Is It Safe to Eat Out?: How Our Local Health Officials
Inspect Restaurants
To Assure Safe Food
or Do They?

By Thomas Peacock and Steve Langille

There are over 76 million cases of food poisoning a year with 315,000 hospitalizations and over 9 thousand deaths! Food poisoning is a worse public health hazard than toxic waste!

• Language: English
• Publisher: iUniverse
• Release date: Jun 3, 2002
• ISBN: 9781469795379

Thomas Peacock

Thomas Peacock is a Supervising Environmental Health Specialist with the County of Alameda in California, currently manager of the Solid & Medical Waste Unit. The office is across the street from the Oakland Raiders Football Team. He has worked in Environmental Health for 26 years. He received his B.S.E.H. from East Tennessee State University and a M.P.A. from California State University, Hayward. He will be moderator of a panel on restaurant grade average at the National Environmental Health Association Conference in Minneapolis at the end of June 2002. He is a Lieutenant Colonel in the U.S. Army Reserve, in the Medical Service Corp, and is also Civil Affairs qualified. He may participate in the war on terrorism or homeland defense but cannot speak further at this time. His wife, Deborah, and he have been married most of their lives and have four adult children. Tom is no relationship to Tom Peacock Cadillac of Houston, TX. In his spare time he coaches youth track and field and has had several athletes go on to be state and national champions in high school. He is also very active in his parish, volunteering hundreds of hours every year. His favorite place to go to eat is Las Vegas.

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All Rights Reserved © 2002 by Thomas Peacock, REHS, MPA

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Contents

Acknowledgements

List of Abbreviations

The Whole Menu

Introduction, Why Inspect

Restaurants?

Food Poisoning is Worse than

Toxic Waste!

Sanitation Insanity—a system

that runs by itself

Can Restaurants still be that

dirty?

What is a restaurant

The Food Inspection System

Who are these Local Health

Public serves us

It’s Not Just Free Meals

Dropped in My Lap

From New York to Los Angeles

Is it all about Money?

Teach the Cooks to Cook Safely

Quality, Like a One Room

School

What should be done about

restaurant food safety?

What you can do to protect

yourself

Sliced and Diced

From Federal to State

County-Run Programs

City and City & County Run

Programs

Special District Run Programs

Dessert

Matching Interlude

And Now for Something

Entirely Different:

The Enneagram

It all seemed like a Dream

Hey, Slackers, How to get Your

Ode to Restaurant Inspection

About the Author

Food Borne Diseases

Survey Form & Results

CitylCountylState Rating List

Great Safe Food Websites

Bibliography

To my wife

Deborah

As in angora

Soft and warm.

Don’t call her Debbie

Even though she’s busy

like a bee.

Acknowledgements

Steve Langille, the artist for all the cartoons within, has been an enormous motivator for this book project. I came to him with ideas and he cracked the whip to keep me moving along. He is an ex-airman with the U. S. Air Force, and he kept me aiming high, and striving to doe the best that I could do.

Phil Fraher III, the artist for the front and back cover is talented and enthusiastic in his portrayal of my crude ideas. He is creative and is a veteran of the U. S. Marines, one of a few good men. We are all currently residing in Newark, California.

I would like to thank all of the following people for their help and advice. Jennifer Eberle opened my eyes about the story of New York City. She is one of only two people teaching about safe food where I work and probably does more good than a dozen others just doing inspections. Joel Grover gave me a good deal of inside information about the corruption in Los Angeles. My son, Joseph, beat me to it in publishing a book of poems entitled, For Her Here. This got me moving again when I hit a wall about two years out. I would like to thank Al Bowen for his insight concerning slovenly and incompetent inspectors. He would frequently roll his eyes and proclaim, it all pays the same. Carmen Barry was tactful in reminding me to be nice. Yvonne Wade was a good example of dedication and professionalism, and I always kept her as a model, so as to not lose track of the good people. George Nakamura, on the NEHA Food Committee, kept my morale up when people wondered how a toxic waste guy could write about food. A professional learns all they need in about two years. The rest is just repetition.

And last but not least, I would like to thank my daughter Elizabeth for scolding me to keep it tight, stop preaching, get to the point, stay

organized, and for graduating from the University of Kansas early. Go Jayhawks!

