New London — A letter by a longtime physician alleging Lawrence + Memorial Hospital is on "an unnecessarily downward spiral" is being circulated among the hospital's 1,600 unionized nurses, technicians and health care workers by union leaders who believe it supports their concerns about how hospital resources are being spent.

Dr. George Sprecace's letter, sent in December to Bruce Cummings, hospital president and chief executive officer, has also been circulated to the medical staff and presented at a recent meeting of the hospital's physicians. Sprecace met with Cummings about the letter. Dr. David Reisfeld, president of the medical staff, said the group took no specific action in response to the letter or Dr. Sprecace's presentation.

"The medical staff is a complex organization, and the members are not monolithic in their views," he said Tuesday.

Mike O'Farrell, spokesman for L+M, said he hopes the wider distribution of the letter leads to "more dialogue" about the challenges facing L+M, which are common to all hospitals as they adapt to lower reimbursement rates and other changes.

Cummings, he said, "always tries to keep an open dialogue," hosting quarterly forums with staff and sharing information through in-house communications.

Leaders of the three AFT unions at the hospital included a copy of the letter as an insert to a newsletter being distributed this week. Matt O'Connor, spokesman for AFT, said the letter "expressed a lot of concerns that the union has had, and raises points about decisions being made at L+M on patient care dollars."

The purpose of sending the letter to the membership, he said, was "to demonstrate that the medical staff shares a number of our concerns." Union leaders also hope distribution of the letter will further their goal of "holding the hospital administration accountable to the core principles agreement," O'Connor said. The agreement was signed between the administration and the union after a bitter strike and lockout late in 2013.

Sprecace, who has had an allergy practice in the city for 58 years, said Tuesday that he did not provide the letter to the union, but he is nonetheless pleased that it is being widely distributed.

"There's a great deal of common ground," he said, referring to issues both he and the union members are concerned about.

In his letter, Sprecace states that an "us versus them," "win-lose" attitude pervades the relationship between the hospital administration and the health care staff. He called for a more collegial relationship to be established in which doctors, nurses, technicians and other staff would be brought in for "honest" discussions about how to confront challenges facing L+M. Similar concerns were raised in a letter last May that was signed by 42 of the 460 members of the hospital's medical staff.

Among the issues Sprecace raises is the administration's "damaging search" to find $35 million in budget cuts and new revenues in its operating budget. The funds should come out of L+M's investments, he said, not areas that affect patient care.

The $35 million figure grew out of an analysis of "every nook and cranny" of hospital operations by the Berkeley Research Group, a consulting firm hired last year by L+M. The result, he said, "has impacted the work environment, producing very real anxiety about jobs and procedures and the like."

"All this affects the community in the quality and quantity of health care that's available," he said.

In addition to concerns specific to L+M, Sprecace said he is also hoping to raise awareness among the general public about problems in health care nationally that will prompt people to contact their elected representatives and take other actions.

The task of finding $35 million in budget reductions and new revenues began this summer and is expected to take about 18 months before final decision are made. Taking it out of investments, O'Farrell said, would not be prudent, because "investments play an important role in our bond ratings."

Reisfeld, the medical staff president, said the issues L+M is facing are not unique.

"Hospitals are having to learn to function at Medicare rates, providing the same or better quality care at less expense," he said. "It's a paradigm shift."

The effort to find $35 million in budget cuts and new revenues, he said, may be painful, but necessary. L+M has ended the last two fiscal years in the red.

"Everyone's been very responsible about it," Reisfeld said. "The challenge is not to drag the hospital down in the process, and that's what (Dr. Sprecace) is concerned about."

j.benson@theday.com

Twitter: @BensonJudy