A British woman found dead in a locked stairwell 17 days after going missing from her San Francisco hospital room probably died of a chemical imbalance due to complications from alcohol abuse, a coroner has said.
Lynne Spalding, 57, disappeared from the city's general hospital on September 21 but her body was not found until October 8.
Assistant medical examiner Ellen Moffat said in a new report that the mother-of-two had been dead for days before the discovery.
The medical examiner's office said Ms Spalding was confused and delirious on the day she disappeared.
Ms Moffat said Ms Spalding, originally from Peterlee, Co Durham, didn't know the day or time or even why she was in the hospital.
She had been admitted for a bladder or urinary tract infection and arrived at the hospital thin and frail with her children worried about her condition.
San Francisco General HospitalAlthough sheriff's deputies at the hospital did a "perimeter search" of the hospital's 24-acre campus within an hour of her disappearance, it was not until September 30 that they attempted a more extensive search of the grounds.
The next day, after it became clear that not all the stairwells used as fire exits had been searched, a supervisor ordered the stairwell searches to continue, yet "only about half the stairwells" ever were, Sheriff Ross Mirkarimi said.
Ms Spalding's friends and relatives spent days scouring the streets of the Californian city with flyers because they were "under the assumption that San Francisco General had been searched and Lynne was not here".
On October 4 a hospital staff member told the sheriff's department that someone had reported seeing a body in a locked stairwell of the building where Ms Spalding had been a patient.
A sheriff's dispatcher told hospital officials the department would respond, but "there is no indication that any one was dispatched to that stairwell".
Ms Spalding had lived in the city for more than 20 years and had two grown-up children, a 19-year-old son and 23-year-old daughter, who both live in the US.
:: Watch Sky News live on television, on Sky channel 501, Virgin Media channel 602, Freeview channel 82 and Freesat channel 202.