A nationwide health care safety inspection group preliminarily denied accreditation last week to Clifton T. Perkins Hospital Center, the maximum-security psychiatric facility that has been beset by patient safety concerns, chronic understaffing and high leadership turnover.

The Joint Commission, a private organization that accredits health care facilities nationwide, was at Perkins from April 1-4 inspecting the Maryland facility, interviewing staff members and reviewing procedures, according to emails from hospital leadership to staff members reviewed by The Washington Post.

It was not immediately clear on Thursday what the commission’s decision is based on or what the accreditation trouble means for Perkins — a 289-bed facility in Jessup that houses people who have been charged with a violent crime and diagnosed with a serious mental illness.

The preliminary denial, issued on the commission’s last day inside the hospital, was an extraordinary move that is one step away from an outright revocation. Before that happens, Maryland state officials will have an opportunity to appeal the decision, according to the commission’s website.

Perkins came under intense public scrutiny after a Washington Post investigation last year exposed chronic dysfunction and dangerous conditions there. The Post’s reporting prompted internal oversight probes, a third-party audit of the hospital and an oversight hearing before Maryland state lawmakers.

The Joint Commission’s preliminary denial is the latest intervention meant to address the hospital’s ongoing challenges.

In a statement, the Joint Commission said it is required to keep information about preliminary accreditation denials confidential. Maryland has 10 calendar days after the preliminary denial was issued to appeal the commission’s decision and 30 days to submit supporting documents for an appeal review committee to consider.

According to the commission’s website, a health care facility can have its accreditation revoked if officials falsify or misrepresent information, if conditions threaten public or patient safety, if there are licensing issues, or if there is “significant noncompliance” with Joint Commission standards. A facility might also face revocation if it has failed to fix problems previously cited by the commission.

The Maryland Department of Health, which is responsible for Perkins, did not answer questions about the commission’s decision — including whether the preliminary denial was based upon findings from the outside audit.

AFSCME Maryland Council 3, the union representing most Perkins employees, said in a statement that the facility’s issues are “a direct result of failed leadership at both the hospital and agency levels.”

“The hospital has long operated without the safe staffing levels needed to properly take care of patients and protect staff,” the statement said. “Our union has been working with the Joint Commission to address these issues and to hold leadership accountable to providing a safe workplace for staff and quality care for patients.”

Perkins employees, lawmakers and patient advocates were scrambling in recent days for information on the commission’s decision. Some only learned of the preliminary accreditation denial when The Post contacted them about it.

On Thursday afternoon, Perkins CEO Aliya Jones sent hospital employees an email announcing the commission’s preliminary accreditation denial, according to a copy of the email reviewed by The Post. The hospital, she wrote, “remains accredited pending responsiveness to addressing the most concerning identified findings,” but she did not say what those concerning findings entailed.

“The Maryland Department of Health is working closely with The Joint Commission and Clifton T. Perkins Hospital Center staff to respond quickly to commission findings,” Jones said in the email. “The health and safety of staff and patients is paramount.”

Leslie Seid Margolis, managing attorney at the patient rights group Disability Rights Maryland, said her organization was “taken aback” to learn of the commission’s decision from a Post reporter “given our deep involvement in protecting the rights of patients at Perkins and our frequent communication with the administration at the hospital and other officials.”

State Sen. Clarence K. Lam, a Democrat representing Anne Arundel and Howard counties and a vocal critic of the Health Department’s management of the problems at Perkins, said he contacted Health Department officials to request a briefing on the situation after also learning of the commission’s decision from The Post. He had not been given any more information from department officials as of Thursday afternoon.

“Unfortunately, we’re left to speculate,” Lam said. “There’s enough that’s happened at Perkins over the last few years that this potential loss of accreditation at the hospital would not be entirely surprising to me.”

A career physician, Lam is a member of the General Assembly’s Joint Committee on Fair Practices and State Personnel Oversight. He co-chaired that committee last year when lawmakers grilled the state’s former health secretary about the hospital’s problems. Lawmakers, Lam said, have a duty to ensure “we are properly safeguarding the well-being of those who are under the state’s care, including patients who are very vulnerable.”

Jones, who has been in the job for less than two months, was brought in to overhaul the hospital’s culture and management following years of mounting tensions that had led to chronic staff turnover, the firing of one CEO and the dismissal of a second interim CEO.

The Post investigation into Perkins, published in the fall, found that state leaders and hospital officials had failed for years to act on complaints about mismanagement, inadequate staffing and violence at the state facility. The troubles escalated in 2023 when patients brawled, a patient was raped by his roommate, and another patient died under suspicious circumstances.

After The Post’s report, then-Health Secretary Laura Herrera Scott said the findings were “of serious concern” to her and Democratic Gov. Wes Moore. She told staff members in a letter she would be implementing changes at the hospital to address “critical deficiencies” and had launched a “top-to-bottom review and investigation into all aspects of policy and procedure” at Perkins.

That investigation included an internal probe in June by the state’s Office of Health Care Quality that found two violations of state law and five violations of standard procedures on issues related to patient care, hospital safety, staff medical training and recordkeeping.

Separately, the Health Department hired the National Association of State Mental Health Program Directors to audit Perkins. At the time, Herrera Scott pledged to make the findings available to the public once the auditors submitted their report by the end of 2024.

But three months after the final report was completed, state officials have yet to release it, despite internal calls from staff members to share the findings and a formal request for the report filed by The Post under the Maryland Public Information Act.

The Health Department did not answer questions Thursday on the status of the audit report. Lam, who has also requested a copy of the report, said Health Department officials told him it was under “legal review.”

“It would be helpful to know what the findings of that report are,” Lam said. “Sooner rather than later.”

All the while, Perkins and the state’s entire psychiatric hospital system have continued to attract scrutiny.

Days after lawmakers grilled Herrera Scott about the troubles at Perkins, a patient there suffered a brain bleed after two other patients stomped on his head nearly 20 times before security and nursing staff members intervened.

In January, Herrera Scott abruptly removed the hospital’s acting CEO. That same week, Disability Rights Maryland filed a lawsuit against the Health Department for failing to promptly move sick patients from jail to a state psychiatric hospital in accordance with state law.

Then, in early February, the governor announced that Herrera Scott was being replaced as health secretary by Meena Seshamani, who served in the U.S. Department of Health and Human Services during the Biden administration.

Jones joined as Perkins CEO in mid-February. In her email to staff members Thursday, Jones said that leadership will be reaching out to “appropriate groups as they work to remediate issues.”

“Continued teamwork will be critical as we work together to correct issues and improve the facility for staff and patients,” Jones said. “Thank you for all your hard work.”