SAN DIEGO -- Four hospitals in San Diego County were each fined $25,000 Monday by a state agency for mistakes that included allowing a patient to fall off an operating table and anesthesia equipment problems that resulted in patient "surgical awareness."

"Ensuring all Californians receive quality patient care is our top priority," said Kathleen Billingsley, deputy director of the Center for Health Care Quality with the California Department of Public Health.

Statewide, fines were levied against a total of 18 hospitals -- some of which had multiple violations -- for "incidents that caused, or were likely to cause, serious injury or death to patients," according to DPH.

At Grossmont Hospital in La Mesa, a patient died after staff failed to activate a stationary ventilator during a transfer, according to the healthcare agency.

Three patients at Palomar Pomerado Health System in Poway experienced "surgical awareness" because staff failed to keep anesthesia equipment in proper condition, DPH reported.

Scripps Green Hospital in San Diego was fined because a patient fell off an operating table during surgery, and at Promise Hospital of San Diego, an unlicensed staff person acted as a licensed nurse, according to DPH officials.

The hospitals may appeal the penalties by requesting a hearing within 10 days of notification.