Mean street, USA: the problem of abuse and violence in the field.

Introduction: How Bad Is It? One day, a young environmental health professional, inspecting a rental property in the company of the owner, found asbestos legging on pipes in the basement. Because the asbestos was friable, regulations in the jurisdiction required the owner to hire an asbestos abatement contractor to remove it.

[ILLUSTRATION OMITTED]

"And he just didn't want to hear that," said Phyllis Boucher, now superintendent/director of the Norwood Board of Health in Massachusetts. They were alone in the basement, and the owner began shouting at her. "He lost it, basically."

Was he threatening her physically?

"I don't know if I was being threatened," Boucher said honestly. "I felt threatened. I was afraid."

That state of uneasy ambiguity is typical of many interactions environmental health professionals have with irate members of the public. To some extent it also mirrors a larger uneasiness about just how dangerous the profession is in general.

"It happens a lot," said Dick Pantages, NEHA Region 2 vice president and formerly division chief of the Alameda County Environmental Health in California. "People say, 'I'll kill you if you do that.' They probably don't really mean it--it's probably just an expression--but if you don't know the person, you have to be careful."

The frequency with which environmental health professionals encounter abusive behavior and violence varies widely by jurisdiction. Paul Guenther, environmental health director for a jurisdiction in north-central Idaho, said that in more than 30 years of work, he has felt that he was in danger only on very rare occasions--"and not in recent years." Although there have been some tense encounters in his jurisdiction (more on those later), his staff are not running into volatile situations on a day-to-day basis. By contrast, several environmental health professionals from urban areas of California told the Journal of Environmental Health (JEH) that such encounters are regular occurrences.

Lawrence Pong, principal environmental health inspector for the city and county of San Francisco, believes that these stories are largely unknown to the public at large, partly because "the average inspector tends to lock [them] up within himself or herself." In an effort to remedy that situation, Pong's department has been publishing a series called "First Person" in a departmental newsletter that is circulated to lawmakers and other health departments (Jeung, 2001; LaMacchia, 2004; Ong, 2001; St. Jean, 2002; Tong, 2001).

The type of abuse environmental health professionals encounter also ranges widely, from comical to bizarre to vicious. In the course of interviewing professionals around the country for this article, JEH heard stories of irate developers caging inspectors in by locking chainlink fences, of nursing-home operators threatening field staff with shotguns and throwing gris-gris powder (the New Orleans version of voodoo powder), of holes being punched in walls. And, of course, two incidents loom large in this discussion: the 1992 murder of Environmental Health Specialist Cynthia Volpe and members of her family by a landlord whose property she had inspected, and the 2000 murder of three state and federal meat inspectors at a sausage factory.

Really terrible incidents may be "few and far between," acknowledged Greg Erickson, director of public health in Wilmington, Massachusetts, "but then, sometimes cops go their whole careers and never draw a weapon." Uncertainty and the potential for conflict are intrinsic to a job that requires one to enter onto other people's turf as--and this seems to be a key part of the equation--a representative of the government.

It can be hard to know exactly how much wariness is warranted. One does not want to devote excessive mental, emotional, and professional energy to protecting oneself from imaginary dangers--and, on the other hand, one does not want to get killed. This dilemma becomes visceral in the wake of incidents like the Volpe and sausage factory murders, particularly so for those who work in the vicinity. One environmental health specialist from California wrote to JEH:

  I find myself trying not to be seen by operators/tenants so that my
  family isn't subject to my work and any possible retaliation. I have
  had several "mystery" flat tires in less than a month (all nails or
  screws), and I don't inspect construction projects of any type. I have
  never had a specific threat directed at me, but vague comments to
  where I feel there is a potential threat. I currently maintain what I
  call my "watch list": operators, owners, tenants, etc.--anyone I feel
  may be or may become a threat to me or my family. I also keep my phone
  unlisted and surf the Web from time to time to make sure no personal
  information is posted.

