‘Salt to a Wound’: Social Workers Still Reeling in Aftermath of Ward 86 Stabbing

Alex Alvarez said the whole event felt like a blur. On Dec. 4, the social worker was doing his typical rounds at Zuckerberg San Francisco General Hospital when he heard a commotion and saw the back of a man who appeared to be attacking his friend.

Alvarez, who also goes by Alejandro, didn’t yet know the hooded attacker was a patient, the same one his colleagues had voiced safety concerns about multiple times after facing threats of violence. He didn’t yet know that the patient, who suffered from severe mental illness, was armed with a knife. He just knew he had to act quickly.

“I just bolt out, and I pull the guy off of him because I noticed no one is doing anything. But that’s likely because everyone saw what was already unfolding, and I didn’t from my vantage point, holding him from the back of his shirt,” Alvarez recalled recently. “And there I am in the hallway, he’s holding him and then he drops him. Nothing was catching up to me when I saw what was actually happening. I just kind of was in shock. And it was at that moment that I realized, oh shoot, he wasn’t punching him, he was actually stabbing him.”

Alvarez had pulled 34-year-old Wilfredo Tortolero-Arriechi off Alberto Rangel, a 51-year-old beloved social worker at Ward 86, the historic HIV/AIDS clinic located in San Francisco General. In the moments that followed, medical staff hurried to provide life-saving care. But Rangel died of his injuries within two days, setting off a fierce debate over the hospital’s safety protocols.

The aftermath of the tragedy has been a whirlwind for the close-knit staff of Ward 86. The fatal stabbing has reignited frustration and fears among workers who told KQED that reports were made to the Department of Public Health, which oversees the hospital, about Tortolero-Arriechi’s concerning behavior and threats of violence leading up to the event.

Now, workers say they’ve been doubly traumatized by public reports they say unfairly portray what happened that afternoon in Ward 86, alongside demands from hospital leadership for them to stay silent and return to work as usual amid an ongoing investigation about the incident and events that led up to it.

“Hospital leadership and security were notified at least two weeks in advance that the patient had exhibited escalating instability, threats to stab healthcare workers, and increasingly violent threats documented by multiple providers. Providers expressed explicit fears for their safety,” reads a new collective statement aimed at hospital leadership and law enforcement from a group of several dozen Ward 86 staff members that was shared with KQED. “Despite these warnings, no clinic-wide safety plan was communicated to Ward 86.”

Officials at UC San Francisco, which runs the hospital with the Department of Public Health, did not respond to multiple requests for a response to the allegations.

In a statement after the stabbing, the Sheriff’s Office said an on-site deputy “intervened immediately, restraining the suspect and securing the scene.”

The union representing sheriff’s deputies went a step further, placing a sponsored post in all-capital letters on Instagram saying that a “deputy sheriff saved Ward 86 from a rapid mass casualty stabbing.”

“This is exactly what deputy sheriffs are supposed to do on high-risk units: be close enough to stop an attack in progress and protect frontline healthcare workers,” Ken Lomba, president of the San Francisco Sheriff’s Association, said in a press release.

The Sheriff’s Office declined to comment for this story.

Alvarez, 32, said he sees the department’s sponsored post regularly, making it hard even to take a break from reality with a social media scroll. Both the post and the city’s official description feel like a blow on top of the trauma he’s still processing from that moment he jumped in to try to save Rangel, whom he looked up to as a fellow queer Latino on the ward.

Multiple Ward 86 social workers told KQED, some on the condition of anonymity, that Alvarez was the first person to intervene in the attack, and eyewitnesses said the suspect dropped the 5-inch knife after being pulled off Rangel, with a deputy intervening shortly afterward.

Officials at UCSF directed Ward 86 staff not to discuss any aspects of the incident unless university legal counsel is present, according to an email reviewed by KQED.

“The sheriff’s deputy did not intervene immediately during the attack. Ward 86 staff — not law enforcement — physically intervened to stop the assault,” reads the collective statement from staff. “The attacker remained unrestrained for several minutes after the assault ended.

Staff had to repeatedly direct the deputy to remove the attacker from the scene.”

Tortolero-Arriechi allegedly stabbed Rangel in the shoulder and neck. He has been charged with murder in connection with the fatal stabbing, according to the District Attorney’s office, and he is scheduled to enter a plea on Wednesday. After his arrest, he was hospitalized at San Francisco General and was recently discharged from the psychiatric ward and transferred to county jail.

“A life was lost, and that is never something we take lightly. I give my condolences to Mr. Rangel’s family, friends, and colleagues,” his attorney, Deputy Public Defender Sylvia Nguyen, said in an email. “Being a social worker — working behind the scenes in all aspects of medical care, serving residents who are most in need of resources and support — is often a thankless job that people do out of the goodness of their hearts. It’s clear he made an impact on so many lives.”

The hospital has increased security and law enforcement presence in the ward, which did not have metal detectors prior to the incident, by tightening control over access points and adding weapon-detection technology.

“We are implementing immediate security enhancements to protect staff and patients, while also advancing long-term structural changes to prevent future incidents,” a spokesperson for the Department of Public Health said in an email. “In addition, the city is engaging an independent security firm to objectively review the Ward 86 incident and our safety practices systemwide. These assessments will inform both immediate corrective actions and long-term investments.”

The city reported the incident to the California Department of Public Health, Cal/OSHA and the Joint Commission, which evaluates and accredits healthcare organizations.

One social worker said the hospital made some crisis counselors available and told workers they can visit San Francisco General’s trauma and recovery center for group processing sessions, but accessing those services has not been straightforward.

In the meantime, staff have been told to report back to work, with a welcome breakfast scheduled for this morning. Several said they still don’t feel safe enough to return yet.

“My colleagues and myself experienced a really traumatic incident that should have been prevented,” said Lindsay Felten, a clinical social worker at Ward 86. She said that the lack of support from management has felt like “adding salt to a wound.”

Felten and other Ward 86 staff are calling for protected time off, as many are now navigating both the trauma of the event and paperwork for additional therapy needs and workers’ compensation. Others are dipping into their sick leave and vacation bank to give themselves more time to heal.

“We’re being told they did everything they could, that the sheriff saved the day, when the way we see it is like we showed up for ourselves,” Felten said. “We kept our other patients and colleagues safe.”

Alvarez is seeking workers’ compensation and has yet to return to the ward. “I’ve been too nervous to go back,” he said. “I will avoid the area. I don’t even drive by it.”

Threats and risky situations were not uncommon at San Francisco General before the incident last month. The hospital is known as a “safety net” for many of the city’s most vulnerable, and that often means taking in patients who are turned away from other places due to behavior, needs or because they are on Medi-Cal.

Ward 86 started as the first-ever dedicated HIV/AIDS outpatient clinic in 1983, at a time when the government and many medical institutions turned a blind eye to the epidemic.

The clinic still performs essential HIV care, and over the years, the population it serves has grown increasingly complex. Many patients are extremely low-income and come in with dual diagnoses, including substance use disorder and other mental health challenges.

The fatal stabbing has intensified debate over hospital security for both workers and patients.

Alvarez, who was in the midst of finals for pre-med classes he’s taking at City College at the time of the attack, wishes there was more he could do in Rangel’s final moments. He’s hoping to one day become a physician’s assistant or doctor.

“It cemented,” he said, “why I want to do this.”