Editor's Note: Dr. Eric Balch and Dr. Tricia Kalwar say they did not sign Dr. Moalli’s letter. Their names were included in a list of 44 doctors who signed the letter.

New London — A letter to the Lawrence + Memorial Hospital board of directors with the names of 44 physicians says L+M has become a "not doctor friendly hospital" and that recruitment and retention of medical staff are suffering as a result.

"We have lost many excellent doctors to other hospitals," the letter, which circulated last week and was discussed at the board meeting Monday, states. "Those who have left have found a better atmosphere elsewhere."

Written and signed by neurologist Dr. Daniel Moalli, it lists the departure of at least 18 specialists and general practitioners over an unspecified length of time as evidence of the problems at the hospital. Moalli could not be reached to comment Wednesday.

Attached to the letter are the names of 38 current L+M doctors and six who have either retired or transferred to positions elsewhere who supported the statements.

"We would like to participate with you to correct this perception," the letter concludes.

Mike O'Farrell, spokesman for L+M, said that in response to the letter, board Chairman Granville Morris is scheduling a series of meetings with the doctors named in the letter. During the meetings, Morris hopes to hear more about the doctors' specific concerns, O'Farrell said.

"From our perspective, the doctors are a vital part of everything we're doing, and we need to stay engaged with them," he said. "They are a vital voice in all we're doing."

O'Farrell said there are a total of about 460 doctors on the L+M medical staff.

Many of the doctors on the list are part of Lawrence + Memorial Medical Group, the hospital-affiliated practice network, while others practice independently.

O'Farrell said changes in health care are creating many new challenges for hospitals, and that doctors' input will be essential to effectively meeting those challenges.

Pulmonologist Dr. Niall Duhig, vice president of the medical staff and a member of the board, said the main message of the letter is that there needs to be better communication between the hospital administration and the doctors. While he was not among those who signed the letter, he said he understands the sentiment it expressed.

"We must have increased dialogue, otherwise we will lose physicians," he said. "We're definitely feeling the loss of doctors in this neighborhood. Doctors have so many choices about where to go."

The physicians who signed the letter, he said, are "all very well-respected doctors."

"They're not angry people," he said.

Dr. Robert Keltner, also a pulmonologist, said he would have signed the letter if he had seen it, but he was out of town while it was circulating. Discontent about the relationship with the administration has been growing since before the strike and lockout of nurses and technicians last fall, a difficult episode that added to the concerns about decisions being made by the administration, he said. In recent weeks, a consulting firm has been examining hospital operations and making recommendations that are likely to result in staff reductions and possibly layoffs.

Consultants' recommendations have been presented to the doctors, he said, including one that hospital operations could be streamlined.

"One of the observations was that the administration is top-heavy, that there are too many vice presidents," he said. He and other doctors agree with this assessment, he said, but are not confident that it will be heeded.

He noted that the doctors who signed the letter are "not the rabble rousers and the bomb throwers" and that Dr. Moalli is known for being very "conservative."

"That says a lot," Keltner said.

Many of the doctors on the list did not return messages requesting comment, or declined to comment. Some of the signers, asking not to be named, said there is a basic lack of respect for the doctors, and that they also object to the way the strike and lockout were handled.

Anesthesiologist Dr. George Sprecace, one of the signers, said there is an "adversarial" relationship between the doctors and the administration that must be corrected for L+M to successfully adapt to the financial pressures and other changes facing health care.

"The last straw was the nurses' strike and how it was handled," he said. "It left a bad taste in everyone's mouth."

Dr. David Reisfeld, general surgeon and president of the medical staff, disagreed, saying the strike and lockout is "a separate issue."

"This is a physician-hospital relationship issue," he said. "I know all of the signers, and the letter expresses a sentiment that has legitimacy."

Reisfeld said concerns about a strained relationship have been festering for some time but have become more pronounced in recent months.

The physicians want more collaboration with the administration as it determines how to meet the complex challenges of the changing health care environment, he said.

"Physicians want to be part of the solutions moving forward," he said.

j.benson@theday.com