In the three years before staff cuts at Shady Grove Adventist Hospital led to increasing complaints from doctors, nurses and patients about the quality of care at the Rockville facility, the hospital's executives gave themselves large raises and severance payouts, according to federal tax returns.

The largest amount went to Bryan Breckenridge, who received $4.74 million in compensation and lump-sum pay in September 1997, when he left his job as president of Adventist HealthCare Inc., the regional nonprofit company that also owns Washington Adventist Hospital in Takoma Park, seven nursing homes and a New Jersey hospital. His top aide, chief financial officer Edmund R. Peters, left soon afterward with $3.1 million.

Adventist officials said it was a recognition of the pair's lengthy service and part of a broader attempt by the hospital system's board to catch up with compensation paid by other health-care organizations in the region.

"The board made a reasonable business decision that retirements for a number of the executives . . . were not adequately funded in comparison to what they would otherwise have received" in a nonreligious organization, said Adventist's general counsel, Kenneth B. DeStefano. "The decision was made to do a catch-up, if you will."

Adventist's board chairman, Ronald M. Wisbey, saw his compensation leap from $161,000 in 1996 to $447,000 the next year and $364,000 in 1998. Adventist officials said half of Wisbey's compensation--salary, benefits, deferred salary and expense accounts--is reimbursed by another pair of Adventist hospitals in Ohio that also employ Wisbey as their board chairman.

Cory Chambers received $319,000 in total compensation as Adventist's executive vice president in 1996, followed by $815,000 the next year and $842,000 in 1998. After a range of patient-care problems at Shady Grove was publicized last month, Adventist's board forced Chambers to resign and named Wisbey as his temporary replacement.

The salaries, according to the Adventist system's own consultant reports, are well above the amount paid to hospital executives in this region with similar responsibilities. The figures have been closely held by the Adventist system, but were disclosed yesterday in response to a request by The Washington Post to review documents the tax-exempt organization has filed with the IRS.

The salary figures drew an angry reaction from some of those whose complaints about patient care at Shady Grove have led to increased scrutiny of the facility by state regulators and a national hospital accreditation group.

"I think it's outrageous that a hospital claiming financial constraints can compensate their executives to this extent," said Alan Kravitz, a surgeon who pushed the Shady Grove medical staff to voice its concerns about the quality of care at the 263-bed hospital in response to a patient death. Kravitz added that he was shocked by the salary figures.

Breckenridge and Peters could not be reached for comment yesterday. Hospital officials said they would ask Wisbey and Chambers whether they wanted to comment; neither called The Post.

Shady Grove once was considered by regulators to be a top-notch acute-care facility, but now its leaders are struggling to keep officials from revoking the hospital's accreditation and kicking it out of the Medicare program because of what regulators have said was a series of treatment mistakes and poor management of nurses and other employees.

The Adventist hospital system had an operating surplus of $13.4 million in 1996, $12.5 million in 1997 and $19.5 million in 1998. But its financial situation has gotten tighter this year, and the system has laid off or redefined the duties of 78 employees at Shady Grove and Washington Adventist hospitals.

As a result, doctors and nurses at Shady Grove say, nurses are being worked too hard, leading to an increase in treatment mistakes. In some cases, they say, at-risk patients have not been monitored as closely as they should have; in others, nurses have given patients the wrong medicine. One patient from the intensive care unit died, state regulators say, after being left unattended in a hallway.

Ronald Marx, a former chief executive officer at Washington Adventist Hospital until he was forced out in 1993 as part of a reorganization plan, said yesterday that it was Breckenridge's idea to boost executive compensation. He said the company's growing executive payroll helped put Shady Grove into a position of overworking its nursing staff.

Marx said he was being paid $150,000 a year when he left, and that it was not a competitive salary for the area hospital market. Still, he believes Breckenridge and Wisbey went too far in raising management salaries.

"What Mr. Breckenridge was trying to arrange in compensation for executive people--I didn't think that was going about it the right way," Marx said. "That is why these hospitals ran into trouble."

"I would dispute that executive compensation is tied to problems" at Shady Grove, said Adventist spokesman Robert Jepson.

Adventist officials have commissioned several surveys of executive compensation in area hospital systems. Consultants found that in several cases, Adventist executives with relatively high salaries were receiving big raises anyway. In 1996, Breckenridge, for example, was receiving $416,000 in total pay--equal to the highest pay in the surveys--but his compensation for that year was increased to $716,000.

Hospital officials said yesterday that in light of The Post's inquiry into the executive salaries, they planned to take the unprecedented step of immediately sharing details about the salaries with the company's 5,700 employees. "This is something that we hope to work through with our employees," DeStefano said. "This is hopefully going to be a galvanizing event that reinforces our commitment to the employees, to the physicians and to the other constituents of Adventist HealthCare."