"ED is only a small part of the hospital, and there'd be half a dozen departments exactly the same as ED, moaning and being concerned about funding restraints."
If the DHB had unlimited resources, it would put more money into ED and other departments, but funding was being cut in "real terms" and that was one of the main factors in decision-making, he said.
However, he did not accept medical staff fears reported yesterday that ED might not be clinically safe when funding for two temporary senior registrars ran out in June.
Dunedin's complement of ED doctors was not out of kilter with other centres, he said.
Rosters were being reviewed with the help of external consultants to make the best use of staff, which would make up for the loss of the two temporary registrars.
He did not accept the board was cutting back ED staffing.
"We've had issues with trying to find the appropriate level of staffing within ED."
This week, ED head Dr Tim Kerruish resigned as clinical leader over the doctor staffing level row, but continues as an ED specialist. He said the last straw was the DHB pulling funding to hire permanently the two senior registrars. Locum funding would also be cut, he said.
Senior clinicians had serious doubts about clinical safety, particularly on weekends, Dr Kerruish said. The 10-bed ED observation unit opening this year might have to shut at weekends.
In response, Mr Bunton said the observation unit would stay open seven days a week.
The unit was about "getting people out of corridors".
"It won't result in any more patients coming into ED."
Longer waits in ED did not usually affect patient safety, although it did for certain patients.
Asked if he accepted Health Minister Tony Ryall's six-hour ED target, with which Southern DHB has struggled, Mr Bunton said: "I think it's an important target over and above reasons of clinical safety. I'm sure if your 85-year-old grandmother came into hospital, the last thing you'd want [her] to do is lie in a hospital corridor for 12 hours."
Funding for the two senior registrars was never confirmed - on that there had been a "different interpretation" between management and Dr Kerruish.
Former clinical leader and ED specialist Dr John Chambers said management should examine why Dr Kerruish resigned, and possibly redefine the role to ensure the person was properly supported.
Dr Chambers, who stepped down last year after 17 years in the role, said Dr Kerruish reached a point where he could not carry on.
A "short-term" approach driven by funding put the clinical leader, charged with long-term planning, in a difficult position.
"When we're trying to construct a workforce, it's very difficult to plan, when there's all these short-term reactions to budgetary constraints."
While permanent staff looked more expensive, they were cheaper in the long-run than locums, Dr Chambers said.
Mr Bunton said it was "very difficult, almost impossible", for DHBs to plan long term, because of pressure to meet budgets. That meant DHBs could only "plan for the immediate [future]".
He did not agree the clinical leader role needed to change.