List of Abbreviations

Abbreviations

Ag Agriculture Department, usually state or county agency

CDC Center for Disease Control and Prevention in Atlanta, federal government

CEHA California Environmental Health Association, professional society

CSPI Center for Science in the Public Interest, a non-profit watchdog

DEH Department or Division of Environmental Health

DHHS Department of Health and Human Services, federal government

DHS Department of Health Services, usually one of the state agencies

EPA Environmental Protection Agency, federal government

FDA Food and Drug Administration, federal government, part of DHHS

HACCP Hazard Analysis Critical Control Point, a new procedure

LUST Leaking Underground Storage Tanks

NEHA National Environmental Health Association, a professional society

OSHA Occupational Health and Safety Administration, federal government

REHS Registered Environmental Health Specialist, one class of Sanitarians

Sani Nickname for a sanitarian, or environmental health specialist

USDA U. S. Department of Agriculture, federal government

PART I

The Whole Menu

o o o o o o o o o o o o o o o o o o o o o o o o o o o

Old proverb

You can’t make omelets without breaking eggs.—Julia Child

1

Introduction, Why Inspect

Restaurants?

o o o o o o o o o o o o o o o o o o o o o o o o o o o

Progress always involves risks. You can’t steal second while keeping one foot on first.

I am a manager in a large Environmental Health Department in Alameda, California, but I started as a restaurant inspector, or Sanitarian. I supervise thirteen specialists in overseeing the cleanup of contaminated sites, and inspecting hazardous material and waste facilities. Most of these are Leaking Underground Storage Tanks, known as LUST sites. Everyone thinks that this is a more glamorous and interesting type of work than inspecting restaurants. It gets attention in the press, is challenging, uses sophisticated technology, costs owners far more money, and has a higher public profile.

We were looking at many new methods for reducing contaminants, evaluating proposals for various new technologies and methodologies, and for cost effectiveness. And, most important of all, we were saying when sites were essentially clean. The laboratory detection levels for many chemicals were getting so low that it was extremely expensive to say that there was nothing of anything left anywhere in a bunch of dirt down even to 30 feet deep or even more. We were also looking at protecting ground water that had no current use from contaminants in the parts per billion range. We were trying to make decisions that could affect the use and availability of resources for future generations. The levels we were dealing with was like saying there were five aliens from Mars alive on the earth somewhere. Could you find them? Is that significant? That’s how small a number we were using to be able to close sites.

And that small number is not what is really important. The essence of what we were doing was to have environmental degradation cleaned up and to be able to say afterwards that there was nothing left that could negatively affect human health or the environment. That was a lot different from saying that there was nothing left at all. For almost everything there are levels that are significant and levels that are not. We had to be able to tell the difference. Usually that was a range rather than an actual standard and that was where we had to look at a myriad of site specific conditions such as soil types, potential for bioremediation, sensitive receptors, routes of entry, fate and transport of contaminants, commingling plumes from different sources, background or natural levels, contaminants of concern, toxicity under various conditions, and the literature. We were just starting to look at Risk Based Corrective Action (RBCA pronounced Rebecca) and were doing a lot of calculations with projected risk factors assigned and it got me thinking. Maybe I should look at risk in the food inspection program the same way we were looking at risk in the hazardous waste program.

The essence was to have environmental degradation cleaned up and to be able to say afterwards that there was nothing left that could negatively affect human health or the environment. That was a lot different from saying that there was nothing left at all. For almost every chemical there are levels that are significant and levels that are not. We had to be able to tell the difference. This was the essence of environmental health: making a place safe and healthy for everyone and every living thing.

We were in the media all the time. I’ve been an expert witness in several cases that resulted in felony convictions. I’ve been on television during the evening news on Thanksgiving Day. Members of our Board of Supervisors call regularly to find out about our cases. Every legislator wants to have his or her name connected with a hazmat bill. We were getting almost a million dollars a year to do this work from the State and Federal government. So why would I want to look at public health and safety in the restaurant industry? I don’t even do that kind of work anymore.

