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SFFD department physician outlines duties, warns mandatory health screens stalled as members distrust program
Summary
Department physician Dr. Ramon Terrazas told the commission his office focuses on candidate medical exams, return-to-duty and OSHA compliance, but said mandatory periodic exams were suspended for low participation; union representatives said members lack confidence in the physician's office and cited delays in return-to-duty cases.
Dr. Ramon Terrazas, the San Francisco Fire Department's department physician, told the Fire Commission that the physician's office exists to "protect the health and safety of the members of the department," describing routine duties including entry-level physicals, promotional and probationary exams, return-to-duty and fitness-for-duty evaluations, respirator certification and hearing and TB testing.
Terrazas said the office performs comprehensive medical testing (laboratory tests, EKG, spirometry and audiometry) for candidates and current members who require certification to perform job duties. He described ongoing programs for respiratory protection and hearing, and said TB testing logistics and annual hearing testing are being rethought to move toward mobile testing platforms that could serve individual battalions.
Commissioners pressed Terrazas on preventive care, cancer and PTSD screening and whether the physician's office could do more proactive work. Terrazas told the commission that the department once had a mandatory periodic exam on the books but suspended it "several years ago" after participation was so low that it became cost-prohibitive. He said, without an explicit policy or mandate, the office lacks authority to require broader screening and that many members continue to rely on their personal primary care physicians for routine health care.
Union leadership publicly criticized the office during the meeting. Dan Casey, identifying himself as an EMS captain and Local 798 executive-board director, said the union has "longstanding dissatisfaction and lack of confidence" in the department physician's office and listed two recurring member concerns: uncomfortable or inappropriate interactions during medical evaluations and what the union described as unnecessary delays or additional testing imposed on members seeking return-to-duty clearance. Casey said those delays have, in some cases, driven members to retain outside attorneys to expedite return-to-duty.
Terrazas acknowledged cultural barriers — including members' reluctance to disclose personal health information — and said that a mix of policy changes, education and operational adjustments would be needed to increase voluntary participation in prevention and screening programs. He cited the department's successful partnership with the San Francisco Fire Fighters Cancer Prevention Foundation for urinalysis and bio-monitoring; he said the foundation-led program drew higher participation because it was viewed as separate from the department.
The commission requested follow-up briefings on policy options and structural changes that might increase participation in health checks and on how to track cancer and PTSD incidence within the membership beyond workers' compensation claims. The commission also asked the physician and chief's office to return with proposals for improving prevention, outreach and data collection.
The presentation and discussion concluded with a brief public comment period; the union's Dan Casey urged the commission to address the issues he described so the physician's office can better serve members.
What happens next: The commission agreed to continue oversight and requested future presentations on policy options to increase participation in voluntary health checks and to clarify responsibilities for cancer and behavioral-health outreach.
