Ten minutes before Mayor Ed Lee took the podium at San Francisco General Hospital last week, a shoeless patient in a gown wandered unattended outside the building for about five minutes before a sheriff’s deputy brought him back inside.
The mayor was announcing a review of the hospital’s safety measures after the body of a missing patient was found in a rarely used stairwell more than two weeks after she disappeared.
Lynne Spalding’s case might be unprecedented, according to the hospital, but incidents like the one involving the shoeless man are not — further raising questions about S.F. General’s ability to keep track of patients.
“We don’t encourage people to leave before their care is complete,” said spokeswoman Rachael Kagan. “They may do so.”
Since January, 96 “AWOLs” have left without a word. Since patients are not held against their will, competent adults can leave whenever they want.
The hospital documents AWOL cases — anyone who has been gone for more than four hours — but is not required to report them to the state or police.
San Francisco General Hospital is not alone when it comes to such patients. According to 2011 data from the Office of Statewide Health Planning and Development, 38,333 patients in California either left a hospital without informing staff or signed a statement to leave despite medical advice to the contrary.
S.F. General is required to report deaths and serious disability associated with missing patients, but no such cases had been reported at the hospital for the past decade until Spalding, according to the California Department of Public Health.
In 2012, there were 16 such cases statewide.
Last week, in response to Spalding’s death and disappearance, the hospital launched new procedures meant to prevent similar events in the future. They include a daily check of the fire stairwell, along with automatic stairwell checks by Sheriff’s Department security staff when stairwell alarms are triggered and deactivated. Also, when a fire stairwell near an inpatient unit is activated, a census of the unit must be conducted to ensure all patients are present and accounted for.
“The stairwell where Spalding was found did not have the kind of alarms that need to be deactivated,” Kagan said. “It will now, as we are making this standard on all fire stairwells.”
A 2009 survey of S.F. General’s “fire life safety” systems conducted by the federal Center for Medicare and Medicaid Services had no findings regarding stairwells or alarms, Kagan said.
Spalding, 57, was admitted to the hospital Sept. 19. She may have been suffering from some kind of infection, said family friend David Perry.
On Sept. 21, Spalding disappeared from her hospital bed. A search followed, but her body was not found until Oct. 8 when a hospital engineer discovered it while doing a regularly scheduled inspection of an emergency exit stairwell.