The crash happened just before 8 pm, at the intersection of Divisadero and Grove Streets.
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Police say a suspected DUI driver was involved in a fender bender.
When the suspect tried speeding away, he or she ran a red light at the intersection hitting a car.
The suspect's then vehicle careened into the opposite direction and slammed into a third car head-on.
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The driver in the other vehicle is said to be in "grave condition."
Four others suffered non-life threatening injuries.
Police say drugs and alcohol are suspected.