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Two security guards escorted a homeless man from the grounds of a hospital at two in the morning and left him in the car park of a factory.
James Keyes died five hours later of hypothermia and alcohol intoxication after being left in the car park near Maidstone Hospital.
The 51-year-old was a frequent visitor to the hospital and was well known to both medical and security staff.
Joanne Hands, head of security for the Maidstone and Tunbridge Wells NHS Trust, said it was not hospital policy for those causing a nuisance to be taken beyond the hospital boundary, only to be removed from the building.
But security guards engaged by Corps Security who carried out the physical security at the hospital said it was common practice to do so.
Coroner Katrina Hepburn heard that Mr Keyes had a long history of drink and drugs abuse.
His medical records first noted his dependence on drugs in 1990. He took crack cocaine and heroin. Over the years, many medical services had tried to help him, but he would either miss appointments, turn up too drunk to be assessed, or become abusive to the medical staff.
In more recent years, alcohol addiction seems to have become his main problem. He told one doctor he consumed three or four bottles of wine a day.
Mr Keyes travelled around the county and was a familiar patient at many hospitals, either because he had self-reported to A&E or because a concerned member of the public would find him comatose on the pavement and call an ambulance.
"We assisted him out of the wheelchair. I laid him down on his side. He swore at me..." Jason Merry
Mr Keyes had been to prison several times for theft, assault and once for taking a doctor hostage.
Maidstone Hospital imposed a rule that whenever he was in the building he had to be accompanied by a security guard - partly to protect the staff from his abusive behaviour, and partly to protect him from himself, as he had a habit of stealing the hand sanitiser liquid, which had an alcohol base, and drinking it.
Whenever he was in the building, nurses would collect the sanitiser bottles and hide them away.
In the three months before his death on August 17 last year, he had attended Maidstone Hospital A&E 27 times.
On August 16, last year, he attended the hospital's A&E department four times in one day.
The first time he discharged himself after only 10 minutes. The second and third times, he was discharged after treatment for alcohol intoxication, but had to be escorted from the building by security staff. On those occasions he was taken off site to the area of the shops in Hermitage Walk.
On the fourth occasion, at around 7pm, Mr Keyes, who had learnt the key code to the doors in the ambulance bay, let himself in and fell asleep on the chairs in the waiting room. He was not booked in as a patient.
Senior sister Rebecca Mitchell took the decision to allow him to stay there and sleep because she said: "I felt that at least he was safe."
When he awoke at around 2am and headed towards the toilet, one of the other nurses asked security guard Jason Merry to remove him from the Majors department, as he was not a patient, and earlier that day had damaged a toilet roll holder in the loo.
Mr Merry and another guard, Abubakar Sidiq, found Mr Keyes lying on the floor of the toilet. They placed him in a wheelchair - one witness described it as "dragged him into a wheelchair" - and took him out of the building.
Mr Merry said that on this occasion he decided to take Mr Keyes across the road, rather than near the shops, because he was concerned for the safety of the Tesco workers who might turn up to open the shop later that morning. Tesco had previously complained to the hospital about Mr Keyes' behaviour, he alleged.
Mr Merry said: "We assisted him out of the wheelchair. I laid him down on his side. He swore at me."
"In hindsight, I would have booked him into the department at this stage..." Rebecca Mitchell
Sister Mitchell had spoken to Mr Keyes just before he was wheeled out. She described him as "drowsy" and said his condition had changed from earlier in the evening. However, she said she had walked away "in frustration", after Mr Keyes had again been verbally aggressive towards her.
Challenged by Mr Keyes' family that perhaps she didn't care what happened to him, Sister Mitchell said: "We are all in our jobs because we care."
But she agreed: "In hindsight, I would have booked him into the department at this stage."
The inquest was shown internal CCTV footage of Mr Keyes being pulled along a corridor in a wheelchair by Mr Merry. He appeared to be dragging his feet on the floor and seemed unresponsive, although Mr Merry said he was alert and talking.
After they went off shift at 6am, Mr Sidiq gave Mr Merry a lift. They decided to call in on where they had left Mr Keyes to check on his condition.
Mr Merry said they found Mr Keyes asleep on the ground and snoring. Mr Merry shook his shoulders to wake him and ask if he was okay. which was confirmed by Mr Sidiq.
The guards then left.
However, when staff for Dempsons, a packaging manufacturer, arrived 30 minutes later, they found Mr Keyes on the ground and unresponsive, and called for an ambulance.
Paramedics spent around 45 minutes at the scene trying to resuscitate him. He was taken back to the hospital at 7.28am, where he died.
Both Maidstone and Tunbridge Wells NHS Trust and Corps Security were legally represented at the hearing.
Both had also carried out their own investigations into the events of that night.
Consultant Andrew Moran, who had conducted the review from the health trust, found that Mr Keyes had "not been looked at with fresh eyes."
He said that at the point Mr Keyes awoke he should "probably have been booked back in the system and reassessed."
A number of potential improvements had been identified and were being put in place, including conflict resolution training for staff and setting up multi-agency meetings for difficult cases.
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A written report from Corps Security was read to the court which concluded its officers had "shown a high level of support for Mr Keyes."
A toxicology report revealed Mr Keyes had a potentially fatal level of alcohol in his blood of 449mg per 100ml, that was over five times the drink-drive limit of 80mg.
A post mortem revealed he died from hypothermia and acute food aspiration, aggravated by hepatitis C.
The coroner was due to deliver her verdict this morning, but responded to a last-minute request from Mr Keyes' daughter, Samantha Keyes, that she should review CCTV footage from the exterior of the hospital, which had not been presented to the court.
Miss Keyes said that the CCTV footage that had been shown had been very distressing for the family and she did not believe that her father had been conscious when he was wheeled out.
The coroner agreed that the footage would be helpful in assisting her to reach a verdict and adjourned the inquest until July 25 while attempts were made to trace it.
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Read more: All the latest news from Maidstone
