How safe is our food?

State, local inspectors struggle to implement new standards

Friday, July 15, 2016, Vol. 40, No. 29
By Hollie Deese

It’s not easy being a food inspector in Tennessee, dealing with an updated statewide food code to protect the public from foodborne illnesses and educating restaurateurs, many with their own ideas about their cuisine, on following the rules.

The work is particularly trying in Nashville as inspectors feel the growing pains of a rapidly-expanding city and an increase in food establishments seeking the necessary permits to operate.

“You see these cranes that are up all over town, and usually that might be a condo or apartment building. But on the first floor many times there’s some kind of restaurant or something to do with food there in the building,” says Brian Todd, director of communications at the Nashville Metro Health Department.

“With every one of those, there usually is something that is added to it for us.”

In 2013, the Tennessee General Assembly passed the Tennessee Retail Food Safety Act, the first significant change in how the state regulates and inspects retail food establishments including grocery stores and restaurants in 30 years. It gave food operators two years to implement the 2009 Food Code.

The Food Code is a model law published by the U.S. Food and Drug Administration that provides guidelines for retail and food service establishment regulations by federal, state and local governments.

The act applies to all retail food establishments in Tennessee that are regulated by either the Tennessee Department of Health or the Tennessee Department of Agriculture. That includes restaurants, delis, catering operations, ice cream shops, school cafeterias, licensed health care facilities, pop-up restaurants, grocery stores, convenience stores, butchers and seafood markets, shared-use operations and food trucks.

The code went into effect after the two-year grace period was up in July 2015, but it has not been a seamless process.

“It took a good year of going out and doing what we were calling a soft rollout of talking about the new items that would debut during the inspection that they needed to get into compliance,” says Kevin Clark, food program manager with the Knox County Health Department.

The old code was so outdated it didn’t mention sushi, according to Steve Crosier, director of the Metro Health Department’s Food Protection Services division, who says the previous code they were working on was from 1976.

The new code will increase his department’s workload even more. Some restaurants will need to be checked twice as often as they had previously, and implementing other changes will bring a bit of a learning curve for food establishments.

“It’s still a little hard, and we know it takes a little longer for inspection, but times have changed and we finally caught up with the changes,” Crosier says.

The code has also turned inspectors into educators, in a sense, walking owners through the new needs like having an employee sick plan on file.

“It comes down to each restaurant proving that they have a food safety program in place. That’s what the big picture’s about,” Clark says. “It’s a lot of education, retraining and verifying that they’re actually following through, that there is a system there.

“The way it’s written is more of a partnership that if you come into compliance with the science behind making people sick and possibly losing your business and your means of survival, you will operate more efficiently. You’ll be more successful and this is a win-win for your customers, for your business and for public health. That’s the new vision and message.”

The workload

In 2013, the Metro Public Health Department’s Food Division handled the inspections of 4,580 establishments with food permits, including restaurants, retail grocery stores, snack bars and school cafeterias. Three years later, it is responsible for nearly 4,900 establishments in need of inspections and food permits. The number keeps growing.

The food safety inspection program conducts unannounced inspections at least twice each year using an FDA-approved standardized 44-item inspection process.

During the inspection, officials are especially focused on the five risk factors that could cause a foodborne illness:

-- Foods produced from an unapproved source

-- Improper temperature in storage and cooking

-- Cross-contamination

-- Improper cleaning and sanitizing of utensils and equipment

-- Poor employee health hygiene

Already, Nashville is behind in inspections and is ready to make two hires, one to work with food protection and the other to work with public facilities including pools, schools, daycares and hotels, Crosier says. Starting salary for an inspector is $36,800.

Crosier says he hopes the new hires will be able to work with both departments.

“The same thing has happened with (inspectors who work with pools, hotels, etc.) as our restaurants,” Crosier adds. “You have all these new hotels being built, they all have pools. The apartments, they have pools.”

Twelve Nashville inspectors currently handle food only, working with about 4,900 establishments. Six others handle establishments such as tattoo parlors, pools and hotels.

“We contract with the state health department, and part of the way that we’re funded is the permitting,” Todd says. “We’ve increased almost 20 percent in the last five years so we use that money to request two additional inspectors to keep up with the growing demand for inspections in Davidson County.”

“If we have anybody out for any reason at a time, that throws us in a pretty serious bind,” Nashville’s Crosier adds.

In Knoxville, the Knox County Health Department’s Food Protection Division has 11 inspectors who work both food and public facilities, monitoring about 2,135 food establishments – some in conjunction with Department of Agriculture regulation – in addition to 500 day cares, schools and hotels and nearly 600 pools and tattoo parlors.

An inspector can average four to six restaurant inspections a day, with chains like Subway and Taco Bell on a set program that moves quickly. Kitchens with a sushi set up and/or large buffets might take longer to inspect.

Both Knox and Davidson health agencies are also contracted by the Department of Agriculture, as well, to handle grocery stores, stop-and-go gas stations and other retailers that also have a cooler, like Walgreen’s.

