Department of Public Health director Daniel Tsai told staff at San Francisco General Hospital in a private meeting last week that inadequate protocols led to the recent stabbing of a social worker in a clinic hallway, Mission Local has learned.\u00a0<\/p>\n
Tsai said a \u201croot cause analysis\u201d also confirmed that clinic workers intervened to stop the attack \u2014\u00a0directly contradicting early claims made by the sheriff\u2019s union that a deputy had done so.\u00a0<\/p>\n
While previous statements by DPH in the aftermath of the December killing indicated a need to improve policies, workers saw the meeting as the first time the department has appeared to take responsibility for the incident.\u00a0<\/p>\n
At the March 16 meeting with staff, Tsai and other officials presented initial findings from a \u201croot cause analysis,\u201d and outlined multiple ways that insufficient protocols led to the fatal attack at the Ward 86 HIV clinic.\u00a0<\/p>\n
Social worker Alberto Rangel was at Ward 86 the afternoon of Dec. 4 when a patient, Wilfredo Tortolero Arriechi<\/a>, arrived with a knife. Wilfredo Tortolero Arriechi<\/a>, 35, had allegedly threatened his doctor at Ward 86, and the day of the stabbing, DPH had requested additional security, which arrived in the form of a sheriff\u2019s deputy who began shadowing the doctor.\u00a0<\/p>\n But when Tortolero Arriechi arrived, no one was monitoring the elevator entrance to the clinic. He entered the clinic and began stabbing<\/a> Rangel in the middle of the hallway. Rangel died two days later.\u00a0<\/p>\n Tsai noted a \u201clack of a sufficiently robust, consistent, see-the-whole-picture, make a threat evaluation.\u201d\u00a0\u00a0<\/p>\n \u201cEven once a threat was identified,\u201d Tsai said at the meeting, there was a lack of protocol around \u201cwhat exactly is supposed to happen and what everyone is supposed to do.\u201d Communication back to staff who raised concerns was also lacking, he said.<\/p>\n There \u201cshould have\u201d been a protocol, Tsai added, assessing entry and exits to Buildings 80-90 where Ward 86 is located as well as to the ward\u2019s entrance on the sixth floor. Hospital leadership also should have considered where the sheriff\u2019s deputy would be most effectively stationed, he said.\u00a0<\/p>\n Tsai said that DPH\u2019s head of security and the sheriff\u2019s office had done an \u201cassessment of priors\u201d for Tortolero Arriechi and, finding \u201cno priors,\u201d determined that deploying a single deputy would suffice.\u00a0<\/p>\n Mission Local revealed<\/a> that Tortolero Arriechi\u2019s social media, for weeks prior to the stabbing, showed a man who was mentally unstable. He made incoherent rants, rehearsed confronting his doctor on video, and even posted a photo of a kitchen knife<\/a> stabbed through one of the summaries of a Ward 86 clinic visit.\u00a0<\/p>\n Staff at Ward 86 had repeatedly told hospital leadership in the weeks leading up to the stabbing that they felt unsafe around Tortolero Arriechi.\u00a0<\/p>\n Tsai said that increased staffing for threat assessments are now in place.\u00a0<\/p>\n \u201cWe have substantially increased the staffing for threat escalation so that if it\u2019s an emergency, there\u2019s a very clear response time,\u201d Tsai told staff at the meeting. He noted a single phone number was now available to call in other cases, and acknowledged \u201cspecific instances\u201d when that call process had failed.\u00a0<\/p>\n A source who attended the meeting said Tsai acknowledged that response time was another issue. The source said Tsai acknowledged that medics didn\u2019t arrive for nearly 15 minutes, despite the stabbing taking place on the campus of the city\u2019s main trauma center.\u00a0<\/p>\n Conflicting narratives\u00a0<\/p>\n Tsai reassured Ward 86 staff that the \u201croot cause analysis,\u201d confirmed their version of events \u2014\u00a0that clinic workers intervened in the attack and did first aid.\u00a0<\/p>\n In the days after the stabbing, the sheriff\u2019s union had put out a statement \u2014\u00a0since deleted \u2014 claiming that the deputy on site had stopped the attack and \u201clikely\u201d prevented a \u201cmass casualty stabbing.\u201d The statement, posted on Dec. 9, said that the \u201cdeputy responded, intervened to stop the attack, helped secure the individual, and allowed medical staff to begin lifesaving care.\u201d\u00a0<\/p>\n \u201cIf the assailant had been able to move freely down the hallway, we could be talking about multiple staff and patients stabbed,\u201d sheriff\u2019s union then-president Ken Lomba added at the time.\u00a0<\/p>\n Tsai said that it was staff, not the deputy, who responded first.\u00a0<\/p>\n \u201cThe first responders to actually intervene and pull the assailant off Alberto was Ward 86 staff,\u201d Tsai told staff at the meeting. \u201cThe things that you have said are well documented and also corroborated with multiple primary sources and not just interviews, but bodycam footage and detailed call timestamps.\u201d\u00a0<\/p>\n Mission Local first reported an eyewitness account<\/a> from a Ward 86 worker who separated Tortolero Arriechi from Rangel, while the deputy was seen nearby petting a dog. Multiple witnesses said Tortolero Arriechi stood still and did not move after staff pulled him off Rangel and began trying to save Rangel\u2019s life.\u00a0<\/p>\n The deputy was described by clinic staff as moving to apprehend Tortolero Arriechi \u201cseveral minutes\u201d later.\u00a0<\/p>\n \u201cStaff had to repeatedly direct the deputy to remove the attacker from the scene,\u201d read a January statement<\/a> from Ward 86 workers outlining the attack and inconsistencies, and demanding public acknowledgement of the inaccuracy and an apology from the sheriff\u2019s department.\u00a0<\/p>\n In the days after the stabbing, Tsai announced<\/a> that DPH would contract with a third-party security firm to review the circumstances that led to the incident. It is unclear whether that review is complete or separate from the review presented to staff last week.\u00a0\u00a0<\/p>\n