Chaos and Loss at a City Clinic

What Killed the Tom Waddell Urgent Care Clinic?

by Dr. Derek Kerr

• • • • • • • April 2025 • • • • • • •

Chaos is a feature of City clinics that serve challenging patients. These include those struggling with homelessness, poverty, addiction, mental illness and related diseases. The Department of Public Health (DPH) has long delivered special and compassionate care to this population. A notable example was the Tom Waddell Urgent Care Clinic on Ivy Street (aka Dr. Tom Waddell Way), named after a local physician and gay Olympian who died of AIDS. Over time, the Clinic’s services expanded to include Primary Care, Street Medicine, Shelter Health, Sobering Center, Respite Care, and the Street Overdose Response Team.

For years, the disorder visiting the Urgent Care Clinic was handled effectively – without compromising the quality of services. That changed in 2013 after Tom Waddell separated its Urgent Care and Primary Care services. Sources say that urgent Care was left dangling with inadequate staffing, supervision and clinical procedures. Several former Tom Waddell nurses, anonymized to prevent retribution, told the Westside Observer (WSO) how the resulting disorganization impacted clinical care and staff well-being. The WSO also reviewed 150 pages of correspondence between them, the DPH and beyond. By 2016, veteran nurses were protesting operational deficiencies that compromised patient care.

A new Nurse Manager came in 2017 but lacked on-site supervision as the Medical Director was split between Urgent Care and Primary Care. In 2018, a relatively new Charge Nurse was appointed to oversee patient care. None of the veteran nurses wanted the job due to fears of liability related to operational disorder. But there was no formal orientation and training for the new Charge Nurse - or any new employee. Previously, new staff received a 6-week orientation. In addition, the new Charge Nurse reportedly lacked the managerial skills to stabilize a high-stress workplace. Sources assert that her bullying and irascible style intensified tensions. And, her boss, the new Nurse Manager couldn’t control her intimidating behavior, while lamenting the “drama” roiling around him.

Somehow, existing policies and procedures went missing, and no written policies came with the reorganization of the clinics.

Instead, staff relied on spotty “institutional memory” to implement clinical protocols. Efforts to internally address these issues — plus staffing and equipment shortages — gained little traction.

These issues are red flags for regulators, but the complainants did not contact State or Federal authorities. Instead, a 2017 email from the nurses’ union, SEIU 1021, noted; “…the response from clinic management and HR managers has been totally inadequate and unacceptable.”

By 2018, two veteran nurses had elevated their complaints to “negligent patient care.” They protested that; “(we)… have picked up the tab for a team that is lacking in clinical experience and judgment and professional standards.” Both felt vulnerable practicing in a disorderly, unsafe environment. However, Human Resources (HR) declined to address workplace safety — claiming its domain was limited to allegations of misconduct.

The complainants sought redress from a succession of DPH officials. That led then-Health Director Barbara Garcia to order a 2018 review of reported lapses in patient care. Unfortunately, this investigation sparked hostilities toward the complainants. That August, Garcia was forced to resign due to a conflict of interests.

The clinical review withered.

Hostile Work Environment

Managers attributed operational problems to “factions” and “personality conflicts” rather than underlying systemic issues. Reportedly, the Nurse Manager told nurses that the allegations raised by the complainants were “not true.” That assertion dragged other nurses into the fray. Sources say the Nurse Manager enabled a split within the nursing team by using staff to garner support for himself.

At an impromptu nursing meeting, attendees were urged to say how upset they were about the complaint investigations. The tone was accusatory. Reportedly, the Charge Nurse insisted, “It’s not OK to bring this type of shit behind our backs.” One antagonist declared that no Union complaints should be made unless all agreed. These maneuvers aimed to turn other nurses against the complainants, a form of mobbing. The Nurse Manager did not intervene, sources say. Yet, the Board of Supervisors had passed a 2007 Resolution condemning mobbing — noting that excellent employees are often targeted.

In May 2019, two 20-year career nurses filed a Grievance against the Nurse Manager, alleging retaliation for Union activities, violations of the DPH Code of Conduct and harassment. It also referenced his inability to control the Charge Nurse’s profanities and scorn toward staff and patients.

The Grievance demanded;

1. Retraining or replacing the new Nurse Manager and the Charge Nurse.
2. Nurse Manager to work on the floor once a week to understand clinical issues
3. Nurse Manager to respond to complaints in writing and better mediate staff disputes.
4. Regular staff meetings to discuss professional conduct and clinical lapses.

The Nurse Manager rebutted the allegations of mismanagement directed at him and denied the Grievance. Moreover, HR stated that professional misconduct and patient care issues were not Union Grievance matters. That’s because the Memorandum of Understanding between the Union and the DPH only covered wages, work hours and discipline. Many allegations were discounted for falling outside the 15-day limit for a Grievance. For HR, there was “insufficient evidence of interference with Union activities.” One HR representative even accused the two nurses of “confabulating.” Oddly, that mental disorder had not been noticed during their two decades of service. However, some concessions were granted, like drafting a new Medical Director to supervise the Nurse Manager.

Without a resolution, disputes about patient care, bullying and mismanagement flared, leading Nurse #2 to mourn; “…no functional team nor ability for a collaborative, respectful work environment.” Nurse #1 requested reassignment from this hostile environment but was repeatedly denied. She was forced to keep working under a Nurse Manager against whom she had filed a Grievance. Her pleas to modify her work schedule in order to care for her dying father were stymied by bureaucratic nit-picking. In 2019, a Psychiatrist diagnosed her with PTSD and authorized a Medical Leave.

