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Health departments becoming educators

Health departments becoming educators

Judy Craine, the longtime co-owner of Holman’s Bar and Grill in Portland, Ore., says she sympathizes with New York restaurateurs who have had to deal with an embarrassed city health department after a videotape of rats swarming around an after-hours KFC-Taco Bell outlet made the national news.

There was a time when Portland restaurateurs were locked in much the same sort of adversarial relationship with their health department, she said.

But times have changed.

“When the restaurant inspector used to come to the door, the reaction would be, ‘Oh no! Quick, hide something,’” Craine said. “But now it’s more like, ‘Oh good. Here’s someone who can help me.’”

New York’s recent rodent exposé served once again to accentuate the problems and underlying hostilities that exist between some restaurant communities and their local health inspectors. But at the same time, the scandal served to point out a widening gap in the ways individual health departments across the nation choose to pursue their mission.

Where some departments view themselves strictly as regulatory agencies with unilateral powers to act sternly and often punitively, others are taking a more progressive, educational approach in an attempt to work with foodservice operators in their jurisdictions.

“Many people on the regulatory side of food protection have a drive to be educators,” said Nelson Fabian, executive director of the National Environmental Health Association, or NEHA, a Denver-based organization representing members of local and county health departments around the country.

“We appreciate that we have both a legal and moral responsibility to be regulators, so no one is talking about compromising the essence of that role,” he said. “On the other hand, more enlightened people in food safety and, in general, a growing majority of food safety professionals in the regulatory arena are very much of the belief that we need to work as partners with the restaurant community.”

To be sure, that is not yet the case everywhere. In New York, a sense of “us versus them” seems to pervade much of the restaurant community—even though both sides agree upon the critical importance of ensuring food safety throughout the city.

Frustrated restaurateurs argue that while the department has a difficult job to do inspecting the 20,000-plus foodservice outlets throughout the five boroughs, it can be excessively punitive. The recent wave of tough inspections sparked by the rat incident resulted in the closing of nearly 300 foodservice operations since late February.

Fines are a major source of contention.

William Liederman, the former owner of Mickey Mantle’s Restaurant and now proprietor of Burgers and Cupcakes, said: “New York restaurants are too picked on. Restaurants are getting crushed by fines. At Mickey Mantle’s we paid somewhere between $50,000 and $100,000 in fines over 18 years.”

During the first nine months of 2006, the health department collected $16 million in fines, according to city statistics.

“I know it’s a tough situation—the health department is between a rock and hard place,” said Chuck Hunt, executive vice president of the New York City chapter of the New York State Restaurant Association. “But I’ve also tried to convince the department that instead of being a meter maid and simply writing out tickets, it should pursue an educational process and give operators the opportunity to correct the faults.”

Some critics argue that New York is lagging behind other, more progressive health departments around the country. One industry observer who requested anonymity characterized the department as “living in the Dark Ages. It seems to be more about fining operators than protecting public health.”

Advocates, however, maintain that the New York health department has been charged with performing a particularly difficult assignment, given the age of the city, the nature of its infrastructure and proximity of its many high-rise buildings—not to mention the sheer number and diversity of foodservice outlets.

Zane Tankel, chairman and chief executive of New York-area Applebee’s franchisee Apple-Metro Inc., whose company must work with three county health departments—New York, Westchester and Rockland—calls them all “pretty diligent, even though New York has become a lot stricter” since the rat videotape was aired.

New York health commissioner Thomas Frieden, commenting on the rat episode, acknowledged that “in this instance there were failings of personnel, policy and practice.” Nevertheless, he said, “our restaurant program performs well overall.”

Some restaurateurs in other parts of the country acknowledge that their health departments also can be tough when the circumstances call for it. However, they maintain that a vital level of cooperation exists between the local foodservice community and restaurant inspectors.

“We look at our relationship with the health department as a partnership,” said David Cohn, president of the Cohn Restaurant Group in San Diego. “I’m not saying there aren’t conflicts, but it’s not adversarial. I truly believe they’re there to help.”

Not only does the San Diego health department communicate with local restaurateurs, Cohn said, but it also includes them in key policy and hiring decisions. When the department needed to hire a new executive for the food and housing division—the county entity responsible for conducting restaurant inspections—Cohn, who then was serving as the chairman of the local chapter of the California Restaurant Association, was asked to help interview candidates.

Gary Erbeck, director of the Department of Environmental Health for the County of San Diego, said: “We like to have the industry involved to help select management. They will have to work with them on policy issues throughout their tenure.”

In recognition of its progressive practices, San Diego’s health department was awarded the Samuel J. Crumbine Consumer Protection Award for Excellence in Food Protection in 2005.The award is presented annually to a local public health department by a jury of environmental health officials and public health sanitarians. Award winners are considered models for other public health and safety programs in the country. The award is sponsored by Conference for Food Protection, the American Public Health Association, NEHA, Foodservice & Packaging Institute, and others.

San Diego’s health department also formed a foodservice advisory committee that brings members of the restaurant community together with members of academia to review policies and measures pertaining to food safety in the San Diego area.

“It’s really about forming a team, being accountable and operating in a transparent manner,” Erbeck said.

The trust factor between the department and local restaurateurs extends beyond the sphere of restaurant inspections.

“Whenever we receive a foodborne-illness claim from a customer, we tell them to contact the health department and report it,” Cohn said.

Erbeck said that the department then looks to see if it is an isolated incident or whether there is a pattern starting to emerge and whether there have been complaints in the past.

“We try to work with the restaurant on it,” he said.

