Objective

To determine whether the Department of Health adequately monitors designated health departments’ oversight of food service establishments to ensure they comply with the State Sanitary Code to prevent or mitigate outbreaks of foodborne illness. This audit covers the period January 1, 2014 through April 12, 2018.

About the Program

The Centers for Disease Control and Prevention (CDC) estimates that, each year, roughly 48 million people in the United States – or 1 in 6 Americans – get sick from a foodborne illness. Compliance with health codes and guidelines can help protect public health and prevent some of these illnesses.

The Department of Health (Department), through its Division of Environmental Health Protection, is responsible for overseeing New York State’s more than 90,000 food service establishments (Establishments) and for ensuring that those Establishments are adhering to the State Sanitary Code (Code). The Department administers regulatory programs designed to minimize environmental health threats and provides policy directives and implementation guidance to county and city health departments and State regional and district offices. The Department’s oversight is implemented at the local level through four regional offices (Capital, Central, Western, and Metropolitan) responsible for county and city health departments and the Department’s district offices. Thirty-six counties and the City of New York have a health department; the 21 counties without full-service health departments rely on the Department’s district offices. Hereafter, we collectively refer to the county and city health departments, including the New York City Department of Health and Mental Hygiene, and Department district offices as designated health departments. These departments are responsible for permitting and inspecting Establishments to ensure compliance with the Code and investigating complaints and reports of foodborne illness. They must also notify the Department when they initiate an investigation of a foodborne illness outbreak or when an unusual prevalence of foodborne illness is identified. Consumers may submit food-related complaints against Establishments to their designated health department. The Department requires each designated health department to investigate all complaints and reports of foodborne illness in an accurate, complete, and timely fashion. Designated health departments must maintain a surveillance system to record complaints and identify possible foodborne illness outbreaks.

Key Findings

• The Department has implemented inspection, complaint and outbreak investigation, and enforcement procedures and requirements for designated health departments to follow to ensure compliance with the Code to prevent or mitigate outbreaks of foodborne illness. However, designated health departments have not conducted inspections as frequently as recommended, and not all high-risk Establishments are inspected by more highly trained inspectors, as the Department recommends, hindering the Department’s oversight ability. Department reports show that high-risk Establishments were inspected twice a year, as recommended, only 44 percent of the time. Another report showed the percentage of high-risk Establishments inspected by more highly trained inspectors steadily decreased from 76 percent in 2014 to 64 percent in 2017.
• Designated health departments are not adequately ensuring enforcement of, or documenting justifications for the absence of, actions to address Category I public health hazards, as directed by the Department. Overall, of the 984 Category I violations, 717 (73 percent) resulted in no enforcement action, and for 590 of the 717 (82 percent), inspectors also did not provide justification for the lack of enforcement actions.
• We found systemic issues with the quality of data the Department relies on to carry out its oversight of Establishments. Error-prone reporting and problems transmitting data from designated health departments to the Department’s Environmental Health Information and Permitting System (EHIPS) have resulted in data inaccuracies. Such deficiencies, along with inconsistent use of reporting functions, diminish the Department’s ability to conduct useful analyses and to provide meaningful information to designated health departments – information that could help designated health departments focus their limited resources on areas of highest risk to consumers.

Key Recommendations

• Implement procedures to incorporate periodic data analysis and consistent use of EHIPS reporting mechanisms to:
  • Assess the performance of designated health department functions that need improvements;
  • Identify patterns and/or areas of concern involving non-compliance with the Code; and
  • Provide information to regional offices and designated health departments to assist them in the most effective allocation of staff resources (i.e., to more effectively assign certified inspectors and assess risk levels of Establishments).
• Ensure that designated health departments take enforcement action for Category I violations or document justification for not doing so, especially for Establishments that demonstrate a pattern of repeated violations.
• Take steps to improve the accuracy and completeness of EHIPS data including, but not necessarily limited to:
  • Implementing procedures for input, quality assurance, and utilization of information; and
  • Developing fixes for data errors and the inability to transmit data from designated health departments to EHIPS.