{"id":93261,"date":"2025-12-13T12:24:23","date_gmt":"2025-12-13T12:24:23","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ca\/93261\/"},"modified":"2025-12-13T12:24:23","modified_gmt":"2025-12-13T12:24:23","slug":"s-f-hospital-waited-too-long-to-address-violence-staff-says","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ca\/93261\/","title":{"rendered":"S.F. hospital waited too long to address violence, staff says"},"content":{"rendered":"

The lethal Dec. 4 stabbing of beloved social worker Alberto Rangel<\/a> was a shock to his colleagues. That such a crime could occur at a San Francisco General Hospital clinic<\/a> was not.<\/p>\n

Healthcare workers say the city repeatedly ignored their grievances and proposals for more robust safety precautions. Only in the wake of Rangel\u2019s killing, they said, are administrators finally implementing some changes staff have sought for years.\u00a0<\/p>\n

Employees and patients at the HIV\/AIDS clinic Ward 86 report that, following Rangel\u2019s death, more sheriff\u2019s deputies now guard and scan patients at a major entrance to the hospital. But the nurses\u2019 union has repeatedly asked for these exact protocols over the last six years, according to letters to the California Division of Occupational Safety and Health, meeting notes, and bargaining proposals from 2024.\u00a0<\/p>\n

Those demands came as workplace violence at the hospital has increased.\u00a0<\/p>\n

In October 2024, there were 32 recorded violent incidents at the General Hospital, according to Department of Public Health data obtained by Mission Local. By October 2025, there were 51 such incidents, a 60 percent increase.\u00a0\u00a0\u00a0<\/p>\n

Hospitals across the country show similar increases in workplace <\/a>violence. Nationwide, the Occupational Safety and Health Administration has found hospitals one of the most hazardous places to work<\/a>.\u00a0<\/p>\n

\u201cWe\u2019re given a bunch of lip service that DPH is in the process of making things better,\u201d said a nurse with San Francisco\u2019s SEIU 1021 union. \u201cThings just aren\u2019t getting better.\u201d<\/p>\n

Workplace violence on the rise<\/p>\n

There were 495 documented incidents of workplace violence at San Francisco General Hospital, which is operated by the Department of Public Health, between October 2024 and October 2025. Of those, 65 percent involved physical violence, while 35 percent were only verbal.<\/p>\n

\u201cAs a level one trauma center, we have well-established safety procedures and protocols in place which are activated to ensure a rapid, coordinated response for incidents of violence,\u201d responded the health department. In 2023, the department instituted the Safety and Feedback Events system (SAFE), with staff input. \u201cThis system reflected a significant shift in how staff could more easily report safety events and concerns and improve how we monitor and track safety\u201d at San Francisco General Hospital. <\/p>\n

But staff say numerous incidents of assault and verbal abuse go unreported, especially at community clinics outside the main hospital. Such incidents are too frequent, they said, and there are too many barriers to filing a report: \u201cWe have had many assaults nearly daily on campus,\u201d said nurse Katie Aschero, who added that many of her colleagues were afraid of retaliation for speaking out.<\/p>\n

\"SeveralA broken window at Tom Waddell Urban Health Clinic, a Department of Public Health operated clinic in the Tenderloin, covered with plywood. Photo courtesy of a community contributor. <\/p>\n

In San Francisco, public healthcare workers serve a vulnerable population that would potentially be refused entry in many other hospital systems. Many patients rotate from sleeping in shelters to emergency room beds.<\/p>\n

\u201cYou see the breadth of humanity,\u201d said Heather Bollinger, an emergency room nurse. \u201cA lot of patients are wonderful,\u201d but, she said, \u201csome are very mentally ill, and very frustrated because they\u2019ve been thrown into a system that is not designed to help them.\u201d\u00a0\u00a0<\/p>\n

While many healthcare workers say they want to ensure security does not deter patients from accessing services, they recognize the risks associated with being the city\u2019s de facto \u201csafety net\u201d for people with nowhere else to go.\u00a0<\/p>\n

