Tim Darragh of the Knight-Ridder Tribune reports that Pennsylvania must boost spending by tens of millions of dollars, give easier public access to information and consolidate oversight for public health services if it ever hopes to fix its broken system for inspecting restaurants and food retailers.
The state’s leadership has known for years that Pennsylvania’s food inspection system needs fixing. But little change has come.
“We haven’t had a reason to take a look at it,” said state Sen. Jake Corman, chairman of the Senate Public Health and Welfare Committee, which has legislative authority over Pennsylvania’s public health systems.
However, statistics and a Morning Call analysis suggest there’s much that needs examination. Two-thirds of reported food-borne illnesses in a 14-year period in Pennsylvania were linked to the state’s eateries. And the newspaper’s analysis of 78,000 food inspection records reveals severe problems with the system: years between inspections at many establishments, undertrained and ill-equipped inspectors, and spotty or nonexistent recordkeeping. The newspaper undertook months of legal action to obtain the information for its analysis.
In 2002, state officials received a road map to improvement at a roundtable of health officials and food industry representatives, which recommended remedies for many of the problems identified by The Morning Call’s analysis. The panel’s recommendations were largely ignored.
Even without the panel’s recommendations, all Pennsylvania had to do was look at what other states have done.
Consider Louisiana, for instance.
Louisiana uses general tax revenues to pay for its approximately $11.5 million inspection program. Pennsylvania also uses tax revenue to pay for its $9.1 million Department of Agriculture system, but that’s where the similarity ends.
Louisiana provides a one-stop inspection shop, the Department of Health and Hospitals, for food establishment inspections in that state. In Pennsylvania, the responsibility for inspections is scattered among the Agriculture Department, 10 full-service systems operated by cities or counties, and 230 local bare-bones operations in smaller communities.
Louisiana employs almost four times as many inspectors as Pennsylvania and gives them only 74 percent of the Pennsylvania inspectors’ workload. That gives Louisiana a chance to inspect its food retailers and world-renowned restaurants an average 2.5 times a year, compared with Pennsylvania, where restaurants average one inspection every two years.
Louisiana also has one other thing that Pennsylvania lacks: easy public access to restaurant and food retailer inspection reports. In April, at a cost of less than $500,000, the state began putting the reports online for every one of the 35,269 licensed eateries in Louisiana.
In Pennsylvania, it took The Morning Call months and dozens of requests to state and regional offices under the Right-to-Know Law to obtain inspection reports. Even then, two municipalities refused and one — Easton — relented only after two months of legal wrangling. Few agencies keep computerized records, and some don’t keep any records at all.
Louisiana officials wondering if the public would be interested in online restaurant inspection reports didn’t have long to wait. The state’s Web site received so many hits that its computer server crashed two days after it went live.
On Sunday, The Morning Call’s online database of about 200,000 food inspection records, including more than 78,000 from the Lehigh Valley area, debuted on mcall.com. It is the only online source for this information in Pennsylvania.
Like Louisiana, Pennsylvania once was poised to improve its food establishment inspection, in 2001 and 2002, when experts hoped the incoming Rendell administration would show interest in boosting public health. But progress toward system reform faded as the administration’s other budget priorities crowded out public health needs.
In 2001, a panel of health officials and food industry representatives called the Pennsylvania Food Safety Alliance issued recommendations to industry and state and federal officials urging improved public health services, including food establishment inspections. The group pushed for consistent regulation of food establishments, standardized training, a central inspection system, food safety education, an assessment of the risks of inspector vacancies and unqualified health officers, and better surveillance of food-borne illness outbreaks.
State officials have yet to act on many of the recommendations, leaving Pennsylvania with no standardization in training or qualifications for inspectors, recordkeeping or the frequency of inspections.
The state has taken two steps in response to the alliance’s report: the creation of an Internet-based disease reporting system and the adoption of the FDA’s Food Code in 2003. The reporting system provides faster tracking of food-borne illness outbreaks for epidemiologists, but not the public. For consumers, the newer Food Code has led to one noticeable change: Restaurants now are required to post health warnings on menus if they allow customers to order foods that could be hazardous, such as hamburger cooked rare.
Reforming Pennsylvania’s systems will require new streams of federal, state or local taxes or fees, as well as a major restructuring of bureaucracies over three levels of government.
