Victorian surgeon Bruce Waxman has spent the past two months independently reviewing the area health service's proposal and released his findings last Tuesday.

He endorsed controversial plans to develop Mount Druitt Hospital as an a elective surgery centre and relocating emergency surgery to Blacktown, Westmead and Nepean hospitals.

But Professor Waxman identified several flaws, including lack of resources, sustainability of the emergency department and willingness of staff and the community to support the plan.

He said the management of pediatric surgical emergencies and children presenting to the Mount Druitt emergency department with respiratory problems was a dilemma.

A senior hospital employee, who wished to remain anonymous, was pleased that Professor Waxman recognised the need for extra resources, including the opening of a fourth operating theatre and transforming the former intensive care unit into a day procedure suite.

But he criticised the endorsement of emergency surgery and raised concerns about transportation of patients from Mount Druitt and the availability of beds at other hospitals.

The staffer listed three cases in the past six months where patients most likely would have died, had after-hours surgery at Mount Druitt Hospital not been available.

He said the area health service's administrators should be held accountable and hand back their salaries after the first death at the hospital, if the plan went ahead.

``It's not OK for Mount Druitt Hospital to be put in unacceptable danger and my colleagues feel just as strongly about this as I do,'' the employee told the Star.

``I cannot believe that they're considering taking away the safeguards currently in place. They're playing with children's lives.''

Blacktown Mayor Charlie Lowles supported the hospital employee.

``We are all aware of the pressure on the public health system, but we must not compromise the health of our children, particular in an emergency,'' Mr Lowles said.

``We also must not disadvantage the very communities that already experience a number of barriers in accessing quality health care.''

The recommendations came as no surprise to campaigner Debbie Robertson.

``It was neither a win nor a loss and we can build from this by pushing for the things that need to be kept or brought to Mount Druitt,'' she said.

She praised the area health service on last week's launch of a new mammogram service at the hospital.