June 7, 2020

Dear Stakeholders,

Our world is entering an unprecedented time of movement and action; likely the first of its kind for younger generations and unlikely to be our last. The urgency of this unique moment, in this unique time, cannot be overstated. We are seeing institutions—once stolid in their stances to maintain the status quo—shift and change under the pressure of massive demonstrations and collective action. A 17-year-old girl named Tiana Day led tens of thousands of protestors over the Golden Gate Bridge on behalf of #BlackLivesMatter for the first time in history this past Sunday. Nearly 100,000 people assembled ~5,700 miles away across 3 cities in Germany to decry US policies, inaction, and ineptitude Through protests—civil and sometimes uncivil disobedience— the grip of structural racism and oppression is loosening. That is why we believe now is the time to acknowledge that police violence—the extension of patriarchal violence that it is—is a public health emergency.

We can not call for justice for all if we are unwilling to interrogate the ways we, too, uphold racism, white supremacy, and toxic patriarchy. It is time for us to address the Department of Public Health’s relationship to the San Francisco Sheriff’s Department; their presence in our hospital and community clinics, their impact on the mental and physical health of our most vulnerable patients, and the path to pursuing alternative forms of community “policing” (née accountability) for all patients.

Even before the ubiquity of social media live streams and internet activism, we knew violent incidents had been perpetuated against patients while in the “sanctity” of our clinical settings. Primum non nocere. First, do no harm. In our system and in our city, those who end up on the wrong side of a fist, a taser, a baton, or a gun are often mired with a similar set of overlapping characteristics: poverty, addiction, and trauma. When Fernando Guinill was brutally assaulted in the SFGH Emergency Department in November of 2015, the consequences meted out by the judicial system were not befitting the crime. This lack of accountability can no longer be tolerated. We, as health care professionals and as a healthcare system at large, cannot assign value to patients based on our own subjective and moralistic understandings of their underlying conditions. Conditions such as addiction, trauma, homelessness, and mental illness are inextricably linked to and propagated by the elements of structural racism; not individual deficit as capitalism would have us believe. We also find it to be unconscionable that within our public health system, the distribution of sheriffs across clinics reflects society’s inherent racialized beliefs around intrinsic threat. Why might it be that clinics like Chinatown Public Health Center and Ocean Park Health Center do not have police presence, but clinics such as Southeast Health Center and Maxine Hall Health Center do? Rhetorical in nature, the answer to this question screams of implicit bias and institutionalized racism.

No one deserves to be verbally accosted. No one deserves to be physically assaulted. No one deserves to lose their life in this way. Assuredly, no one deserves any of these fates when seeking help from us, those called to be stewards of their health and wellness. So this begs the question, why are we still here if these incidents, many which assuredly have not been caught on camera as in the example above, still occur?

The UCSF Family Medicine residents made an earnest attempt to change this reality several years ago. They drafted and released a statement in solidarity with the call to protect Black lives. They met with hospital administration. They staged demonstrations. They presented Grand Rounds, held multidisciplinary noon conferences, and began attending hospital safety leadership committee meetings. They identified stakeholders within the Board of Supervisors. Of note, they took these steps as active medical residents; working 40-80 hours week in and week out for what would amount to minimum wage if viewed through the lens of hourly work. Nevertheless, they persisted. The fruits of their labor, however, seemed to have faded into the background. Although they were not able to facilitate renegotiation of the MOU between the City of San Francisco and the Sheriff’s Department, they were able to draft a checklist with the hopes of decreasing egregious incidents of violence by increasing individual accountability. This checklist seems to be missing from our current procedures and protocols around security.

The General Hospital has not always had such a close relationship to the Sheriff’s Department. The private institutional “police” provided security which incorporated values of cultural humility and respect. As we know from study in the area, it is wholly important for community-oriented security to include agents of change who come from and are deeply invested in said community. This commitment must also carry with it a deeply embedded commitment to keeping all community members safe. We argue that rapport and relationships are at the center of the true and holistic approaches to security and without them we can never be “of” those we claim to serve.

Invariably there will be calls from some within our walls, aghast at the idea of abolishing our current system. Those who also have trouble imagining a world without police. Likely also those whose life or state of mind has never been threatened by individuals wearing the same uniform. We acknowledge that these folks’ concern for security is as valid as our concern regarding inequitable treatment. However, the solutions in this matter do not exist along a binary. We have to believe that between the hundreds of talented and compassionate people who comprise the Department of Public Health, there is enough brilliance and creativity to imagine a future without sheriffs within our institution’s walls and thusly making safety a possibility for all.

As such, we, the undersigned, have the following demands moving forward in this process.

1) Immediately disarm deputies working in the hospitals and clinics. We know that guns, pepper spray, tasers are not tools of de-escalation and we should be actively creating an environment where we can foster peaceful conflict resolution.
2) Mandatory de-escalation training and evaluation for competence using these protocols
3) Mandatory and regular mindfulness workshops
4) Offer a reconciliatory process for current and past victims of abuse and assault, including family members and friends who have also have been impacted by these events
5) Institute the checklist developed previously to document each incident where the
Sheriff’s Deputies are called to respond
6) Establish an oversight committee which includes patients, providers, and administrators
7) Do not renew the MOU between the Sheriff’s Department and City of San Francisco. We need an alternative option which better reflects our commitment to progressive community accountability.
8) Replace this system with one which hires individuals committed to trauma informed care, deescalation, and community investment.

We owe this to our patients, we owe this to our multidisciplinary colleagues, we owe it to ourselves to heed this call for change and adjust to a new normal where All our lives are valued, because Black lives are valued.