Staff photo by Tim Barber Erlanger/Former Erlanger CEO Kevin Spiegel speaks to attendees in the lobby of the new Children's Hospital outpatient building at Erlanger last year.

It's musical chairs time again at Erlanger.

Just over five months ago, physicians at our public hospital — the nation's 10th largest public hospital system — became so fed up after three years of unanswered concerns about patient safety in Erlanger's emergency department that they took the extreme action of making a "no confidence" vote on the hospital's top management, specifically hospital CEO Kevin Spiegel and two of his aides.

On Wednesday, nearly two weeks after the Erlanger Health System board of trustees called a special meeting to briefly talk publicly about Spiegel's leadership (but not vote on it), board Chairman Mike Griffin announced that Spiegel has left his post after six-and-a-half years.

Spiegel said Wednesday the decision for him to "separate" from Erlanger was mutual.

But that seems unlikely, given that it's unclear if the board will pay Spiegel any severance, which could amount to as much as two years of salary or $1.93 million, according to a copy of his latest employment agreement.

Meanwhile, the hospital's trustees will select Spiegel's successor at its regularly scheduled meeting on Sept. 26, according to an Erlanger statement.

That's concerning. Two weeks?

The statement says nothing about a nationwide search — or even an internal search — for a new CEO to guide the hospital that traditionally through the years has see-sawed between millions of dollars in red ink, then black ink.

Just as we've seen wild swings in Erlanger's bottom line, we've also seen over the years some rocky leadership transitions. In the past 25 years, Erlanger has had five chiefs. All, it seems, were shown the exit. Four received severance, settlements or court judgments — altogether tallying nearly $2.3 million.

Kevin Spiegel is the latest example of what happens when the board moves too quickly. He was hired in a 16-minute meeting after trustees returned from a 45-minute closed meeting they said was about "parliamentary procedure."

With no discussion about any of the three candidates under consideration, one board member threw out Spiegel's name and in a 5-3 vote, trustees hired him for $680,000 a year. The remainder of the meeting was spent taking another vote to have the meeting minutes state that the Spiegel vote was "unanimous."

So when we read a statement from the hospital that trustees will select Spiegel's successor at a meeting in just 13 days, we are ready to take a no-confidence vote on the board. After all, this is the same crew that less than a year ago gave Spiegel a $46,000 raise, bringing his base annual salary up to $964,000.

Trustee Linda Moss Mines said during that October 2018 board meeting that the recommendation for a raise came after "careful consideration" and was based on Erlanger's expanding footprint, financial growth and stability as an organization.

"Leadership is paramount in accomplishing our vision and goals," Mines said at the time.

Come on! Even then, Spiegel's leadership was not without controversy. For starters, the May no-confidence vote letter went to the board noting that for three years physicians had brought concerns to hospital management with no response: "Patient safety issues have been raised with management since 2015," the physicians wrote in that letter dated May 9. "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."

Three years? The board knew nothing? Did nothing?

It's one thing for doctors and managers to squabble about money and contracts. It's another thing entirely when the question is patient safety, including "chronic operational issues, such as inefficiency, understaffing, poor morale and policies that cause overcrowding in the emergency department and operating rooms."

In the meantime, Spiegel was busy talking — spinning visions of a new children's hospital. So far, we have a $40 million pediatric outpatient facility; the inpatient rooms are just as they've always been (yes, they need a major overhaul). Plus, Erlanger took over, dropped and then sued over the collapsed Hutcheson Medical Center, leaving many North Georgians bitter. Now Erlanger's rival, CHI Memorial, owns and operates Hutcheson: So much for that expansion. There's more, but you get the idea.

The moral here is that it isn't just the musical chairs of the Erlanger CEO and top managers we need to be worried about.

We also need to be asking what's wrong with a board of trustees that continually gets snowed early, often and usually for a few years too long by the fast-talker of the moment.

Erlanger is governed by an 11-member board of trustees: six appointed by the county mayor with approval from the Hamilton County Commission, and four appointed by a majority of our local Tennessee legislative delegation. The Erlanger medical chief of staff also serves as a trustee.

The board members serve without pay, and the learning curve is enormous. It is not a job for the faint of heart. Please mayor, please lawmakers: Choose Erlanger trustees very, very carefully in months and years to come. And slow this crew down on its newest game of musical chairs.