wife.

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In the letter addressed to Simcock on Wednesday, copied to all senior doctors at Waikato Hospital and seen by the Herald, Senior Medical Staff Association (SMSA) chairwoman Dr Margot Rumball criticised Murray's leadership as not directed at issues identified in a 2014 Review of Opportunities for the Incoming chief executive.

These included capacity and demand at the 600-bed Waikato Hospital, where a policy to put patients in treatment rooms and lounges was developed under Murray's watch to cope with overflow; and mismanagement of surgeries, now costing the DHB $25 million a year in outsourcing, requiring a complete overhaul by consultants at a cost of $1.4m.

Rumball said rather than concentrate on areas of concern, attention was diverted to:

• The $14.7 million refurbishment of the KPMG building to house 800 DHB staff, which Rumball said "would provide physical isolation of hospital clinicians from executive management". The refurbishment was initially costed at $7.7 million but blew out to almost double that requiring ministry approval.

• Development of virtual health app SmartHealth powered by HealthTap, a US-based organisation "with limited, if any, experience in the Australasian healthcare environment".

• An initiative to establish a new medical school.

She said those enterprises came at enormous cost to the DHB including that elective surgery continues to be outsourced because of insufficient theatre staff, with more than 10 full-day lists a week regularly cancelled, outsourced or designated local anaesthesia only.

Patients were frequently being treated in non-purpose-designed areas, and delays in access to radiology and follow-up appointments were also major issues.

Rumball described an eroding of clinical governance under Murray's tenure, underlined by the loss of accreditation for obstetrics and gynaecology training, threatened losses of accreditation for orthopaedic training and paediatric medicine training, and a part failure of the Medical Council accreditation review to train first- and second-year doctors.

Rumball said the culture at Waikato Hospital was under threat and there was a "dysfunction between senior clinicians and some senior managers".

She also took aim at Simcock, referencing a 2014 letter from the SMSA to him about concerns over the appointment of Murray, and saying clinicians were not properly represented in the decision.

The 2014 letter referred to Murray's previous performance in New Zealand health management and allegations of his "poor reputation" with senior medical staff relationships.

"From our perspective, as board chairman, you provided personal reassurance that due diligence did not support our concerns," Rumball wrote.

"There is perception that you and your controversially appointed CEO have not delivered on the promise to address the opportunities the review identified."

She said the SMSA welcomed the appointment of interim CEO Derek Wright, but the group wanted input into Murray's replacement, a process expected to take 18 months.

In response, Simcock said at the heart of the clinicians' concerns was a belief they had been unable to adequately participate in key decision-making within the DHB, and that this had been the case for at least 10 years.

"It is disappointing that contrary to the board's wishes, and in spite of the issue being frequently raised with Nigel Murray, this situation did not improve during his time as CEO."

He said what was important now was that senior clinicians, management, and the board "have a common view of what needs to happen to improve the situation, and that process has already begun".

Simcock said other concerns in the letter had previously been discussed with doctors.

He previously told the Herald all references for Murray were outstanding and that concerns expressed at the time of his appointment were not relevant to the role of CEO.

In a public letter last week Simcock said Murray's recruitment involved a group of people, was agreed by the board and was not his decision alone.

Murray could not be reached for comment.