\u201cI\u2019m always worried about my safety,\u201d said a former employee of the HIV\/AIDS clinic where Rangel was killed. \u201cA couple years ago, a client became so angry they started punching walls and cabinets,\u201d said another former coworker. \u201cMy colleague in the emergency room was violently attacked,\u201d said a nurse at the main hospital.\u00a0<\/p>\n

As tensions rise in overcrowded clinics<\/a> across the city, staff have been forced to physically restrain patients and seize weapons, the nurses\u2019 union wrote in a 2019 letter<\/a> to Cal\/OSHA. Those concerns persist.<\/p>\n

Megan Green, a nurse on the hospital\u2019s workplace safety committee, recalled a time a patient smashed a medical stand through a window. It shattered because it was not made of safety glass. The patient jumped through the opening and purportedly ran down the street until they were apprehended on a roof.<\/p>\n

\"ModernA shattered window at San Francisco General Hospital. Photo courtesy of a community contributor. <\/p>\n

San Francisco General Hospital is a sprawling campus with buildings from the 20th and 21st centuries. The web of clinics operated by the Department of Public Health throughout the city is even more expansive.\u00a0<\/p>\n

How staff typically respond to security threats varies by location. What\u2019s universal is confusion about the protocol.\u00a0<\/p>\n

\u201cWe don\u2019t know who to call for help,\u201d said one nurse. \u201cWe don\u2019t know what the response time will be, who\u2019s going to respond, or what words to say to them to get them to respond.\u201d<\/p>\n

The health department stated that all safety complaints are assessed for \u201clevel of severity,\u201d with high-level threats forwarded to the Assault Governance Task Force. This group of clinical, administrative and security personnel review the threats, and, if determined to be credible, log them on a database shared with the sheriff\u2019s department.<\/p>\n

Threat management, the health department continued, is also reviewed at \u201cSecurity Leadership Meetings,\u201d which includes the sheriff\u2019s office, General Hospital risk management, UCSF risk management and others.<\/p>\n

\u2018No safeguards\u2019\u00a0<\/p>\n

Green said she\u2019d never done a drill in her 12 years working at the hospital, and that the only secure place to hide in the event of an active shooter was the bathroom.\u00a0<\/p>\n

After a 2020 inspection, Cal\/OSHA alerted General Hospital that it would cite<\/a> an extensive list of healthcare workers\u2019 allegations about workplace hazards as \u201cserious.\u201d Among these allegations: administrators failed to communicate a workplace violence prevention plan, failed to implement safety procedures, and failed to immediately provide nurses who\u2019d been assaulted with first aid.\u00a0<\/p>\n

Cal\/OSHA later fined the hospital $26,660 for four violations<\/a>.\u00a0<\/p>\n

Five years later, the Department of Public Health still relies on a panoply of contracts with the sheriff\u2019s department and others to provide security. But half a dozen staff said they were still unsure of the location of deputies\u2019 posts<\/a> and unclear on the responsibilities of deputies, cadets and private security guards.<\/p>\n

The relationship between General Hospital and the sheriff\u2019s department has been rocky. Following the killing of George Floyd, some nurses pushed to get deputies out of the hospital<\/a> altogether, citing their disproportionate use of force against people of color.\u00a0<\/p>\n

In 2021, high-level proposals were put forth<\/a> to, in part, replace armed deputies with private guards trained in health care security. These plans, the health department notes, were moved forward in 2022 after ratification by the health commission and Board of Supervisors. In 2024, Sheriff Paul Miyamoto agreed<\/a> to let private security supplement his deputies \u2014 not because of anyone\u2019s concerns about their behavior or effectiveness but \u201cdue to a shortage of available Sheriff\u2019s Office personnel.\u201d<\/p>\n

Short-staffing in the sheriff\u2019s department is a longstanding and well-documented<\/a> problem. It was only this year that the department reported being able to staunch the depletion of its deputies.\u00a0<\/p>\n

But understaffing continues to take a toll. Mission Local on Tuesday reported Department of Public Health data regarding deputies not making assigned security shifts at the hospital\u2019s psychiatric emergency center. The data showed that, 90 percent of the time last month, deputies were not present. On 17 days in November, there was no deputy presence whatsoever.\u00a0<\/p>\n

