University Professional and Technical Employees union members rally outside San Francisco General Hospital on Dec. 11 in response to the fatal stabbing of social worker Alberto Rangel. 

As a clinical social worker at San Francisco General Hospital, Julia Williams works closely with people whom many residents go out of their way to avoid. Her patients have severe mental illness, substance use disorders and difficult-to-manage behaviors. No other facility in the city will accept them. 

Williams, 30, is passionate about improving conditions for these patients. So much so that she returned to work just a few months after giving birth to her first child. 

Then a patient sexually assaulted her. 

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Williams was the patient’s primary social worker and had been painstakingly building trust. But one day last June, Williams said, the patient suddenly engaged in “impulsive sexual behavior” at the hospital’s inpatient psychiatric unit. Internal emails I reviewed corroborated the assault.  

The incident was “extremely traumatic,” Williams told me. But she only took one day off to cope. She’d already used her paid days off to extend her maternity leave, and even though she was eventually diagnosed with post-traumatic stress disorder, she felt guilty about taking more time. It would just put more pressure on her colleagues, many of whom were already juggling huge caseloads amid persistent vacancies. 

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Beyond that, Williams told me, being assaulted seemed to be part of the job description. 

“There’s this culture in inpatient psychiatry that assaults happen so often … that we’re kind of expected to bounce back quickly.” 

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A new survey of behavioral health social workers — who, like Williams, are employed by UCSF and work at community clinics, hospitals and other facilities operated by the San Francisco Department of Public Health — makes clear that she’s far from alone in her experience. 

The survey was shared exclusively with me by the University Professional and Technical Employees, a labor union representing licensed health care workers and research and technical support staff across the UC system. The union launched the survey following the horrific December fatal stabbing of Alberto Rangel, a behavioral health clinician at San Francisco General’s HIV clinic. The suspect charged with murder in Rangel’s death is Wilfredo Tortolero-Arriechi, a troubled patient who had repeatedly threatened hospital staff in the weeks before the killing. 

Among the 120 workers who responded to the survey — out of 190 recipients — an astonishing 50% reported being sexually assaulted or harassed at work. Of those, 40% said they’d been attacked at least four times, 60% said they’d been stalked or intimidated and 85% said they’d been threatened with violence. 

Ninety percent said they’d experienced some type of threat, assault or intimidation — whether physical, sexual or verbal — and had reported feeling unsafe at work at least once to management. But in half those cases, workers said, management took retaliatory action, ignored their concerns or took an “unreasonable” amount of time to address them. 

Unsurprisingly, more than 71% of workers said they’d considered leaving their jobs due to safety concerns. 

That includes Robyn Miles, 39, who’s worked as a behavioral health clinician at an outpatient clinic in the Mission called Citywide Case Management since 2012. Miles frequently does client community outreach — whether that’s the street or a single-room occupancy hotel. 

About a month ago, Miles told me, she was in the clinic’s lobby when a patient threw a cup full of coffee at her, hitting her in the head.   

Thankfully, Miles said, she wasn’t injured, and her manager told her she wouldn’t have to work with the patient anymore. But when the patient returned to the clinic a week or two later, the manager wasn’t there, “and there wasn’t actually a sense of who else would see (the patient), if not me,” Miles said.  

Miles told me she wasn’t necessarily opposed to continuing to work with the patient, but basic safety guardrails were lacking — such as clear protocols for identifying and managing potentially dangerous patients and an established emergency response plan. 

These eminently reasonable asks — along with a systemwide threat assessment and safety blueprint, protected paid time off for employees impacted by workplace violence and upgraded building security — are among the union’s top demands to UCSF and Department of Public Health leadership.  

“We have been screaming from the rooftops about this issue for years,” Matias Campos, a UCSF clinical pharmacist and the union’s statewide executive vice president, told me. “No one took us seriously.” 

Since Rangel’s killing, Campos said the Department of Public Health has started working in good faith to address workers’ concerns, while UCSF has been less amenable.

The union plans to hold a rally on Thursday at noon at UCSF’s Mission Bay campus. It will likely spotlight a resolution approved by the San Francisco Board of Supervisors in October urging UCSF to end its “inequitable two-tiered mental health care system.” The resolution notes that clinical social workers like Williams and Miles — who are employed by the university but work at publicly run health clinics — are paid 31% less on average than those who work at UCSF’s own medical centers, despite identical licensure, education and experience. 

Williams and Miles said this unequal pay structure contributes to high staff turnover, which disrupts continuity of care for the city’s hardest-to-treat patients — and arguably impacts the quality of life for other San Franciscans and the city’s overall recovery. 

In an unsigned statement, the Department of Public Health said, “Safety for our staff, our patients, and our community is not negotiable.” It further noted recent investments, including establishing onsite security, launching a 24/7 threat management team, installing a weapons detection system and improved lighting at the building where Rangel was killed, and putting panic buttons in many rooms and giving community workers portable ones. On Friday, Mission Local reported the California Department of Public Health determined San Francisco General had “no deficiencies” in state or federal requirements in an investigation following the fatal stabbing.

UCSF said in a statement that compensation is determined via systemwide collective bargaining between the Regents of the University of California and the union, and noted a labor agreement was just reached in November. 

The university said it’s working with the Department of Public Health to improve security, “reinforce reporting and response protocols” and reduce risk. UCSF added that it hadn’t seen the union’s survey or reviewed its methodology, but has “provided counseling services, leave options and workers’ compensation benefits to employees directly impacted” by Rangel’s killing, “promptly” reviews “concerns about intimidation, harassment or assault” and doesn’t tolerate “retaliation for raising workplace safety concerns.” 

For Williams, Rangel’s death — just six months after her own assault — drove home just how much trauma is “normalized” for front-line social workers. 

Guest opinions in Open Forum and Insight are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. Their views do not necessarily reflect the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.

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She’s trying to remain “optimistic” that as city and state leaders focus on resolving homelessness, mental illness and substance abuse on San Francisco’s streets, they will finally “appreciate and value and prioritize people working directly with these folks.” 

That’s the least they can do.

Emily Hoeven is a columnist and editorial writer for the Opinion section.

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