Is he going overboard? Perhaps, but as Boucher of Norwood, Massachusetts, told JEH, "you don't know how people will react" to unwelcome news. The proprietor who terrified her when she wrote up his asbestos violation "was not somebody I had any concern about prior to going down into the basement."

Not-knowing is a difficult place to be. When environmental health professionals find themselves worrying about the dangers that may lurk behind each door they knock on, that situation has implications for the practice of the profession in general. This article will explore some of the ethical dilemmas that the potential for violence raises for all stakeholders--field staff, environmental health management, and, not least of all, the general public.

Rage: Is It Getting Worse?

Some of the environmental health professionals whom JEH heard from on this issue thought violence was on the decline in particular jurisdictions or areas (e.g., neighborhoods that used to be "dangerous"); others saw no trend in either direction. Many, however, felt that "people do seem more violent than they used to be," as one environmental health professional from a rural Midwestern county wrote in to say. It is important to note that these impressions are subjective and anecdotal, and that people who responded to queries on the topic may have been self-selecting because of personal experiences with violence on the job or because of an interest in the issue.

Those who saw a rise in aggression blamed causes ranging from the ruthless speed at which society now moves to generally rising levels of stress to the precarious economic straits many people find themselves in to the influence of the electronic media, which, as Mike Hines, a code compliance officer with the city of Thousand Oaks, California, put it, has been "bombarding people with violence as a method for solving problems over the last 25 to 40 years."

Boucher believes that people are generally unwilling to communicate with their neighbors to resolve problems. As a result, the health department gets exploited as a go-between. "And it can be stupid things, like 'My neighbor puts his trash out too close to my side,'" she told JEH. When Boucher asked the complainant if he had talked to the neighbor, she said he told her that they hadn't been speaking for 25 years, and that "'I'm not going to start now.'"

"For whatever reason," Pantages agreed, "we're tending to be a more and more violent society." He cited the archetypal modern scenarios of people indulging their rage: "'He dissed me--that's why I shot him.' 'He cut me off, so I ran him off the cliff.'"

The Volpe Murders

Rage--not just momentary rage, but a sustained, vengeful rage--characterized one of the worst crimes that has been committed against an environmental health professional. In June 1991, Cynthia Volpe, who worked as an environmental health specialist for Kern County, California, was assaulted while investigating a housing complaint about a rental property. The property owner, Robert Courtney, beat her so badly that her recovery necessitated several months off work. Charges were pressed, and Courtney was prosecuted. In August of 1992, while the case was in jury, Courtney went to Volpe's house and murdered her, her husband, and her mother. He was killed the next day after a police chase (Ng, 2000).

"You're Not the Boss of Me"

An antagonistic relation between business operator and environmental health professional is not an inevitability. Sometimes, as Deborah Smith-Cooke of San Luis Obispo County, California, wrote to JEH, "the inspector is seen as an extension of the business" because "he or she is there to help ensure that things are done safely." Sometimes, however, "the inspector will be seen as a necessary evil to be put up with" or as "a threat to the business, so that the inspection becomes a struggle for 'power' in the mind of the operator." When these two attitudes prevail, the working climate grows difficult, and the environmental health professional may have to deal with "hostility, threats, and psychological warfare."

Often, it's not only a question of money. "People get very upset if someone of authority can approach them on their property," observed Michael Reynolds, second vice president of the California Association of Code Enforcement (CACE), an organization that has been working with the California Environmental Health Association (CEHA) on the issue of violence against code enforcement officers. For an example of another motive, see the sidebar on page 67.

Many of the environmental health people JEH heard from, especially those working in Western states, touched on the theme of operators who believe they should be able to run their facilities as they see fit, without interference--especially from representatives of the government. Guenther of the North Central District Health Department in Idaho told JEH that in the past 15 years, his jurisdiction has experienced an influx of extreme-right groups: "the Constitutionalists, the Patriot-type folks, white supremacists--they go by different names." Often, members of these groups do not recognize the authority of government agencies to regulate and enforce codes. "We've had those situations," Guenther said, mildly.

