The key problems are ever-increasing demand, a frozen budget and the 20-bed aged care facility Kauri Lodge, which DHB consultants say is too small to be viable. As a result it has to be propped up with funding which should go to prevention and primary health care.
In a statement distributed at consultation meetings, the trustees said they opposed any proposal to close Kauri Lodge or the two GP beds.
While the proposal had some merits, it failed to address the reality that Whangaroa was a rural area where patients lived in isolated areas and already travelled considerable distances to access health services, the trustees said.
Closing Kauri Lodge would cost local jobs (37 has been cited as a worst-case scenario) and put other businesses, such as the local pharmacy, at risk. It would also mean that elderly folk who could not be cared for at home would have to move away from friends and family.
The trustees accepted that their governance and management needed improving, but questioned why the review had focused only on services provided by the trust and not on other providers working in Whangaroa.
They were also unhappy about rushed consultation. It had been "something of a sham," they said, with consultants shaping evidence to fit the desired conclusions.
Kaeo trustee Brendan Tuohy told more than 80 people at a public meeting late last month that the trust was looking into ways of expanding Kauri Lodge to make it financially viable. It was currently being subsidised to the tune of about $400,000, he said.
Others at the meeting suggested asking patients to pay $10 to see a GP; a staff member offered to replace the current unobtrusive donation box with a "bells and whistles" version and to challenge patients to use it.
DHB representative Kim Tito emphasised that the proposal was not a done deal and that consultation was genuine.
The DHB was reviewing all its contracts as it grappled with burgeoning demand, driven by an ageing population and the diabetes epidemic, coupled with a squeeze on government funding, he said.
The review was aimed at making sure the board was spending its money in the right places to get the best health outcomes. If nothing is done it would go from break-even now to a $30 million deficit in four years' time.
The deadline for submissions has been extended to July 24.
