The day Corinna Heyn-Jones was brutally attacked in San Francisco General Hospital’s emergency room, she said, the unit was functioning as it often does: understaffed and overwhelmed.

As she grabbed supplies near the nurses’ station in the center of the unit, a patient — agitated and unrestrained — punched her in the face and grabbed her short blond hair.

A nearby sheriff’s deputy, two deputy police officers and some colleagues scrambled toward the petite nurse and attempted to pry the patient off her. But the patient’s grip was unrelenting. She said the patient thrashed her to the ground, jammed her head against the floor, grabbed at her eye-sockets and shoved fingers into her upper lip.

Heyn-Jones — who is considering suing the hospital for allowing an unsafe work environment — said she felt as though the abuse would never end.

Of course this is happening, the 31-year-old travel nurse remembered thinking after she was pulled to safety.

It was only a matter of time.

Several nurses who work in the emergency room said the Oct. 3 attack is not unusual.

In San Francisco’s public hospital emergency room, they say, violent assaults on nurses are a likely outcome. They see the violence as a symptom of deeper issues at the hospital, which has struggled to handle a dramatic increase in patients — many of them homeless, mentally ill and drug-addled — coming through its doors.

The hospital declined to discuss details of the attack, citing patient privacy, but another nurse present confirmed Heyn-Jones’ account.

After receiving numerous complaints from hospital staff, Cal/OSHA, the state agency that oversees workplace safety, and the California Department of Public Health opened separate investigations into conditions at the hospital late last year. While the agencies declined to discuss details of the investigations, more than a dozen nurses interviewed by The Chronicle described an emergency room in frequent disarray.

Chronic understaffing, they said, leads to inadequate care and assaults on nurses from patients who are psychotic, drug-addicted or both. They described gurneys with overflow patients in the hallway and homeless patients who are discharged — often with just a turkey sandwich and bus token — to make room for others in the jam-packed waiting room.

The nurses work in several departments — the emergency room, psychiatric emergency services and in a locked inpatient psychiatric unit. Many of those interviewed are members of Service Employees International Union 1021, a labor union that often spars with city departments. In accordance with its policy, The Chronicle agreed not to name some nurses, who feared retaliation from their employer.

The conditions at the hospital have also caught the attention of San Francisco City Hall.

Mayor London Breed and the Board of Supervisors recently passed legislation, called Mental Health SF, that promises more case managers and treatment spots around the city. Elected officials hope such changes will reduce the number of people who tumble into the emergency room after running out of places to go for help.

But it might be years before all the changes from Mental Health SF are in place, and it’s not clear how the city will pay for the increased resources.

Terry Dentoni, chief nursing officer, said she sympathizes with her staff. She said management is working on changes to improve conditions, such as streamlining the hiring process, adding more social workers to the hospital’s Social Medicine Team, and creating better workplace violence-prevention training.

“There are really complex patients, and we are trying to manage them differently,” Dentoni said. “We have tried to keep being innovative. ... Is there opportunity to do things better? Absolutely.”

At the core of San Francisco’s homelessness and mental health crisis is a dearth of housing, shelter beds, drug treatment programs and mental health professionals. There are more than 8,000 people living on the city’s streets, a 17% increase from two years ago.

Many turn to S.F. General for help. “We can’t say no. We don’t say no,” said Christa Duran, an emergency room nurse. But, she said, “we are put into a position where we are outnumbered.”

Emergency room visits increased from 68,000 in 2015 to 82,000 in 2018. That number dipped slightly in 2019 to 79,000. The increases can be attributed to a new, larger emergency room with more capacity; changes in state insurance that cover more people; and more homeless people with complex needs on San Francisco’s streets.

Dr. Christopher Colwell, chief of emergency medicine at S.F. General, told The Chronicle in October that the emergency room cannot be expected to handle everyone — particularly those coming off the streets, whose needs could be largely met with primary care, drug treatment programs and housing.

“As a whole system, we are not adequately caring for this group of patients,” Colwell said. “We have a lot of people who need help with substance use issues, and the hospitals are not always going to have the resources to manage all of those.”