One day one of my former staff, Juliet, a geologist who was studying to be a Registered Environmental Health Specialist, came to me and said that food was actually more important to public health than hazardous waste because there is more documented illness and death with food! I couldn’t believe what she said. Even when I was an inspector I never thought of the restaurant inspection program being very important. It was just one of the routine things that was allotted an incredible amount of time. At East Tennessee State University I only took one class in food. Most of that curriculum was on food ingredients, additives, pesticides, growth hormones, production, transportation, processing, packaging, storage, food poisoning, and preparation. There was only a one-hour class on inspecting restaurants in my whole Bachelor of Science degree. I had a hundred times more hours studying toxic substances.

Image463.JPG

Juliet was always one to get excited about flaws in the system and such but this time it was different. She was talking about illness and death. And it wasn’t just her idea. Her trainer in the food inspection

program had given her some statistics that supported her claim. In 1983 the Center for Disease Control and Prevention in Atlanta, estimated that there were approximately 6 million cases of infectious foodborne diseases resulting in 9,000 deaths! The CDC is the U. S. government agency assigned the responsibility of making decisions on this subject. With all the press that hazardous waste and LUST sites get, and all the money spent to clean them up, how could you be at greater risk eating out at a restaurant? It just didn’t make any sense! Our department sure didn’t give attention to the restaurant inspection program as if it was our most important activity.

As a manager I had spent years in weekly manager’s meetings, enduring repetitive comments like:

The restaurant inspection program runs by itself.

We’ve done all we can to improve food safety.

You guys are bleeding us as the only program that pays for itself.

You guys will eventually run out of work, but there will always be a need for restaurant inspection.

Restaurant inspection is a pretty easy job with very little stress and not much responsibility. Actually it’s a lot like being on vacation, and getting paid for it.

We probably can’t do any more as far as reducing food-borne illness.

All we ever talk about is Haz Mat. Why don’t we talk about the Food Program more since more people do that?

All of our staff is self-managed, they all are the best in the Bay Area. You can’t name anyone better, so that makes us the best in California, which makes us the best in the whole United States of America, and the world. Now that we’ve settled that let’s go have lunch

None of this made me comfortable. Week after week, I would hear the snipes and the unsubstantiated praise. It never changed. This was getting really old. They laughed at my daughter’s choice to go to the

University of Kansas, like, who would ever want to go there when they were in California? Was she stupid or just naive? Could she have seen The Wizard of Oz one too many times? What is a Jayhawk anyway?

We had too many people with the same roots who had been there for too long. The group was stale, where everyone thinks they know you, keeps you pigeon-holed like in junior high school, has unwritten rules about acceptable topics, and arguments about the insignificant. They never implemented or changed anything of value. It was like a club, without any purpose or goal other than the social relationships, meager as they were.

Leadership had faltered because nobody would make a decision that would stand. Old grudges festered. Decisions and processes stagnated on a debate over what type of letterhead to use or a never-ending filibuster on what the organization’s mission should be. The public was never involved in any discussion. There was paranoia about working with other agencies on anything.

I thought about our attitudes towards food safety. How could one presume that there would always be a need for restaurant inspection at the same time suggesting that no more could be done to reduce food poisoning? Wasn’t the act of inspecting causing some kind of positive improvement? Do inspectors have any effect on food poisoning rates at all? If they were to stop doing inspections would the rates go up or do they stay the same? I never heard any discussion of what the rates even were.

In our department we were trying to lower rates of home violence, alcoholism, smoking and diseases caused by smoking, homelessness, infectious diseases, drug addiction, and infant malnutrition. Nobody ever said that we had done all we could in any of these programs. There were even problems like A.I.D.S. with increasing rates. In fact, higher rates tended to help a claim for more funding for a program, rather than less. So why were we silent on restaurant inspection? Maybe nobody could tell? Maybe nobody would tell?

So I began a quest: to find a Health Department that is truly protecting people from food poisoning and assuring safe and wholesome, unadulterated food. That is what this book is about.

I examined the procedures we seemed to follow in the food program. We were without a chief and, because of a rotation scheme; I was officially acting chief for a month. I talked to every one of the inspectors in private. Some people were very reluctant to talk. I sent out written schedules a week ahead and some claimed they had not seen a thing. Even though I was only temporary, officially I was their boss’s boss. I heard insightful comments from those who would talk, like:

My boss doesn’t even know where I sit. He never talks to me.

