A staff revolt against dangerous conditions at a Maryland hospital has forced the removal of the top two executives and perhaps paved the way to restoring quality care.

The 263-bed Shady Grove Adventist Hospital in Rockville, Md., was accredited with commendation by the Joint Commission on the Accreditation of Healthcare Organizations in July of 1998, scoring 99 out of a possible 100. But the hospital staff knew their hospital was in trouble. Although Shady Grove was profitable and patient volume was growing, management was reducing the nursing staff in anticipation of future financial problems. As conditions deteriorated, experienced nursing staff members left and were replaced with temps and nurses fresh out of school. "They tell you to just do the best you can--but that's not good enough for a lot of nurses," said one nurse quoted by the Washington Post.

According to the newspaper, 11 nurses wrote a letter to the administration warning that "our patients are continuing to receive short shrift due to inadequacies of our staffing."

Administrators apparently ignored them. Medical errors became more frequent. A woman died after she was taken out for a test and left unattended in a hallway. And the hospital laid off more nurses. Finally, the medical staff's executive committee demanded unanimously that the administration restore safe staffing.

At first, the hospital's owner, Adventist HealthCare Inc., which is controlled by the Seventh-Day Adventist Church, denied that anything was wrong. "I reject the notion that there are patient care problems at the hospital," said a company spokesman, according to the Post. He said comments made at the executive committee meeting were "ridiculous, absolutely inappropriate and out of line."

But Maryland public health officials began their own inspection of the hospital, inspecting patient records and interviewing staff, after the newspaper reports. The inspectors soon confirmed what the nurses and doctors had been saying. Patients and their families reported nearly 100 incidents to the state.

Adventist HealthCare then changed its tune and removed both the chief executive and the chief operating officer of the hospital.

One doctor at the hospital said the staff will be watching closely to see how the positions are filled. "I believe we need more than an old-boy-network selection process," she said. "We need competent and qualified administrators."

In a letter published by the Post, AFT president Sandra Feldman said Shady Grove proves the need to change the way hospitals are accredited. "All inspections should be unannounced," she wrote. "Front-line health care workers should be given the opportunity to tell surveyors what's really going on in the facility and receive whistleblower protection. ... Inspectors should see hospitals the way patients and health care workers see them every day. Otherwise, inferior care won't be eliminated."

Meanwhile, reporters for the Post continued digging and discovered that the hospital has been giving giant pay raises to its executives. A departing president of the "non-profit" company that owns Shady Grove was given $4.74 million as a going-away present when he left in 1997. His top aide departed soon afterward with $3.1 million. One executive forced out by the staff revolt had been paid $842,000 the year before.