Five days after an off-duty cop moonlighting as a security guard shot a mentally ill patient at St. Joseph Medical Center, federal investigators were sent to inspect the hospital. The patient had been in the throes of a psychiatric crisis, and had struck one officer with a hospital tray table right before he was shot.

But since the Houston Police Department wouldn't let its two officers, whom officials haven't publicly identified, talk to investigators, hospital staff was left to explain their actions for them.

When questioned by the Centers for Medicaid and Medicare Services investigators, hospital staff said the confused patient stopped being a patient and became a criminal suspect as soon as he grew uncooperative and aggressive with the security guards — as CEO Mark Bernard put it, the off-duty cop who shot the patient entered "police mode." Staff even said the officer, who police say suffered a head injury, was justified in using lethal force against the patient. "If it should happen today, they would have not done anything different,” Bernard told investigators.

Which might explain why, three weeks later, on September 23, CMS threatened to terminate the hospital's funding if it didn't immediately correct “deficiencies” that put patients in “immediate jeopardy” (such as shooting a mentally ill patient in crisis). In a letter that was first reported by the Houston Chronicle Thursday afternoon, CMS officials told St. Joseph's it has until October 8 to implement a plan of action before its federal funding evaporates.

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CMS spokesman Bob Moos told the Houston Press that such threats to defund a hospital are “truly rare.”

CMS's 51-page inspection report on the incident outlines what happened at the hospital on August 27. The night before, 26-year-old Alan Pean tried to drive himself to the hospital amid a severe panic attack, but, as his attack worsened, he crashed into parked cars in St. Joseph's parking lot when he arrived. Doctors took him to the emergency room to treat minor injuries, then transferred him to the medical psychiatric ward, where they found that he had a history of manic-depressive disorder and anxiety disorder. During his stay, hospital records noted that Pean appeared confused and repeatedly left his room naked. When he wouldn't listen to nurses to keep his clothes on and wouldn't let them button up his hospital gown, they called security.

Around 10:45 that morning, two uniformed, off-duty HPD officers moonlighting as hospital security entered Pean's room, closing the door behind them. Pean became aggressive, according to the report, in part because the officers entered his room unannounced. When the guards couldn't calm him and Pean grew combative, they tased him. One officer ultimately shot Pean in the chest when the patient hit the officer with a hospital tray table. The bullet nearly hit a vital artery. Then officers handcuffed Pean.

The inspection report filed by CMS indicates that the hospital “failed to ensure there were systems in place that protect the patient right to safe and appropriate care,” that the hospital “failed to have systems in place to maintain the safety of confused patients and ensure they receive appropriate healthcare intervention when they exhibit aggressive behavior towards staff,” and that these failures resulted in Pean's life-threatening injury.

In its report, CMS also blames the hospital for failing to provide adequate training, supervision or direction to security guards in the first place, which resulted in the shooting of a disoriented patient.

St. Joseph's CFO called the scene that morning (remember: a disoriented mentally ill patient who was confused and then became aggressive with guards who weren't trained to handle mentally ill patients) a "criminal investigation." In these cases, he said in the report, hospital policy no longer applies. Their right as cops to use deadly force on anyone they feel presents a threat trumps their role as hospital-hired security paid to protect staff and patients in fragile situations like this one.

In its plan of action, the hospital, which did not return a request for comment from the Press, notes that it plans to implement a Behavioral Emergency Response Team that will “bring resources and skills to the bedside to assist in managing the patient's disruptive or atypical actions that are perceived as scary or risky behaviors.”

And regarding the actions of those police officers, the hospital notes that it revised the Commissioned Peace Officers' job descriptions to state that their "primary function is to maintain the peace.” So at least that's cleared up.

You can read the entire inspection report here: