"The level of deficiencies was of such scope and gravity as to pose a serious and immediate threat to patient safety," Carol Benner, director of the Maryland Office of Health Care Quality, said yesterday in a letter to the institute's chief executive.
Benner initially banned admissions for two weeks and ordered a long list of actions to correct deficiencies at the facility, which treats up to 70 patients at a time.
But yesterday, after the institute appealed to state officials not to disrupt the arrival of patients from a waiting list, she relented and said that previously scheduled patients could come. Some priests have been waiting since October to enter St. Luke.
Benner said St. Luke will be closely observed by state monitors during the two-week period, which began Thursday. Then the state will consider lifting, extending or expanding the restrictions, she said.
In her letter to the Rev. Stephen J. Rossetti, head of the institute, Benner expressed frustration with policy changes that St. Luke proposed earlier in the week. "The measures that you proposed were not sufficient to ensure that patients at the St. Luke Institute were protected from self-harm or that they will receive adequate care and treatment," she said.
Benner has required the hospital to increase the number of trained nurses on hand, add two safe rooms for at-risk patients, complete a suicide risk assessment for all patients. Also, it must remove locks from patient rooms and check on patients in their rooms instead of waiting for them to check in with the front desk, and she specified how many nurses should be on hand and barred them from preparing drugs for distribution to patients.
At the same time, the Joint Commission on Accreditation of Healthcare Organizations, a Chicago-based private agency that inspects hospitals and nursing homes on behalf of federal and state governments, has moved to revoke St. Luke's accreditation after concluding that conditions there pose an immediate threat to patients.
Until the suicide of Rev. Alfred J. Bietighofer, 64, of Bridgeport, Conn., the commission had given St. Luke top ratings for more than a decade -- findings that meant state health inspectors had no reason to visit. Under state law, only a complaint or an incident like the suicide prompts state officials to inspect such a facility.
Rossetti did not respond to requests for comment, but a member of St. Luke's governing board said the staff earned an international reputation for excellence by managing a wide variety of psychiatric problems among Roman Catholic priests and nuns. Little about the way the facility runs today has changed since the joint commission issued its glowing reports, most recently in 2000.
"The same staffing levels, policies and procedures are in place that were in place then," said Sister Carol Keehan, who is also chief executive of Providence Hospital in the District. "Sometimes, the intense pressure that's on the patients who come here now, particularly for pedophilia, may mean that we need to jack it up a bit."
On May 16, Bietighofer hanged himself in his room at the institute. His body was found by a nurse, and police ruled it a suicide. A priest for 37 years, Bietighofer had been sent to St. Luke by the Diocese of Bridgeport for evaluation after four men alleged that he fondled them during the 1970s and 1980s when they were minors. He had resigned April 29.
In a letter to Benner this week, Rossetti said that after Bietighofer was admitted May 12, a nurse asked him if he was suicidal. "He admitted that he had suicidal ideation two weeks previously but then explicitly denied to her any current suicidal thoughts," the letter said.
"She said that based on her interaction with this client that he appeared to be perfectly okay," Rossetti wrote. "In fact, he went to the dining room, mingled with other clients and subsequently brought back a list of his other medications to her. Throughout these interactions, he appeared to be normal."
In an interview, Benner said she was hopeful that St. Luke would improve its operation. "They have responded quickly to our suggestions. They acknowledged the problems, and it sounds like they're working hard and fast to get the problems fixed," she said.