Hospital emergency department specialist Dr John Chambers, who is also a union representative, said Mr Butterfield appeared to be the "main driver of the idea of actually cutting medical staff to try and balance the books".
Mr Butterfield has made strong comments at recent board meetings about a doctors' wages cost overrun at Dunedin Hospital.
Senior clinicians and their union, the Association of Salaried Medical Specialists, have been at odds with Dunedin Hospital management over a staffing level row, which last month prompted clinical leader Dr Tim Kerruish to resign. He remains on staff as a specialist.
At the time Dr Kerruish said the DHB had backtracked on recruitment promises, including adequately staffing the $2.7 million 10-bed observation unit opening in a couple of months.
Dr Chambers said Dr Kerruish's resignation "resonated quite strongly" within the organisation.
A constructive though "rather sombre" meeting took place last week with management.
"It now rests with the executive ... to decide how to proceed [as to staffing]."
The vacant clinical leader position would probably be advertised, he said.
Dr Chambers pointed outWaitemata had received an additional $153 million for facilities and staff over the past three years.
"SDHB [is] spending [$2.7 million] to turn [the site of the former cafe] Muffin Break into a 10-bedded Muffin Ward ... with no funding for additional clinical staff.
"We really are the poor cousin of our northern colleagues."
In response to claims he was cutting staff, Mr Butterfield said his role involved taking a broad overview of the financial position, and he was not involved in departmental detail.
"No. We're not cutting staff to balance the books, we're saying to staff you've got to manage to the budget that you have set, now that's quite different ...
"The budget, as I understand it, is something ... that was drawn up in conjunction with staff, and I assume staff knew what they were doing when they set their budgets, and I expect them to stick to them."
Staffing requirements of the new observation unit were still being worked through, he said.
To label Southern DHB a "poor cousin" was "grossly misrepresenting" the DHB's position.
Mr Ryall also rejected the "poor cousin" tag, saying the DHB received $71 million extra operating funding in the past three years, as well as an additional $28.6 million to cover deficits. He also pointed to $25.3 million approved for Southern DHB capital projects.
"Finances in the health service are tight, but Southern DHB has got a fair share of the available funding. Southern will get a further boost in this year's Budget."