"In 2000, I pulled into the parking area of a feed store that let vendors set up on occasion," Brian Supallo, environmental health program manager in Yavapai County, Arizona, told JEH:

  I had to chase off an illicit food vendor and went inside to let the
  feed store owner know. I suggested that he have food vendors contact
  the health department before setting up, mentioning that this would be
  a way to reduce liability to his business. He was appreciative, until
  I mentioned the word "permit." He went into a five-minute rant
  against government interference, said he would sh-t on the American
  flag, and that he had often thought of packing a vehicle with
  explosives and parking it at a government building.

Remarkable in that rant is the notion that people who work in a government building are so intrinsically bad that any amount of violence committed against them would be a matter of righting wrongs--justified, perhaps heroic. There are echoes here of the Oklahoma City bombing, although, Supalla told JEH, when he reported the incident to the police, it was determined "that the man did not pose a threat."

The scapegoating of government employees--especially those, like environmental health professionals, who have an enforcement role--is common currency in public discourse. "It's the old bureaucrat thing," Pantages said. "It's the if-they-could-get-honest-work-they-wouldn't-work-for-the-government mentality." Even people who would never dream of committing violent acts toss these animus-laden sentiments around. In time-honored fashion, politicians fan the flames by exploiting the scapegoats for political advantage: "I don't know how many times I've been in city council meetings where they've blamed the staff," Pantages added. "[They say,] 'We'll have to chastise the staff for that.' Well, okay, if the staff has done something wrong, but a lot of times all the staff has been doing is enforcing the policy of the city council or the board of supervisors--and taking the heat for it."

This is not the place to take up the debate about the dangers inherent in hate speech. Nevertheless, it's fair to say that an intense anti-government or anti-regulation atmosphere can put enforcement personnel at particular risk by granting an air of philosophical respectability--or even social sanction--to certain baldly antisocial attitudes: indifference to the impact of one's behavior on one's neighbors ("it's my yard, and I can fill it with old wrecks if I want to"); authority complexes ("nobody tells me what to do"); paranoia ("those government bureaucrats are out to get me"); and delusions of grandeur ("I am the law").

The Sausage Factory Murders

All those attitudes were on display when Stuart Alexander, proprietor of the Santos Linguisa Sausage Factory in San Leandro, California, closed his plant rather than comply with new cooking-temperature and record-keeping rules that went into effect at the beginning of 2000 (Chapman, 2004; Lickteig, 2000; Marshall, Jokelson, Holbrook, & McMillan, 2000). According to acquaintances, Stuart particularly loathed "meat inspectors," but also resented "fire marshals, police, building inspectors and nosy neighbors--anyone he felt was burdening him with unnecessary red tape" (Holbrook & Marshall, 2000, p. Al). Within a couple of months, he began operating the plant again, without permits (Lickteig). He received visits from the U.S. Department of Agriculture (USDA) and the California Department of Food and Agriculture, as well as from Alameda County Environmental Health. The environmental health specialist, according to former Division Chief Pantages, saw that "this guy was really agitated and hostile, and he had the good sense to leave." He was due to accompany state and federal agriculture inspectors when they returned to the plant, but, by a stroke of good fortune, was not notified before they left for the site and did not accompany them.

In the meantime, Alexander (according to testimony given at his trial) had been heard bragging that he was going to shoot the inspectors "execution style" (Associated Press, 2004).

On June 21, 2000, Jean Hillery and Tom Quadros of USDA and Bill Shaline and Earl Willis of the state agriculture department went to the San Linguisa plant to cite Alexander for operating without licenses. Alexander was not present when they arrived, but drove up and ordered them to leave his property. He began walking back and forth from his office to his truck. The inspectors called for police backup. About a minute later, Alexander also phoned the police, asking them to remove "trespassers" from his property (Pimental & DeFao, 2000). He turned on his own video cameras, fetched three handguns from a locker in his office, and shot Hillery, Quadros, and Shaline multiple times (Anderson, 2000; Marshall et al., 2000). Willis was waiting outside for the police. When Alexander came after him firing two guns, Willis was able to escape by running away (Ashley, 2004; Lee, 2004).

