A vigil held for S.F. General Hospital social worker Alberto Rangel, who was stabbed to death at the hospital in 2025. State regulators hit UCSF with a hefty fine after finding numerous safety issues in the wake of the stabbing.
Scott Strazzante/S.F. Chronicle
California workplace regulators fined the Regents of the University of California-San Francisco $142,000 for a number of safety failures found after the fatal stabbing of a 51-year-old social worker in December at San Francisco General Hospital.
Following an investigation by Cal/OSHA, state regulators accused UCSF of not having an effective workplace violence-prevention plan. The Department of Public Health owns the hospital and employs most of its nurses, while UCSF employs the doctors and many of the social workers that work at the facility and affiliated clinics.
A 38-page report produced by Cal/OSHA included eight citations, seven of which were considered “serious,” meaning the violation was grave enough that there was a realistic possibility that death or serious physical harm could result from the cause of the violation. Inspectors found that UCSF failed to immediately report Rangel’s stabbing to Cal/OSHA, failed to properly maintain violence incident logs and failed to keep accurate records of workplace safety inspection records.
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A UCSF spokesperson could not immediately respond to the fine Tuesday morning.
The penalty was issued alongside a similar $130,500 fine against the hospital, for a total of $272,500 — 10 times a similar penalty the state regulators issued in 2020 after another significant incident of workplace violence.
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“Cal/OSHA’s role in this investigation is to focus on worker safety, examining what occurred, determining which workplace safety laws were violated, and identifying the protections and procedures that must be in place to prevent another tragic event,” said Katherine Wzorek, a spokesperson for the Department of Industrial Relations, which oversees Cal/OSHA, in a statement.
The agency’s nearly six-month long investigation began less than a week after the Dec. 4 killing of Alberto Rangel, a social worker at the hospital’s sexual health clinic, allegedly by a mentally ill patient. Rangel, 51, died from his injuries days after the stabbing.
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Wilfredo Jose Tortolero-Arriechi, now 35, is accused of stabbing Rangel after becoming obsessed with his doctor and showing up at Ward 86, the hospital’s HIV clinic, to confront him. Tortolero-Arriechi, who is charged with murder, has pleaded not guilty.
After learning that Tortolero-Arriechi was headed to the hospital, the city’s public health department asked the San Francisco Sheriff’s Office to dispatch a deputy to the clinic, records show. The deputy was guarding the doctor on the opposite side of the clinic when Tortolero-Arriechi entered and stabbed Rangel as the social worker tried to calm him down and escort him back to the elevator, records show.
Many of the allegations mirror the citations levied against SFGH, such as failing to identify hazards in the clinic where Rangel worked by allowing uncontrolled access to the clinic, failed coordination with San Francisco sheriff’s deputies and other security when dealing with dangerous patients, failed to report and track threats or acts of violence, and failed to train employees how to respond to acts of workplace violence.
One finding included the hospital’s failure “to develop a site specific plan” to make sure that employees “understood their respective roles in managing threats” posed by volatile patients suffering from substance abuse, or mental health issues.
The report found that Ward 86 did not have weapons screening or working security cameras, and didn’t have security guards covering all the entrances at the clinic after learning of Tortolero-Arriechi’s stalking and threats.
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But Cal/OSHA inspectors also faulted UCSF for the immediate response to Rangel’s stabbing, alleging that the hospital did not call a code, meaning an internal alert to notify staff of an urgent situation and said that the hospital’s behavioral and medical emergency response teams did not respond to the incident.
The university system has previously said that its leaders have spent months working with the city’s health department, as well as hospital, city and union leaders to review safety and security measures, patient-handling protocols, and workplace safety practices. Since the stabbing, the university and hospital said they have implemented “meaningful improvements to security, reinforce reporting and response protocols, and continue evaluating additional steps to further reduce risk across hospital and community settings,” spokesperson Kristen Bole previously said.
The Cal/OSHA reports come less than two weeks after Rangel’s husband, Stuart Moulder, announced he was preparing a wrongful death lawsuit against the city.
Nick Casper, an attorney representing Moulder in a wrongful death claim against the hospital, previously told the Chronicle that he found Cal/OSHA’s findings “encouraging.”
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“The findings are significant because they contain many of the same concerns healthcare workers, labor unions and frontline staff have been raising for years,” he said.