NEW : As many as 40 people are dead in the fire , state media cite local investigators as saying . The fire broke out at the psychiatric institution in the early morning , reports say . The fire broke out shortly before 3 a.m. The Emergencies Ministry says 23 people have been killed , state media say . A fire at a psychiatric clinic in Moscow killed 38 people , sparking calls for better fire safety .
NEW : As many as 40 people are dead in the fire , state media cite local investigators as saying . The fire broke out at the psychiatric institution in the early morning , reports say . The Emergencies Ministry says 23 people have been killed , state media say . A fire at a psychiatric clinic in Moscow killed 38 people , sparking calls for better fire safety .