Last week about 100 community members and staff marched in protest of the growing unrest and managerial issues at Portland District Health.

Following the protest the hospital's chief executive Christine Giles alleges her access was cut off, including to her own emails.

She told The Standard she was on extended unpaid sick leave due to alleged bullying.

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Meanwhile, reports show issues facing the hospital stretch on for over a decade and despite thousands being spent on reviews, little has changed.

In 2019 Associate Professor David Hillis reviewed the medical workforce model at PDH.

The report, Towards a sustainable medical healthcare workforce in Portland, has never been made public despite calls from the community and staff for its release.

Seen by The Standard, the report describes the current hospital setup as "ad hoc", "fragmented" and calls for a complete overhaul.

It calls for the use of rural generalists - doctors with a broad range of skills suited to rural environments - over the next five to 10 years.

"Despite significant financial and governance support being provided, poor financial performance, instability in leadership and poor organisational culture continue to escalate," Professor Hillis said.

He described the model of medical coverage at PDH as "strained", with a mixture of international medical graduate junior and senior medical staff.

He said a dispute between local medical practitioners and the hospital meant there was no GP support within PDH, and there was a lack of on-site senior medical staff to provide a higher level of supervision.

Echoing concerns raised by previous board members, he said PDH's reliance on locum services was "very expensive", making up 39 per cent of total medical labour costs in 2018/19.

At the time the report was done, locums made up a significant chunk of the budget, costing $3.3 million of the $8.5 million medical labour costs in 2018/2019.

Across Victoria locums are difficult to get and can cost $2500 per day, not including on-call costs of up to $700.

"Despite substantial medical staff expenditure, the profile of the specialist hospital remains fragile with its weakness demonstrated by substantial locum and short term appointments," Professor Hillis said.

"Unfortunately, despite enormous effort and financial commitment, the stand alone specialist hospital model remains flawed."

He criticised past state government inaction.

"These issues are not new," he said. "There have been many reviews of PDH, health service delivery in south-western Victoria, regionalisation of health services in Victoria, training of health practitioners and clinical safety across Victoria.

"During this review frustration was frequently expressed that the clinical service issues have not been addressed appropriately.

"It is most strongly recommended that no further reviews be undertaken until the recommendations accepted by the DHHS and PDH are implemented."

However, chief executive Chris Giles said this advice was ignored.

"A soon as the report was signed off by PDH in 2020, the department commissioned a review by KPMG of the medical workforce at Portland, Warrnambool and Hamilton at a cost of about $60,000. Now the new board has done two further reviews," she said. "Hillis was clear there was to be no more reviews."

Professor Hillis said funding was not the key issue at PDH.

"It is the structural concerns that dominate," he said. "An isolated specialist hospital, not effectively integrated into regional services, staffed with very junior resident medical officers and with limited effective hospital-local general practitioner interaction is not achieving the level of care required. The model needs to change."

He said there was a a lack of training pathways and poor recruitment in regional areas like Portland.

"It leaves PDH and many other outer regional hospitals as locum-led outposts providing an inadequate service to the community," he said. "Portland could be a highly successful demonstration site of the national rural generalist pathway in Victoria."

PDH opened in 2003 and operates at the higher end of the description of a local health service which includes maternity, lower complexity surgery and 24-hour urgent care.

Portland has workforce shortages for all medical specialties and has been identified as a distribution priority area for GPs.

Portland is also one of the busier urgent care centres in outer regional areas with about 9000 presentations per year.

The report reveals tensions across south-west Victoria more generally.

"There are multiple levels of hostility between Warrnambool, Portland and Hamilton in health and other government services," Professor Hillis said.

"Both Hamilton and Portland do not view themselves as 'giving up' services to Warrnambool particularly if it impacts on their organisational goals. Warrnambool does not see itself as necessarily supporting smaller facilities if the cost is disruptive of its own services.

"This complexity produces different definitions of success or required service delivery. Initiatives are not supported fully and there is a sense of increased fragmentation across the region and wariness of the larger entities.

"Collaboration becomes very difficult. Both subregional and regional discussions do not appear to be delivering tangible outcomes for the benefit of the community."

Former board chair Andrew Levings said this was a statewide issue faced by rural hospitals.

"There's a huge need for improvement by the government in the funding of rural health services," he said.

"It looks like the government has been overcome by this metro-centric approach and they're not looking at what's happening in places like Portland, that are further away from where the voting population is.

"Portland is the largest exporter of any city in the state. Health services are paid from the revenues that flow from this economic activity. The government needs to remember that and provide an adequate health service to this community."

PDH anesthetist Dr Peter Reid has been a Portland resident for 37 years and his children were born at the hospital. He said the situation at the hospital was deteriorating.

"Doctors don't do this. We don't go into newspapers ever," Dr Reid said. "But we're here today because we finally had to because we were being ignored by the board.

"We were given replies which were far from explanatory and it has continued to ignore us.

"We want a local board. We want Mike's wife on the board who was on the board, and who wanted to be back on the board and isn't because she wasn't allowed. This sort of thing is happening here, it's dreadful.

"We have plenty of local people who have all the capacity required to be board members here in this town. It's rather insulting that we're relying on people from Melbourne, who don't know us."

The hospital board did not meet protesters last week, and instead gave people four days to have their say via an online form.

It drew criticism from the community, with some questioning how members without internet were expected to participate.

"Call a community meeting at the Civic Hall. It's that important," one community member said on social media.

The questions were answered on a video posted on the hospital's Facebook page.

Board chair Professor Peter Matthews said he was open to further communication.

"There is no substance to claims PDH will be closed, downgraded or amalgamated," Professor Matthews said.

"PDH has many partnerships; it will continue these partnerships and will have new partnerships that is a sensible thing for any hospital. PDH has advertised for specialists positions and will continue to do so and continue to work with the government on these issues."

He said the new board was likely to be paid higher than previous boards due to the embedded problems. The next meeting to address the Hillis report will be in late March.

"The Hillis report recommendations are far reaching and will be implemented over years, not months," Professor Matthews said. The DHHS was contacted for comment.

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