Cal/OSHA has fined San Francisco General Hospital a record $130,500 after the fatal stabbing of a social worker in December exposed “serious” safety lapses.
Felix Uribe/For the S.F. Chronicle
San Francisco General Hospital was utterly unprepared to deal with workplace violence when a social worker was fatally stabbed there in December, California’s Division of Occupational Safety and Health said in issuing a record fine against the facility.
State safety inspectors fined S.F. General $130,500 for seven workplace-violence-prevention violations, six of which were labeled “serious.”
The agency’s investigation, released Wednesday, began less than a week after the Dec. 4 killing of Rangel, a 51-year-old 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.
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.
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Tortolero-Arriechi, who is charged with murder, has pleaded not guilty.
Social worker Alberto Rangel, shown in a photo held by his husband, Stuart Moulder, was fatally stabbed at S.F. General in December.
Gabrielle Lurie/S.F. Chronicle
Cal/OSHA’s 38-page report, issued Wednesday, included seven citations for violating state safety standards and identified 77 specific failures by San Francisco General to maintain a safe workplace.
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The hospital failed to maintain proper security staffing, failed to identify hazards in the clinic where Rangel worked by allowing uncontrolled access to the clinic, and failed to create proper threat management plans, the report found. Inspectors accused the hospital’s leaders of numerous breakdowns in coordinating with UCSF (whose employees staff the hospital), the sheriff’s office and other agencies.
OSHA inspectors cited the failure to intercept Tortolero-Arriechi and accompany him through security, the failure to prevent him from bringing a weapon onto the hospital’s campus, and several other “serious accident-related” lapses.
One critical finding included the hospital’s failure “to develop a site specific plan” to make sure that employees, security and others “understood their respective roles in managing threats posed by high acuity patients with substance abuse, mental health, exhibiting behaviors of concern, and histories of violence.”
The report found that S.F. General failed to create a plan to identify threats, to effectively restrict building access and screen for weapons, and to communicate with staff about threats. The hospital also failed to deploy or coordinate security, train staff on emergency procedures, or intercept Tortolero-Arriechi, who had previously threatened and stalked his doctor, according to the report.
S.F. General failed to effectively restrict access to the building housing the HIV clinic during a fatal December stabbing, the state Division of Occupational Safety and Health concluded.
Lea Suzuki/S.F. Chronicle
In an emailed statement, city health department spokesperson Christine Falvey said the agency learned of the fine and citations Friday and was “carefully reviewing” the safety watchdog’s findings.
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Falvey said the health department took “immediate action” after the attack on Rangel and fully cooperated with Cal/OSHA’s review.
“Countless additional security measures have been initiated or expedited to strengthen workplace safety, including enhanced physical security measures, expanded security staffing, increased crisis prevention and response training, and a fundamental change in security structure governance to better connect leadership to frontline staff and their concerns,” she said.
“The safety for our staff, our patients, and our community is not negotiable,” Falvey said, noting that the department has already addressed “the vast majority” of the state’s findings and will continue to invest in safety changes at the hospital.
The Cal/OSHA report came a week after Rangel’s husband announced he was preparing a wrongful death lawsuit against the city.
A memorial honors slain social worker Alberto Rangel in his San Francisco home.
Gabrielle Lurie/S.F. Chronicle
The inspectors also faulted the hospital for not making sure its staff and security worked together to de-escalate Tortolero-Arriechi’s behavior or make sure that, after he showed up at Ward 86, a deputy accompanied and monitored him as he interacted with Rangel.
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The report also accused the hospital of not having proper procedures to ensure employees knew how to report violent threats or other workplace violence concerns to their superiors or to the sheriff’s office as well as failing to provide a photo or physical description of Tortolero-Arriechi to clinical and administrative staff, security, and law enforcement assigned to identify and respond to potentially dangerous patients.
Inspectors accused the hospital of failing to identify recurring hazards in Building 80/90, which houses Ward 86, the clinic where Rangel worked, including not having procedures for securing weapons and not having a protective barrier at registration. Surveillance cameras on the floor where Rangel was stabbed didn’t work, and the health department failed to address inconsistent security guard staffing, the report said. Inspectors also cited the hospital for not having enough staff at the clinic to manage dangerous or erratic patients with histories of drug use, threats or violence.
CAL/OSHA’s fine is the largest it has levied against the hospital and follows years of warnings by whistleblowers and previous sanctions by the state over patients’ assaults on workers, inadequate staffing and attendant employee burnout as well as fears about high-risk patients at the city’s “hospital of last resort.”
A photo of slain social worker Alberto Rangel is displayed during a memorial at S.F. General Hospital in December.
Lea Suzuki/S.F. Chronicle
In April 2020, the state safety watchdog agency fined the hospital $26,660 for workplace safety violations, including retaliating against employees who complained about dangerous conditions.
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In an emailed statement, a spokesperson for University Professional and Technical Employees CWA Local 9119, the union that represents social workers at the hospital, said Cal/OSHA’s investigation “once again confirms the reports of UPTE frontline clinicians that chronic short staffing and high turnover endanger both workers and the public.”
“It’s long past time for UCSF to take responsibility and end this dangerous and inequitable system,” he said.