Restaurant inspection rates vary by county

Back in 2002, with at least 85 people sickened by Salmonella, Bucks County health inspectors discovered that kitchen workers at a Lone Star Steakhouse on Route 1 were washing tomatoes and raw chicken in the same sink. They shut the place down until an additional sink could be installed to prevent cross-contamination.

"We thought we had it nailed," recalled Bill Roth, who oversees food safety for the county health department.

Not exactly. When the Centers for Disease Control and Prevention analyzed victims' stool samples, Roth recalled, they noticed something completely different: The same strain of Salmonella had been found elsewhere. Connecting the dots, federal investigators traced the outbreak to contaminated tomatoes from a Virginia farm that were making gastrointestinal life very unpleasant for hundreds of people in 26 states.

The missing-sink violations cited by inspectors at the local steakhouse had nothing to do with it.

The case illustrates both the strengths and weaknesses of restaurant inspections. On the one hand, they catch only a tiny percentage of potential problems, and only on the day that inspectors visit. On the other hand, they keep restaurateurs on their toes - using the same sink to rinse raw produce and uncooked poultry is a recipe for diarrhea, even if it wasn't the cause that time.

"Put it this way," said David Damsker, director of the Bucks County Health Department. "If you leave some children alone, they will be responsible. Some other children, take away parental supervision . . . and some places would be incredibly horrendous."

Bucks provides restaurants with a lot of supervision. Its inspectors automatically visit the vast majority of the county's 2,600 food establishments every six months - twice as often as routine inspections are performed in Philadelphia and every other county in the region except Montgomery (also twice a year).

Repeat inspections to follow up on violations are scheduled within 10 days, Bucks County officials said, compared with 30 in the city.

Yet Bucks finds fewer violations. And fewer violations mean fewer repeat visits - every inspection is a surprise - to follow up on the routine inspection.

Inspectors there recorded an average 1.1 serious violations per visit in 2014 compared with 1.6 for Philadelphia, according to an Inquirer analysis of inspection reports. The disparity was greater for all violations combined: 3.2 per inspection in Bucks vs. 6.0 in Philadelphia.

Whether the lower number of violations in the county means Bucks restaurants are cleaner is unclear. Philadelphia may simply have a higher proportion of full-service restaurants, which do more complex food preparation than convenience stores or other food establishments. That means more can go wrong, and can be spotted by inspectors.

But food safety officials in Bucks County speculated that their policy of routine inspections twice a year - a goal that most localities don't have the resources to meet - are responsible for the difference.

"We go more for education than for enforcement," Damsker said. More-frequent routine visits give kitchen workers a better understanding of food-safety issues, he said. That leads to fewer problems.

The emphasis on education has gained traction nationwide over the past decade. Throughout the region, most jurisdictions, including Philadelphia, now perform what are known as "risk-based inspections."

They put a higher priority on violations that are known to increase the risk of foodborne illness than on cosmetic issues such as missing ceiling tiles. One of the highest priorities - and among the most common violations - is having an employee present at all times who is trained to recognize problems such as a refrigerator that isn't quite cold enough to kill harmful bacteria.

"There is a lot of turnover in the food industry," said Roth, the Bucks County Health Department's director of environmental health. "We try to develop a relationship with these people by trying to see them more often."

Still, neither Bucks nor any other local jurisdiction meets voluntary inspection guidelines developed by the Food and Drug Administration. They recommend three visits a year for many full-service restaurants, and four for preschools, hospitals, and nursing homes. Philadelphia does achieve quarterly inspections of kitchens that serve the most vulnerable populations; no suburban county manages that, and most of the nation's big cities don't either.

And while Bucks County schedules routine inspections twice as often as Philadelphia does, the city actually conducts about the same number of total inspections per facility (1.8 per year total in Bucks vs. 1.7 in the city). That's because city inspectors find more violations in their initial visits, leading to more reinspections. Whether one approach is better than the other at preventing foodborne illness is unknown.

Officials in Bucks County, like elsewhere, said they were most concerned about ethnic restaurants whose workers grew up in cultures where food is handled differently than in the United States. "That kind of place we probably inspect every 60 days," Roth said.

While inspectors now focus on education, they can force restaurants to fix problems through an escalating series of punitive measures. Most involve money. Bucks charges $185 for the first reinspection and $305 for additional visits.

Repeated minor violations can land a place in district court, where the lowest fees were recently raised from $30 to $300.

Repeated critical violations can lead to a license suspension and, eventually, permanent closure. That has happened only twice in the last couple of years, Roth said.

The county can also order a temporary shutdown to fix an immediate health threat. That was the case in 2002, when dozens of people got sick after eating at the steakhouse in Middletown.

The new sink was installed and the place reopened after a week. Only later did federal investigators determine that the restaurant had not caused the problem: there was no way to know that its tomatoes came in with Salmonella, which can be killed by cooking but is not easily washed off raw produce.

But bad publicity did the place in, Roth said.

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@DonSapatkin

Michele Tranquilli of the Philadelphia Media Network staff contributed to this story.