During the trial, the defense argued that the government inspectors had hounded and baited Alexander to the point of insanity (Chapman, 2004b, Lee, 2004). The jury was not convinced, however.

"It was a real gratification when Stuart Alexander was convicted on all counts," Pantages told JEH. Given the traction that demonization of government employees sometimes gets, the conviction may also have given other environmental health professionals a sense of vindication and a measure of relief in the knowledge that in this worst-case scenario, the law does back them up.

In December 2004, Alexander was sentenced to death.

Responses in California

The Volpe murders and the sausage factory murders sent tremors through the ranks of the profession, especially in California. In response to the Volpe murders, some jurisdictions have gone so far, according to Suzanne Du Vall Knorr, as to limit the areas covered by environmental health programs--excluding housing issues in particular. CEHA has been more proactive in its approach, offering traveling safety seminars throughout the state. Du Vall Knorr and Pantages both noted that these seminars have been well attended. See Table 1 for some of the strategies that are being used around the country to help protect environmental health professionals from violence.

Calls for Legislation

CEHA has been working, for many years, to pass legislation designed to give environmental health professionals more legal protections than they now have. Since Robert Courtney murdered Cynthia Volpe and her family in her home, most California environmental health professionals with whom JEH spoke are particularly eager to obtain laws that make their home addresses and telephone numbers confidential. For more on confidentiality legislation, see the sidebar at right.

The legislative road has been long and winding; Pantages noted that environmental health professionals are not a large constituency compared with groups like nurses or police, and that "no one's going to get too worked up over our perceived plight."

"The response by the legislature to R.E.H.S. concerns was not favorable," agreed Du Vall Knorr. "CEHA found itself in the position of having to educate politicians on the importance of environmental health, with limited resources and limited funding."

Collaboration

CEHA's solution to this problem has been to join forces with the California Association of Code Enforcement (CACE) to work on legislation. According to CACE second vice president Michael Reynolds, CACE's constituents are, for the most part, vector control inspectors, zoning code enforcement officers, and building code enforcement officers. Their duties have areas of overlap with traditional environmental health duties. Even more basically, the two groups have the task of "enforcement" in common. "We do have some environmental health inspectors [as members of CACE]," Reynolds added, "but not a great number of them; we would like to see as many people as possible join our organization."

Legislative Strategies

CACE has shown itself to be resourceful, determined, and persistent with respect to legislation. In the process, it has gleaned some lessons for working with lawmakers that state environmental health associations around the country might find of value.

Gerald Rettela, CACE's legislative coordinator, told JEH that in the past his organization hired a "legislative advocate" and found that approach less effective than one might think, because CACE was small and could not pay a great deal of money. So CACE began to do its own lobbying, "just hand-in-glove," Rettela said, "trying to explain what we're encountering in the field and asking them [the legislators] if they could find it in their hearts to sponsor us for a piece of legislation."

He soon found that "the big players, ironically, are the legislative counsels who back up the legislators." From then on, Rettela's approach has been to set up meetings with the legislative counsels of the public safety committee members.

"And bring your war boots with you," he said. "That's what I did, ... brought in all my warriors, and we sat down and had a meeting of the minds. In my mind that's the only way to go."

It is not only a question of selling the language of the bill, Rettela added, but also of selling oneself. "You have to have all the facts and figures. And, of course, they have to be entirely accurate. Because they [legislative counsel] have a tendency to check up on the authenticity of what you're saying. If you don't know something, say so, and say you'll get back to them. But you try to anticipate what they're going to ask you so that you have that information on hand."

There have been some modest successes. Senate Bill 919, signed into law on September 3, 2003, wrote a definition of the term "code enforcement officer" into the California Penal Code (California Penal Code, 1995-2005a). Environmental health is covered under this definition; in the eyes of California law, environmental health specialists are code enforcement officers. The legislation also raised the penalty for assault against a code enforcement officer from up to $1,000 and/or six months in prison (the penalties for assault against an ordinary citizen) to up to $2,000 and/or one year in prison. The penalty for battery is raised from up to $2,000 and/or six months in jail to up to $2,000 and/or one year in jail (California a Penal Code, 1994-2005b).

