Ashley Duran is expecting her first child in September, and she plans to deliver the baby at Brookwood Baptist Medical Center, which for decades has been a popular destination for Alabama families giving birth.

But she read reports last week on AL.com that federal regulators have threatened, for the second time this year, to cut off the hospital's Medicare and Medicaid payments if patient care issues cited by regulators aren't addressed by Aug. 9.

"I'm happy so far," Ashley said. "What I read makes me a little shaky."

Many patients at Brookwood aren't even aware of the investigation that could endanger the hospital's existence if regulators followed through.

"The doctors I've had have been excellent," said Ruby Russell, who has undergone two surgeries at Brookwood. "All went well."

But she said she'd not heard about the warnings from federal regulators. She'd hate to lose her hospital and her doctors, she said.

"I had both my my kids here," said a mother pushing a baby in a stroller into the hospital. "I had a great experience."

She, too, said she hadn't heard about the investigation.

Dr. Richard Craig, executive director of the Jefferson-Blount-St.Clair Mental Health Authority, said the investigation could have major ramifications on mental health care in Alabama.

"Brookwood Baptist Hospital operates one of the largest psychiatric inpatient units in town," Craig said.

If the investigation resulted in a shutdown of federal funding, "That may have an impact on the availability of inpatient care," Craig said. "It would take away over 100 beds. It's well over 100. That would make waiting to get psychiatric care a much longer wait time. There would definitely be a shortage of psychiatric beds."

Despite the potential catastrophic impact of a loss of services from Brookwood, the hospital will have to make a convincing case to regulators for the state and the Centers for Medicare and Medicaid Services, he said. "CMS is going to do what they're going to do," Craig said. "I don't know what Brookwood has to do to satisfy regulators, but I'm sure they're working hard to do just that."

In a statement Monday, a spokeswoman for Brookwood said they would have no further comment on the investigation other than the hospital has submitted a plan of correction to regulators.

"The Plan of Correction has been submitted and we await the follow-up survey," said Laura Clark. "Throughout the survey process, the hospital remains an approved provider of services in the Medicare and Medicaid programs."

Debbie Carlson, a former investigator for the State Department of Public Health who took part in investigations that resulted in the shutdown of nursing homes, said it's a serious concern to both patients and the hospital.

"As a patient I would think twice that this is going on," Carlson said. "I think it's very bad for the people who need care. I just wonder what's going to happen to the Medicare/Medicaid patients who need care if they are cut off."

It's important the hospital address safety concerns, she said.

"Brookwood needs to be quite worried," Carlson said. "There's a good chance they could lose it (federal funding) if they are not in compliance. I've seen them do it to nursing homes. Hopefully they can get this corrected. It's serious. The good thing is Brookwood has a chance to correct it and get it right."

Since opening the first freestanding Women's Clinic in Alabama in 1988, Brookwood has been one of the busiest hospitals for births in the state. It updated with construction of a $57 million Women's Clinic in 2010 and also added an $8 million expansion of its inpatient psychiatric department that year.

In 2015, Baptist Health System and Tenet Healthcare Corp. formed a joint venture that brought Brookwood Medical Center into a regional group with several Baptist hospitals. Tenet is the majority partner and manages Brookwood Baptist Health.

Brookwood Baptist Medical Center has easy access to Mountain Brook, Homewood and Vestavia Hills, making it the over-the-mountain hospital of choice for generations. But there have been growing pains.

In 2016, a Jefferson County jury awarded a $16 million verdict to a Mountain Brook couple on claims against Brookwood Medical Center for medical negligence and reckless fraud for the hospital's natural birth advertising campaign at the time of their child's birth in 2012.

In 2015, Trinity Medical Center moved from Montclair Road to U.S. 280 and became Grandview Medical Center, a move that Brookwood had opposed in court. That put a new competitor in an area that was a strength for Brookwood.

This year, the troubles have been with regulators.

The first warning from the Centers for Medicare and Medicaid Services came after a patient died in the psychiatric department in April. The patient suffered a heart attack after being placed in restraints. Officials from CMS said the staff did not follow proper procedures for physically restraining a patient.

Officials from Brookwood Medical Center submitted a plan of correction and were approved to continue providing services to Medicare and Medicaid patients in May.

In a survey completed July 12, inspectors found more problems at Brookwood that provoked another warning from CMS. Two patient deaths, one severe injury and trauma from falls could have been prevented by following hospital procedure, inspectors found.

"The amount of the violations and the severity of the violations are shocking," said Tommy James, an attorney who has handled similar cases against hospitals. "These aren't minor deficiencies, all of these deficiencies could potentially lead to loss of life."

The survey also found that hospital staff failed to properly track patients' vital signs, putting them in danger of death or injury. One investigator discovered that no staff members, including nurses, entered a patient's room for 10 hours in May.

In January, a bipolar patient in a psychiatric program escaped the facility and jumped from a parking garage. The patient disappeared after she checked in for treatment, but before the first group therapy session. A review of the records showed that her husband called several times to check on her and warn staff she might try to leave, according to an inspection report. According to the report, staff failed to notice the patient had escaped and never tried to track her down.

A 35-year-old patient admitted in May nearly died after an extreme drop in blood pressure went untreated by hospital staff. The nurse did not notify the doctor of his decreasing pressure until the patient became unresponsive. The patient was placed on a ventilator and treated in intensive care for more than a week.

On June 10, a patient died after receiving a dose of pain medication for possible indigestion. The monitor indicated the patient's pulse had stopped 15 minutes before a family member notified staff. The monitor technician failed to notice a decline in the patient's heart rate before the heart stopped.

At least one other patient with diagnoses of psychosis and depression left the hospital in July and was found in the woods nearby.

"The Centers for Medicare and Medicaid Services has determined that Brookwood Baptist Medical Center is not in compliance with the conditions of participation," read the most recent notice from CMS. "The Medicare program will not make payment for hospital services to patients who are admitted after August 9, 2018."

Loss of that funding could be enough to shut down a hospital, but it takes a lot for that to happen. "The threat of termination is generally not credible in the absence of persistent fraud or gross negligence," said David Becker, associate professor of health at the UAB School of Public Health. "That said, none of this is good news for Brookwood."

It would be a blow for Brookwood, and a crisis for Birmingham, if federal funding was shut down, many observers say.

"I'm concerned mainly about the potential loss for the city," Dr. Craig said.

AL.com staff writer Amy Yurkanin contributed to this report.