A commissioner has been appointed to replace the board of Waikato District Health Board.

Health Minister Dr David Clark says former director general of health, Dr Karen Poutasi, will take up the Commissioner’s role from tomorrow.

Clark says he's carefully considered Board members' submissions, but the appointment of a Commissioner is necessary to lead the significant changes required at the DHB.

He says the fact nine of the 11 board members offered to resign reflects the seriousness of the challenges they've been dealing with.

Clark says the return to an elected board will follow the 2022 elections.

Dave Macpherson and Mary Anne Gill wrote their own letter to Clark last week saying that they were the only two board members elected in 2016 and resigning would tarnish their reputations and align them with several "bad" decisions.

"We refute the claim that this is a dysfunctional board as described by our board chair, deputy chair and crown health monitor," they wrote.

The appointment of a commissioner would require a law change to cancel the October 2019 elections.

The DHB has grappled with a number of issues including the resignation of former chief executive Nigel Murray after a spending scandal; the appointment of a Crown Monitor in August 2018; pulling the plug on a failed multimillion-dollar online doctor service; and having one of the largest DHB deficits in the country.

The Waikato DHB deficit was $37.2 million in 2017/18, and is forecast to balloon to $56.1m deficit for 2018/19 - with increasing deficits forecast for future years.

Murray resigned in October 2017 after a DHB investigation and a State Services Commission inquiry found he spent $218,000 on travel and accommodation, half of which was either unauthorised or unjustified.

Then-board chairman Bob Simcock resigned the following month after the Herald revealed the Serious Fraud Office was investigating.

At the same time the DHB spent $25m on a virtual health solution that was a flop and eventually scrapped. That is now the subject of an investigation by the Auditor-General's office.

In August last year Clark appointed Crown Monitor Ken Whelan to "provide the board with the extra support it needs in its work to improve governance and leadership at the DHB".

Whelan is a principal at consultancy Francis Health and was part of a team engaged by the DHB at the start of 2018 which undertook $1.8 million of work.

Whelan is paid $35,000 per year as a Crown Monitor on both Waikato and Counties Manukau district health boards.

In February, Waikato DHB halted a four-month $73,000 recruitment process for a permanent chief executive officer citing "challenges" that it would not elaborate on.

The move came after it was criticised for complaining to the Solicitor-General over the inquest into the death of Nicky Stevens in mental health care at the DHB.

Stevens is the son Macpherson, who together with partner Jane Stevens wants an apology and compensation from the DHB over their son's suicide after he left the Henry Rongomau Bennett Centre unescorted in 2015.

Interim chief executive Derek Wright resigned after withdrawing from the recruitment process. His last day was on April 26.

Sacking an entire board is relatively rare and signals the governance level of a DHB is in dire straits.

In 2015 then-health minister Jonathan Coleman sacked the 11-member board of Southern District Health Board over serious financial concerns including a $42 million deficit.

Sacked health boards

• June 2015: Southern District Health Board members sacked by then Health Minister Dr Jonathan Coleman over longstanding financial woes.
• February 2008: Hawke's Bay District Health Board members sacked by then Health Minister David Cunliffe for not managing a serious conflict of interest.
• July 2000: Tairawhiti District Health Board members sacked by then Health Minister Annette King after 465 patients received the wrong results for prostate cancer.