Maryland hospital inspectors yesterday began what they called a "full-scale investigation" into complaints that the safety of patients at Shady Grove Adventist Hospital is being threatened because of mistakes by overworked nurses.

A team of three nursing inspectors from the state health department--who also represent the federal government--converged on the Rockville hospital yesterday to interview doctors, nurses and patients and to review documents related to several incidents reported Sunday in The Washington Post.

Doctors and nurses at Shady Grove say that staff cutbacks have led to rampant mistakes and that the hospital's 600 staff nurses are too busy to become familiar with a patient's history or to help any but the sickest patients.

Doctors said those pressures have led nurses to give patients the wrong medications, to violate medical orders and to miss signs of problems that should have been reported to physicians. And this month, doctors said, a patient from the intensive care unit died after being left unattended elsewhere in the hospital.

The inspectors invited the public to come forward this week about patient care problems at the 263-bed hospital, which is owned by a corporation controlled by the Seventh-day Adventist Church.

If the state inspectors find significant problems, the hospital's state license and its federal certification to receive Medicare payments could be threatened, and Shady Grove could be subjected to tougher government scrutiny each year to stay in business, said Carol Benner, head of the state's office of health care quality.

Cheryl Winchell, a former Shady Grove medical staff chief who now is on the board of the hospital's parent company, Adventist HealthCare Inc., said the investigation does not frighten hospital officials.

But she blasted the doctors who make up the executive committee of Shady Grove's medical staff, which last week took the unusual step of passing a harshly worded resolution demanding that hospital administrators improve staffing levels.

"Without question, I think this is a devastating way to try and correct a perceived problem," she said. "Whenever you attack an institution in which confidence is an important part of the success of the endeavor, you have essentially cut off your nose to spite your face."

Winchell said the 15 members of the medical executive committee are refusing to confront the economic realities faced by the hospital, which is in good standing with the state and which received a high rating last year from a national hospital accreditation group. Critics have said that the accreditation is more a reflection of the hospital's paperwork efficiency than its quality of care.

Shady Grove officials say they, like many administrators at hospitals across the nation, have had to cut costs because of declining payments from health plans.

"I see a group of very dedicated hospital administrators just being faced with another obstacle because of a peevish medical staff that can point a finger but doesn't have a solution," Winchell said. "If you can tell a hospital how to run better with less money and less staff, come in and tell me how to do it."

But Wayne Ledbetter, an orthopedic surgeon who has held leadership positions on Shady Grove's medical staff, said yesterday that the hospital staffing is deficient.

"You're talking about continuity, maturity, judgment, experience," he said. "I have been frustrated perpetually with the lack of teamwork in the operating room as nurses are constantly reassigned and new nurses are being trained."

Benner, of the state's health care quality office, said the inspection will be expanded if necessary.

"We'll wait and see if three [nursing inspectors] is enough," she said. "Depending on what we find, it could take up to two weeks. But we'll be there for however long it takes."

CAPTION: Three Maryland nursing inspectors have begun a review of the quality of nursing care provided by Shady Grove Adventist Hospital in Rockville.