one is a thermal oxidizer. two types of abatement. >> does that also reduce smell? >> they both do. >> they both do? >> absolutely. yeah, like, for example the place in berkeley that they keep referencing corow, they have a five kilo roaster abated by a vortex. and they have never received one complaint. and i've actually personally stood above the stack at full second crack. and there's zero odor. and i have a letter from the. >> question for staff along those same lines is what do you know about smoke abatement? >> i put a ton of information in the packet. >> sorry. >> southwest team leader, that question directed to me or staff. we have limited knowledge. our staff did do some research herself and communication

with air quality management. she might be able to, gabriela. >> so part of the concern from the neighbors is the method they are going to abate the fumes that are going to be. so with the air quality staff member, the difference between what they are providing and what the bay area air quality actually identifies as being an abatement system is essentially the method. one method that the air quality staff members identify and give points for abating is one where they are doing thermal they break the parols down to essentially water. whereas their method the vortex they are referring to and that they have already is a different method where they are using speed to break down the particles. but in that case, the barrier air quality is saying they do not identify that as being an abatement so no

points are given to them if that makes sense. >> interesting. >> okay. so i don't see anything in front of us as a dr request as extraordinary. it's a business that's going into a urban area near schools. and we see this all the time. i think the question for me from the requester is about whether there are proper mitigations for the activity. and that is totally not in our per view. so we don't have jurisdiction over air quality. and i trust that the bay area air quality management board does. they are the experts. and they set the standards. and so i will be supporting this

project. >> commissioner fung. >> i'm going to take the opposite path. because if the bay area air quality board is not given this system, the same smoke abatement capabilities as the other one then, you know the fact that they already bought the system i think is a separate issue. i understand it's a financial issue. but i'm also leaning then, toward being conservative on these things and not seeing future appeals on this issue. >> commissioner johnson. >> would you mind coming up and just clarifying that last point that you made? so there's the

scoring or point system. and they give extra points for one type of system but both systems abate the smoke issues, correct? >> correct yes. so coffee roasting, the bay area air quality, what they analyzed and identified to me is there are certain levels of air pollutants that they allow to be put into the air. a certain stage those air pollutants become harmful and the way they test is done through various studies. and those air pollutants reach a threshold and the way they are tested is as the most sensitive body activity, for people who have asthma and all that, they take those conditions into consideration they analyze those and come up with these thresholds. at those thresholds they analyze things like the coffee roaster. they analyze if you are going to roast this amount of tons of coffee, what does that

mean in terms of air pollutant. they have certain thresholds. if your coffee roaster falls below the flesh holds they are saying there's not going to be any significant harm to the population of the area. they do allow you like say you go over that, there are methods you can reduce those one of them being you have this thermal system the abatement system and the other one being as identified the system that cycles the whole thing and breaks it down into particles. the system the bay area air quality identifies and gives points to but that's not they have studied to say that makes sense we'll give points to that kind of system. if that makes sense. >> to clarify, you are saying they don't give points to it because they haven't studied it? >> that's one method they haven't really looked at so they are saying the only one we identify and give points to is the one that uses the thermal system.

>> and that's the afterburner that's been discussed? >> yes. >> so the other system the proposer is proposing to you is a system they haven't tested yet. >> yes. >> have they commented? so i'm a little confuse ed. also explain the volume change. because they initially came in with the intent to roast a much larger volume air quality management had them reduce it to what is a .5-tons per day. >> yes. that came as a result of the mediation that happened in terms of how much of the coffee roasting are they going to do, how many hours they'll do. the final numbers we got they'll reach, if at that, they'll be at the 33 percent of the 90 percent they are allowed to throw out there. >> okay. so that's to me, the important point. because i feel like i don't want to go off on

