The medical boss at Noble's says concerns about the care of seriously ill patients could trigger major changes at the hospital.
Ten senior medics wrote to Medical Director Stephen Upsdell expressing concern at what they say are major shortcomings in the management of acutely unwell patients.
The consultants claimed 'poor practice and system failures' allowed too many patients to suffer from 'avoidable harm', a term which covers incidents ranging from drug errors and falls to hospital-acquired infections.
The group representing a cross-section of medical disciplines, claims attempts to highlight concerns are often overlooked by management, only rarely resulting in 'tangible health improvement measures'.
The consultants go on to call for an external review of services.
Their letter was sent last autumn but has only now come to light after a copy was passed to Manx Radio.
Mr Upsdell says immediate action's been taken to address concerns, with a raft of new initiatives in the pipeline in five different areas.
He told us there will be big improvements in some services, but that could mean the focus in future will be on providing core services:
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