(CNN) — No one ordered a full search for a missing San Francisco hospital patient until nine days after she disappeared, authorities say. Nine days.
In that time, Lynne Spalding Ford's family scoured the city and passed out thousands of fliers — only to find out she was dead in a stairwell at the same hospital.
Now, authorities have revealed a series of mishaps leading up to the discovery of Spalding Ford's body at San Francisco General Hospital — 17 days after she was reported missing.
Exactly when and how Spalding Ford died remains a mystery. But more clues are surfacing about her final days:
Spalding Ford, 57, checks into San Francisco General Hospital for a bladder infection.
A hospital employee calls the sheriff's department in the morning and says Spalding Ford has been missing for 40 minutes, San Francisco Sheriff Ross Mirkarimi said.
The caller also describes the patient as African-American — even though the patient is later described as Asian in a sheriff's department log book. The sheriff's department oversees security on the hospital's campus.
Authorities make a perimeter search of the hospital grounds, but deputies didn't immediately classify the woman as a missing person.
Later that day, evening shift deputies stationed at the hospital didn't get briefed about Spalding Ford from the earlier deputies.
Four days after Spalding Ford's disappearance, the San Francisco Police Department asks the sheriff's department to pull surveillance video to see if there are any images of the patient leaving.
The sheriff's department tries to look through the surveillance footage, but can't "due to hardware problems," Mirkarimi said. The vendor responsible for maintaining the video equipment was notified.
Nine days after Spalding Ford went missing, the hospital asked sheriff's deputies to search its entire 24-acre campus. But that search didn't include all stairwells.
After realizing not all stairwells had been searched, a deputy and staff went to scour the stairwells. But only about half of them were searched.
The video equipment vendor manages to recover surveillance video from the hard drive, and images are given to San Francisco police the next day.
A hospital employee tells the sheriff's department that someone reported a person lying on the 3rd- or 4th-floor landing of Stairwell 8.
"The Communications Center staff responded, ‘We'll take care of it,'" the sheriff said. "There is no indication that anyone was dispatched to that stairwell."
That same day, an employee on the fifth floor reported hearing banging coming from Stairwell 8, a hospital official said, according to Spalding Ford's family attorney Haig Harris. A hospital spokeswoman later confirmed that the official called Harris, but did not elaborate on the conversation.
A hospital engineering employee who was conducting a routine check found Spalding Ford's body in an exterior stairwell.
The hospital and sheriff's department said the alarmed stairwell, which exits to the hospital grounds at the bottom, "is a fire exit that is not routinely used by staff, patients or the public."
The sheriff's department said it's implemented a series of new policies have been implemented since Spalding Ford's death, including daily patrols of fire exit stairwells and working with hospital staff to repair faulty alarms.
"I would like to express my sincere condolences to the family and friends of Lynne Spalding Ford," Mirkarimi said. "We have taken immediate measures to address and make certain such a tragedy never happens again."
Mirkarimi said his department will review technical problems, such as faulty surveillance equipment and the fact that parts of the hospital were not covered by cameras. He also said policies and procedures of the deputies at the hospital will be reviewed.