He walked out of hospital, collapsed and died. State finds facility isn’t responsible

California public health officials will not hold a San Diego County medical facility responsible for failing to detain a patient who died after leaving the hospital’s intensive care unit Aug. 11, 2022.

A California Department of Public Health “statement of deficiencies” obtained last week instead finds that Paradise Valley Hospital in National City should have more thoroughly documented the condition and circumstances of Alberto Herrera, 32, who fell unconscious in front of a nearby taco shop after walking out against the advice of his caregivers.

Joanna Hurtado, Herrera’s former fiancee and the mother of his two children, filed a state complaint after his death, telling state regulators that given the evidence contained in his medical records, a mental health hold or other means should have been used to keep him from leaving Paradise Valley.

“Because of them, my daughters and I have cried for 323 days because we miss Albert,” Hurtado said Friday.

First responders found him unconscious in front of the taco shop about an hour after he left, then took him back to Paradise Valley’s emergency department, where he died not long after arrival.

The state’s six-page statement of deficiencies focuses on whether Herrera’s departure should have properly been considered an elopement, a technical term used when a patient leaves a medical facility while still under treatment, or as leaving against medical advice, which is generally preceded by attempts to educate patients on the possible consequences of forgoing needed medical care.

Herrera’s case was documented as an elopement, but medical and security personnel interviewed by a state investigator indicated they thought his departure should have been categorized as leaving against medical advice as employees advised him to stay.

There are indications that the investigation did explore whether Herrera should have been kept at Paradise Valley on a “5150” hold. That law allows a person to be held against their will for up to 72 hours if their behavior is believed to put themselves or others in danger or if they are considered to be gravely disabled and unable to care for themselves.

Findings indicate that a security officer on duty in Paradise Valley’s emergency department Aug. 11 said he did not believe that Herrera met the criteria for a 5150 hold “because he wasn’t aggressive, and he seemed clear, he didn’t have slurred speech or hostility, he was a nice guy and, if I had met him on the street, I would probably be friends with him.”

The officer told an investigator that had he believed Herrera was trying to elope, rather than leave against medical advice, he would have called a “code green,” which would have led to the closure all of the building’s exits to keep him inside. Instead, security guards “escorted the patient out of the hospital, and he walked out without their help.”

But Herrera’s medical records, which were obtained by Hurtado as the legal guardian of his next of kin, provide additional insight into his behavior leading up to his departure.

Nursing notes and other documents show that Paradise Valley admitted Herrera on Aug. 10, 2022, suffering from acute pancreatitis, kidney failure and the symptoms of suspected alcohol withdrawal. Overnight, nursing notes show that he became increasingly agitated, giving confused answers to nurses’ questions, pulling out intravenous medication lines and ripping soft restraints on his arms that were put in place to keep him in bed.

A nurse documented Herrera’s agitation and confusion waxing and waning during his stay. Shortly before his departure, his nurse wrote that he attempted to leave the hospital covered only in “a bed sheet covered in drops of blood.” Hospital personnel, notes state, found Herrera donated clothes to cover himself while simultaneously pleading with him not to leave the hospital.

Hurtado said she cannot understand why caregivers did not heed her request to have Herrera assessed for a mental health hold.

“Their deficiency is that they didn’t chart correctly, and that they need to chart better,” she said. “They get a slap on the wrist; they get away with it as if his life did not matter.”