Top physicians say they've lost confidence in Erlanger leadership

Top physicians who oversee the quality and safety of medical care at Erlanger Health System say they've lost confidence in the hospital's executive leadership, according to a document obtained by the Times Free Press.

A copy of a letter sent from Erlanger's Medical Executive Committee to its Board of Trustees Chairman Mike Griffin dated May 9, 2019, says the group met that week and voted unanimously "no confidence in the structure of the current Executive Leadership to ensure quality and safety of patient care."

Several members of that committee who wish to remain anonymous for fear of losing their jobs said the vote of no confidence was directed at the executives who oversee service lines that affect efficiency and patient care quality. The people responsible for those areas of the hospital are CEO Kevin Spiegel, Chief Operating Officer Rob Brooks and Tanner Goodrich, Erlanger's vice president of operations.

Concerns about chronic operational issues, such as inefficiency, understaffing, poor morale and policies that cause overcrowding in the emergency department and operating rooms, were spelled out in the Medical Executive Committee's letter.

"Patient safety issues have been raised with management since 2015," the physicians wrote.

"Despite over 3 years of complaints and concerns by patients and physicians, hospital management has been ineffective in addressing these issues. There exists a lack of accountability in senior management who are either unable or unwilling to effect necessary changes to insure patient safety," the letter states.

Specifically, patient overcrowding at the main campus emergency department "has resulted in prolonged boarding of patients and difficulty in appropriate staffing, which has unfortunately contributed to adverse patient outcomes," it states.

The letter is signed on behalf of the Medical Executive Committee by its officers: Dr. James P. Bolton, chief of staff; Dr. Christopher E. Young, vice chief; Dr. Christopher V. Poole, secretary; Dr. James "Jay" Sizemore, immediate past chief.

Spiegel said in a statement that management is aware of the concerns, and patient care and safety are always the hospital's top priorities.

"Rest assured that my team and I are working very closely with medical staff leadership and all Erlanger physicians. We are committed and focused on addressing concerns promptly and effectively," he said.

Those with knowledge of the letter said they could not comment on its contents, because communication related to patient safety and quality improvement are privileged under Tennessee law.

"It is disappointing that someone involved in Erlanger's processes would have shared otherwise privileged documents," board Chairman Griffin said in a statement. "Regardless, I'm very comfortable saying that, while we, like many health care systems in today's environment, do have ongoing challenges with relations between the medical staff and administration, we are committed to resolving those challenges."

In another statement sent Friday afternoon, Griffin said, "At this point, the board has complete confidence that Mr. Spiegel and the team will work with the medical staff to resolve the issues brought to the board's attention."

Board Vice Chairman Phil Smartt said he echoes Griffin's statement. Attempts to reach the board's other officer, Secretary Linda Moss Mines, on Friday afternoon were unsuccessful.

Erlanger is Chattanooga's only public hospital and houses the region's only children's hospital and level-one trauma center, meaning it treats the most severe injuries. It is the largest regional provider of care for indigent patients; has seven hospitals and six air ambulances serving parts of Tennessee, Georgia and North Carolina; and is the tenth largest public health care system in the United States.

The system has 838 acute-care beds and treats patients from an area spanning 50 counties, according to the Erlanger website.

Erlanger is governed by an 11-member board of trustees who are appointed and serve without compensation. Six members are appointed by the Hamilton County mayor, and four are appointed by the Tennessee General Assembly. Bolton, the chief of staff, serves as the 11th trustee as well as head of the Medical Executive Committee.

While bylaws state that "ultimate authority for the operation of the Health System lies with the Board," trustees delegate the responsibilities of operations to the chief executive officer and of patient care to the medical staff, which is led by the medical executive committee.

The medical executive committee is comprised of the hospital's 11 department chiefs who serve a two-year term. Members are elected by their department except for contracted departments, which are appointed by the committee but typically nominated by their department. Officers are elected by the entire medical staff.

The Dean of the University of Tennessee College of Medicine at Chattanooga and Erlanger's chief medical officer also serve as voting members on the committee, and the chief executive officer is an ex-officio non-voting member.

Tension between business-minded administrators and clinically trained staff is common in hospitals across the country. A 2018 survey of U.S. physicians by the Physicians Foundation found that 46% of doctors considered relations between physicians and hospitals somewhat or mostly negative and adversarial.

Spiegel said in an email that Erlanger is no different in that "even though management has the utmost respect for physicians, at times healthy disagreements occur."

"This is particularly evident during periods of significant growth and expansion as Erlanger has achieved in recent years," he said.

Some recent disputes between management and doctors at Erlanger include graduate medical education, neonatology services and radiology contracts.

In his statement, Griffin said improving the medical staff and management relationship has been his "highest priority" since assuming the role of board chairman in January.

"Quite frankly, I believe the relationships are in a better place today for that," he said. "The Board takes these matters very seriously and continues to work with physicians and administration to ensure that we are providing exceptional patient care and continuously striving to improve quality, safety and service throughout the organization for the benefit of area residents."

Griffin also said the medical staff's request to be more involved in Erlanger's throughput initiative - which is always a priority but became a major focus last year - is already in the works. Throughput is the movement of patients through a hospital. Efficient throughput leads to more timely medical care, lowers costs, improves outcomes and increases patient satisfaction.

State Sen. Todd Gardenhire, R-Chattanooga, is chairman of the delegation that appoints four of Erlanger's trustees. He said it's the board's responsibility to "do whatever they can do to make a change, get to the bottom of the situation and change the management so physicians and patients have confidence in the quality of care." As an appointing authority for a public hospital, he said he shares in that obligation.

"When the doctors at the hospital do not have confidence in the leadership of the hospital, that's a major, major blow to the management and operations of that hospital," he said.

Hamilton County Mayor Jim Coppinger, who appoints six trustees, said he trusts the systems in place are working.

"I have confidence in the board of trustees, and more specifically in the leadership of the chairman, Mike Griffin," Coppinger said. "I think the board has outstanding leadership, and I'm sure they're going to work through whatever the issues may be."

Contact staff writer Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.