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Correction: This story was updated at 6:54 a.m. June 27 to say the meeting is Thursday night, not Tuesday.

some text Above is a copy of a letter from Erlanger's Medical Executive Committee to trustees.

Erlanger Health System's proposed fiscal year 2020 budget will address many concerns outlined in a recent letter from physicians who oversee patient safety and quality care in the hospital, according to a statement from Erlanger's board chairman.

The budget was discussed and approved during a committee meeting Monday and passed to the full board for approval at its regularly scheduled public meeting Thursday night.

Mike Griffin, chairman of the health system's 11-member board of trustees, said in a statement Wednesday he had "no further thoughts on the budget but [feels] strongly that it will address many of the concerns regarding staffing, morale and physician relationships going forward."

Issues outlined in the letter dated May 9 center on years of emergency department overcrowding and understaffing at Erlanger's main campus, "which has unfortunately contributed to adverse patient outcomes," it states.

The letter goes on to say efforts to fix the problem "have yet to yield substantial change," which led elected members of the Medical Executive Committee to vote unanimously that the committee "has no confidence in the structure of the current Executive Leadership of the Erlanger Health System to ensure quality and safety of patient care."

On Wednesday, Griffin echoed a previous statement about the letter and the hospital's executive leadership under CEO Kevin Spiegel.

"As I stated last week, our Board is confident that Erlanger's administration is working to address the concerns identified in the Medical Staff's letter regarding the current structure of executive leadership," he said. "As to Mr. Spiegel's future at Erlanger, the Board of Trustees has an employment agreement with him and will continue to comply with the terms of that contract, always acting in the best interests of the organization. Any discussions related to his employment or other personnel decisions would not be in order or appropriate."

some text Above is a copy of a letter from Erlanger's Medical Executive Committee to trustees.

Other trustees could not be reached for comment or deferred comment to Griffin.

The new budget allocates $36.1 million for capital investments, with nearly $9 million going toward projects that include post-anesthesia care unit expansion, an endoscopy center at Erlanger East hospital, MRI equipment replacement and a nurse call system. Officials at Monday's meeting said these projects will help alleviate some of the overcrowding by helping to move patients more efficiently through the hospital.

The letter's authors also referenced nurse-to-patient ratios, stating that "Erlanger's ratios are not in line with national staffing standards" and comparing Erlanger's "roughly 1:6 and sometimes higher" nursing ratio to those at Vanderbilt University Medical Center, which according to the letter "diverts patients if the 1:3 nursing ratio cannot be maintained as a patient safety measure."

Henry Hoss, chairman of the board's budget and finance committee, said at Monday's meeting that the biggest challenge is hiring people to staff these units.

"I just want to make sure there's enough money in our budget to cover it — it's not a budget issue we're dealing with," Hoss said.

Officials on Monday confirmed the budget exceeds standards for staffing and said nursing ratios in the emergency department aren't fixed, but rather scale to the severity and volume of patients.

Dr. Amar Singh, an Erlanger urologist, said he's heard the nursing ratio argument before, but Erlanger and Vanderbilt aren't fair comparisons. Singh said he often struggles to get indigent patients into Vanderbilt.

"Vanderbilt is not a safety net hospital, as far as I'm concerned," he said. "Safety net hospitals have a different problem in the emergency room, so when we compare, I think we all have to be careful how we look at the ratio of nurses in our emergency room and the hospital."

On Wednesday, Erlanger's Vice President of Patient Logistics Donna Bourdon told the Times Free Press the hospital has also approved 13 new positions — including registered nurses stationed in the emergency department — to facilitate patient flow.

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

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