Security slip-up in death of woman
S.F. General official tells of breach at building where body was found
A security breach allowed a 75-year-old woman residing at a senior center on the San Francisco General Hospital campus to enter a nearby power plant, where she was found dead in a stairwell 10 days after she was reported missing, the head of hospitals said Thursday.
The woman, Ruby Andersen, lived in a residential care center for the elderly at the Behavioral Health Center, which is operated by the city’s Department of Public Health.
San Francisco Sheriff Vicki Hennessy, whose department provides security to the hospital, said Andersen was able on May 19 to sign herself in and out of the residential care facility, which allows its residents to come and go as they please, after indicating to staff she would return at 4 p.m. that day, Hennessy said.
An engineering staffer discovered Andersen’s body at 12:52 p.m. Wednesday, Hennessy said, but investigators aren’t certain how long it had been there.
Hospital officials Thursday stressed that while Andersen was a resident on the hospital’s campus, she technically wasn’t a patient.
Andersen’s daughter, Charlene Roberts, expressed outrage in interviews Wednesday, and said her mother suffered from dementia. Hospital officials would neither confirm nor deny this, citing privacy laws.
The discovery of Andersen’s body was reminis-
cent of a 2013 case in which the body of a San Francisco General patient, Lynne Spalding, was found in a hospital stairwell more than two weeks after she went missing from her room.
Roland Pickens, director of the San Francisco Health Network, said officials beefed up their security protocol after Spalding was found dead nearly five years ago, but that didn’t include securing entrances to the campus power plant.
Andersen was able to gain access to the hospital’s power plant building because it was not security-badge protected from 6 a.m. to 6 p.m. to allow for the flow of crew and materials, Pickens said. The stairwell where Andersen’s body was found can be accessed by two different levels and was used as a fire exit.
Pickens said the hospital immediately corrected the issue and a security badge is now required to access the building at all hours.
“In hindsight, one would say, yes, we should have done that for every building on campus,” he said. “The power plant just was not something on the radar.”
Andersen’s disappearance touched off a different security protocol for deputies than a “code green,” which is called when a hospital patient goes missing, Hennessy said.
When that happens “we search every nook and cranny of the campus, including that building,” Hennessy said, referring to the power plant.
Sheriff ’s deputies routinely patrol the interiors of hospital buildings where patients are located, as well as the exterior areas of the campus, including the power plant. The interior of the power plant is not regularly patrolled under the current agreement with the hospital, Hennessy said.
A team leader from the Behavioral Health Center reported Andersen missing May 20 at 1 p.m. after she didn’t return the previous evening, Hennessy said. The sheriff added that a deputy immediately responded, took a report from the team leader and went on to try to contact Andersen’s family.
The deputy additionally made checks with the hospital, jail and medical examiner’s office, Hennessy said, before entering Andersen’s information into a missing and unidentified persons system that can be accessed by police.
The report was forwarded to San Francisco police the following day, and Andersen’s family returned messages May 22, Hennessy said.
The San Francisco medical examiner will conduct an autopsy, while the San Francisco Sheriff ’s Department continues to investigate.
Kelly Hiramoto, director of the San Francisco Health Network’s Transitions program, said there are 50 residents at the facility where Andersen lived. She described the senior center as a “nonmedical board and care setting.” Services include making sure residents eat regularly and take their medications, but residents do have the right to decline their medications.
Hiramoto confirmed that the center cares for those with mental health issues, but officials would not elaborate on which issues they treat.
The hospital power plant where Andersen’s body was found is behind Building 80, an outpatient clinic on 22nd Street and San Bruno Avenue, across 22nd Street from the main hospital building. The center is about 300 feet from the twostory power plant structure, which was built in 1971.
Rachael Kagan, a spokeswoman for the city’s Department of Public Health, said Andersen’s body was found by an employee on the engineering staff in an internal stairwell.
Spalding’s body also was found by a hospital employee, but in an outside stairwell used as an emergency exit at the main hospital. The 57-year-old had entered the hospital with a bladder infection.
An autopsy revealed that she died of dehydration and liver problems and had been dead for several days when her body was discovered. San Francisco paid the woman’s family nearly $3 million to settle a lawsuit.
After that incident, the hospital put into place new policies for checking on patients, including regular passes through building stairwells. Kagan noted that, unlike Andersen, the hospital immediately knew Spalding was missing and had been looking for her.
Andersen’s daughter declined comment on Thursday.