Jurisdiction and does not appear on the agenda. Speakers shall address remarks to the commission as a whole and not to individual commissioners or department personnel. Commissioners are not to enter into debate or discussion with the speaker. Lack every response does not necessarily constitute agreement with or support of statements made during Public Comment. Thank you very much, madam secretary. At this time we will ask for general Public Comment. Any member of the public wishes to give Public Comment, please approach the podium. Seeing none, Public Comment is closed. Item 3 approval of the comments. Discussion and possible action to approve meeting minutes. Minutes from regular meeting on september 25, 2019. Thank you very much, madam secretary. At this item approval of the minutes we will ask for Public Comment. Any member of the public wishes to give Public Comment, please approach the podium. At this point Public Comment is closed. Commissioners. Thank you very familiar. Very thank you very much. We have a motion. We need a second. Thank you very much. Moved and second. Call for the question. In favor say aye. Approved. Thank you very much. Item 4. Update from Department Physician to provide an update and overview of the duties and responsibilities in the Physicians Office. Good morning, raymond terrazas. Welcome to the commission. Good morning commissioners, chief nicholson, invited staff. Could you reflect that the commissioner has joined us for the Commission Meeting this morning. Yes, president. Good morning. Thank you very much for the opportunity to provide this update to you. It is with great pleasure that and with humility that i stand before you here today. So for todays presentation, i will review with you the operations of the office of the department of the physician. Even though i am the one standing before you, please understand there is i do work with a wonderful and very dedicated staff that includes our nursepractitioner and miss Barbara Marino who provides administrative support. She is a fixture in the department and dedicated Civil Service employee. So before i begin my presentation, i think it would be important to review with you the Mission Statement, and also to review the role that the office of the Department Physician plays in the San FranciscoFire Department. Then lastly, i will provide opportunity for questions and answers. I will keep my presentation brief in deference to the chief and command staff so that they can discuss important matters with you. Any Mission Statement begins with a vision. Our vision is very simple. It is to support the mission of the San FranciscoFire Department. Our mission in the office of the Department Physician is plain and simple to protect the health and safety of the members of the department. One of the functions of the office is to guide, direct and advice members of the department concerning their health, fitness and to advise the chief on the individual members suitability for performing the essential functions of the job. In order to accomplish this, we evaluate all candidates for the San FranciscoFire Department in an effort to identify any medical condition that could affect their ability to perform the essential functions of their job and engage in emergency operations. Then we will also inform the chief of the department whether any individual candidate or a current member is medically certified to perform the essential functions of the job. We perform all of the medical examinations for all of the entry level positions in the Fire Department, and we also perform all of the promotional and probation air reexamines. The examination is quite extensive for candidates, not only does it involve ahead to toes examination we perform forensic testing in the office and we will obtain Laboratory Examinations that includes blood tests, ekg, pulmonary function tests, hearing tests, and all of these are geared towards identifying preexisting conditions that may impact an individuals ability to perform the job. We also will perform the commercial drivers exam for the handful of employees in the department who require that for their job, and for current members, we will evaluate the results of their hearing tests and in an effort to make sure that the department is in compliance with oshas Hearing Protection standard. In addition, we certify members for use of respirators as part of the osha protection program. Under the transmissible disease standard for which the Fire Department is a covered entity, we also will review the results of the annual Tuberculosis Testing that we perform for members. And since the standard also encumbers the employer to provide vaccines for transmissible diseases, we provide all of the vaccines that are covered under this standard. The affor mentioned programs in isolation may not appear to be significant, but they are a major component of the Departments Health and safety program. One thing that i would like to mention is that annual testing for tuberculosis is about to undergo a radical change in the United States as it pertains to healthcare workers, and since First Responders are considered to be covered under the healthcare worker, annual Tuberculosis Testing is going to go buy the wayside. Other entities have implemented the recommendations from the cdc, and the only barrier that prevents hospitals in california from making that change and for that matter covered entities, is a change in policy at the level of calosha. That is coming down the road. We also perform all of the return to duty evaluations for members of the department, and a return to duty evaluation is performed whenever a member has been in a period