It happened after noon as people were leaving work for lunch. 

A car pulled up alongside another vehicle parked on Leavenworth Street near Golden Gate Avenue. Shots rang out through San Francisco’s rough-and-tumble Tenderloin neighborhood. When police arrived on the scene, they found two people suffering from gunshot wounds. A third victim later walked into a city hospital seeking treatment for a gunshot.

The Oct. 12 shooting rattled employees of Tom Waddell Urban Health Center, a medical facility on that street corner that serves some of the Tenderloin’s most vulnerable—homeless people and residents of supportive housing.

“Some employees felt traumatized, and they left and went home to just process the situation,” said Cheryl Thornton, an eligibility supervisor at the clinic who was working that day. “But others stayed working, because it’s happened before.”

Plus, there were still patients to treat.

Though a shooting at the footsteps of a public health clinic is a rare occurrence in San Francisco, it wasn’t the first time that the problems of the city’s struggling Downtown had endangered the lives of the people tasked with alleviating them.

For Laronda Mayfield, who works at the city’s Human Services Agency (HSA), the worst moment came two years ago, when a man charged through a plastic glass window over the front desk, destroying computers and forcing her and a social worker to flee out the back door. It took six sheriff’s deputies to restrain him, she said.

“That was one of the latest horrifying incidents I’ve experienced here since the pandemic,” Mayfield told The Standard. 

The problems faced by these workers—many of whom are city employees—came to greater public attention in September, when an inhabitant of the Windsor residential hotel stabbed a social worker four times in an attack the district attorney believes to be an anti-LGBTQ+ hate crime. 

In the aftermath, the victim’s union, Service Employees International Union (SEIU) Local 1021, said the attack could have been prevented had the city taken threats against the social worker more seriously. 

It’s a view that many workers on the front lines of issues like homelessness, addiction and mental health echo: They need more protection.

“You’re always on guard because of the neighborhood and what’s happening,” Thornton said.

Workers like these perform some of the most important—and least glamorous—jobs in San Francisco. They are tasked with keeping vulnerable people housed, fed and healthy.

“They are not the highest-paid people in the city, but they are the ones who are the glue to the city,” said Theresa Rutherford, president of SEIU Local 1021, which represents many of these employees.

But as the Covid pandemic and the proliferation of cheap, deadly fentanyl exacerbated problems like homelessness and addiction, these workers increasingly have felt threatened.

For Mayfield, the irate client hurtling through the plastic glass was just one of many incidents she and her colleagues have faced in the last few years.

She has worked in the Human Services Agency’s piebald Moorish Revival building on Mission Street since the agency moved there in 1992. Her job is to help low-income residents access benefits like supplemental nutrition and MediCal.

Her work is so important that she was one of the employees coming into the office every day during the pandemic. But that means she also saw the neighborhood deteriorate before her eyes as Covid shuttered San Francisco.

The block of Mission between Eighth and Ninth streets is a hotspot for homelessness and drug use in the South of Market neighborhood. She says it is traumatic and terrifying to see people using fentanyl and fighting in the streets outside.

“It just breaks my heart every single time,” Mayfield said.

It has gotten so bad that few HSA employees go out to lunch anymore or exit the building until their shift is over, she added.

But although the HSA building is guarded by a sheriff’s deputy daily, the neighborhood’s broader ills sometimes cross its threshold.

Last year, a man overdosed in the building’s lobby. When paramedics arrived on the scene and tried to move him, a gun fell out of his sock, Mayfield said. Another coworker was attacked on the day she returned from maternity leave.

“She didn’t even make it in the door,” she said. “I haven’t seen her since.”

In October, Mayfield turned to the city’s Human Services Commission to ask for help. “What is it going to take for us to get help?” she asked, according to meeting minutes.

In an email, the HSA told The Standard that it has contracted with Urban Alchemy, a nonprofit focused on improving public safety, to provide street monitoring, safety and de-escalation services. It has also assigned additional guards at the entrance, enhanced screening protocols at the metal detector and keeps in contact with police about safety and street conditions. 

The situation is similarly difficult at Tom Waddell. According to Thornton, one of her colleagues was physically assaulted and knocked to the ground while taking a cigarette break on the back steps. The Leavenworth side of the building—part of an area known as Pill Hill—is the site of many tents and a lot of open-air drug dealing and use.

In an email to The Standard, the Department of Public Health admitted that Tom Waddell is the “clinic most affected by violence in the area due to its location.” In the coming weeks, it plans to fit Tom Waddell’s public-facing windows with ballistic-proof acrylic overlays. 

The health department said it holds biweekly meetings with clinic leadership to address safety issues. 

The department “has been regularly surveying Tom Waddell Urban Health Center staff about safety concerns including increased building safety, potential security escorts and opportunities to receive trauma services, which are already accessible to them through SFDPH,” it said.

The Department of Human Resources added that, in agreement with SEIU Local 1021, the city had deployed signs in work sites across San Francisco to inform members of the public that assaulting a city employee is a punishable offense under California law. 

Despite those efforts, Tom Waddell remains a difficult work environment.

“We have encounters,” Thornton said. “Not all the encounters end up being violent, but you can have a verbal altercation from people who are psychotic and ill [all the way] up to physical violence.”

The problems are particularly acute in San Francisco’s single-room occupancy (SRO) hotels, which often house recently homeless and indigent people.

Many of their residents suffer from mental health issues, struggle with addiction and need support to stay housed.

That job falls upon people like Moises Vega, who has worked as an on-site case manager at Hotel Le Nain, an SRO in the Tenderloin, since February. His day-to-day tasks can range from helping residents apply for food stamps or paratransit to simply letting them place a phone call.