the tangent of equipment. i just want to know did the air quality board assess this activity and did they say that under what they have, it is safe? >> yes, it is, yes. they did a preliminary study. they can't issue the permit yet because of the land use, which is why this process has to happen first before the bay area air quality can give them the permit to roast. >> okay. thank you. commissioner fung. >> i don't know how we become an expert on coffee roasting. and i understand that it's tied to the land use issue, which is the -- i don't think anybody here is against the coffee operation by itself. but in terms of the roaster is the same issue. i'm still leaning against

it. and but i am willing to consider a continuance if the parties can get together and mutually decide certain things, then i may consider that. >> so this is a discretionary review not a conditional use authorization. >> commissioner koppel. >> how so exactly? >> permitted use outside of the request for discretionary review so you have to have four votes to take discretionary review to deny the project right? otherwise it gets approved. so tonight would need a unanimous vote in order to deny the project or take the dr and

impose additional conditions. >> you're saying i cannot make a motion to continue? >> you can make a motion to continue. you can certainly continue the matter. >> i'll make a motion to continue. >> i'll second that. >> very good commissioners. how long? not long? you want to go to. >> commissioner johnson? >> i am just concerned that there are not clear directions for the continuance and we'll be in the exact same position in a few weeks. >> but we may have more commissioners. so i'm not in favor of a continuance. so i guess we can. >> your next available hearing date

is probably november 14th. >> there's no way we can condition the project sponsor to use a certain roaster is there? . >> i mean, the attorney is not here but i don't see why you couldn't. >> we have to continue if that were the standard. i disagree. so i'll just say i think that this is not within -- this is not within our purview. i think we are not qualified to be assessing air quality standards. i also, you know what weighs on me is it's really difficult for small businesses in san francisco. we have been talking about this for years, you know, when somebody finds a business model has bought the equipment has worked with the neighborhood, has done all the things that they are supposed to have gone through, the air quality management

board and it sits before us, i feel like they should get a decision from us. i don't agree with continuing it. and i also just agree that we would force them to -- disagree that we would force them to use that piece of equipment that is not required and where the activities have already been assessed as meeting the standard. >> so november 14. >> commissioner koppel. >> i was going to make a motion to approve it with the condition they use the -- what's it called? the afterburner. >> can we do that. >> because i'm not as concerned with the details of it but i'm concerned with being neighborly and acknowledging the request of the neighbors. >> commissioner johnson. >> i would just feel more comfortable if that is the direction but i feel like we would need to consult the city

attorney. so i would suggest a continuance. >> so november 14th? >> however, i would also say that i agree -- my voice -- i agree with president melgar that this is beyond the jurisdiction of the planning commission and as a land use, i think it's appropriate. >> just one more question. i'm not trying to get everybody to be an expert on air quality. i do think that is beyond the scope of what we normally do. but my understanding is the reason the air quality district signed off is because of the volumes that are now proposed. so if you're in a situation where they had higher volumes i could see the air quality district saying you need to do a different type of approach. but what they said is because the lower amount of volume emits only x amount, they seem

comfortable with it just like it was a car or any business that had emissions. >> that's right. and that was true prior to them mediating and reducing the amount they were going to roast. >> if it goes back to exposure. and i think the notion it's about how much of something there's always a certain amount of bad stuff that gets emitted from certain types of projects. they said as long as you don't exceed this amount, we are okay. and that's why they signed off is my understanding. >> commissioner fung. >> last comment. i understand that the issue of dilution in terms of exhaust. we've done a lot of dsl4 which is the highest containment facilities possible. and there are a number of things, the question is what bothered me was that

sometimes which you don't want in the air is not based upon how much. i think that's a very poor standard. in other words, they're saying that if you only do this much then it's not going to create any damage. that's possible. but it's not necessarily the best standard. >> okay. so we now have the city attorney who ran over here from her office. >> we should vote on the continuance because i don't think it's going to go. >> okay. let's vote on the continuance. >> there is a motion that has been seconded to continue this matter to november 14. on that motion fung? >> aye. >> johnson. >> no. >> koppel. >> aye. >> melgar. >> no. >> the motion fails two to two with commissioners johnson and melgar voting against. is there

