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Staff file photo by Erin O. Smith / Erlanger's new Children's Hospital is show here near completion last November.

Physican leaders at Erlanger are so worried about patient care that they took the extreme measure in early May of making a "no confidence" vote on the hospital's top management — aimed at hospital CEO Kevin Spiegel, Chief Operating Officer Rob Brooks and Vice President of Operations Tanner Goodrich.

We say this is extreme because Erlanger, Chattanooga's only public hospital, houses the region's only children's hospital and level-one trauma center — meaning it treats patients suffering from most severe injuries. Erlanger also is the largest regional provider of care for indigent patients. As the 10th largest public health care system in the United States, it has seven hospitals and six air ambulances serving parts of Tennessee, Georgia and North Carolina. And it's extreme because it's not every day the public learns about serious operational issues that suggest major fractures between hospital leadership and medical staff.

Yet several members of Erlanger's 17-member Medical Executive Committee — doctors elected by the hospital's collective physicians — said in that letter to the board of trustees that their vote of no confidence is the result three years of concerns over patient safety. They said their concerns — chronic operational issues, such as understaffing, overcrowding in the emergency department and operating rooms, inefficiency and poor morale and policies — consistently fell on deaf ears, according to a letter signed by four committee leaders: 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. The letter was sent to board trustees on May 9.

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," the letter states.

Patients understand. Especially patients who've spent the night in pain in the ER hallway waiting for an early morning emergency surgery, or families who've lost loved ones in that wait.

In a statement, Spiegel seemed to chalk it up to Erlanger's "significant growth and expansion" in recent years and "healthy disagreements" between physicians and hospital managers, something he says "is common in hospitals across the country."

"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.

We are not resting assured.

Just eight months ago, the Erlanger board gave Spiegel a $46,000 raise, bringing his base salary up to $964,000 — based on "Erlanger's expanding footprint, financial growth and stability as an organization," according to news coverage at the time. In his CEO report, Spiegel said Erlanger had grown its net revenue between 13 and 15 percent for five straight years (though this year doesn't promise to be so good).

Spiegel trades in vision, talk and pretty monuments. He steered the hospital on a $40 million building campaign for a "new" Children's Hospital, (actually its' not a hospital; it's a really, really spiffy children's outpatient facility). It's pretty. We'll give it that — complete with an 1891 steam locomotive out front, hang gliders from Lookout Mountain inside and a firetruck on the third floor. Yet the children's actual hospital facilities remain exactly as they've always been.

On the other hand, physicians and hospitals trade — or should trade — in patient care. Yet Erlanger's board has clearly settled for management's talk and profit over patient care, at the expense of the hospital's emergency department — every hospital's real front door.

For a public hospital, this is not acceptable. That these issues have simmered for several years is not acceptable. The trustees are ultimately responsible for Erlanger; the public entrusts them with overseeing how the hospital functions.

Spiegel's management needs review, and if the Erlanger board insists on remaining as snowed with him as it was eight months ago, then our elected officials who appoint Erlanger board members (the Hamilton County mayor and the local delegation of the Tennessee General Assembly) need to provide much stiffer review of their appointees, as well.