But although he performs a critically important service for some of the city’s most vulnerable people, Vega does not feel safe at work. 

Some residents have knives and other sharp objects, he said. They can become angry and aggressive, in some cases when using drugs.

“We get cussed out all the time,” Vega said.

A few days ago, a man who lives at Le Nain punched another in the face, he said. The latter hit back with his cane. Vega and his coworker were forced to put themselves between the man who started the fight and the other residents.

Le Nain lacks on-site security, Vega said. Instead, they called the off-site security company, but a guard never arrived. They also called the police, who came and talked to the man but did not take him into custody.

Vega says the hotel needs a security plan, a protocol that explains what to do in a dangerous situation like that. He believes it is particularly true after the Windsor stabbing, which left him shaken.

“I was just heartbroken,” Vega said. “That was an extreme failure.”

In a message to The Standard, the Department of Homelessness and Supportive Housing said it is updating its safety protocols in the wake of the Windsor stabbing. 

Among the changes will be a requirement that all supportive service staff are “completely trained in crisis management and de-escalation and have completed regular refresher trainings throughout the year,” the department said.

Unlike Vega, Carl Johnson isn’t a city employee and doesn’t enjoy public sector benefits. 

But he saw the problems Downtown San Francisco is facing up close during two-and-a-half years working at the Granada, a single-room occupancy hotel in Lower Nob Hill.

In 2020, the City of San Francisco purchased the historic hotel, which had long served as an affordable retirement community for seniors, and transferred it to the nonprofit Episcopal Community Services. The latter organization contracts with Caritas Management Corporation, a for-profit company that employed Johnson, to run the facility on a day-to-day basis.

But after the purchase, problems persisted at the Granada, including infestations of vermin like bedbugs and rodents and an egregious incident in which a resident was arrested for attempting to rape a 90-year-old woman.

Johnson says the Granada lacks some of the security features he has seen in other single-room occupancy hotels. 

The reception desk is not an enclosed, locking booth—which means the front desk clerk has no protection from an aggressive resident or visitor. When the property was undergoing renovations, some of the other exits were blocked off, making it even more dangerous for workers.

Johnson said he witnessed people entering the hotel with weapons like swords and machetes. He also felt the hotel was lax about its rules regarding drugs: Residents sometimes used drugs in front of staff.

While most residents followed the rules, some were more difficult and could become belligerent.

“At any time, you never knew how volatile they could be,” Johnson said.

Among his biggest concerns is the preparedness of the staff: Johnson had received de-escalation training at a prior job, but he felt that not everyone working at the Granada was properly equipped to handle risky situations.

In a message to The Standard, Beth Stokes, Episcopal Community Services’ executive director, said her organization had used $60 million in public funding to renovate the Granada, but that work remained to be done.

She stressed that Episcopal’s philosophy is “housing first,” meaning sobriety is not a requirement to remain housed, although the lease terms include a zero-tolerance policy for drug use in common areas.

“Our service staff regularly receive comprehensive training, including de-escalation, trauma-informed care, harm reduction, and overdose prevention and reversal,” Stokes said.

What eventually drove Johnson to leave the Granada wasn’t physical danger; it was logistics.

To get to work, Johnson needed to drive. But Caritas couldn’t provide him with parking. That meant racking up over $2,000 in parking tickets.

Caritas doesn’t “provide you any parking, and the city really doesn’t help because they have no mercy on you,” Johnson said. 

Eventually, his car was towed while he was at his second job with another housing nonprofit. Because of his tickets, he was unable to renew his registration. 

Lacking a means to get to work, Johnson decided to quit Caritas. He also lost his second job. Now, he finds himself in what he terms a “sticky situation.”

Johnson spent over $1,000 getting his car out of impound. Thanks to a sympathetic Department of Motor Vehicles agent, he received a one-day pass to move his vehicle. But his registration remains in limbo, and he’s still in the hole for parking tickets.

He sees the irony in racking up so many fines from the city while performing a job that is, effectively, a public service.

“We’re putting ourselves in debt trying to help the less fortunate,” Johnson said.

One thing is clear: Most people in these lines of work want more protection. The SEIU Local 1021 union wants to make sure city employees get it.

With the union members’ collective bargaining agreement set to run out in July, they are starting negotiations on a new contract. They want safety to be front and center.

There is always some inherent danger in the front-line work that these union members do, but the city needs to make it safer, according to union president Theresa Rutherford. 

“In the cases of areas like the Tenderloin, … the employer has not stepped up and done some of the standard, basic things that are necessary to create that safety,” she said.

Among its demands, her union is asking the city to do a safety assessment and create standard safety procedures for each work site. It also wants more sheriff’s deputies on the premises and more staff members of Urban Alchemy in the area.

SEIU Local 1021 is also requesting that the city provide its employees with parking and shuttles from work to parking and public transit.

The union wants de-escalation training for all city workers. That demand could be particularly important.

Vega, who had to stop a fight in the Hotel Le Nain just days ago, says he lacks de-escalation training. Thornton, who works at Tom Waddell Urban Health Center, is currently taking classes to increase her ability to handle thorny situations at work.

During the past 30 years, she has worked at public health clinics across the city. During that time, she has received de-escalation training. But after coming to Tom Waddell in the Tenderloin, she concluded it was not enough to safely work with the community in the Tenderloin.

She is currently taking mental health courses to better understand how to work with the population the clinic serves.

“Most people have trauma. They have addiction. They’ve been incarcerated. They’re unhoused,” she said. “Because it’s concentrated here, I believe you need more in-depth training on de-escalation and how to deal with it.”