San Francisco General Hospital Fined for Serious Safety Violations After Social Worker Stabbing

UCSF faces eight citations, with seven marked “serious.” Citations in the 38-page report say that the institution failed to immediately report the incident to Cal/OSHA and failed to provide records of workplace safety inspections and violent incident logs.

UCSF did not immediately respond to a request for comment.

The Cal/OSHA report against SF General included seven citations, six of which were marked as “serious.” Those included that the hospital failed to develop a safety plan after the patient made threats of violence, no photo or physical description of the perpetrator was shared with clinical staff and the hospital did not notify staff about the threats of violence.

The report also pointed out that the clinic did not have security cameras or weapons screening at the building, and failed to provide security guards at all entrances to the building after threats were made. The suspect, Wilfredo Tortolero Arriechi, 35, was arrested at the hospital and has been charged with murder. He has pleaded not guilty.

Alejandro Alvarez, the social worker who pulled the attacker off Rangel the day of the stabbing, said the Cal/OSHA report findings were validating but unsurprising.

“It’s pretty upsetting to hear our security cameras weren’t working right in the hallway of the clinic,” Alvarez said. “The work is demanding, but at the same time, we still deserve to be working in a safe space.”

Alvarez added that the $130,500 fine against SF General, the largest so far from Cal/OSHA against the hospital, is “not accountability. It is a beginning.”

Officials at San Francisco’s Department of Public Health have responded to the incident with a number of safety changes at Ward 86. Those changes have so far included hiring more security staff, launching a threat management team to triage reported threats and installing metal detectors at entrances.

“The safety for our staff, our patients and our community is not negotiable, and we will continue to keep staff and patients safe with a strengthened and modernized approach to safety and security,” a spokesperson for the department said. “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.”

City officials have also committed $15 million annually and $7.5 million in one-time infrastructure improvements for healthcare worker safety throughout the Department of Public Health.

Rangel’s husband, Stuart Moulder, meanwhile, plans to sue the city for his wrongful death and for failing to take necessary steps to protect workers after multiple reports of the alleged attacker’s violent behavior were reported to hospital management.

Nick Casper, the attorney representing Moulder, said the findings in the latest Cal/OSHA report dovetail with the allegations in their complaint.

“The findings really paint a picture of two specific-but-related failures,” Casper said. “There were longstanding systemic deficiencies involving security, training, coordination and workplace violence prevention. And there were specific failures about appropriately responding to a known and escalating threat posed by this patient.”

Casper pointed to previous workplace safety violations and resulting fines from Cal/OSHA at SF General, and a lack of proper recourse from the city.

In 2020, the hospital was fined more than $26,000 after a nurse was attacked and staff faced retaliation for complaining about a dangerous work environment.

“For years, there have been prior Cal/OSHA investigations and citations from violent attacks on their frontline healthcare workers. And many of the same deficiencies that were cited in this same report relating to Alberto Rangel were also cited in those citations,” Casper said. “There were all these years of notice to the city, and they failed to act until one of their frontline healthcare workers was killed.”

The institution’s failure to act on known deficiencies in the hospital’s safety response has haunted Alvarez, who remains on leave from his position.

“Their own leadership had already identified these exact deficiencies for Ward 86. Four years before Alberto was killed, someone inside that institution put it in writing. And nothing happened,” he said. I do not know how to sit with that. I am still trying.”