What Next?

How much of a deterrent will higher penalties have?

"None," Pantages, suggested, "unless you're wearing a big sign that says, 'If you hit me, you're going to get the electric chair.' Who knows? Who cares?"

The value of the law, several people told JEH is to ensure that when attacks occur, the penalty will be of enough consequence to send a message to the public in general. Both CEHA and CACE recognize that the impact will be modest, and they are interested in pursuing further legislation.

Given the reality of budget shortfalls in California, CACE has decided to take the long view, laying the groundwork for future legislation rather than immediately pushing more bills. Toward this end, CACE and CEHA have distributed a survey to their members soliciting information about the extent to which they encounter hostility, violence, and other dangers in the field (the survey can be found at www.cacel.org/survey.htm).

"We have a problem here in California," Rettela said. "Fiscally we're really in bad shape. So I've got my hands tied. I cannot draft any legislation that would have a fiscal impact on the budget." For the time being, he's working on "language that is free and clear of causing the coffers to dwindle in California." One such project is the insertion of language in the California government code that would set minimum qualifications for code enforcement officers.

Here, though, there may be some divergence between the interests of environmental health and the interests of the code enforcement profession in general. The California Health and Safety Code already requires environmental health specialists to pass an R.E.H.S. exam. To sit for the exam, candidates must have a bachelor's degree. Different amounts of work experience may be combined with different numbers of course credits in chemistry, microbiology, biology, physics, and math (California Health and Safety Code, 1994-2005). Rettela sounded a little envious; California law currently specifies no qualifications at all for code enforcement officers, and the standards he considers it practical to propose for the profession set the bar much lower: "E.g., you've got to be at least 18 years old, you've got to be a U.S. citizen, you've got to be physically in good shape, and you've got to have a high school diploma."

An Existential Dilemma

At some point in doing research for this article, JEH began to wonder whether the solidarity that has developed between environmental health professionals and code enforcement officers in California might have drawbacks as well as advantages. Every environmental health professional reading this article is surely aware that the task of giving environmental health a public face is a daunting, complex, and urgent one. While it is important to recognize the dangers facing personnel in the field and to take action to mitigate them, it is also important to make sure that the profile of the profession does not imply a more consistently conflictual relation with the public than is actually the case.

JEH suspects that the survey mentioned above, much like JEH's own queries on the topic, is more likely to garner responses from those who have encountered violence than from those who have not. Indeed, it is designed to provide evidence supporting an argument in support of legislation, not to be an objective assessment of the extent of the problem. The introduction to the survey tells respondents. "This survey will help to establish statistical information and testimonials that will be critical to the passage of legislation designed to help protect nonsworn 'public safety officers.'" JEH notes with some uneasiness that this language implies a series of identities or equations--environmental health specialist = code enforcement officer = "nonsworn 'public safety officer'"--that take the profession two giant steps closer to associating itself with the concept of policing. (Among some members of the profession there is a sense that such a move would in fact be advantageous; see the sidebar on page 73.)

The official California classification of environmental health specialists as a type of code enforcement officer does not necessarily mean that all code enforcement officers are environmental health specialists. But that distinction may be hard to maintain in public discourse, which tends to miss subtleties. An anecdote from JEH's experience in researching this article will illustrate how quickly this confusion can occur.

A query soliciting comments from environmental health professionals was forwarded, on behalf of JEH, to ceha.org and volpe.org, two professional listservs that had environmental health subscribers. In short order, JEH received over 50 e-mails from code enforcement officers who were not environmental health specialists sharing their experiences of violence in the field and thanking JEH for doing this work on their behalf. There was also an agitated letter from "a concerned member of the public" who wrote under the impression that JEH "was interested in hearing thoughts and encounters that Code Enforcement officers have experienced in relation to threats and violence that are work related." This correspondent wanted JEH to know that he had experienced "an out of control code enforcement officer" and that he hoped the research "would be of an unbiased nature."

