The fatal stabbing of Alberto Rangel, a 51-year-old social worker at Zuckerberg San Francisco General Hospital, earlier this month has brought to light long-standing concerns regarding security at the hospital, which serves as the city’s largest public healthcare facility.
Despite numerous warnings from whistleblowers and sanctions from state regulators over the past years, the tragedy has laid bare the urgent need for enhanced safety and security measures.
San Francisco General Hospital Had Escalating Security Concerns
Interviews conducted by the San Francisco Chronicle with more than a dozen current and former hospital employees, labor advocates, and sheriff’s office personnel reveal that before Rangel’s murder the staff had repeatedly flagged unsafe conditions and raised alarms about “high-risk” patients and frequent assaults on workers.
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The fatal incident involving Rangel seemed almost inevitable to many within the hospital, given the history of reported violence.
In response to this tragedy, Department of Public Health (DPH) Director Dan Tsai and S.F. General CEO Susan Ehrlich have pledged to implement comprehensive security changes. These include hiring an external firm to review safety practices across DPH facilities, increasing security presence, expanding screening and access controls, and fast-tracking the implementation of new weapons detection technology.
However, Tsai noted that overhauling security will require significant funding increases, a challenge given the city’s already strained budget.
A Hospital Under Pressure: Patient Overload and Workplace Violence Risks
San Francisco General is often referred to as the “hospital of last resort,” catering to patients that other hospitals refuse and frequently exceeding 100% capacity.
Internal records reviewed by the San Francisco Chronicle reveal a disturbing rise in workplace violence, with 324 incidents logged over a 13-month period ending in October 2024. A survey by the hospital’s union, SEIU 1021, found that nearly all respondents reported experiencing physical or verbal abuse at work, with many citing repeated incidents.
Staff, Labor Advocates Debate Security Measures
The debate over security measures has been contentious. Labor advocates have long called for metal detectors, panic buttons, and better lighting, but these proposals have been denied in past negotiations. Meanwhile, the number of sheriff’s deputies assigned to the hospital has decreased from 45 in 2022 to 28 in 2025, exacerbating staffing issues during the pandemic.
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In an effort to address these concerns, DPH introduced Behavioral Emergency Response Teams (BERT), composed of clinically-trained professionals to handle behavioral incidents. These teams have been successful in resolving most calls and reducing the use of force. However, significant gaps remain, as Ward 86 where Rangel was fatally stabbed lacks permanent deputies or BERT staffing.
In the aftermath of Rangel’s death, DPH officials have promised to hire independent investigators to review the incident and security protocols. Yet, despite these assurances, frontline workers continue to express unease, questioning the adequacy of the measures in place.
