Two months after the lethal stabbing of a social worker at a San Francisco General Hospital clinic, seasoned city healthcare workers say safety problems still remain at many of the city’s clinics.
Most of the dozen workers who spoke to Mission Local — including doctors, nurses, and counselors — asked to remain anonymous, saying they could lose their jobs for speaking to a reporter.
But as the city’s Department of Public Health follows Mayor Daniel Lurie’s directions to make cuts, they wanted to make one thing clear: safety in the city’s medical facilities requires more than just the presence of security personnel.
It requires widespread training in de-escalation, working with patients with complex needs, and crisis response, they said. These programs are on the chopping block.
“If the clinic is a brick, they are the mortar,” the veteran practitioner said of the clinic workers.
The Department of Public Health has proposed cutting $17 million from contracts with community groups. To avoid direct clinic cuts, the biggest portion of those cuts, $6 million, is likely to come from staff training programs.
That is a mistake, practitioners said. More and better security training is exactly what healthcare workers said they need. Already, health workers at clinics and community centers say they’ve been asked to do more with less for the past year. Several reported feeling unsafe for the first time in over 10 years of working for the city.
Six weapons, five days
The day after Alberto Rangel, a 51-year-old social worker, was killed at Ward 86, the city’s HIV clinic, staff at the Medical Respite & Sobering Center in the South of Market held a meeting. In the five days prior, they had confiscated six weapons, including an ice pick and a samurai sword, a nurse recounted.
She wasn’t shocked by the weapons. Many clients carry them to make themselves feel safe, she said. She was heartbroken by Rangel’s murder, but that hadn’t surprised her either. Given the security holes at her own facility and the overwhelming flow of patients, she had felt “a death was coming.”
“I don’t always know the depths of someone’s mental illness,” she said. “I don’t have the time or the support to figure all of that out.”
San Francisco Department of Public Health staff work far beyond the General Hospital. The city offers a wide range of services at designated clinics, health centers, and medical programs everywhere from Chinatown to the Bayview. It works with and funds groups that treat substance use disorder, behavioral health issues, and more.
These facilities, known as “safety nets,” are designed to be low-barrier. Their patients are often food insecure, homeless, and coping with trauma. Working with this population has never been easy, and experienced providers say learning to “de-escalate” conflicts is essential. So is clear communication about the city’s safety protocols.
That was brought home by Rangel’s killing on Dec. 4, 2025.
Rangel was an experienced professional — simply “the best,” his friends and colleagues said. They believe the city failed him by not having a plan in place to prevent a man who was a known threat from reaching him.
Community healthcare workers say they’ve been seeing more patients like Wilfred Tortolero Arriechi, the man accused of killing Rangel — people struggling with multiple issues. A patient might show up for a shot, wound care, or medication, and end up asking about behavioral health services, transportation, and even something to eat.
Patients seem more volatile these days, some nurses said. Giving care has become “more dangerous than it ever was.”
Not every healthcare worker who spoke with Mission Local said their on-the-job safety had gotten dramatically worse. But they could see why their colleagues might feel that way: “I’ve never felt that employees matter less than they do now,” said one veteran practitioner.
Online security training supplants safety drills
Several staff said security training is lacking, especially for city contractors. There are few drills to teach new hires crisis response skills, they said. Instruction often takes the form of e-learning modules that have to be clicked through.
Workers described the environment in the city’s clinics and community centers as substantially different than a computer quiz. For example, one social worker said: If someone starts yelling in the small, extremely crowded facility where they work, agitation spreads rapidly among patients who are often packed “shoulder to shoulder” in the facility’s waiting area with their pets and their belongings. In these situations, a security guard must know how to push through such a melee, speak calmly in response to threats, and never fight back.
The social worker felt that their clinic handled these situations well. But it handled them well, they said, because staff there had years of experience addressing such crises as a team.
More deadly situations, though, are harder to prepare for. In over a decade, said a nurse at Medical Respite and Sobering Center, she’d never been told what to do if there was an active shooter on site. Once, she said, she did not leave the building for 16 hours because she was the only person on site trained to provide emergency medical care.
Once a week, her colleague guessed, clients fight and someone has to be escorted out. Incidents like these are often not reported, because staff have not been trained on how to file those reports.
Still, both felt that security at their center was “light years ahead” of others thanks to the efforts of their managers, who paid out of pocket for screening wands. Other community groups helped install metal detectors before the city did.
“The city gets amazing people,” the veteran practitioner said. “But it does not understand how to support a workforce.”
Nurses at San Francisco General Hospital complained for years that their safety concerns and demands for more robust security protocols were ignored. Community healthcare workers say they, are left even more “naked.”
Veteran nurse Heather Bollinger compared security at the hospital to “Swiss cheese.” But, she said, the hospital is large enough that the presence of hundreds of staffers adds a level of safety that clinics lack.
Beyond General Hospital, safety changes rolled out more slowly
The “safety net” centers across the city are “the stepchildren of the Department of Public Health,” one nurse said. Security is getting better at some locations, she said.“But it’s not consistent.” For instance, security guards at one clinic may be trained to station themselves at the entrance post, while those at another are told to patrol the block.
Since Rangel’s death, the city has been tightening security. The Department of Public Health has installed weapons detection systems, security cameras, and badge readers. It has also hired additional security managers. Regular emails are sent to Department of Public Health staff detailing these and other improvements.
According to a Jan. 16 email sent to Department of Public Health staff, security staff were deployed to “10 previously uncovered clinical sites” and a “centralized threat escalation process” was launched.
“This builds on efforts to create a balanced program focused on prevention, response, and de-escalation,” the email said. It also gave staff information on who to call if they have a safety concern, in order “to reduce confusion and ensure faster, more consistent responses.” A Jan. 23 email announced that panic buttons in the clinics were tested.
In a Feb. 13 statement, a spokesperson for the San Francisco Department of Public Health wrote that a “100-person team of DPH and University of California San Francisco staff” has been working since December to make “significant investments in workplace safety and security throughout its entire system of care,” including “increased crisis prevention and response training.”
All facilities controlled by the Department of Health now have onsite security, it continued, and there are formal threat-escalation protocols in place for all staff.
But according to a Department of Public Health employee, there is no centralized team thinking about consistent safety protocols for community providers in the way that there is for security at SF General. Complicating the matter is the variety of places where DPH staff work — not all of them are owned by the Department of Public Health.
“They are trying,” a Department of Public Health employee said. But budget cuts are getting in the way, and the “stressed system is going to get more stressed.”
The city has not resolved the root of the problem, said another employee. That would be training an influx of new hires to cope with the unique challenges of working in “safety net” facilities.
Without that preparation, they said, fixes like guards and metal detectors will only create a “false sense of security.”