But even as visits have increased, the number of nurses has not kept up with demand.

S.F. General is actively trying to fill 75 vacancies in its staff of about 900 full-time registered nurses, according to the hospital. About 14 of those full-time positions are in the emergency room. Several nurses said 14 more positions might not be enough to handle the demand.

The hospital says it takes an average of 147 days to hire a new nurse. The Department of Public Health recently hired a new director of human resources to figure out how to streamline the hiring process.

“We are aware we are not fully staffed at all times and are taking all steps possible to hire in a timely fashion,” said Brent Andrew, spokesman for the hospital.

John Fazio, a clinical nurse specialist in the emergency department for 34 years, said short staffing has a cascading effect on patient care.

Several beds in the 58-bed department are unavailable or shut down nearly every day because of staffing shortages or patients waiting for admission elsewhere in the hospital. Still, he said, nurses are left to supervise several high-needs patients at a time.

Meanwhile, nurses are sometimes required to work overtime to make up for short staffing.

“This is the worst I’ve seen the department in 34 years,” he said.

Assaults tend to happen more frequently when patients are agitated and left without direct supervision, said Jen Ford, a per-diem nurse who was present during the October attack on Heyn-Jones.

The hospital keeps statistics on workplace violence, but Dentoni, the chief of nursing, said they may be unreliable because of assaults that may go unreported or officially logged. But the hospital has created a workplace violence committee that focuses on preventive strategies and de-escalation.

Still, several nurses said they often feel unsafe coming to work— despite the creation of the new committee.

Ford, who said she has been attacked numerous times herself, has been on the emergency room’s violence prevention committee since it was formed in November. But she said nothing new has been implemented since then.

“We lack the appropriate staffing to give direct one-on-one or closer care to patients,” Ford said. “I’m overwhelmed by the safety concerns when I go to work. ... You just put your head down and do the best you can.”

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Inside the emergency room on a recent afternoon, two units for lower-need patients seemed to run smoothly. But the third unit, reserved for extremely sick patients, including those with behavioral health issues, was so full that two patients waited on gurneys in the hallway.

In another wing at Psychiatric Emergency Services — a unit meant for about 20 patients experiencing psychotic episodes — two police officers could be seen near a patient on a gurney, while another man waited to be let into the unit.

When a reporter attempted to enter the unit with the hospital’s director of communications, a staff member stopped them.

“It’s not safe in here right now,” he said.

Psychiatric Emergency Services faces many of the issues of the emergency room: understaffing and overcrowding.

The unit is often so crowded that it operates on “condition red,” which means it cannot accept more patients. From October to December, the unit was on condition red 40% to 54% of the time.

Dr. Mark Leary, deputy chief of S.F. General’s psychiatry department and acting head of the psychiatric ER, told The Chronicle in November that a reason for the increased numbers could be that patients are staying in the unit longer because of a lack of beds available elsewhere.

“Whenever there is a bottleneck anywhere in the system of care,” he said, “it’s going to have a ripple effect.”

The nurses who spoke to The Chronicle have become so concerned about conditions at the hospital that they have been holding rallies, flooding public comment periods at the Board of Supervisors and signing petitions demanding change.

A group of them worked with Supervisor Ahsha Safaí this month to draft a resolution urging the Public Health Department to pay heed to their concerns.

Many said the attack on Heyn-Jones was their breaking point.

For Heyn-Jones, the attack will probably be the last time she steps into an emergency room.

While she has recovered physically, she said the emotional trauma remains.

As a travel nurse assigned to temporary jobs, Heyn-Jones said she has been stationed in emergency rooms all over the U.S. and around the world, from Texas to Uganda.

Never, she said, has she felt as troubled and unsafe as she did in San Francisco General Hospital’s emergency room.

“Every ER has an element of risk,” she said from her home in Canada, where she returned after the attack. But at S.F. General, “I was concerned one of my colleagues would get killed one day.”

Trisha Thadani is a San Francisco Chronicle staff writer. Email: tthadani@sfchronicle.com Twitter: @TrishaThadani