The 93-year-old chronically depressed patient said he’d lived long enough, and that his physical problems would only get worse over time.
Then, he told a few nurses at Santa Barbara Cottage Hospital about his suicide plan: he would deliberately fall down, making sure to hit his head, and die.
And in August 2015, when no one was in his room, the man did just that at the hospital, which has been fined $100,000 by the state.
His story is among 10 reports of negligence at nine California hospitals — including two in the Bay Area — that led to penalties recently issued by the state public health department.
The incidents took place from 2014 to 2017, and led to a combined $549,555 in fines levied against those hospitals.
Among the more egregious errors:
Santa Barbara Cottage Hospital, Santa Barbara
Investigators found that the hospital had failed to provide a safe environment for the elderly suicidal patient and prevent him from carrying out his plan. Among other issues, the hospital staff did not tell a security guard, who was monitoring the patient from a video camera behind the nurses’ station, that he was suicidal.
The hospital issued a statement saying that the suicide “deeply saddened our patient care team and everyone involved. When a patient is in our hospital, our priority is to provide care with integrity and compassion.”
Palmdale Regional Medical Center, Palmdale
By not following its suicide risk policies, a patient got a hold of a pair of scissors and stabbed himself 69 times, causing critical injuries including a stroke, injury to the heart, liver, abdomen, and neck, and left-sided paralysis.
Penalty: $49,500
Doctors Medical Center, Modesto
Investigators found that staff didn’t sufficiently monitor a male patient who had exhibited increasing sexually explicit behavior; he was able to enter a female patient’s room and sexually assault her.
Penalty: $47,250
Methodist Hospital of Sacramento
Because rules for giving high-risk medications to patients weren’t followed, a pregnant woman in labor who should have received a drug used to stimulate contractions was instead given a drug that increases blood pressure in critically ill patients. That damaged the woman’s heart muscle, and could have caused her death.
Penalty: $47,452
Desert Regional Medical Center, Palm Springs
Investigators found that an emergency room nurse gave a patient a blood transfusion with the wrong blood type. That led to the patient’s kidney failure, multiple medical treatments to remove harmful wastes and excess fluid, and prolonged hospitalization which could have resulted in the patient’s death.
Penalty: $82,500
California Pacific Medical Center – Davies Campus Hospital, San Francisco
Investigators said a stroke patient who was given a higher than ordered amount of medication to prevent blood clotting may have contributed to the patient’s brain death.
Penalty: $47,452
California Pacific Medical Center – Davies Campus Hospital, San Francisco
A female patient suffering from delirium and at high risk for falls was required to have a sitter watch over her. But at some point, the sitter left the woman alone in the room; the woman stood up and fell, striking her face on the floor. She suffered bleeding on the brain, which led to her decline and death several months later.
Penalty: $66,600
Regional Medical Center, San Jose
Investigators determined that the hospital failed to give two drugs immediately — as ordered –to a 52-year-old man in a neck brace who had fallen at his home. The hospital staff delayed giving the man one drug to prevent blood clots and another to prevent additional seizures for about four hours and 1.5 hours, respectively.
The delay contributed to a rapid decline in his health and may have resulted in significant physical impairment.
Penalty: $33,300
