ABC News, February 3, 2014

A state investigation has found that key errors were made by San Francisco General Hospital and the San Francisco Sheriff's Department after a disoriented woman went missing last fall. Lynne Spalding, 57, disappeared from her hospital room in September of last year. Her body was found weeks later in a locked hospital staircase. According to an investigation report by state health inspectors from the Centers for Medicare and Medicaid Services, hospital staff made errors in Spalding's care including ignoring a doctor's order that Spalding should be monitored at all times. Spalding was suffering from an infection and was disoriented when she was admitted. Two days before she disappeared nurses were ordered to "NEVER leave patient unattended," the report said.
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