SEATTLE (AP) — Federal scrutiny has intensified on Washington state's largest psychiatric hospital as authorities 300 miles away went door-to-door handing out flyers searching for a patient accused of killing a woman who had escaped the 800-bed facility two days earlier by crawling through a window of a lower-security ward.
Western State Hospital in Lakewood, south of Seattle, had already been under investigation for attacks on patients and staff and a failure to improve safety when Anthony Garver, 28, and another patient escaped through the ground-room floor window Wednesday night. The other patient was captured the next morning after getting on a public bus not far from the hospital.
On Friday, the hospital revealed another patient was missing. That patient, who authorities did not consider an immediate danger to the public, has not been found since failing to return from a group outing the same day the other two men escaped. The incidents did not appear related.
U.S. regulators already were investigating a recent violent attack on a hospital worker and a patient-on-patient sexual assault at Western State Hospital. A workplace inspection released this week found a series of missteps that posed safety risks, including unlocked rooms, unattended items that could be used as weapons and workers who abandoned their posts instead of watching patients.
The Centers for Medicare and Medicaid Services has repeatedly cited the facility over safety concerns and threatened to cut millions in federal funding. An agency spokesman says the hospital is under additional scrutiny over the escapes and recent assaults.
Garver was last seen on Thursday in the Spokane area where his parents live after his father called authorities to report his son had stopped by briefly. Authorities have used SWAT teams, dogs and helicopters to search for him, and Spokane County sheriff's Deputy Mark Gregory said investigators were not sure whether he left the area or was hiding in the woods.
Garver had been charged in 2013 with tying a 20-year-old woman to her bed with electrical cords, stabbing her 24 times in the chest and slashing her throat. The murder charge was dismissed after a judge said mental health treatment to prepare him for trial was not working.
Mark Alexander Adams, 58, who escaped with Garver, had been charged with domestic assault in 2014. Like Garver, he was found too mentally ill to stand trial and a judge ordered him held at the hospital.
State officials would not explain why Garver, an ex-felon with a history of running from authorities, was kept in a lower-security area. Some high-security units require patient checks every 15 minutes, but Garver was not placed in one, staffers say.
"He was in a locked area with locked windows and hourly checks," said Kathy Spears, a spokeswoman for the Department of Social and Health Services, which oversees the state's mental health care.
The hospital says the men were discovered missing 45 minutes after they were last seen, but police said it took an hour and a half. Security staff was inspecting the windows Friday to determine how the men loosened the bolts.
Garver was under more restrictive conditions than the other patient missing on Friday from the hospital. That person, who was deemed unfit for trial on residential burglary charges, had gone with an escorted group to buy clothing outside the hospital and left "unnoticed through an exit door" Wednesday, Spears said. The hospital did not identify the patient.
The history of violence at the facility stretches back years. Hundreds of employees have suffered concussions, fractures and cuts in assaults by patients, resulting in $6 million in workers' compensation claims between 2013 and 2015. Patients also have attacked other patients, causing serious injuries.
Federal regulators sent notices to the hospital four times last year after inspectors found it failed to ensure the safety. The facility has until May 3 to address the violations or lose millions in funding.
Most recently, a patient with a history of violent behavior choked and punched a mental health technician on March 26, according to an internal report. A March 23 report said a male patient slipped out of his monitors and was found in a bathroom with another male patient, who said he was sexually assaulted.
The hospital faces new scrutiny after the two attacks and escape, said Steven Chickering, associate regional administrator of a division of the Centers for Medicare and Medicaid Services.
"CMS was aware of all three of these situations, and cannot comment on how they will affect Western State Hospital's federal funding," Chickering said in an email. "CMS is currently following its procedures and processes for these situations."
In addition, the hospital's safety and emergency management manager sent a memo to staff Thursday citing numerous violations observed during a recent review.
Some of the problems involved how the hospital is laid out, "but they also observed actions by staff that could pose a safety and/or security risk," Pamela Rieta's memo said.
Her team saw a patient wearing a long necklace, telephones with long cords, an unattended chair and other items that could be used as weapons left at the nurse's station, the memo said.
Cabinets and lockers in activity rooms and kitchen areas were unlocked and unattended. Patients returning from ground privileges were not scanned for contraband. Several kitchen doors were propped open without staffers present, allowing patients to enter, the memo said.
The team also saw staff leave their posts "to hang out and talk ... not observing the patients."
The state's Behavioral Health Administration, which oversees the facility south of Seattle, is conducting a safety review and will bring in outside experts to help, assistant director Carla Reyes said.
Gregory, the Spokane County sheriff's deputy, said he hopes Garver will be held in a more-secure facility after he is apprehended.
"He has a history of running from law enforcement and of not doing what he's supposed to do, so I hope when he is caught, he'll be placed in a facility that has better security," Gregory said.
Follow Martha Bellisle at https://twitter.com/marthabellisle.