It seemed that one could not write an article about environmental health without eliciting a strong expectation that one's topic was or should be code enforcement officers. JEH believes that this conflation may not always be a healthy thing for the (environmental health) profession, for a couple of reasons. First, environmental health has ongoing struggles with invisibility, and it is instructive to notice how quickly the environmental health element got lost in the larger, hotter debate about code enforcement in general.

Second, despite the areas of overlap between environmental health and other kinds of code enforcement, there are some differences in professional culture. Environmental health professionals conduct many routine inspections of permitted facilities that may or may not turn up violations. They may have (at least in an optimistic scenario) ongoing cooperative relations with the people they regulate, as well as an educational role that on occasion may even be perceived as helpful. While it is true that violence can erupt in any situation (witness the sausage factory murders), it is also true that environmental health has many encounters with people who are used to being inspected. They may or may not like it, but they expect it, and it's part of everybody's routine. Non-environmental health code enforcement officers often go out in response to specific complaints. In other words, they go to a site more or less expecting somebody to have done something wrong. Although they do not carry guns, many do carry pepper spray and batons. JEH heard stories from code enforcement officers about incidents that involved "going hands on and taking care of business" or "wrestling the subject to the ground." That activity would generally fall far outside the job description for environmental health professionals; indeed, it runs counter to the explicit directions most have from their departments to simply leave the premises if they feel uncomfortable. Even the vocabulary differs; the use of a term like "subject" bespeaks a different relationship with the regulated party.

Most code enforcement officers who contacted JEH for this story said that violence and verbal abuse were constant, everyday occurrences in their work. By contrast, environmental health professionals generally spoke of hostile incidents as happening "from time to time" and "occasionally."

The point here is not to downplay the dangers faced by environmental health professionals. Nor is it to pass judgement on the professional culture of code enforcement, which may well be appropriate to the challenges its practitioners face. Rather, JEH would simply like to raise the question: How well does it serve the profession to be closely identified with the tougher profile of code enforcement?

JEH put this question to both environmental health professionals and code enforcement officers and received some interesting responses.

Du Vall Knorr pointed out that in some places the professional culture of environmental health is already changing. For budget reasons, some jurisdictions have been demanding that environmental health staff spend less time on each inspection, with the result that there is less time for teaching and less opportunity for rapport to develop between operator and inspector. When the emphasis is on churning out inspections, Du Vall Knorr believes, there is a greater probability of violence.

Also, she said, in some of the "less desirable" areas of environmental health such as food vehicle inspection, housing inspection, animal sanitation, and vector control, environmental health professionals respond more frequently to complaints and "work with a different clientele with a different mindset." More generally, the potential for violence and the type of clientele vary widely within the broad field of environmental health.

Rettela of CACE suggested that some of the same professional differences exist among other code enforcement areas. He sees it as a difference between compliance agencies and enforcement agencies. "If the nuisance or the wrongful situation continues, do you just crank out paperwork saying you shouldn't do that, you're a naughty person, correct it please? [That would be a compliance approach.] With the enforcement agency, they [violators] get a notice, and if they don't do it [correct the problem], bang. A formal complaint is issued or a citation is issued [in other words, there is quicker recourse to legal sanction]."

CACE Second Vice President Reynolds, who is a building inspector, pointed out that he does put a good deal of emphasis on educating the public. "We don't want it to appear to be too much of an authoritarian-type force over people. We want to educate them about why we have these rules in place--and how it benefits everybody .... If people start screaming and yelling, let them scream and yell, let them get some steam out. Then explain to them that we understand, that this is the reality of the situation and it does have to be addressed. Most of the time people will calm down and understand." He added, "It's a very precarious line to walk when you're an enforcement officer. You can't be too firm, and you can't be too lenient. You've got to know how to balance on that line."