Why should I say anything, they are going to do what they want anyway? When questioned this particular ‘specter had no clue who they was. I asked if I was a they and he said, certainly not. You listen. Maybe you’ll do something.

It all pays the same. Why should I do any more than anyone else?

It doesn’t matter what I do today, I can always do it tomorrow, or next week, or whenever.

You have to meter your work here so it lasts to the end of the month.

It was all Ignorance and Apathy, and maybe even a little corruption. I don’t know and I don’t care, unless there is something in it for me. And many of them were so bold as to tell me to my face. None of them blamed me for any of it. They all thought it was somebody else at fault, or a system like the County. None of these people felt that they were contributors to the situation they were complaining about. They all insisted that they did their job the best they could.

I worked in a program where we would eventually run out of work about the year 2005. But right now we had more work than we could possible do. We had over six hundred sites and were closing one every other day, or one hundred a year. That number sounds like a lot except, that at that rate it would still take six years to close them all. Oh, and we were still getting eighty new cases a year, so maybe it will take a lot longer. A little math says more like thirty years. And the national agenda was to have these sites cleaned up by about 2005, when the funding ceased. We certainly weren’t stagnating. Many cases were left to flounder because staff couldn’t work on all of them simultaneously. And then there was the new problem of the gasoline additive MTBE.

Along the way I found some very surprising facts:

• Most inspections only cover lunch, Monday through Friday.

• Too many cooks never see an inspector.

• Most supervisors have no idea where their inspectors are or what they are doing. You just have to trust them.

• It’s no longer public service, but Public Serves Us.

• Inspection work is assigned like a one-room school.

• Most inspectors meter their work, as if they didn’t have enough to do.

• Differences in inspection frequency vary over 400%, as reported.

• A common belief is that the restaurant inspection program runs by itself.

• There is little outside scrutiny of the effectiveness of inspection programs.

• Too many inspectors don’t feel that what they do is important.

• There is too much reliance on fees collected from the restaurants they inspect. Corruption is extraordinary, especially given the small number of inspectors.

So what is the risk of food poisoning? Is it a serious problem? Is there anything we can do about it, especially with all the food we eat that is prepared by others?

2

Food Poisoning is Worse than

Toxic Waste!

o o o o o o o o o o o o o o o o o o o o o o o o o o o

Food poisoning: 6 million cases and 9,000 deaths a year.—Center for Disease Control and Prevention, 1983.

.. .their judgment was based more on wishful thinking than on sound calculation of probabilities; for the usual thing among men is that when they want something they will, without any reflection, leave that to hope, while they will employ the full force of reason in rejecting what they find unpalatable.

—Thucydides, the Peloponnesian War, 400 B.C.

Is the risk of eating out a serious one? The Center for Disease Control and Prevention (CDC) in Atlanta is the federal agency charged with answering this question. The CDC says that about 85% of all foodborne disease outbreaks are traceable, and these are split evenly between meals consumed in the home and those consumed out. Your risk may already be higher from eating out because well over half the meals are still consumed at home. Some food experts believe that foodborne illnesses are becoming a bigger problem because today’s families are busier than those of yesteryear and they don’t spend as much time preparing their own meals.

According to Public Health Reports, July-August 1998, a majority of food poisoning cases can be traced to public eating establishments. People rarely report when they get sick at home. It results in only one to a few cases and many people misinterpret the disease for the flu. Most people do not seek medical attention for the diarrhea and vomiting that results, unless it lasts for more than a few days. There are also many over the counter medical products that help treat the symptoms. Some of these diseases are so common that everyone knows someone that will readily give out free advice.

Food poisoning is often associated with summer picnics or large family get-togethers. These do pose a significant health risk but how many times do we do this a year? Voluntary and mutual parties have other social benefits that we all cherish. A restaurant is in business to make a profit and we are outraged if we get sick from their poor sanitation and food handling practices. We consider it far more important that a restaurant got us sick, than that Aunt Bea’s potato salad sat out too long and did the same thing.

