By Adeola Oni-Orisan, Erinma Ukoha, Maisha Davis
On July 8, 2020, Asmara Gebre, a Black certified nurse midwife, was leaving San Francisco General Hospital (SFGH) after a long shift. Her phone was dead, and her daughter was eagerly awaiting her return home. But as she left the hospital, Gebre witnessed six San Francisco Sheriff’s Department (SFSD) deputies harassing a Black man, and she decided she had no choice but to intervene. When Gebre boldly inquired about why the deputies were physically removing him from campus, the sheriffs refused to respond. Instead, they mockingly laughed and eventually left her alone with the man they had just deemed “dangerous” enough to be forcibly removed by six deputies.
Having witnessed enough hospital-sanctioned police violence, she sent a letter to her department and hospital administrators that evening informing them that she would be calling in sick every day that the sheriffs were still present on campus. “As a Black identifying midwife,” she wrote in her open letter, “I must stand with my people – even when I am scared or powerless.” In that letter, which currently has over 1,500 signatures in support, Gebre emphasizes that no singular event can encapsulate the collective harm that law enforcement has committed against our hospital’s most vulnerable populations in their most vulnerable times, especially patients who identify as Black, Indigenous, and People of Color (BIPOC).
Gebre’s story sheds light on the problem of involving the criminal justice system in healthcare. For the last 20 years, the San Francisco Department of Public Health (SFDPH) facilities have relied solely on the Sheriff’s Department for security services while attempting to provide healthcare to our county’s community members who depend most on our safety net services. The people we care for, as three Black physicians, come from diverse circumstances, and many bring with them complexities of trauma, adaptive and maladaptive coping strategies, economic inequities, and the burden of racism. Instead of providing a person-centered, healing environment, we ask our patients to seek care in a hospital with lobbies and hallways flanked by armed officers. We ask them to exist in clinical spaces inherently rendered unsafe for many by the sheer physical presence of sheriffs. Entangling sheriff presence with our medical care presumes the concept of safety requires armed law enforcement for all; an assumption which invariably leads to harm for many. According to recent data released from our hospital’s use-of-force reviews, in 2019-2020 there were 111 use-of-force incidents. In 70% of those incidents Black individuals were involved, despite representing only 24% of emergency room visits that year. This data mirrors what we all know to be the unfortunate truth: people of color – whether in our homes, schools, streets, or hospitals – are overwhelmingly victims of police brutality.
In the wake of national uprisings protesting countless police murders and a global pandemic that disproportionately affects BIPOC communities, our Department of Public Health has been pressured to address how it upholds systemic violence, racism, and white supremacy through its relationship with the Sheriff’s Department. The DPH Must Divest coalition originated in June 2020 after a petition penned by Dr. Maisha Davis, a family medicine physician, that called for the removal of sheriff deputies amassed almost 1,000 signatures. DPH Must Divest demands that hospital stakeholders vow to remove SFSD from our facilities and instead invest that $20 million annual budget in our patients and community.
As of today, our facilities remain in the less than 1% of hospitals nationally that use a law enforcement agency as their primary means of security. We understand that there have been and undoubtedly will be incidents where providers, staff, and patients feel unsafe or threatened, but we must choose to respond with nonviolent, de-escalation techniques as opposed to armed sheriffs. The vast majority of healthcare facilities in the US have systems to do so without resorting to penal measures. We must act now to create an equitable, community-centered system without armed officers, thus making safety and well-being a reality for all.
Now over a month into her strike, Gebre does not plan to return to work while deputies are still present. As the only Black midwife, it has been challenging to be away from her patients, yet Gebre remains steadfast: “Hands are an important tool in midwifery. Among other things, we are baby catchers. I have made an unwavering decision – I will sit on my hands until the sheriffs are removed. We are capable of re-imagining a just and evidence-based alternative to address the safety concerns in our facilities.”
Dr. Adeola Oni-Orisan is a third-year resident physician in the UCSF Family and Community Medicine program at San Francisco General Hospital. Dr. Erinma Ukoha is a fourth-year resident physician in the Obstetrics and Gynecology program at UCSF. Dr. Maisha Davis is a family medicine physician at Maxine Hall Health Center within the San Francisco Department of Public Health.