“That is not something that you just flip the switch on,” said Michael Diskin of the Allegheny County Health Department, who helped lead the alliance, which formed in 1999 to fight food-borne illness.
It’s unlikely that even small changes are on the immediate horizon, since legislative leaders said they are not focusing on food safety. Corman, the head of the Senate Public Health and Welfare Committee, said he was unfamiliar with the alliance’s recommendations, or those from the 2002 roundtable that urged then-Gov. Elect Ed Rendell to repair Pennsylvania’s declining public health infrastructure.
“I haven’t been informed by anyone that this is a significant issue,” Corman said.
It’s no better on the House side, where there has been little effort to provide relief to the overwhelmed Agriculture Department.
“Nothing relating to that has come before the committee,” said Allentown state Rep. Jennifer Mann, a new member of the House Agriculture and Rural Affairs Committee.
However, the roundtable did call for legislative action, specifically reforming Act 315, the 1951-era state law that allows counties and municipalities to create full-service health bureaus. The law “has been inadequate to stimulate and support local health department needs,” the expert panel’s report to Rendell said. “It must be reconsidered as the public health environment has drastically changed.”
Among other things, the 50 percent match Act 315 authorizes to set up and run a full-service health department is insufficient for many counties, said Maureen Hennessey-Herman, a roundtable panelist. Hennessey-Herman, who helps coordinate activities among Delaware County’s 41 local health boards, said she hasn’t determined what level of state funding would be sufficient.
“It’s a large undertaking,” she said. “You need places for those people to work — all of those things that make an office function. And the per-capita [funding] that the commonwealth provides is not enough to meet that obligation.”
Northampton County, which is looking into creating its own Act 315-level health department, found another reason why reform is needed. The county last year needed the state to amend the law so county officials could just consider the health department without legally committing to it.
“Changing the verb changed what the counties could do,” said Ron Dendas, program director for the Dorothy Rider Pool Health Care Trust. “It gave Northampton County wiggle room to investigate this.”
Since the roundtable’s findings, “there haven’t been any discussions about changing Act 315,” said state Health Department spokesman Richard McGarvey.
Only four Pennsylvania cities, including Allentown and Bethlehem, and six of 67 counties, including Bucks and Montgomery, conduct their own food establishment inspections under Act 315. The rest of Pennsylvania has two options for food inspections. They can leave them up to the Agriculture Department or set up a local board of health under another code with no accountability to the state. Sometimes, the agencies’ coverage overlap.
Besides Northampton County, Lancaster and York counties also are considering creating their own departments under Act 315.
Northampton County Councilwoman Mary Ensslin, a backer of the county’s effort, said people are shocked to learn about discrepancies in public health services between the city of Bethlehem and the rest of the county.
“They argue with me, ‘No, it can’t be,’ ” she said.
The point Ensslin hammers home on the county level is the same that Diskin’s group, the Food Safety Alliance, identified for the state. There is, it said, “no state-based ‘champion’ for food safety in the Legislature.”
Rendell also has done little to address the problem, keeping funding for the Agriculture Department’s inspection program at the same level for 2006 — $9.1 million and 57 inspectors for 47,000 food establishments.
Rendell’s office bounced questions about funding back to the Agriculture Department. Spokesman Michael Smith said the state has no plans to increase the number of inspectors because additional money is unavailable.
Officials expect that a new computer system in the department at least will improve efficiency, allowing inspectors more time to visit establishments.
While the funding remains stagnant, the number of restaurants continues to grow.
“There are more restaurants, and more people are spending more money on eating out — than in the past,” said Caroline Smith DeWaal, director of Food Safety for the Center for Science in the Public Interest, a Washington, D.C., consumer interest group. “Restaurants are a real growth industry and the state regulators are having trouble keeping up.” And, she added, funding for restaurant inspections is among programs most vulnerable to state budget cuts.
For the Agriculture Department to provide comprehensive and frequent inspections, it would need its budget quadrupled to $36 million, said Bobby McLean, director of the department’s Bureau of Food Safety and Laboratory Services.
In neighboring New Jersey, the structure is similar to Pennsylvania’s. Inspections are handled there by more than 100 county, regional and municipal health departments. The inspection data are not collected on the state level.
