The first phase of a new children's hospital at Erlanger Health System rises across Third Street from the hospital in 2017.

No matter how you slice it, a letter expressing "no confidence in the structure of the current Executive Leadership" of Erlanger Health System by its Medical Executive Committee is shocking and concerning.

The fact, according to the Medical Executive Committee, that issues resulting in the "no confidence" memo have been extant for nearly four years is additionally bewildering.

"Patient safety issues have been raised with management since 2015," a May 9, 2019, letter from the doctors group to the hospital's board of trustees says.

The letter concluded that the doctors don't have confidence in hospital leadership "to ensure quality and safety of patient care."

The executives who oversee the service lines that deal with patient care quality and efficiency are hospital CEO Kevin Spiegel, Chief Operating Officer Rob Brooks and Vice President of Operations Tanner Goodrich.

The letter further spells out the concerns of the doctors group, saying 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."

The charge that the actions of executive leadership have led to "adverse patient outcomes" is serious. However, the specificity and quantity of the adverse outcomes were not delineated in this letter.

Nevertheless, board Chairman Mike Griffin and Vice Chairman Phil Smartt expressed confidence that Spiegel and his team would work with the medical staff that brought the grievances to resolve them.

Given that, we hope they have intimate knowledge and confidence that the relationships between hospital executives and doctors have improved since the early May letter.

Griffin told the Times Free Press he believes "the relationships are in a better place today" since improving those relationships was his "highest priority" when he became board chairman in January. He further said the medical staff's request to be more involved in the hospital's throughput initiative is already in the works. Throughput is the cycling of patients through the hospital's various resources.

Spiegel said in a statement that Erlanger is no different from other hospitals in the occasional tension between administrators and clinical staff and that, "even though management has the utmost respect for physicians, at times healthy disagreements occur."

He further said, like any hospital executive might under the circumstances, that administrators and the medical staff are committed to addressing the concerns promptly and efficiently.

We can't help but return to the doctors' letter that states the issues have been raised since 2015.

Neither do we know how much the executive leadership may have been focused elsewhere in the last nearly four years, but we do know that during that time the hospital has erected or planned to erect, among other things, the first phase of a new children's hospital at the main campus, a medical office building at Erlanger East, a Heart and Lung Institute at the main campus, a mental health hospital not too far from the main campus, upgraded emergency facilities in Bledsoe County, and a primary care and express care facility in Hayesville, North Carolina.

Hospital leadership also attempted but was denied a bid to build a free-standing emergency department in Bradley County and a request to establish an ambulatory surgery center in Ringgold. A planned regional hospital in Sequatchie County hasn't materialized.

During the building boom, disputes also have risen between executive management and doctors on issues of graduate medical education, neonatology services and radiology contracts.

Also factoring in the day-to-day operations are the givens that Erlanger is the area's only public hospital, meaning it provides a tremendous amount of uncompensated care; that it is the area's only level-one trauma center, meaning it treats patients with the most severe injuries; and that it has the region's only children's hospital.

Together, all that means there are a lot of moving parts over which executive management and doctors may disagree. How dire — or irreversible — is the "no confidence" and how much concern there is in the pablum statement from Spiegel are hard to gauge.

This much we know: Expressions of "no confidence" and "adverse patient outcomes" will make potential patients worry. If what has been expressed is accurate, they should worry.

Chattanooga needs Erlanger to be a strong and well-functioning public hospital. It is incumbent on hospital management not only to say it is addressing the medical staff's concerns but to address them, address them promptly and correct any actions or inefficiencies that would lead anyone to think that visiting Erlanger for treatment might result in an outcome other than the reason they visited.

A meeting of the hospital's trustees on Thursday may provide more clarity. It is imperative that board members get to the bottom of these issues and protect this essential community asset.