SAN FRANCISCO, Calif. — On Wednesday, Juliette Suarez, a UCSF licensed clinical social worker and UPTE member, published an op-ed calling for safe staffing standards for social workers at San Francisco General Hospital following the death of her colleague, Alberto Rangel.
On Dec. 4, 2025, Alberto Rangel suffered a “fatal stabbing,” which has “brought renewed urgency to…long-held concerns about safety” within San Francisco General Hospital clinics.
Following Rangel’s death, the Department of Public Health “added security at some hospital sites.” However, “many UCSF campus social workers are still working in clinics without security.” This includes times when “they conduct home visits and deploy street teams.”
Based on a survey conducted by the UPTE union of department-affiliated UCSF social workers, “90% of (them) reported experiencing some type of assault, threat or intimidation (physical, sexual or verbal) at work.”
Along those lines, “over 71% said they’re considering leaving their positions at UCSF due to safety concerns.”
More than half of the department-affiliated UCSF social workers “have been on the job for three years or less – and 80% of staff do not stay past six years.”
Because UCSF is constantly “losing experienced clinicians,” the system is “constantly trying to bring new people up to speed.” Suarez said this “disrupts continuity of care,” noting the “impacts every day in (their) clients’ frustration with long wait times, new faces they’re expected to trust and interrupted services.”
This uncertainty and fluctuating conditions “increase the risk for staff and patients.”
Suarez criticized UCSF’s approach, claiming staff are “under-resourced and underpaid.” She argued that this “cannot continue.”
An example of this treatment can be seen in the caseloads social workers manage at Ward 86, where some social workers carry caseloads of “as many as 600 patients.” By comparison, the Alameda Health System “enforces a patient ratio of 1 to 50 for social workers serving similar high-acuity populations.”
Suarez also emphasized that social workers are underpaid, noting UCSF social workers in department-affiliated roles are “paid less on average than colleagues at UCSF hospital sites like Parnassus, Mission Bay and Mount Zion.” Those locations “often serve more stable patient populations in lower-risk settings.”
Across all locations, staff hold “identical clinical licenses and (perform) the same level of work,” while UCSF social workers work in “higher-risk settings.” However, “UCSF does not allow its department-affiliated social workers to move up the career ladder available to their hospital-based counterparts.”
The inability to move up the career ladder further exacerbates “staffing problems,” as workers are forced “to move to higher-paying hospitals.”
The Department of Public Health released an audit in April “showing where leadership has fallen dangerously short.” Suarez stated that “UCSF supplies the frontline behavioral health staff to the department, but refuses to adequately invest in them.”
The audit “recommends immediately installing new weapons detection systems, increasing on-site security and creating a new governance structure to connect…the frontline staff…with department leadership regarding safety policies.”
According to Suarez, the audit “uncovered deeper structural issues and calls for ‘adequate workflow for outpatient and clinical setting grievances.’” She said that because social workers face hundreds of caseloads, “it backs up the system and makes patients upset, creating combustible situations.”
Additionally, the audit identifies it as a “risky practice” for staff to work alone without access to duress buttons or escorts.
The audit also acknowledges that “staff feedback must be embedded into decision making” because of workers’ “essential insight.”
The staff is “committed to breaking the vicious cycle of adverse care and preventable violence.” They stated that “safe staffing in healthcare is a basic, well-established standard – not an aspirational goal.”
Suarez called it “shameful that one of the wealthiest institutions in one of the wealthiest cities in the world has not made the investments necessary to keep San Francisco’s healthcare workers and residents safe.”
Overall, Suarez said she wants “the city and UCSF to take concrete action now” and is “calling for a real partnership between the city of San Francisco and UCSF to invest in (their) underfunded mental health programs.”
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