“Really, the only inspections that occur in Knox County that aren’t done by us would be when you have a food manufacturing plant and the Department of Agriculture does that,” Knoxville’s Clark says.

Challenges for chefs

Kathleen Cotter opened her cheese business, The Bloomy Rind, inside Porter Road Butcher in East Nashville five years ago. She agrees there have been some growing pains as everyone familiarizes themselves with the new code.

“They’re trying to get everybody trained and up to speed with the new regulations,” Cotter says. “There’s some things that are easy and some things that are challenging.

“I think that they have the greater good as their priority. I think it’s just always a challenge to get it communicated out to everyone so they know what they’re being held accountable to.”

Sick employees cause most issues at area restaurants and those around the country, Crosier says. One of the big changes in the code addresses that, though high-staff turnover in the restaurant industry makes training an issue.

“One of the things that this program has done for as long as I’ve been here is provide food safety training, not only in English, but also Spanish and Mandarin-Chinese,” Crosier says. He estimates 1,500-1,800 service workers have come through the training program.

Finding source of foodborne illness

When it comes to national food health crises like the Chipotle or Jeni’s Splendid Ice Cream recall, the health departments work with the Southeastern Food and Drug Administration representatives on resolution. But since those issues typically originate at a manufacturing facility outside the area, procedure doesn’t really change.

“Unless we receive a recall from the federal or state level, we wouldn’t necessarily change our process or our behavior with the restaurant unless we were having issues with their performance in their area,” Clark explains.

Inspectors in both Knox and Davidson counties say health outbreaks happen, but it can be hard to pin certain illnesses to food as opposed to simple human proximity, like a Noro virus outbreak earlier this year at a local hotel in East Tennessee.

“When you have a tight group of people together, they’re socializing, and that virus goes hand-to hand with their contact,” Clark says. “We couldn’t really implicate the food, but potentially there had been an ill worker and when that happens we go in, we work hand-in-hand with them to sanitize all contact surfaces like used room cards, even candy dishes that have wrapped candy that could have been touched, ATMs, elevator buttons.”

Clark points out they were able to contain that outbreak to just the group from the hotel. But when they know for sure the illness or potential outbreak came from food, the process of tracking down the source quickly is critical. And all it takes is a phone call for them to spring into action. Well, two phone calls.

“We get single illness reports all the time, and people tend to think that the last thing they ate is what made them sick,” Clark explains.

“It could have been, but more than likely with the volume of a restaurant, if you didn’t get another phone call from a separate party, it’s unlikely that the food was the exact source. More than likely it was human transmission. You can pick up viruses anywhere – the bathroom, at the counter, on the rim of a glass.”

But when that second call comes in pointing the finger at the same food item, it’s time to narrow down where the food was consumed and how the person ate the food.

Clark says Knox County had a small E. coli scare earlier in the year following a USDA recall on beef from an area processing plant. The product was quickly contained because it was from such a small grower that only a couple of specialized restaurants were carrying the local beef.

“We were able to send out samples to the lab, a fully-cooked hamburger patty and a raw patty, and they could clearly identify the E. coli strain in the raw and if it was cooked to the proper temperature, that was the kill step,” Clark says.

“The couple cases we had were from the burgers being undercooked. We have a consumer advisory so there is a risk by doing that.”

Locally produced foods

In that E. coli scare, it was the mindset that the beef was produced locally on a small farm that gave people the impression they could consume it undercooked. And it is a growing concern among inspectors as the trend in small farming increases.

“We’re trying to educate and talk to our operators because there is the idea that local, grass-fed, organic, is completely safe but it needs to be cooked just like it is was mass produced,” Clark explains. “Just because it’s smaller-scale, there’s a misperception, I think, from the public, that they can eat that toward the rare side.

“You should be cooking that to 155 degrees, regardless.”

But, it can be hard convincing even some chefs of the importance of treating local ingredients the same as they would items from a large purveyor.

“Sometimes chefs have the prerogative to do what they want to do,” Clark adds. “They have strong opinions on what they want to do regardless of what the regulator is telling them.”

The Tennessee Department of Agriculture is responsible for stand-alone food service establishments like restaurants, says Samantha Jean, the department’s deputy director.

And just as the number of restaurants has increased, so have the number of farmers and food artisans needing regulation.

Also, neither farmers markets nor roadside stands are given permits but still may be inspected by the TDA.

“We understand there are individuals that may be operating without our knowledge,” Jean via email.

“The consumer should ask to view their TDA permit, and the product should be properly labeled. That includes name and address of producer, name of product, ingredients of product in descending order of predominance by weight, any food allergens, and net weight or volume.

“It’s also recommended, though not required, that a date on which the food was processed be included on the label,” she adds.

Jean also says the food safety standards are the same for organics, and there are certain restrictions that an organic producer must meet.

The USDA sets the organic standards and compliance with these standards is determined by a certified third party auditor.

