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Coroner rebukes Vista Medical Center East, cites hypothermia as cause of death for patient found on roof

A woman found unresponsive on a roof at Vista East Medical Center in Waukegan wearing only her hospital gown died of hypothermia, according to preliminary findings released Monday by Lake County Coroner Jennifer Banek.

During a news conference, Banek identified the woman as Chelsea Adolphus, 28, of Waukegan. Adolphus was missing for nearly seven hours before she was seen on the roof and staff were notified, Banek added.

A final determination of the cause of death is pending toxicology reports.

Besides offering condolences to the family, Banek, who as a nurse anesthesiologist previously cared for patients at Vista East, rebuked the hospital and reiterated her concerns about a lack of care and safety there.

Banek said her office issued Vista owner American Healthcare Systems and the Vista Medical Leadership Team a preservation lettering ensuring “all paper, video, digital and electronic evidence is not destroyed, overwritten or deleted.”

A representative from American Healthcare Systems did not respond for comment.

According to Banek's office, Adolphus was admitted to the hospital about 4 a.m. Wednesday, Jan. 22, for undisclosed medical issues. At about 11:09 p.m. the next day, Banek said her office was notified of a death that occurred in the emergency room at Vista East with “unusual circumstances.”

According to Banek, Adolphus was missing from her room at about 2 a.m. Thursday and was discovered about 8:45 a.m. by another patient or patient family member and taken to the emergency room, where her body temperature was determined to be about 50 degrees.

Hospital staff tried to resuscitate and warm Adolphus for 14 hours before she was pronounced dead at 11:03 p.m.

Banek said her office notified Waukegan police, who are investigating.

Vista East is the only privately operated hospital in Lake County, Banek said.

Its Level 2 trauma designation was revoked last year for five weeks by the Illinois Department of Public Health for not having appropriate blood supply and clinical staff available, Banek said.

“In high stakes industries, like health care, we rely on evidence-based practices, transparency and effective oversight as protective measures to make certain people do not die,” Banek said in prepared remarks.

“A death is not the threshold by which we should be measuring the necessity for a call to action,” she added.

In recent weeks, Vista furloughed 69 employees including “sitters” — staff members who monitor and ensure patients are safe, Banek said.

Adolphus’ brother, Paul, spoke briefly at the news conference.

“The family needs answers,” he said.

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