of temporary or partial total disability. The purpose of the return to work evaluation is to facilitate transition to regular duty. Then at the request of the department, we will also perform fitness for duty evaluations, depending on circumstances. The office of the Department Physician assisted with managing the assistance program. We are a liaison between the department and the Workers Compensation department in that role we provide advocacy for the member. We also assist in case management. We facilitate the scheduling of appointments, we facilitate the arrangement and scheduling of needed tests, and then we also serve as the vehicle for transfer of information that the division of Workers Compensation needs in order to adjudicate a claim or to manage a claim. For future opportunities we are always looking to reevaluation or operational activities, and to that end i would like to mention that we are near embarking on a new paradigm for tb and hearing testing in the department. We recognized a while back that the manner and logistics of how tb and hearing testing occurred in the department was logistically cumbersome so we put in place a plan for embarking on a mobile platform for bringing the tb test and hearing test to the station. We wont be able to bring it to every single station, but we will be able to bring the testing to individual battalions. Once we implement the mobile platform, we could also look at leveraging the program for bringing other services on a battalion basis to the members. Any questions . President nakajo thank you very much, doctor. Does that conclude your briefing this morning . Yes, sir. President nakajo all right. We will have members of the public to give Public Comment on the presentation. Any member of the public wishes to give a comment on this physicians report, please approach the podium. Seeing none, Public Comment is closed. We have questions or comments from the commissioners. Thank you very much, Vice President covington. Thank you for being here, doctor raymond terrazas. I have one question related to the performance of the dnz and dot commercial driver exams. Could you tell us more about your involvement in those . The office will perform those examine nations for members that need them. It is only a handful. Is it a physical or eye exam, what kind of exam. Full physical exam mandated by the department of transportation for any commercial driver or anyone who fits the definition of commercial driver, and there are various identifiers and requirements for the examination. So which members of the department would have to what are the titles of the members of the department that would have to come to you for this exam . They are mostly based out of the bureau of equipment. If you are going to drive a vehicle that has more than 12 passengers, you have to be certified by the department of transportation as a commercial driver before you can drive that vehicle. I see. All right. How long have you been head of the office of the department of the physician . 11 years, maam. During your tenure, have you seen any particular trends you would like to share with us in terms of the health of the department . One major change reflects the age breakdown of the department. When i entered the department, we were topheavy, so to speak. Quite a number of members in the department who were chronologically gifted. As younger members have come into the department with increased hiring in the last decade, the age profile of the department has changed, and, consequently, just when ever there is a change in the age profile within an organization, you are going to have a difference in injury rates. You will have a difference in sickness rates, and for that matter career ending injuries. The good news is that we have fewer careerending injuries. We also have many more women in the department now than previously. Have you noticed any particular challenges that women in the Department Face . Not in terms of their ability to perform their job. There is no question there is no difference there. There never was and there shouldnt be, but one has to recognize that the pressures that women face are going to be different than the pressures that men face just because of where our society is today, and that may exert some psychological stress of one degree or another. I am not saying they are more prone or they have more of one or the other, but their position in our society places excess pressures on them in that regard, and in that regard they may face a higher level of stress. But those are psychological as opposed to physical challenges. Are there any physical challenges you noticed . None. Nothing that would be gender specific . Correct. What about the incidents of cancer in the department . Cancer has always been an issue, and more and more because of changes at the division of Workers Compensation, cancer is more readily recognized as being work related. Fewer claims are being denied for cancer. There is an increasing body of evidence that clearly points to the fact that firefighting as a job is a carcinogen, and there is no dispute there. With continued exposure to fire suppression, with continued exposure to the hazards, toxins, chemicals, the cancerous soup that exists at any fire, there is always going to be exposure, and our members will always be at risk. From a medical standpoint, where would your profession, not you individually perhaps, but where would your profession rank firefighters in terms of the most challenging, physically challenging careers . No dispute there, high. Number one, two, three . As far as occupations, it probably is on par with law enforcement. Not as high as