San Francisco General Hospital and Trauma Center
San Francisco Department of Public Health
Statement on Sheriff’s Investigation Update about the Death of Lynne Spalding
November 6, 2013
Today, San Francisco Sheriff Ross Mirkarimi released preliminary findings of his investigation into the tragic death of patient Lynne Spalding Ford at San Francisco General Hospital and Trauma Center (SFGH).
The Sheriff’s Department contracts with the Department of Public Health (DPH) to provide security services at SFGH and other DPH sites. Today’s announcement was our first opportunity to learn the contents of the Sheriff’s investigation.
It is good to have more information as we are all seeking answers about what happened to Ms. Spalding, so that it will never happen again.
“Our security arrangement must respond to the needs of our patients and staff,” said Barbara Garcia, Director of Health. “It must be so difficult for Lynne Spalding’s family and friends to hear today’s news. We owe it to them, and to all our current and future patients, to strengthen our security services.”
The hospital has been cooperating with all of the investigations into this tragedy, including those by law enforcement, and now also by federal health care regulators. That team is on site and has been interviewing every staff person, from SFGH, UCSF, and the Sheriff’s Department, who was involved in the case.
“The federal investigation is helping us tremendously to learn more about what happened to Ms. Spalding,” said Sue Currin, CEO of SFGH.
Immediate next steps include:
· The independent review of our security and facilities systems by UCSF has begun, and its first priority is a review of security system controls for SFGH patient care buildings. The first recommendations are expected in 30 to 90 days.
· Today, we began a program to re-train and re-orient all Sheriff’s Department staff on the SFGH campus.
· We are exploring expanding our existing private security contracts to make up for current shortfalls.
· The Director of Health is working with the Health Commission to seek near and long-term solutions to ensure patient and staff safety.
“Our only focus is on having a safe and secure environment for our patients, staff and visitors,” said Currin. “To do that, we need to get to the root causes of what happened in Lynne Spalding’s death. We will do whatever it takes to make that happen, and make any and all required changes so that our hospital meets the highest standards. It is our responsibility.”
In addition to the next steps outlined today, the hospital already has taken several measures to tighten the security of our emergency exit stairwells and can assure our patients, staff and the public that they are safer now than they have ever been. These steps include:
· daily emergency stairwell checks by Sheriff deputies
· we have updated all emergency stairwell door alarms to now require deactivation with a key (note that none of these alarms were deficient, broken or inoperable; they just weren’t all set to require manual deactivation.)
· when a stairwell alarm rings, it triggers a security check by Sheriff deputies
· when a stairwell alarm rings, and the stairwell is near a patient care unit, the charge nurse immediately checks the unit to ensure that all patients are accounted for