The sheriff\u2019s department responded that it could neither confirm nor deny this data, but pushed back on the methodology. By its own count, its deputies were only wholly absent at the psychiatric emergency center five days, not 17.\u00a0<\/p>\n

\u201cIn most cases,\u201d the sheriff\u2019s department said in a statement, \u201ca deputy is assigned to that post and is on campus responding to calls, completing reports or assisting elsewhere.\u201d<\/p>\n

But a deputy \u201cresponding to calls\u201d or \u201cassisting elsewhere\u201d will, by definition, not be at the psychiatric emergency center. While the sheriff\u2019s department noted that the deputies may be nearby, in a crisis there is a delineation between nearby and on-site.\u00a0<\/p>\n

Hospital personnel have complained of non-uniform and even non-functioning safety equipment and procedures. Wards have panic buttons, but they can be placed in areas that are difficult to access, staff said. Deputy response times appear to range anywhere from two to 40 minutes.<\/p>\n

Union nurses said they were unable to get clear security protocols. \u201cYou have to call the sheriff and hope they respond,\u201d one said. \u201cIn the meantime, hope your colleagues respond.\u201d<\/p>\n

When in doubt, several said, just scream for help.\u00a0<\/p>\n

\"\"Sojourn Chaplaincy chaplain John Wolff leads the group in prayer at the start of the vigil for Alberto Rangel on Dec. 7, 2025. Photo by Mariana Garcia.<\/p>\n

Clinics left \u2018naked\u2019<\/p>\n

In a document obtained by Mission Local outlining a November security meeting between public health officials, the sheriff\u2019s office and private contractors, Wilfredo Tortolero Arriechi, the man charged with the killing of Rangel, was \u201cunder investigation\u201d as a potential threat.\u00a0<\/p>\n

This was due to alleged aggressive outbursts toward the doctor he purportedly visited Ward 86 on Dec. 4 to confront. It is unclear, however, how thoroughly this information was disseminated to on-the-ground staff.\u00a0\u00a0\u00a0<\/p>\n

The sheriff\u2019s department has unconditionally defended the performance of its deputy on Dec. 4, noting that he was assigned as \u201cstandby safety support\u201d to Ward 86. This term indicates the deputy\u2019s task was to protect the doctor who had been threatened, not proactively seek the alleged attacker. It is not clear that health department officials who requested a deputy be deployed to Ward 86 grasped this nuance \u2014 and nobody in leadership appears to have explained this <\/a>to the Ward 86 staff who witnessed the violent death of their colleague.\u00a0<\/p>\n

The sheriff\u2019s department states the deputy went above and beyond his assignment, searching for Tortolero Arriechi even though he wasn\u2019t necessarily tasked to. According to a court filing from the District Attorney\u2019s Office, the deputy wrote in his incident report that he heard the attack \u201cwhile looking for the defendant\u201d with another doctor on the ward.<\/p>\n

The DA filing noted that the deputy was \u201cassigned to Ward 86 regarding a threat from a patient, Defendant Wilfredo TortoleroAriechi [sic].\u201d<\/p>\n

Veteran nurse Bollinger compared security at the hospital to \u201cSwiss cheese.\u201d But, she added, the presence of hundreds of staffers and patients at the hospital adds a level of safety that community clinics lack.<\/p>\n

A nurse at the Department of Public Health\u2019s Medical Respite and Sobering Center at 1171 Mission St. estimated that, once a week, clients fight and someone has to be escorted out. She said she was informed on Thursday that metal detectors would finally be arriving on Friday, on an \u201caccelerated timeline.\u201d In the meantime, she said, two nurse managers purchased their own screening wands.\u00a0<\/p>\n