As management became more defensive, so did the complainants. They felt that management was “perpetuating a culture of silence and corruption…(and)…abusive behavior towards women.” Further complaints were filed with HR’s Labor Relations and Equal Employment Opportunity (EEO) divisions. These included allegations of whistleblower retaliation. The resulting investigations were marred by ever-changing investigators, egregious delays and opacity.

Workplace Becomes Toxic

In November 2021, Nurse #1 was shocked to learn that the Charge Nurse, while gossiping with colleagues, had falsely accused her of being “hypersexual” and engaging in sex with another employee on the premises. Incensed by the smear, Nurse #1 filed a sexual harassment complaint. It took HR 18 months to conclude that “…inappropriate behavior and violation of DPH policy occurred.” HR rejected the more serious charge of sexual harassment. For the Charge Nurse’s violation of DPH’s Code of Conduct, HR vowed that “…appropriate action is being taken…” But that did not include transferring the victim to another site as she had been requesting for months.

In 2021, yet another nurse (RN #3) filed complaints alleging harassment, bullying, and unprofessional conduct by the Charge Nurse. When a poorly planned program expansion saw nurses scrambling to fill staffing gaps, her concerns about inadequate staffing, supervision, and policies were spurned. Though not interviewed by the WSO, she joined other nurses in testimony at the 5/1/23 Civil Service Commission meeting (from 6 to 18 minutes). “During this time, I experienced adverse employment actions. I was removed from my position…while the employee remained in position.” But hostilities continued. So, “I ended up having to reassign to a new department completely.” Contrary to City declarations, speaking up drew retaliation rather than protection. In sum, “The City and HR fail to enforce their own policies. This also contributes to the loss of nurses and retention.” The WSO emailed the involved Nurse Manager and Charge Nurse for their comments. The former declined, and the latter did not respond. Importantly, our interviewees emphasized that their managers had also been trapped in a dysfunctional system.

Why Did This Happen?

A 2024 Medscape survey of 7,723 nurses showed that the worst part of the job was “administrative/workplace politics,” cited by 22%. That doesn’t fully explain the turmoil described above.

Poor Planning: The DPH has a history of setting up new programs without the planning, staffing and resources required to do the job. The notorious Flow Project that deformed Laguna Honda Hospital and eventually led to its 2-year shutdown in 2022 is a case in point. Similarly, the 147-bed Mental Health Rehabilitation Facility was thrown into chaos when forced to admit aggressive psychiatric patients circa 2000. Eventually most of its beds were switched to residential care and a Navigation Center called Hummingbird Place. The facility was rebranded as the Behavioral Health Center.

Likewise, in 2023, the Tom Waddell Clinic on Ivy Street was replaced by/rebranded as the Maria X. Martinez Health Resource Center on Stevenson Street. The sole remaining Tom Waddell Clinic provides Primary Care at Golden Gate Avenue.

Inexperienced Managers: When new, undertrained managers were brought in, they struggled to address complaints from veteran staff. They viewed these concerns as threats. Critics were isolated and badmouthed. Eventually, they were driven out.

Fearing retaliation, some bullied nurses kept quiet.

Favoritism in Hiring: According to RN #2, “Managers were selected based on who they know rather than qualifications. They did not want independent thinkers.” As a result, “Incompetent managers could not handle the split between the Urgent Care and Primary Care clinics.” Most of the managers previously knew each other personally or professionally, thus forming a self-protective “club of friends.” By covering for each other, there was “little accountability or follow-up on problems,” noted RN #4, another 20-year veteran. Moreover, a “white boys’ club” emerged, limiting diversity in hiring and sensitivity toward patients, while fostering racial bias and sexism.

Poor Complaint Resolution: Avenues to resolve complaints within DPH were broken. When nurses protested to Human Resources, they were swept into a suffocating bureaucratic maze, with demoralizing delays, dead-end referrals, and personnel churn. Their discrimination complaints lingered for years. Frustrated and sensing sabotage, they pursued multiple avenues of redress, generating more work for investigators. Unresolved, complaints intensified, up to; “…discrimination against patients due to their membership in protected categories.”

Meanwhile, unresolved discrimination claims raised the ire of Black employees in other City departments. Mayor London Breed hired Stanford Professor William Gould to investigate the widening complaints about the Department of Human Resources, especially its Equal Employment Opportunity (EEO) investigations of discrimination claims.

In 2021, the Gould Report validated the criticisms from Tom Waddell nurses and other distraught employees. Specifically, “In addition to these procedural inefficiencies, aspects of the EEO complaint process are not conducive to an independent and neutral investigation of claims. And, the end of the process frequently leaves serious workplace disputes and animosities unresolved.” Reforms ensued.

Mismanagement impairs employee morale and patient care. Conscientious employees will try to remedy the dysfunction. If ignored or repressed, they will burn out and leave. The antidote, suggests RN #2, is “A paradigm shift in internal philosophy — and a whole new team.” RN #4 prescribes “A complete overhaul of the DPH, starting with HR.” Their protests were not in vain. Records show that the Maria X. Martinez Clinic, which replaced Tom Waddell Urgent Care, now has written policies and procedures, training protocols, and a management structure that had previously been missing. Sadly, at least 4 devoted nurses left over 2 years — a loss for the DPH and its patients.

Dr. Derek Kerr is a San Francisco investigative reporter for the Westside Observer and a member of SPJ-NorCal. Contact: watchdogs@westsideobserver.com

April 2025