Du Vall Knorr believes it is possible that the environmental health and code enforcement professions will eventually merge: "The trend is in that direction already, and in reality, we're all code enforcement officers, just in different areas."

Rettela told JEH that the term "code enforcement officer" is simply an umbrella term. "It's just like saying, 'I'm a doctor.' Well, what kind of doctor are you?"

What Kind of Environmental Health Professional Are You? A Dilemma for Field Staff

Lawrence Pong reminded JEH that going into uncomfortable situations is part of the job. "This is what we signed up for. You know, a lot of us are qualified for lab jobs, where we would be surrounded by test tubes and chemicals and we wouldn't have to deal with anybody. Or you know, I could get a card shop and sell flowers and cards--good golly! I like what I do."

Brian Supallo of Yavapai County, Arizona, suggested that "sanitarians with a thin skin won't survive more than a few months, unless they have a passion for public health work." Indeed, as illustrated by a story NEHA President Balsamo shared with JEH, an idealistic attitude about one's work sometimes provides a measure of protection:

  I used to go to the projects. These places were horrible. No running
  water, sewage, terrible. I'm this white guy in 1969 to 1973, and
  that's when the Black Panthers were very active. They took over a
  housing project in New Orleans. Was I intimidated? I was probably too
  stupid. I never felt like they were going to harm me. Because I was
  there to help them.

And, he said, he was fine.

Jeff Lojeski, an environmental health specialist in Riverside County, California, believes that field staff who encounter hostility in the field may have a part in stirring it up:

  I work in the division that inspects all retail food facilities and
  all public/semi-public swimming pools. We also handle garbage and
  sewage complaints in the unincorporated areas of the county .... Most
  of the inspectors I've seen who have had problems with physical
  violence have taken a hard-edge attitude that has put them at odds
  with their operators from day one. I've also noticed that code
  enforcement has had more problems than most of our department
  inspectors .... I don't think the situation is getting any worse;
  the confrontational aspect of the job has always been there. I just
  think that the attitudes of some of the inspectors have changed and
  have become much more militant.

In other words, the expectation that one will encounter violence can give one a manner that is in itself provocative.

"Inspectors operate by themselves, so it's hard to determine what goes on out in the field," noted Dick Pantages. "I do think a lot of people need some lessons in tact and how to essentially give bad news to people in a more palatable way. You don't just walk in and say, 'I'm the man, and you're going to do it because I say so.'"

It's not only too much orientation toward an authoritarian or law enforcement mentality that can be a problem. Balsamo told JEH that many environmental health professionals are used to thinking in terms of their scientific training, "where things are arranged in nice neat compartments--facts and stuff," but that they haven't learned to handle the stresses of dealing with people. When he worked in New Orleans, environmental health professionals received no training in interpersonal skills: They had to learn on their own, and some people proved more adaptive than others. "Some people never wanted to speak to people right," he said. "And they were always getting complaints." For an example of the kind of protection afforded by verbal skills, see the sidebar on page 75.

Du Vall Knorr agreed that environmental health professionals need to know when not to push someone any further. "It's important for the inspector not to make things personal," she said. "To stay as professional as possible. And be frank with people. Lay out all their options. Sometimes times there are lots of different solutions to the problem. So that the person doesn't feel put in a box."

Pantages was emphatic: "If it looks like it's going south, please. Don't argue. Forget that the law says you have a right to be there. If he demands that you leave, leave."

"Back up and leave," agreed Jorge Goitia of Alameda County Environmental Health. "There's no choice. Unless you're also a hot-head, and that's not good, I think."

In other words, it is not part of the job to force someone to comply with the law. "It's not that the code wouldn't be enforced," Du Vall Knorr said, "but perhaps not at that moment. You might set up something different, not have meetings at that person's facility, bring him into the office." Or, if necessary, several interviewees pointed out, environmental health staff can return to the site with a buddy or bring along someone whose specialty is law enforcement--the police.

