Eighteen hospitals in California were fined for state health code violations in which patients died from various mishaps such as an improperly inserted tube and a ventilator that wasn't turned on. Other violations include surgical tools left inside patients after surgery.

The fines made public Monday stem from investigations by the California Department of Public Health that found shoddy care had either killed or endangered the lives of several patients. The hospitals were each fined $25,000 — the latest of dozens of penalties the state has issued in recent years to more than 40 hospitals.

"The number of penalties will decrease and the quality of care will dramatically improve as hospitals take action to improve," said Kathleen Billingsley, director of the health department's Center for Healthcare Quality. "The entire intent of these fines is to improve the overall quality of care in California."

The report detailed a death at a La Mesa hospital in which a worker failed to turn on a ventilator for a patient who was being transferred. Another patient in Los Alamitos died after falling from a wheelchair with no seat belt on, and a Santa Ana hospital lost a patient from a medication overdose.

At Doctors Medical Center in San Pablo, a registered nurse improperly inserted a catheter into a patient's neck vein on Sept. 1, and the patient died as a result of an air bubble from the tube. The report found the nurse had not completed a required anatomy class or the hospital's training on protocol.

Defending himself in the report, the unidentified male nurse told investigators, "I am the pro of the hospital. The other nurses call me to put in IVs that they cannot get in."

A message seeking comment from the medical center was not returned Monday.

In other cases, patients had surgical instruments or sponges left inside their bodies during surgery, requiring a second surgery to retrieve the misplaced items. The report also found some patients experienced surgical awareness during their procedures due to improper anesthesia.

The state has issued 61 such penalties to 42 hospitals, Billingsley said.