Jean points out that allergens are a significant public health concern, along with bacterial contamination and growth, cross contamination and time/temperature issues.

If Crosier and his crew run into violations at food establishments, the measures depend on the severity of the issue. And they do find plenty of violations.

“If it’s a floor drain backed up or there is no hot water or refrigeration we would cease operation immediately,” he says. “If it’s something we can get them to move, like a set of coolers not working but they can move it to another cooler, then we allow them to do that. It depends on what the cooler temperature is, we might embargo the food where they would have to destroy it.”

Helping hands

Mike Brown was hired by the TDA to help guide food business owners and entrepreneurs through the regulatory process.

He directs them to classes at The University of Tennessee Extension Service and UT’s Center for Profitable Agriculture offers programs and classes.

It’s well worth it for those new to a food business who can contact the TDA for information regarding what type of product they wish to produce, and Jean adds an area inspector will work with them in complying with the requirements.

“Challenges vary depending on the risk of the product one wishes to manufacture and sell,” Jean explains.

“The higher the risk, the more regulatory requirements one must meet. Understanding food safety is key and along with that is realizing the liability one assumes when providing a product for public consumption.”

Navigating the waters of regulation and food safety compliance is something longtime chef and food entrepreneur Laura Wilson has dealt with, and something she now helps others with through Citizen Kitchens, a culinary incubator for food entrepreneurs and co-working commercial kitchen in West Nashville.

“She’s done a great deal of work and she has great relationships with the health department and the department of agriculture, so she facilitates making sure the producer knows what they need to be doing and helping them get in line with what’s required of them,” Cotter says of Wilson.

Wilson was a professional chef for more than 20 years including stints in Chattanooga and New Orleans before moving to Nashville in 2002, working at Wild Iris and F. Scott’s. But she was ready to trade in the 80-hour workweeks of a chef for something that still fulfilled her but left time for her family, so she helped open Holland House, did some moonlighting at Tin Angel and participated in her first Iron Fork competition.

“Then, in 2013, I ran into some friends from the Nashville Farmers’ Market who wanted to expand the use of the test kitchen there, the Grow Local Kitchen,” she recalls. “They really wanted to see classes and all kinds of programming in the kitchen.

“As I spent time there, I realized there were so many food artisans. The small makers’ culture in Nashville was turning into a huge culture that needed a place to legally manufacture their goods.

“I love the idea of having someone’s homemade cookies, but I’d like to know that there aren’t 40 cats in the house.”

The Department of Agriculture does offer a domestic kitchen certification program, so if you don’t have indoor pets and have an appropriate kitchen and a space to store things, you actually can produce nonperishable goods out of your home.

Wilson wanted to provide these food entrepreneurs with a place to produce food in a safe and wholesome manner and to still be able to focus on the growth of their food businesses.

They needed a place to do it that was not in their homes.

“If I am a restaurant, and I’m cooking food for people to eat in my restaurant, well, that’s really straightforward. That is the Metropolitan Department of Health,” Wilson says.

“If I am cooking in my restaurant, and I make soup, and I chill that soup and put it in a grab-and-go container in my restaurant, that is a Department of Health.

“If I make that soup in a commissary kitchen or if I want to make it at home with my licensed domestic kitchen, then that comes under the purview of the Tennessee Department of Agriculture.”

Wilson knows all this because of how many times she has called the government agencies on the behalf of the food artisans and farmers she helps navigate to get fully and safely certified.

“A lot of what I really work hard to do is to gather some of that information so that when someone is ready to start a food business whether it’s a restaurant or a manufacturer, I just try to help them,” she adds. “You don’t know who the first person in line is.

“I opened Citizen Kitchens because I saw that there was a great need for manufacturing space and catering space. People that are in small food business, they tend to be more artists and creative.”

Wilson’s space in West Nashville is 2,800 square feet, opened in September and already totally full with food entrepreneurs like Wolfe Cakes, Ancestor Bakery, Sifted, Crepe A Diem food truck, Two Goat food truck, Wise Butters, MEEL, Wedge Oak Farm and more.

“I’m working very hard on opening a new space that’s at least 10,000 square feet and to expand our wrap-around services to really help people more with their filings,” she says.

“People have just found us. I haven’t even done branding yet. I don’t have business cards. I don’t even have a logo.”

Nashville Grown also is housed in Citizen Kitchens, a nonprofit launched in 2012 that aggregates and distributes local farm produce to restaurants and institutions.

Set up like an Amazon shopping page, there’s produce from 35 different farmers sold to nearly 50 different restaurants.

The first year of Nashville Grown, $60,000 worth of produce was sold. Last year it was $158,000.

“That’s how we can offer both organic and conventional farm goods. It’s my great hope that the income and scalability from Nashville Grown, of enabling small farms to grow, will also enable them to do things that open other doorways for them,” Wilson says.

“Getting GAP certification will allow them to sell to Metro Schools. Those are doors that we want to help open.”