A plan to expand the Dallas Parkland Hospital board drew criticism from some Dallas County commissioners, who heard about the plan Tuesday.
A consultant study recommends increasing the volunteer board from seven to 11 members.
Board Chairwoman Debbie Branson said the current board has received the study but taken no final action on it yet.
"We consider it to be a road map to a more effective system of governance, something all of us want to have," she said.
Several Parkland supporters urged county commissioners to look favorably on the change.
"The current board size will fatigue even the most strident community volunteer, given the amount of work that we have," Parkland supporter Gregory Davis said.
Commissioner Elba Garcia said she appreciates the work of volunteer hospital board members but complained that communication between the county's hospital and the Commissioners Court is poor. Commissioners get most of their information from the media, she said.
"I think all of us here at this Commissioners Court wants to see Parkland succeed," she said. "But for that, I think the first thing that needs to happen is, we need to have a clear vision of communication and the budget before we start to make the changes."
Commissioner John Wiley Price said Parkland officials have blocked his effort to obtain information about pending issues.
"It appears as though I'm getting rebuffed and running up against the wall," he said. "Just give up the information."
Hospital officials recently revealed that construction of the new $1.27 billion hospital is running $16 million over budget.
Meanwhile, the hospital board is considering plans for an unfunded $18 million arched bridge across Harry Hines Boulevard between the old and new hospitals and a return of merit raises for top executives in a new operating budget.
All of this comes with federal safety inspectors currently in the hospital for a major review that threatens to end around $400 million in annual federal funding after Parkland failed safety inspections two years ago.
"Until they get a CEO, they're going to continue to have these problems," Price said. "No one has long-term, vested interest."
The search for a new Parkland CEO has been underway for well over a year since long time leader Dr. Ron Anderson was forced out in late 2011 in the wake of the federal safety inspection failures.
Federal inspectors have mentioned board governance issues in their reviews of Parkland Hospital.
County commissioners control the hospital board and budget, but board members operate the hospital.
No action was taken Tuesday. Board expansion would require a change in state law.
Branson said the board is working on all of the pending issues and will work to improve communication with county commissioners.