The Puget Sound Veterans Affairs is scrambling to improve Seattle and American Lake psychiatric wards after flunking a May accreditation inspection that cited imminent threats to the lives of mental-health inpatients.

Inspectors issued a rare "preliminary denial," which occurs in less than 1 percent of the reviews of the nation's hospitals. They detailed their concerns in a letter sent to the VA Puget Sound Health Care System after the four-day review of hospitals and clinics in Seattle, American Lake and Bremerton that serve more than 60,000 patients a year.

"The decision is based on findings that the environment of care is not safe," said Charlene Hill, a spokeswoman for the Chicago-based Joint Commission on the Accreditation of Health Care Organizations.

Both the accreditation commission and the VA have so far declined to release the commission letter to journalists or Sen. Patty Murray, who today is scheduled to visit the Seattle hospital on Beacon Hill to review efforts made to remedy the problems.

Murray, in interviews Thursday with reporters, characterized the problems as "very serious," and said she was concerned that VA officials could be downplaying the commission findings. She expects to have a written copy of the commission findings for release today.

VA officials said the rating reflected concerns about physical threats on four wards — such as window-blind cords that could be turned into nooses by suicidal patients and breakable glass frames that a homicidal patient might use to carry out an attack. Inspectors also were concerned about how the VA assessed patients who entered these wards for their potential to harm themselves or others.

Within 24 hours of the inspection, said Dr. Robert Barnes, associate director of mental-health services for the Seattle division, the hospital had started tearing out grab bars, removing side rails on beds and unbolting pictures from the walls.

Barnes said these actions upset many patients, who rely on such homey touches as bulletin boards with notes and pictures above their beds.

They were also expensive.

"We're spending hundreds of thousands of dollars to do this," said Barnes, who added the hospital would spend $200,000 on new beds alone.

The accreditations are voluntary, and the preliminary denial — reported Thursday by the Tacoma News Tribune — does not threaten to shut down any services.

But the inspection results are an embarrassing setback for a Veterans Affairs hospital network that has taken on a high-profile role serving an expanding patient base that includes thousands of returning Iraq and Afghanistan veterans.

Murray, D-Wash., and others in Congress have helped secure substantial boosts in funding to hire new staff and secure new equipment for mental-health services that had struggled for years amid tight budgets and rising demand for services.

Many of the veterans with mental-health problems are seen through a network of outpatient clinics. But the four wards, typically averaging about 40 patients a day, offer much more intensive care. And some private therapists who also work with these therapists give the programs high marks.

VA officials say their psychiatric inpatients at the Seattle and American Lake wards voluntarily commit themselves to treatment for drug or alcohol abuse, post-traumatic stress disorder and other mental-health problems. There have been two suicide deaths, one in Seattle and one at American Lake, in the past 15 years.

Stan Johnson, acting director for the Seattle division, said he didn't believe the suicide at the Seattle hospital, which occurred last fall, was the focus of the commission's decision. "I don't think that was the only contributing factor," Johnson said.

VA officials say that many of the conditions that triggered the preliminary denial of accreditation have been around for years; an inspection three years ago did not result in a preliminary denial. More recently, the accreditation commission has put a sharper focus on mental-health wards, and the most recent inspections reflect that focus, said Jeri Rowe, a VA Puget Sound spokeswoman.

At the Beacon Hill Veterans Hospital on Thursday, hospital officials detailed what they said were the deficiencies cited in the inspection.

Toilet grab bars, doorknobs, doors, ceiling sprinkler heads and even under-sink plumbing could pose a risk to a patient bent on suicide, Barnes said. The inspectors cited pictures on the wall, furniture that could be picked up, and canisters of hand disinfectant in stations outside patient rooms that could be used to attack another patient or staff members.

"They have essentially told us this is an unsafe environment," said Stephen Rice, nurse manager for the Seattle hospital's psychiatric areas.

Many of the physical problems, but not all, have been removed or changed since the inspection. Renovations are also under way at American Lake.

Because the physical environment had those dangers, inspectors also thought the hospital's assessment of patients was deficient, Rice said.

"The Joint Commission did not think the assessments were up to the level of risk in the environment," he said. "They wanted a statement in the chart that this patient is safe to be in this specific environment," such as in a room with a doorknob.

Many of the items cited by the Joint Commission, such as the bathroom grab bars, were originally put in place because many of the patients have mobility difficulties, Barnes said.

"It's a balancing act," he said. "We thought we had a good system in place."

Hal Bernton: 503-292-1016 or hbernton@seattletimes.com

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com