So far, there has not been a lot of attention paid to the critical issue of reporting. There are just so many other reportable diseases that have received a lot more attention. One public health official estimates that only one of every 250 cases of food-borne illness is eventually reported to a state or local health department. This gross under reporting can significantly undervalue the whole purpose of food safety. The public can assume that food poisoning is not important and not as common as it is. This is a much worse problem if the very health officials charged with assuring safe food conclude the same thing.

There is no such thing as a one to three day flu with symptoms of nausea, diarrhea, and vomiting. This is actually food poisoning, although many people will say they had the flu and not report it. Food poisoning takes from twelve hours to over three days from exposure to onset of symptoms. That time frame corresponds to the regularity of the digestive tract, the bodies system that is under attack. Such a long time interval may involve many meals. Usually the last one you ate was at home and nobody wants to think they poisoned themselves. It’s better to just say you got the flu.

Health Officials certainly are unable to plan an effective program to control diseases if they don’t even know how much disease there is. Disease counting and reporting has been one of the most basic activities of Public Health since the beginning, about 150 years ago. In a global economy we also have the possibility of global diseases. Yes, we have diseases coming from other countries. Some of these are emerging diseases, which are new ones we have not seen or studied before.

"Finally, we have the public health and regulatory authorities who are smarting under consumer activist claims that they have been sleeping on the job, which makes any response short of capitulation seem like a feeble attempt at whitewash and self-justification. At the same time their ongoing messages on how to really improve public health, like…cooking your food properly…are completely eclipsed." (Fabian, W. Douglas Campbell, March/April 1991)

America is not doing well in most other areas that Public Health experts count compared to the rest of the developed world. We are far down the list in longevity, infant mortality, low birth weight infants, and immunization rates and have some of the highest rates of heart attack, stroke, and cancer. In our poor health performance against the rest of the developed world food poisoning does not seem to be very important, and certainly is not doing any better!

Do we still have food poisoning? Actually food poisoning is more of a new thing due to our urbanization and departure from the farm. A very good explanation was in a CDC issue of Emerging Infectious Diseases by E. M. Foster, Professor Emeritus, Food Research Institute, University of Wisconsin, Madison, WI:

When I was growing up on my parents’ farm in East Texas, we never thought about food poisoning or unsafe food. The only foods we bought were sugar, flour, and oatmeal; everything else we produced and preserved on the farm. My mother spent all summer canning fruits and vegetables for winter. We had no refrigeration; we cured our own meat and drank raw milk. But I never heard of botulism, staph poisoning, or salmonellosis or perfringens poisoning until I studied bacteriology in college. Only then did I wonder how we survived with no refrigeration in a hot climate. Finally, the answer came to me. We just did not give the bacteria time enough to develop so they could hurt us. Leftovers from breakfast—hot biscuits, eggs, ham, bacon or sausage, oatmeal, coffee or milk—went right out to the chickens. Lunch leftovers—biscuits, cornbread, vegetables, or fried chicken—were saved for a cold supper 4 or 5 hours later. Any food left went to the pigs. The bacteria had only a maximum of 3 or 4 hours to grow, and that usually is not enough. I survived and went on to study food microbiology, which included what was known then about food poisoning.

Food poisoning outbreaks are more interesting and heroic for a health official. She can be the white knight riding in to solve the mystery, taking charge of the situation, appearing confident and calming in the media, and earning great positive publicity for a health department normally hidden from the public eye. Actually only a fraction of all food poisoning is involved with known outbreaks. But many more of us get food poisoning in less noticeable circumstances and suffer the consequences in private. How many of us?

The CDC said 6 million cases and 9,000 deaths! The nonprofit Council for Agricultural Science and Technology estimates that between 6.5 and 33 million cases occur each year. The National Center for Health Statistics has come up with 9,100 deaths per year from food poisoning. Another government estimate is 24 to 81 million cases per year with an estimated 10,000 deaths. While these numbers vary they all seem to be in the same order of magnitude. That alone would lend credence to the enormous incidence rates involved. The annual cost of food-borne I illness is much more than just in sick people. The annual

financial cost is estimated to be between $7.7 and $23 billion, more than the annual budget of several of our states.

9,100 deaths per year is more than the highest death year for Americans in the Vietnam War. Of course, everyone was not a soldier in Vietnam and we all have to eat so the risk is not the same. But still, think about it! 9,100 deaths is about the same mortality as each year of the AIDS epidemic during most of the 1990’s. This rate is about 20% of the number of people who die in automobile accidents each year. Food poisoning is not exotic or rare.