military because obviously military is the most, but it is up there. Then if you take into consideration that firefighters dont have access to certain Safety Equipment that may be other industries are able to use, you have to factor in the qualifier that firefights is far more hazardous. Okay. Thank you. You are welcome. President nakajo thank you very much. Commissioner. Good morning, doctor. How do you see your job as far as or the job of the person in this position as far as the eyes of the members are concerned . Let me know if you dont understand my question. Could you clarify, please. Commissioner veronese i am trying to understand. When a member comes into your office, is he coming to get a checkup or concerned about his job . Well, the most common context in which we are going to see a member is in the context of return to duty. You know, 90 to 95 of the time it is going to be an uncomplicated process. The member wants to come back to duty. There is no reason why they cant come back to duty and so we facilitate that. So the percentage of your time is spent on return to duty and what percentage would you call that . Is it 90 of your job is return to duty calls . I would say more like 75, 80 just because of the fact that the end probationary candidate exams occur throughout the year. How much of your job is Preventative Care . Since we are not involved in the actual care of individual members, technically speaking, it is minimal. However, every time we see a member for an examination for a return to duty, we talk about prevention. Why is Preventative Care minimal, using your own words, as part of the job of your office . What i a i am hearing if it is correct you said the health and safety of the members is the primary mission of your office. Why is Preventative Care not a bigger percentage of what you do . Maybe i misunderstand the question. You said Preventative Care is a small percentage of what you do. That is what i understood you said. Your idea of Preventative Care might be different than might be. The rubric that i am coming from is one where we engage the patient on a regular basis for continued followup and logistically in if way the office runs we dont have that opportunity for followup care. We have an opportunity when the member comes to the office to devote a portion of the time that we allocate for the member to prevention, yes. That is my question. Why isnt it a primary . If the mission of your office is to if the core mission of your office is health and safety of members, why isnt Preventative Care a larger portion of that . The structure in which we operate doesnt allow for that, and certainly on a casebycase basis if an individual member wants to come back for followup, that opportunity always exists. For example, in the course of an examination we discover that the members cholesterol level is elevated, we will ask first and foremost they address it with their primary care of course and care physician to address that issue and we invite them to follow up with us to make sure the cholesterol levels are improving. We dont mandate they do that. There is nothing within our structure that allows for that. Again, on a voluntary basis, it does happen from time to time. You said that twice now there is nothing in the structure of your office that provides that. What do you mean by that and why isnt there a structure if the primary mission of your office is to support the health and safety of our members . If there is a deficiency that we need to file structural deficiency to fill there. As a commission we need to know that. Why is it that members are only coming to you for return to work stuff . What that says to me is i am going to the Doctors Office to decide whether the future is strong at the Fire Department. That concerns me. I dont think, in my opinion, your office should be that. It should be what your mission says to promote health and safety of your members. If members are walking into your office thinking am i going to have a job when i walk out of here, that concerns me. I would prefer people are coming to your office saying how do i improve my health . What is it we can do as a Physicians Office to improve the health of the department. What strategies are we impleme implementing to improve the health of the department. What is the structural deficiency you are talking about . It speaks to the fact an individual member has a relationship with their primary care physician. They have entrusted the physician for guidance on those matters. When they have a concern, they will go to their primary care physician and get the advice that they seek. They may give us feedback. They may loop back with us to say, hey, i went to the doctor, they said this was going on. How do i ensure this doesnt impact my ability to do the job, and we will take a look and 99 times out of 100, the primary care physician is doing the right thing. Okay. The structural deficiency you are talking about is more of a protocol set where people are we dont see members of the department for physical health and welfare, they go to their doctor for that. If there is something that determines that they can do the job as opposed to doing what the primary care physician is doing, making sure the preventative measures are there to make sure that member is not contracting posttraumatic stress syndrome or cancer or any of the things we know are incidental and hazardous things that occur in this job . Am i reading that correctly . I would say yes. The member is entrusting their primary care physician for guidance on many of those issues, and again from time to time they may come back to us and say, hey, i went to see my doctor,