The public assumes that the government is up to the job of keeping watch on food establishments. But Dennis Gallagher, a professor at Drexel University’s Department of Health Management and Policy, says this is not the case. “The state has never had the resources to do public health services at a level that I think most people expect,” he said.
While Pennsylvania struggles, other states and cities have found ways to improve food inspection systems.
Virginia, Tennessee and South Carolina are among states that oversee their inspections, and all three have more inspectors for fewer establishments than Pennsylvania. Even where state governments don’t do inspections, as in Ohio, the state takes the lead in training inspectors. Ohio’s Department of Health then conducts periodic audits of the 134 local health departments that do the inspections, said spokesman Christopher Weiss.
Some states, such as Florida, use food permit fees to pay for their programs. The Florida division that inspects retailers and processors charges them up to $500 a year in licensing fees. That funds a program the same size as Pennsylvania’s with twice as many inspectors.
Locally, only Bucks and Montgomery counties supplement their inspection programs, with inspectors charging fees for repeat visits: $115 in Montgomery and $225 in Bucks. While not all agencies assess inspection fees, all do charge food establishments to get an annual license.
There’s another way agencies can help their inspection systems at no cost: Give people the information.
In Los Angeles, health officials seven years ago reinstituted a system of publicly grading food establishments based on safety. Consumers can choose restaurants based on a letter grade in the front window of every eatery.
While it’s not a fail-safe program — a clean operator can make a mistake or have an equipment breakdown — researchers this year concluded that even with its shortcomings, the letter-grading system works. A report in March in the Journal of Environmental Health linked public restaurant grading to a 13 percent drop in food-borne illnesses in Los Angeles.
Allentown used a similar system sometime before or around when a health bureau it shared with Bethlehem split in 1980, according to Allentown Health Bureau Director Barb Stader. Stader says the bureau does not favor reinstating the letter-grade system because the inspections are only a snapshot of an establishment’s operations and the grade might not reflect conditions after the inspection.
Meanwhile, online access to food inspection records is growing in other areas of the country.
The health department in King County, Wash., four years ago began putting inspections of restaurants, supermarkets, coffee shops and even outdoor food carts online. Consumers can search by name or address and see how often an establishment is inspected, and what violations, if any, it accumulated.
The system has benefited clean operations and put pressure on those with poor scores, said Environmental Health Services supervisor Todd Yerkes.
“The good operators think it’s a good idea,” he said. “And the ones that get written up — they’re not so happy at times.”
The department, which covers the city of Seattle, provides a wealth of other information on the Web site, including restaurant closures, how to report problems and safe-food-handling tips.
In places ranging from New York City to the state of Mississippi, restaurant-goers can check out an establishment’s record with the click of a mouse button.
Consumers in Pennsylvania, however, can’t get that information online. The Morning Call’s online database is the only online provider of such information in the state.
While the reports are public documents in the eyes of most agency officials, only a few statewide make the information easy to get. Locally, The Morning Call got access to inspection reports only after filing written requests for the information to every inspection agency.
State agencies are moving to computerization, but the public still might not get Internet access to their records.
Locally, only Bethlehem plans to give online access.
The Bethlehem Health Bureau, which keeps paper records now, is working toward computerization. Tony Hanna, the city’s director of Community and Economic Development, promised that the public will be able to view the information.
“If it’s available to us, it’ll be available to the public,” he said.
The Agriculture Department is switching to a new computer system for its records later this year, but McLean said officials aren’t sure if they’ll give public access online.
Bucks County’s health department also is preparing to unveil a computer system. Andrew A. Schafer, chief of environmental sanitation, also would not speculate if the county reports will be available online.
Montgomery County also reported no plans for online access.
All other area communities with local health boards, however, will continue to use paper.
With no single agency in charge, underfunded inspection staffs and unwieldy public health laws, it’s no wonder that Pennsylvania has uneven services, said Margaret Potter, head of the Center for Public Health Practice at the University of Pittsburgh. She recommends a state Board of Health that would be responsible for inspections.
“I do think the time is ripe for an overview of Pennsylvania’s public health laws with an eye to getting some uniformity, some standards and some accountability for monitoring the public’s health,” she said.
Without statewide monitoring and data collection, experts are unable to track trends or quickly attack problems.
“My problem,” she said, “is that there is nobody watching the store.”