an alternate motion? >> so i see that city attorney stacey is here. and so the question that commissioner johnson has, you want to restate it commissioner johnson? >> well, i think there was a potential motion to require specific type of abatement related to the roaster. that would be included in a motion of approval. and a question about whether or not that is something that we could do. >> president melgar, the city attorney's office. i will try to be helpful here. what i understand is that the air quality district did sign off on the

activities with certain type of protective devices installed is that correct? >> mr. washington. >> yes. they were signed off. but it was essentially the volume that they would be roasting. so they reduced the volume that would be done on-site not to exceed a certain amount that would be permissible. >> and the commission even with that reduced volume, the commission may be interested in applying an additional air quality measure beyond what the bay area air quality management district approved? >> yes, that is the question. >> commissioners i know there is some preemption of local ability to impose certain kinds of air quality measures. i

don't know the full range of what locally we would be preempted from doing. i am wondering if there's a more general condition that would work short of requiring a specific type of measure so that it would either give us time to look at what the city could do or what might be necessary or, again a continuance to allow us to look at that issue more specifically. there is some preemption under state law. i just don't know the full range off the top of my head of what is preempted locally. >> okay. so we've been requested a small break since we are down to the four of us. i think maybe do you want to make your motion again? you can't make

a motion again? . >> for something else, right? my original question is if i can make a motion to approve with the condition they use that specific roaster. the answer is no? that's fine. >> when we voted on the continuance, it was before the city attorney came and gave her opinion. and that's changed my vote that i think that if we come back with guidance of what exactly it is that we can and cannot do, i think it will be different. >> is there. >> motion to continue. >> second. >> november 14th. on that motion to continue to november 14th, commissioner fung. >> aye. >> johnson. >> aye.

>> koppel. >> aye. >> melgar. >> aye. >> so moved. the motion passes unanimously 4-0. >> we are now adjourned. so to the project sponsor before november 14th, we will have clarify on what we can and cannot do and make sure that all the commissioners understand that before we vote again on the dr request. thank you everyone, for coming out.

>> shop and dine in the 49 promotes local businesses and challenges residents to do their business in the 49 square files of san francisco. we help san francisco remain unique, successful and right vibrant. so where will you shop and dine in the 49? >> i'm one of three owners here in san francisco and we provide mostly live music entertainment and we have food the type of food that we have a mexican food and it's not a big menu but we did it with love. like ribeye tacos and quesadillas and fries. for latinos it brings families together and if we can bring that family to your business

you're gold. tonight we have russelling for wrestle community. >> we have a ten-person limb elimination match. we have a full-size ring with barside food and drink. we ended up getting wrestling here with puoillo del mar. we're hope og get families to join us. we've done a drag queen bingo and we're trying to be a diverse kind of club, trying different things. this is a great part of town and there's a bunch of shops a variety of stores and ethnic restaurants. there's a popular little shop that all of the kids like to hanghang out at. we have a great breakfast spot call brick fast at tiffanies.

some of the older businesses are refurbished and newer businesses are coming in and it's exciting. >> we even have our own brewery for fdr, ferment drink repeat. it's in the san francisco garden district and four beautiful muellersmixer ura alsomurals. >> it's important to shop local because it's kind of like a circle of life if you will. we hire local people. local people spend their money at our businesses and those local mean that work people will spend their money as well. i hope people shop locally. [ ♪ ] welcome to the epic center did you know that many buildings in san francisco are not bolted

to the foundation on today's episode we'll learn how the option to bolt our foundation in an earthquake. >> hi, everybody welcome to another episode of stay safe i'm the director of earthquake safety in the city and county of san francisco i'm joined by a friend matt. >> thank you thanks for being with us we're in a garage but at the el cap center south of market in san francisco what we've done a simulated the garage to show you what it is like to make the improvements and reduce the reflexes of earthquake we're looking at foundation bolts what do they