\t\t\"\"<\/p>\n

San Francisco <\/p>\n

General campus<\/p>\n

\t\t\"\"<\/p>\n

\n\t\tGraphic by Kelly Waldron. Basemap from Google Earth.\n\t <\/p>\n

One of Rangel\u2019s fellow social workers remembered hearing yelling on Dec. 4, the day Rangel was stabbed in Ward 86. Through his clinic\u2019s window, he saw someone he did not yet know was Rangel with blood \u201cpouring\u201d out of him. Then he watched a gurney race across the street to the emergency room.\u00a0<\/p>\n

Staff at the building where Rangel worked are supposed to call 911 when a security threat arises, said a different healthcare worker. That day, the employee said, a hospital emergency response team also responded in confusion.\u00a0<\/p>\n

A UCSF alert was sent out at 2:40 p.m. telling staff to avoid the building where Rangel had been attacked. \u201cNobody knew what was happening,\u201d the social worker said. \u201cWe thought there was someone running around the building.\u201d\u00a0<\/p>\n

Another alert came an hour later: \u201cBuildings are closed & staff working in those buildings may go home. Please avoid the area.\u201d The social worker wondered how he could do both.\u00a0\u00a0<\/p>\n

Two hours later, staff received one more sentence: \u201cThe security alert for Building 80\/90 is clear.\u201d Everything else the social worker learned about the attack came from the media, he said.<\/p>\n

\"\"Mourners laid flowers and candles at a statue in front of S.F. General Hospital during vigils for Alberto Rangel on Dec. 7, 2025 and Dec. 8, 2025. Photo by Mariana Garcia.<\/p>\n

City\u2019s current response is \u2018reactionary,\u2019 staff say<\/p>\n

Recent complaints go back to 2019, when nurses wrote of a man entering the hospital with loaded weapons, disabled alarms, and an administration that made few changes despite their concerns.\u00a0<\/p>\n

\u201cStaff are actively discouraged from reporting incidents of violence by their management and sometimes by the internal [sheriff\u2019s] staff,\u201d they wrote. \u201cAdministration\u2019s only suggestion to front-line staff is to \u2018not get too close\u2019 to the patients they are required to care for.\u201d\u00a0\u00a0<\/p>\n

That has not changed, nurses said.\u00a0<\/p>\n

\u201cManagers have made harassing statements,\u201d said one. Staff have been \u201cretaliated against for wanting to press charges\u201d or attempting to get a restraining order against a patient with a history of violence, she added.\u00a0<\/p>\n

Throughout 2022 and 2023 the nurses\u2019 union raised concerns about metal detectors with Department of Public Health head of security Basil Price, according to union records.\u00a0<\/p>\n

In 2024<\/a>, during contract negotiations, the union again asked the administration for additional safety precautions \u201cto reduce workplace violence.\u201d Their proposal to add security guards, cameras, and metal detectors at every hospital entrance was rejected on May 2, 2024.\u00a0<\/p>\n

On Dec. 4, 2025, Rangel was fatally stabbed<\/a>. His clinic did not have a metal detector.\u00a0<\/p>\n

This week, the Department of Public Health announced<\/a> it would commission a third-party review of security lapses both at General Hospital and department-wide.\u00a0<\/p>\n

\u201cNow there is an outside firm doing the investigation and putting forth recommendations when we have had assessments and recommendations for years,\u201d a nurse said. There\u2019s \u201cnot a lot of confidence that it will be different now.\u201d<\/p>\n

Additional reporting from Eleni Balakrishnan<\/p>\n","protected":false},"excerpt":{"rendered":"The lethal Dec. 4 stabbing of beloved social worker Alberto Rangel was a shock to his colleagues. That…\n","protected":false},"author":2,"featured_media":93262,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[4735,1280,101,29839,103,102,104,106,105],"class_list":["post-93261","post","type-post","status-publish","format-standard","has-post-thumbnail","category-san-francisco","tag-department-of-public-health","tag-health-care","tag-san-francisco","tag-san-francisco-general-hospital","tag-san-francisco-headlines","tag-san-francisco-news","tag-sf","tag-sf-headlines","tag-sf-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/93261","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/comments?post=93261"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/93261\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media\/93262"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media?parent=93261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/categories?post=93261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/tags?post=93261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}