For the fourth time in as many years, Indian River Medical Center is in the market for a chief operating officer.

Camie Patterson’s resignation was officially announced last Thursday. She spent just 13 months in the position.

After Cindy Vanek resigned in August 2013, her successor, Dan Janicak, was ousted a month after doubling his workload by adding COO duties to his role as Chief Financial Officer.

Then Janicak’s successor, Steve Salyer, was pushed out in December 2015 after 19 months at IRMC.

According to a statement on the hospital’s website, Patterson, 46, has accepted a similar position at Manatee Hospital in Bradenton. IRMC CEO Jeffrey Susi was on vacation when the resignation was made public and unavailable for comment.

“I am so thankful for the opportunity to have been a part of IRMC and the support I received here which allowed me to make a difference,” Patterson said in a prepared statement. The announcement also included a comment from Susi: “For all her work and dedication, we thank her and wish her and her family well.”

Dr. Michael Weiss, a member of the Indian River Medical Center Board, said news of Patterson’s departure came as a “complete surprise.”

Her resignation comes amid ongoing financial challenges at the hospital and a resulting effort to link up with another hospital system, preferably a nonprofit. IRMC is looking for a partner that can infuse capital to upgrade the aging facility. That task is expected to cost $185 million.

Hospital District Board member Tracey Zudans also said she was surprised to hear of Patter’s resignation, “particularly because of her excellent reputation in the community and such a short tenure.”

District Board member Allen Jones said it was his understanding that Patterson was recruited for the job at Manatee Hospital.

“Why wouldn’t she take it?” he asked rhetorically. “Manatee is bigger. Its Emergency Room gets 71,000 patients a year. Indian River gets 60,000. I can’t see any other reason she would leave. I’m sorry to see Camie go. I thought she was terrific.” Jones said he was unaware of any counter-offer from IRMC.

Patterson’s new employer is part of Universal Health System. The release noted the company operates more than 200 health care facilities.

Patterson’s immediate predecessor as COO had a similarly brief stay at IRMC.

Salyer spent 19 months in the position. Shortly before his departure, he was party to a now settled lawsuit between the hospital and Salyer’s previous employer, the then owner of Sebastian River Medical Center.

The suit was based on a non-compete agreement signed by Salyer that prohibited him from working for a competitor within 100 miles of Sebastian. Despite that agreement, Susi hired him and then, a year and a half later, fired him.

Former hospital board member Paul Nezi blames Susi for the high rate of executive turnover.

“I met with Steve Salyer right after he came to the hospital,” Nezi recalled. “I told him he would be fired within 18 months.”

A similar fate befell Janicak, who added chief operating officer duties to his chief financial officer role following Vanek’s resignation in 2013.

“Janicak presented a great turnaround plan for the hospital,” Nezi said. “Then he was fired.”

“Susi’s probably not going to retire, even though it’s been announced,” he added.

Susi previously announced he would retire at the end of 2017. Since then he suspended that firm date, saying he would stay on through the transition to new leadership. Now it appears that transition will include a new chief operating officer.