Maryland health officials say they have found enough problems with nursing care at Shady Grove Adventist Hospital to subject the Rockville facility to stricter scrutiny from state and federal regulators, a move that could threaten the hospital's eligibility for Medicare payments.

"There are clearly some problems. They know they have some problems, and we are working with the hospital to get them corrected," said Carol Benner, head of the state's office of health care quality. "They have problems with nursing turnover and nursing management."

Benner's comments came as a team of state inspectors completed its sixth day at the hospital as part of an investigation that began after The Washington Post reported that doctors and nurses were complaining that staff cuts at the 263-bed hospital were threatening the safety of patients.

Doctors say the cuts have led to rampant mistakes because the 600 staff nurses now are too busy to familiarize themselves with patient histories or help any but the sickest patients. Because of layoffs of staff members who transported patients or equipment and handled menial tasks, nurses have to do more of those jobs themselves, they say.

The increased workload, doctors said, has led nurses to increasingly give patients the wrong medications, violate doctors' orders and miss symptoms that should be reported to attending physicians. The doctors added that earlier this month, a patient from the intensive care unit died after being left unattended elsewhere in the hospital.

State inspectors were joined Friday at Shady Grove by surveyors from the Joint Commission on Accreditation of Health Care Organizations, a private group that rates hospitals nationwide. Few facilities try to operate without the group's seal of approval. Medicare officials usually accept accreditation as the sole qualification for Medicare funding, the financial lifeblood of any hospital.

The findings of the Chicago-based commission's surprise inspection will be considered at its December meeting, group officials said yesterday.

Shady Grove administrators confirmed the inspection activity and said they are cooperating with all requests for information.

"We made ourselves available to them and provided whatever they needed," said hospital spokesman Robert Jepson, who has played down the complaints by doctors and nurses as an emotional reaction to the recent layoffs of nine employees.

Shady Grove, along with Washington Adventist Hospital, is owned by Adventist HealthCare, which is controlled by the Seventh-day Adventist Church. Jepson said that like many hospitals across the nation, Shady Grove is under increasing financial pressure because of reduced revenue from government and private health plans.

And several Shady Grove patients and their relatives have come forward with their own tales of frustrations with the hospital's care.

Gary L. Smith, 37, who monitors clinical trials at the National Cancer Institute, said his mother was hospitalized for heart disease at Shady Grove in April 1997 when her frail roommate fell to the floor, bleeding. Irene M. Smith screamed for help from the nurses and frantically pressed the nurse call button to try to get aid for her roommate, but no one came, Gary Smith said.

"My mom tried to dial the nurses station and screamed for help, and no one responded," he said.

Irene Smith wound up dialing 911. The emergency dispatchers called the hospital and got the nurses' attention that way, Gary Smith said.

The family was shaken by the experience, said Gary Smith, whose mother died the next month.

"They're running a hospital, not a kennel, and people have call buttons in their room for a reason," said Smith, who said he was so disgusted by the level of care that he later sent Shady Grove a donation for $500 in memory of his mother--with the provision that the hospital use the money to send a few nurses to a seminar on coronary care.

Shady Grove's Jepson declined to discuss the incident in which Irene Smith called 911, citing patient confidentiality laws.

Yesterday, Alan B. Kravitz, a surgeon on the medical staff's executive committee who successfully pushed the panel to approve a resolution demanding that hospital administrators address staffing problems, said he has received widespread support from physicians and nurses.

"I've gotten letters and phone calls from other doctors, and in general the medical staff is supportive of me," he said. "I'd still like to see Adventist HealthCare acknowledge that there have been deficiencies in patient care. We haven't seen that yet, and that's discouraging."

Benner said that since reports of the problems at Shady Grove were first published, she has received about 25 new allegations of patient neglect and mistreatment at Shady Grove. She said anyone else with such complaints may call her staff at 410-402-8002.

Meanwhile, the family of Anna Belle Beier--the 79-year-old Potomac woman who doctors say was taken from the intensive care unit for an X-ray and then died when she was left unattended elsewhere--has begun its own investigation into her death.

"The family is very aggrieved at what happened," said Michael F. Flynn, an attorney for the family, adding that hospital officials never offered the details of Beier's death. "They read about it in the paper. They are concerned, and I think anger is an accurate description."

Richard T. Price is angry, too. His mother-in-law, Rhoda Eisler, 76, was hospitalized several times over the summer. Price, a retired D.C. firefighter, said Eisler had to undergo hand surgery after a Shady Grove nurse inserting an intravenous line damaged tendons affecting two fingers.

But the situation was worsened, Price said, because nurses did not bathe Eisler for 10 days. Not until Price's wife and daughter showed up in Room 203, prepared to do the job themselves, did a nursing assistant become available, Price said.

Jepson said he had no comment on the episodes.