do. >> the foundation bolts are one of the strengthening system they hold the lowest piece of wood onto the foundation that prevents the allows from sliding during an earthquake that is a bolt over the original construction and these are typically put in along the foundation to secure the house to the foundation one of the things we'll show you many types of bolts let's go outside and show the vufrdz we're outside the epic center in downtown san francisco we'll show 3 different types of bolts we have a e poxy anchor. >> it is a type of anchor that is adhesive and this is a rod we'll embed both the awe hey that embeds it into the

foundation that will flip over a big square washer so it secured the mud sell to the foundation we'll need to big drill luckily we have peter from the company that will help us drill the first hole. >> so, now we have the hole drilled i'll stick the bolt in and e post-office box it. >> that wouldn't be a bad idea but the dust will prevent the e post-office box from bonding we need to clean the hole out first. >> so, now we have properly cleaned hole what's the next step. >> the next step to use e post-office box 2 consultants that mixes this together and get them into tubes and put a notice

he will into the hole and put the e post-office box slowly and have a hole with e post-office box. >> now it is important to worm or remember when you bolt our own foundation you have to go to 9 department of building inspection and get a permit before you start what should we look at next what i did next bolt. >> a couple of anchors that expand and we can try to next that will take a hole that hole is drilled slightly larger marathon the anchor size for the e post-office box to flow around the anchor and at expansion is going into the hole the same dinning room we'll switch theameter

we'll switch the holes so, now we have the second hole drilled what next. >> this is the anchor and this one has hard and steel threads that cuts their way into the concrete it is a ti ton anchor with the same large square so similar this didn't require e post-office box. >> that's correct you don't needed for the e post-office box to adhere overnight it will stick more easily.

>> and so, now it is good to go is that it. >> that's it. >> the third anchor is a universal foundation plate when you don't have room above our foundation to drill from the top. >> so, now we have our

foundation plate and the tightened screw a couple of ways to take care of a foundation what's the best. >> the best one depends on what your house is like and our contractors experience they're sometimes considered the cadillac anchor and triplely instead of not witting for the e post-office box this is essentially to use when you don't have the overhead for the foundation it really depends on the contractor and engineering what they prefer. >> talking to a qualified professional and see what

>> item number one roll call. (roll call). >> item number 2. general public comment. members of the public may address the commission for up to three minutes on any matter within the commission's 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 physician's 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 today's 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 nurse-practitioner 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 francisco fire 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 francisco fire 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 francisco fire 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 re-examines. 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 pre-existing

conditions that may impact an individual's ability to perform the job. we also will perform the commercial driver's 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 osha's 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 department's 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 cal-osha. 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 won't 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 physician's 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 ma'am. >> 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 top-heavy, 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 career-ending 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 shouldn't 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 don't 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 don't 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 can't 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 am 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 follow-up and logistically in if way the office runs we don't have that opportunity for follow-up 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 isn't 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 isn't preventative care a larger portion of that? >> the structure in which we

operate doesn't allow for that, and certainly on a case-by-case basis if an individual member wants to come back for follow-up that opportunity always exists. for example, in the course of an examination we discover that the member's 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 don't 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 isn't 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 doctor's office to decide whether the future is strong at the fire department. that concerns me. i don't 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 physician's office to improve the health of the department. what strategies are we implement 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 doesn't

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 don't 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 post-traumatic 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, they found i had this. how do i make sure this doesn't impact my ability to do the job. in that case we will provide consultation. we may even gauge in a conversation, dialogue with their primary care physician, and most of the time the doctor is doing the right thing. >> do you think having that mentality as a member, looking at the office of the physician your office, you and the people

that work for for you having the mentality this is a meeting that could potentially take my paycheck away from me, do you think that is a productive mentality to have? do you think it encourages members to come to your office to be open and honest about their health issues? >> i took time to answer that question because that is probably a question best addressed to the members. we don't see every single member on a regular basis. there are members who will we will see for a promotional exam and there is no reason for them to come into the office for