The typical person eats out 213 times in a year, according to the National Restaurant Association. CSPI reports that about 42% of the food poisoning cases are from eating out. This would mean that 34 million people get sick each year and 3,822 people die from eating in restaurants or from restaurant food! Researchers at the CDC also say that up to 80 million people are affected by food-borne illnesses each year. A report in December 1997 by Marion County, Indiana said there were 81 million cases of food poisoning resulting in 10,000 needless deaths. The General Accounting Office (GAO), a congressional agency, reported that food poisoning sickens millions and kills thousands of people every year in the United States. There does seem to be a lot of difference in what people are reporting. But these are rather soft statistics, kind of like the stools of those affected.

Why isn’t food poisoning publicized more? Could it be that the control measures needed are fairly routine, that educated people wonder why anyone would have to be taught to wash their hands after going to the toilet when they are preparing your sandwich? Could it be that proper heating and cooling, proper cleaning and sanitizing, and proper sanitation to exclude vermin are not as sophisticated, highly technical, and complex as they are routine, every day hard work?

Could it be that since almost all of us have gotten food poisoning in the past, and survived, it just doesn’t get most of us excited? We hate when we get it but it doesn’t seem more significant than the common cold. Of course, when I have gotten food poisoning I thought I was going to die, and sometimes hoped that even death would be preferable to continuing the misery. I imagined that inflicting food poisoning on condemned criminals would be a perfectly suitable punishment. Then we could turn them loose, with the promise that we will give them food poisoning again if they turn back to crime. The jails would be empty. Nobody would ever ask for this kind of disease.

We usually don’t assume that the diarrhea, vomiting, and stomach cramps were caused by the bad actions of the people that handle our food. If we did, we would want them to go to jail for what they did to us. It is certainly as bad for society as using drugs.

Image470.JPG

Maybe we don’t realize that virtually all food poisoning is preventable!

Most Public Health officials have so many important public problems on their plate. They must deal with everything from managed care in their hospitals and clinics, the health care financial crisis, A.I.D.S., illicit drug use and addiction, smoking and its diseases, alcoholism, child and maternal health, homelessness, toxic waste, environmental pollution abatement, and, yes, how to pay for it all. There are so many things to be an expert on. And the public, the media, and the politicians demand that they tackle these problems with every minute they have. Food poisoning has not been on anyone’s local or national agenda, until recently.

On January 25, 1997, President Clinton announced a new initiative to improve the nation’s food supply entitled, "Food Safety from Farm

to Table: a New Strategy for the 21st Century. Since then there has been what seems like continuous media coverage about how safe our food is and where the problems seem to be. Most of the attention is going towards food imports, food production, use of pesticides and additives, packaging and processing, and transport. These are admirable pursuits, but they actually have very little to do with the incidence of food poisoning. They are much more related to long term health effects and the development and maintenance of a consistently safe food supply system. It is no wonder because that is what the federal government does. Those activities are certainly important because if a problem goes undetected in a major food processor it can have far reaching effects, especially if the food comes from a foreign country.

The President’s initiative does ask for a lot more than just what the federal government is responsible for doing. The President also directed the responsible federal agencies to work with consumers, producers, industry, states, tribes, universities, and the public to identify additional ways to improve food safety through various government and private sector relationships. But unlike many other federal programs that may be mandated, the Safe Food Initiative is a cooperative voluntary one. Local agencies are not required to comply, and most have not. There is also a lack of monetary incentive for doing so. Whereas many other federal programs, like highway safety, get linked to the acceptance of federal funds, the FDA has only received a pittance to dispense to the states. In the U.S.A., where money talks, the states and local agencies do not have a lot of reason to listen. As the saying of at least one local official goes, Hurray for home rule.

May 22, 1998: Vice President Al Gore announced from the White House Briefing Room that the federal government was launching a computer network to fight food-borne illness. Addressing a problem that affects 33 million Americans each year, he described a new system that will be five times faster at identifying and combating those disease outbreaks. Known as PulseNet, this system would link laboratories, the federal agencies, and state