SouthPointe Hospital in St. Louis is under investigation by state and federal authorities because of numerous incidents that threatened the safety, health and privacy of its psychiatric patients.

A scathing report prepared by state and federal regulators and obtained by the Post-Dispatch last week found that although no patients were seriously harmed in the incidents last year and this year, some were placed in "immediate jeopardy."

The regulators have put the hospital on notice that it is at immediate risk of being shut down unless managers rectify the situation. State and federal officials suggested that poor training of temporary employees and inadequate staffing contributed to a lack of supervision and care of psychiatric patients at SouthPointe Hospital.

Tenet Healthcare, which owns SouthPointe and three other hospitals in the area, said in a statement that the hospital was seeking to correct the problems and to comply with federal and state requirements. The hospital, at 2639 Miami Street, was once known as Lutheran Medical Center.

Among the report's findings:

• During 10 days in April, a male patient with a history of setting fires got cigarette lighters and used them to set fire to the beds of three patients while the patients were in their beds. No patients were injured, state inspectors said.
• Two claims of male-on-male sexual assault between patients were inadequately handled by the hospital.
• Several instances of consensual sex or sexually suggestive contact took place between psychiatric patients.
• Adolescent and adult patients on suicide watch had access to materials in unlocked laundry rooms or unwatched housekeeping carts that could have been used to inflict serious or fatal self-injury.
• Patients placed in restraints or seclusion were not always seen by a physician within one hour - a requirement under hospital policy.
• On multiple occasions, hospital employees did not make the required 15-minute checks on patients or did not make such checks thoroughly.

In one instance, a medical record review showed a patient-care assistant on Dec. 16 found a woman, 69, dead in her room at 7:45 a.m., her body stiff. Hospital records indicated that the woman had been last checked at 7:15 a.m.

The emergency room doctor who examined the body at 8:15 a.m. noted the stiffness as rigor mortis. That could suggest that the patient may have been dead for a longer time without anyone noticing. Pathology texts say that, depending on climatic and biological factors, rigor mortis sets in three to eight hours after death.

Lack of supervision

The report also notes multiple cases of inadequate supervision of patients, including a lack of monitoring patients in smoking lounges, where the hospital's own policy requires it.

In cases in April and June of last year patients got punched by other patients in unsupervised lounges. In January, an inspector looking through the window of an empty smoking room saw something on the floor. The vice president of psychiatric services was called to the door and identified the matter as two piles of stool. A patient had just been in the room.

During one inspection this month, an elderly man wearing nothing but slippers walked into a dayroom where nine other patients were gathered. The man suffered from a psychotic disorder. A social worker took the man back to his room but did not help him get dressed. Twelve minutes later, he returned - still naked.

Fixing the problems

SouthPointe has until Tuesday to develop a satisfactory corrective action plan, including a process for educating permanent and temporary staff in hospital policy.

Carey Smith, chief of the state health department's facility regulatory staff, said a team of state investigators will reinspect the hospital Tuesday to measure what progress has been made and to satisfy themselves that the hospital administration is working diligently to correct the problems.

In the meantime, a state Health Department inspector has been conducting a daily inspection of the hospital.

The Health Department could suspend or revoke the hospital's license at any time. Under current law, Smith said, the state cannot just shut down the psychiatric floors and keep the rest of the hospital open. It would have to pull the entire hospital's license to operate.

But Smith said such drastic action was unlikely and would be unprecedented.

"Nobody in the state or federal government wants to see that hospital closed," Smith said. "There are some areas of the hospital that are functioning very well."