MURRIETA -- According to federal documents, the reasons Southwest Healthcare System stands to lose reimbursement for Medicare and Medicaid patients stem from several instances of improper infection control procedures and the lack of an intercom system in a room that was being used as a nurses station.

A 21-page report released Monday by the U.S. Department of Health and Human Services provides details about an early March survey of Rancho Springs Medical Center in Murrieta, where state health officials found fault with the practices of hospital staff.

State officials said there were incidents of the hospital not using approved practices for cleaning surgical units and gear, a lack of oversight of nursing stations and improper procedures for quarantined areas.

Southwest Healthcare, which also operates Inland Valley Medical Center in Wildomar, could lose its ability to be reimbursed for treating Medicaid and Medicare patients on July 15 if the problems are not fixed.

State officials have said they will conduct an unannounced survey of the hospital sometime between now and mid-July to make the determination on behalf of the federal body.

The latest problems also represent the final barrier the hospital must overcome to reapply for a permit to open a new building on the Murrieta campus, state officials have said.

Southwest Healthcare has been working since the beginning of the year to open a $53 million, 72,000-square-foot building designed to replace the hospital's emergency room, provide space for expanded women's services and be home to Southwest County's first intensive care unit for newborns.

The building would increase the number of emergency room bays from eight to 27.

But state officials denied the health care provider's application to open the building in February, citing a "history of noncompliance" with state and federal procedures.

The hospital has been cited numerous times since 2005 for issues relating to using hospital space improperly and not providing sufficient on-call physicians.

Federal officials have said they cannot comment on an ongoing review of a hospital's practices.

Teresa Fleege, spokeswoman for Southwest Healthcare, declined to comment Monday, but said Friday that the hospital was "diligently" working to correct the perceived errors of practice, and looking forward to opening the new facility as soon as possible.

"We have full confidence that the deficiencies noted in the last survey have been corrected and our Medicare certification will not be affected," Fleege wrote in an e-mail late last week.

According to the report, surveyors determined that patients were at risk of receiving delayed care because a room being used as a makeshift nurses station was not equipped with an intercom.

The lack of such a system left hospital staff searching for available nurses, inspectors said.

State officials noted that hospital administrators were told to install a system in October 2008.

According to Southwest Healthcare officials' response to the federal agency, they plan to "return the space to its approved use" until the state gives approval to use it as a nurses station.

The hospital also was faulted multiple times for not providing proper infection control.

According to the report, surveyors found:

- One visitor was not wearing protective gear when she entered an isolation treatment room to visit her husband, who had a methicillin resistant staphylococcus infection, known as MRSA.

- A physical therapist failed to dress that same patient in protective clothing when the therapist brought the patient out of isolation and into a hospital hallway.

- A certified nursing assistant entered an isolation room without wearing a gown and gloves.

- A registered nurse and a surgical technician admitted to washing their hair covers with their laundry at home.

- A nurse did not allow a cleaning solution to sit on a surface for 10 full minutes before wiping it off.

In their response to federal officials, Southwest administrators stated that some employees who did not follow the proper procedures were disciplined.

Additionally, CEO Dennis Knox sent an e-mail memo and a written reminder with all paychecks in early April to emphasize the importance of following infection control procedures.

Southwest Healthcare also formed a team to weekly observe practices at the hospital and ensure that employees follow correct procedures.

Contact staff writer Nelsy Rodriguez at (951) 676-4315, Ext. 2626, or nrodriguez@californian.com.