The private agency that inspects the nation's hospitals moved to revoke the accreditation of Shady Grove Adventist Hospital yesterday after concluding that patient care at the Rockville facility has suffered from serious management failings.

The decision by the Joint Commission for Accreditation of Healthcare Organizations--a group that has often been criticized as a rubber-stamp for the hospital industry--is a serious blow to one of Montgomery County's key health care facilities. Commission officials said they have taken similar action only 60 times in the past year while reviewing more than 9,000 hospitals and other health care organizations.

Shady Grove, part of the Seventh-day Adventist Church's national hospital system, operates a major emergency room that serves a wide swath of northern and central Montgomery and draws patients from as far as Frederick County, Md. The 263-bed hospital has about 1,300 staff doctors, and the emergency room alone serves 60,000 patients a year.

State officials said Shady Grove is the first Maryland hospital in memory to be in danger of losing its joint commission accreditation. If the decision is affirmed by a joint commission appeal panel, the hospital's state license may also be put in jeopardy.

While it does not mean an immediate shutdown, loss of accreditation sets a hospital on a path of dramatically increased scrutiny from state officials and possible loss of Medicare and Medicaid funding from the U.S. Health Care Financing Administration. Federal officials last night said it is too soon to know what action they will take.

The commission never releases detailed criticisms, but yesterday a spokeswoman said Shady Grove deficiencies fall into these categories: patient rights, initial assessment of patients, planning and delivery of patient care, organizational performance, leadership, human resources management and training, infection control and the admission of doctors to the medical staff.

Shady Grove spokesman Robert Jepson, noting the hospital will appeal the decision, said officials can scarcely comprehend how they could fall so far so fast. The hospital started yesterday with the highest of seven ratings, accreditation with commendation, and finished with the second-lowest, preliminary nonaccreditation. If revocation is upheld on appeal, Shady Grove will drop to the lowest rank, nonaccreditation.

"We simply do not accept that this is a reflection of the type of care we provide," Jepson said. "I find it very interesting that in July of 1998, there were three surveyors who spent three days at the hospital, combing through every aspect of care, and they gave us a score of 99 out of 100.

"Then in October of this year, two accreditors come out for one day for eight hours, and we get this. It's hard to understand."

The joint commission, which inspects 80 percent of the nation's 6,200 hospitals, has the responsibility under federal law of ensuring that hospitals meet the minimum requirements for participating in Medicare. Maryland officials have already said they plan to conduct their own regular inspections of the hospital instead of delegating the task to the commission.

Jepson said improvements had been made even before the Shady Grove medical staff executive committee warned administrators last month that conditions had deteriorated to dangerous levels. The joint commission was unaware of the complaints until Oct. 17, when The Washington Post published an account of numerous problems cited by doctors and patients, including the death of an intensive-care unit patient who had been left unattended elsewhere. The commission, citing the Post report, sent inspectors for a surprise visit Oct. 22.

State officials, who are conducting a more detailed investigation of nearly 100 patient complaints, said two weeks ago that they found serious problems. The state's chief hospital inspector, Carol Benner, cited disqualification from Medicare as a possibility. "I don't think you can downplay the seriousness of the problem," she said.

At the same time, Benner said she was pleased to see that consultants have descended on the hospital to recommend improvements.

The scrutiny has already prompted changes. On Nov. 3, the hospital accepted the resignation of Chief Executive Cory S. Chambers and reassigned Chief Operating Officer Kiltie Leach, who had been overseeing Shady Grove and Washington Adventist Hospital in Takoma Park. Now Leach will head only Washington Adventist.

Yesterday, Shady Grove Adventist board member Cheryl Winchell, a Gaithersburg physician, said she was shaken by the commission's action. She called accreditation a "life and death" matter for a hospital. "I can't tell you how sad this makes me," she said. "The hospital just sounds like it's the worst place on Earth," she said, referring to the commission's conclusions. "But it isn't. . . . This is just astounding."

Doctors who have complained about the hospital's leadership said the joint commission has proved their claims legitimate. "The administration publicly ridiculed us as being peevish and emotional, but clearly they were wrong," said Alan Kravitz, a surgeon who criticized the hospital.

Rhoda Levin, of Germantown, said the commission's findings finally address the kind of shortcomings she experienced while being treated for breast cancer. In 1998, a surgeon performed a painful bone biopsy, under anesthesia, to investigate lesions in her spine.

She could not understand why the results on the biopsy were late. Doctors initially said special studies were delaying things, but finally her physician told her the biopsy sample was misplaced, requiring another operation, she said. Jepson, citing privacy, could not comment on the matter.

"It was horrific, totally bizarre," said Levin, who works at the National Institute of Standards and Technology compiling chemical data. "This underscores for me my own perceptions that things were not right there," Levin said of the accreditation decision. "I'm glad it's happening so people can get the care they deserve."