Craine of Holman’s in Portland, Ore., is similarly supportive of the Multnomah County Health Department. She wrote a letter of recommendation that helped the Multnomah County Health Department win the Crumbine award in 2006.

“We have a fairly unique relationship with the health department,” said Craine, who is a past president of the Oregon Restaurant Association. “They view the [restaurant] industry as a partner with the common goal of keeping the dining public safe. They have a very active advisory committee, and they take our advice. They run the budget and rules by us.”

Lila Wickham, environmental health program manager for Multnomah County, said the department also attempts to approach the inspection process from the industry’s perspective.

“The one thing that is important to them is that they know they are being inspected consistently,” she said. “They want to know inspections won’t vary from inspector to inspector.”

As a result, inspectors are taught to focus on critical violations as laid out in the U.S. Food and Drug Administration’s voluntary food program standards of 2002.

“From a public health perspective, we try to identify critical issues—like temperature violations, cooling, chilling, reheating—and not be overly concerned with issues that don’t lead to foodborne illness,” Wickham said.

For example, Multnomah County instituted a double hand-washing standard that requires restaurant employees to wash their hands twice—first in the bathroom and then in the kitchen hand sink.

Most health departments, in fact, have shifted their focus away from noncritical violations that are not directly linked to food safety—often referred to as “floors, walls and ceilings” violations. Tony Hiller, senior consumer health specialist for the City of Fort Worth Public Health Department in Texas, said county restaurant inspectors likewise are trained to look for critical violations like temperature control and hand-washing problems, and are instructed to subtract points for anything directly related to the causes of foodborne illness.

“Floors, walls and ceilings [violations] no longer count as points,” Hiller said. “They are fineable and still must be corrected, but they don’t contribute to a restaurant’s [inspection] score.”

Fort Worth’s health department also is a Crumbine award winner.

Members of the foodservice industry applaud the growing emphasis on food safety exhibited by more progressive health departments.

“It’s better for all of us when health departments focus on food safety,” said Steven Grover, vice president of foodservice quality assurance and regulatory compliance for Miami-based Burger King and the former vice president of health and safety regulatory affairs for the National Restaurant Association.

Grover, who also spent 15 years running the health department in Northern Virginia before joining the NRA, added: “Unfortunately, a lot of [departments] still focus on the floors, ceilings and walls. It’s the easiest thing to do. But none of those are related to foodborne illness, and when [those types of violations] become the focus, we’ve lost focus.”

More progressive health departments also attempt to maintain open communications with the local restaurant community. Chirag H. Bhatt, bureau chief of the Houston Department of Health and Human Services, says the department has had a representative on the local restaurant association board for the past 15 years.

“It’s a nonvoting member, but we go in there with the intent to exchange information,” he said. “Our relationship with local restaurants has improved dramatically since we started doing that.”

Bhatt said he and other department members also conduct public service presentations in which they discuss the food-safety inspection process. In the past, he also contributed health tips to the chapter’s monthly newsletter.

But, he added, “there is no favoritism. We work with people, but if an operator is careless and belligerent, we will take action.”

Some health departments, like Multnomah County’s, also attempt to educate operators during the actual restaurant inspection by having the owner or a restaurant employee accompany them during the process.

“It’s an educational model along with the regulatory model,” Wickham said, “and it seems to be working. We have the lowest foodborne illness outbreaks in the state, and the state is lower than the national average.”

Multnomah also has created a website that enables restaurant employees to complete the state’s required food handler training course online. Wickham said the site is unique in that it has been set up to communicate with people in seven languages.

“There are those people who learn by print and those who learn better by hearing and seeing,” she said. “Having a combination of two learning opportunities helps people understand better and change their behavior.”

As part of the educational process, however, a growing number of health departments are finding ways to publicly post restaurant inspection results—a decision that many restaurateurs oppose. Nevertheless, experts say the practice is expected to become even more common in the future.

“I think we’re seeing more public access to inspection results, whether posted in the restaurant or through the Internet or even dial-ins to the health department,” said NEHA’s Fabian. “And if it doesn’t already exist today, I predict you’ll soon see health inspection scores available on [global positioning systems] in cars. It will display information about a particular restaurant and also include the health inspection score.”

But if some health departments are making an effort to improve relations with the foodservice community, many restaurateurs likewise are making an attempt.

“I think restaurants are trying to do a better job,” said John Farquharson, president of the International Food Safety Council, a division of the NRA Educational Foundation whose mission is to heighten awareness of the importance of food safety.

Apple-Metro’s Tankel said he has contracted with a company that employs former health inspectors who visit each outlet periodically and make unscheduled inspections. Apple-Metro also works with an exterminator who visits the company’s 25 restaurants each week.

Most operators acknowledge that it’s in the best interest of the foodservice industry to convey a picture of safe restaurants to the American public—particularly as an increasing number of Americans dine out each week. However, one problem operators and restaurant inspectors appear to be facing is the lack of funding for many health departments around the country.

“When I go out to food safety meetings, the health department guys all say they are getting hammered with cutbacks,” Farquharson said.

Houston’s Bhatt acknowledged that funding is a key issue for most public health agencies.

“Why? I don’t know,” he said. “Do we try? Absolutely yes. Do we beg? Yes. Do we still get cut? Yes.”

He noted that there are 5,000 deaths related to food safety issues each year, while there are 2,000 deaths from fire-related issues each year.

“Ask any agency where the funding is going—to fire safety,” he said. “You have to do what you can with what you have. Ultimately, it’s about public health.”

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