San Francisco Department of Public Health Completes Comprehensive Safety and Security Assessment Following Tragic Incident at Zuckerberg San Francisco General Hospital

San Francisco, CA – After the tragic incident in Ward 86 on the Zuckerberg San Francisco General Hospital (ZSFG) campus last December when a valued UCSF social worker, Alberto Rangel, was assaulted by a patient and later died, the San Francisco Department of Public Health (SFDPH) completed a comprehensive assessment of safety, not only at ZSFG, but throughout the entire SFDPH system of care.

In order to better protect staff, visitors, and patients at ZSFG and across all of the Department’s numerous locations - clinics, health centers, administrative offices, jail health services, and field-based programs - DPH activated an Incident Management Team that brought together more than 100 leaders from DPH and UCSF to lay the groundwork to make immediate and long-term safety improvements. The department’s safety and security assessment examined security needs across the Department, while at the same time, immediate safety enhancements were made.

Today, SFDPH released the Department of Public Health Safety and Security Assessment which details the sequence of events leading up to the tragic incident, as well as lessons learned, the rapid response, and ongoing investments to strengthen security and safety. The assessment can be found at this link.

Central to this effort was listening to the concerns of frontline staff, thousands of whom contributed by identifying potential areas for improvement through emails, town halls, anonymous surveys, listening sessions, and direct outreach. The voices of DPH and UCSF caregivers, combined with expert security and operational analysis, have shaped the assessment and are guiding lasting, systemwide improvements to workplace safety. The department has committed $15 million annually to support this fundamentally strengthened and modernized approach to safety and security.

“We are committed to maintaining safe and secure environments for the staff, patients, and visitors who rely on our care every day. Robust security protocols, dedicated personnel, and ongoing training programs have long been in place across SFDPH’s extensive network of hospitals, clinics, health centers, and community-based sites. And, I want to be clear, we can and must do more. This assessment and these investments will have a lasting impact on the safety and well-being of all who walk through our doors. Alberto was a beloved social worker at Ward 86, and we will continue to honor his memory,” said Director of Health Daniel Tsai.

“We heard from many staff members within ZSFG and our partner clinical sites about ways to make meaningful and lasting improvements to safety. Staff also reminded us not to forget the importance of making sure our patients feel welcome. We need to remain accessible to our vulnerable City residents, while instituting changes that protect everyone who walks through our doors,” said Dr. Susan Ehrlich, CEO, Zuckerberg San Francisco General Hospital.

“Together through this collaborative assessment process we intend to avoid a future tragedy. We are committed to working with the Department of Public Health to constantly advance improvements in order to make sure our working environments - both at ZSFG and everywhere our patients are seen - are as safe as possible while maintaining a welcoming, humane environment essential for people seeking care at the General,” said Dr. Jeff Critchfield, Vice-Dean for the UCSF School of Medicine at Zuckerberg San Francisco General Hospital.

The comprehensive assessment identified ten areas for targeted improvement. Since December, significant actions were taken in each area, with many additional improvements planned or in progress.

1. Clear and timely responses to assess and manage security threats
2. Security measures at ZSFG’s Building 80/90
3. Proactive approach to security and incident mitigation
4. Improve facility security through environmental design
5. Clear and transparent safety measures
6. Effective and impactful staff training for emergencies
7. Consistent safety and security policies, including a clear triage process
8. Security protocol for field staff
9. Consistent incident communications and notifications
10. Consistent availability of duress devices and call routing

The full assessment can be found here.