Hospital Security Debate Swirls After San Francisco Social Worker Stabbing

Standing in the lobby of the University of California, San Francisco, administration offices on Thursday, Alejandro Alvarez was struck by the line of six security officers preventing him and other social workers from going upstairs.

“That’s five more than we had,” said Alvarez, one of dozens of UCSF social workers who flooded the lobby during their lunch break in an attempt to meet with Chancellor Sam Hawgood and demand changes to safety protocols at San Francisco General Hospital and other facilities.

The rally occurred nearly three months after a patient fatally stabbed their colleague, Alberto Rangel, at the city’s historic HIV/AIDS clinic, Ward 86 at SF General, last December.

Staff issued warnings in the weeks leading up to his death about the alleged killer, Wilfredo Tortolero-Arriechi, who they said had threatened violence toward a doctor before Rangel stepped in to try to calm him down and was attacked.

San Francisco’s Department of Public Health oversees SF General alongside UCSF. Union representatives say they’ve met with Public Health Director Daniel Tsai and Mayor Daniel Lurie in the weeks and months since Rangel’s death.

But they’ve yet to have a direct sit-down with UCSF leadership, and their frustration is boiling over. Some staff have yet to return to work because they’re experiencing the same post-traumatic stress symptoms they’re used to diagnosing and treating in their patients.

“Alberto’s blood is on their hands!” yelled one social worker to the UCSF labor and employee relations official who came downstairs to take the letter with their safety demands. “He was killed at work!” another cried.

The months following Rangel’s tragic death have been heavy with loss and fear of danger in the workplace.

Findings from a recent survey conducted by the union representing UCSF social workers say that the vast majority of workers have directly experienced or witnessed violence.

Nearly 90% reported having experienced physical, sexual or verbal threats, assault or intimidation on the job, according to the survey. Around 20% of social workers said they have been violently assaulted on the job, and 50% of respondents said they have been sexually assaulted or harassed.

In response to the survey results, UCSF issued a statement saying, “We have not independently reviewed the underlying data or methodology. We are interested in learning more about the information generated.”

While a criminal investigation into the stabbing is still ongoing, UCSF and the Department of Public Health have implemented several changes on site at Ward 86, which opened in 1983 and today serves many low-income patients with dual diagnoses.

They’ve created a 24/7 threat management team to triage and respond to non-emergency safety concerns, added panic buttons at some sites, and updated their security training plans and developed new threat-escalation protocols for staff.

The city said it has also increased security staffing at Ward 86 and other sites, an issue many social workers said has been top of mind since before the December incident.

Prior to the stabbing, SF General had reduced staffing of sheriff’s deputies from 45 in 2022 to 28 at the end of 2025, according to Ken Lomba, president of the San Francisco Deputy Sheriffs’ Association. Multiple workers and a patient told KQED that Ward 86 did not have any metal detectors on-site either.

As additional safety measures have been added to Ward 86, social workers at other clinics said on Thursday that they’re still waiting for the same kind of response where they work.

“We just heard today that any changes needed to our clinic, be that like metal detectors or more panic buttons, could take over a year, so that’s frustrating to hear,” said Nicole Morris, a clinical social worker on the CityWide stabilization team.

But part of the low security is by design. SF General and Ward 86 often care for patients that other hospitals and clinics may refuse, whether that’s due to lack of insurance or the complexity and challenge of the medical and behavioral needs they present.

So too much security or barriers to entry could cause vulnerable patients to avoid care altogether, patient advocates say. Adding too much police presence or security measures has become a point of friction, even in an industry that’s known for having the highest rate of non-fatal injuries, according to data from the Bureau of Labor Statistics.

“This is a very challenging industry to work in. You have risk factors, you are dealing with a public that’s sick, hurting, in pain, all of the above, trying to get access to care,” said Cammie Chaumont Menendez, a research epidemiologist with the U.S. Department of Health and Human Services.

“It might be alarming for patients who are seeking care to go to a hospital that has metal detectors everywhere. Because health care is based in large part on skill, but also on trust.”

Alvarez, who stepped in to pull the patient off of Rangel during the stabbing, said his safety concerns have been made worse by a warped public narrative of the event.

“I was the individual who physically intervened in an attempt to stop the attack. A sheriff’s deputy who was present on the unit and assigned to provide safety support did not immediately intervene and was prompted by staff before taking action,” Alvarez said at Thursday’s rally. “When staff have to guide the sheriff to a life-threatening moment, that tells us something in the system is not working.”

Still, some patients say they feel safer with the added security.

Charles Adams, a longtime Ward 86 patient, was in the clinic on the day Rangel was attacked. He is seeing a therapist but still struggling with nightmares from the event. But he’s seen the gradual security enhancements at his doctor’s office and said that’s made it easier for him to return.

There’s now a locker system outside of the entrance where people can leave their personal items with no questions asked before passing through a metal detector.

“I feel a lot more comfortable about the safety of the building itself,” Adams said. “But the safety risk factor has always been there because of who the clientele is here. A lot of folks are at the lowest economic level, coming off of the streets or maybe under the influence.”

Along with more adequate security, social workers are asking for the hospital to beef up its behavioral health workforce, lower case loads and boost pay for their line of work.

“We’ve appreciated meeting with the mayor and the public health director, but the staffing funds come specifically from UCSF. They have not increased any staffing. And they haven’t added any resources that we need to also implement the changes and the protocols that have been enacted,” said Julia Pascoe, a Ward 86 social worker.

Nearly 71% of those surveyed said they considered leaving their positions at UCSF due to safety concerns.

In response to funding and staffing demands, UCSF officials said the union and university recently reached a labor agreement that includes compensation terms. “Any additional compensation proposals must be addressed through the systemwide bargaining process,” the statement reads.

Pascoe, Alvarez and other social workers say they still don’t feel ready to return.

Going back without adding even more resources to implement the changes feels “even less safe than it was before,” Pascoe said. “And it was incredibly unsafe before.”