Several people interviewed for this article suggested that for individual staff members, one of the barriers to this approach can be the fear that one's colleagues--or worse, one's boss--will think that one is not up to the job. Boucher of Norwood, Massachusetts, told JEH that she felt this kind of pressure because of gender issues:

  I know a lot of it with me was [the thought that] well, they didn't
  think girls could do this job, so I wasn't going to let anybody know
  that I couldn't do it. So I probably put myself into situations that a
  man--or a smarter person--wouldn't have put himself in.

This kind of bravado is a pitfall that young environmental health professionals of both genders are prone to fall into, Boucher said. She thinks departmental training of new staff should emphasize the importance of not being "stupid" and should tell young people in particular that "your abilities and your qualifications aren't reflected on by the fact that you ask somebody for help."

A macho attitude arising out of personal feelings of insecurity, in other words, is the opposite of constructive.

But so--and finding an appropriate balance is part of the dilemma for staff in the field--so is excessive fearfulness.

Pantages told JEH that in one case at least, he thought a very fearful environmental health specialist was exaggerating the danger. The department had been issued a bullet-proof vest by the Oakland police to be worn during inspections at liquor stores where people often loitered and it was thought that there might be drug dealing going on. Pantages said he told this member of his staff to put the vest on at home or at work before she went into the field and to wear something that covered it up. He didn't want people to see the jacket, because he felt it sent the wrong signal.

       And apparently she went out to this place, got out of her car,
   stood on the street corner in front of this restaurant, put on the
   flak jacket, then got on her cell phone and essentially called the
   police and said, 'I think I'm in trouble here.' They sent something
   like five or six squad cars.
       Well, the next time this lady calls, they're not going to take it
   seriously.

He added that the issue of fear places difficult choices before management as well; even if a staff member's fear seems irrational, "they've got it," he said, "and it's difficult to ask them to go into a situation where they are that terrified." Furthermore, not taking someone's fear seriously enough can have disastrous consequences: "The flip side is that she could be dead meat, and you don't want that to happen either."

What Kind of Manager Are You?

Several people who spoke with JEH emphasized how important it is for management to be aware of the possibility of violence and to have procedures in place for addressing hostile situations before they escalate. Joan Markoff, an attorney with the California Department of Toxic Substances Control (DTSC) who has been working on workplace violence issues, suggested that agencies might want to consider having some identified entity that deals with the problem and that can give staff members advice about what to do when returning to a site that is making them uneasy. She thinks providing this kind of support is a crucial function of management, "because you want to have a cordial, professional relationship with the people you are inspecting, but at the same time, you don't want to put your employees at any risk. They shouldn't be expected to assume any risk."

In some departments of environmental health, however, there is a feeling among field staff that they are being expected to assume risk. Several people who communicated with JEH believe that managers are sometimes so concerned about liability and the perspective of the public that they can be less than supportive when their staff encounter conflict in the field. These concerns fell into three main categories:

1. a perception that management may hush up incidents or may be unwilling to press charges because of the potential for bad publicity;

2. a perception that management may be reluctant to intervene until almost too late in situations that are full of danger signals (see the sidebar on page 77 for an example); and

3. a perception that by raising an issue, staff members can get themselves branded as complainers or troublemakers (e.g., Stop whining; it happens to everybody, or--even more chilling in effect--If someone is getting angry with you, you must not be doing your job correctly).

It is an important part of basic safety for management not to create an atmosphere that discourages the reporting of problems. Of course, as Du Vall Knorr pointed out, "even as proactive as a department can be, it can't prevent everything."

There's a lot for a manager to sort out here, and the stakes are high. Occasionally, a staff member may in fact have done something to provoke hostility. Thus, departmental intervention might sometimes involve--in an unaccusatory way (just as field staff are expected to be unaccusatory with members of the regulated public)--a discussion of personal manner and strategies for effective communication. It might reduce stress all around if field staff know that management sees them as human beings who may even make a social misstep on occasion without meriting a violent attack.

Markoff of DTSC believes that even if an agency does not establish a separate entity dedicated to dealing with these issues, it should be a matter of everyday practice that when a staff member identifies a problem in the field, a coordinated effort is made to develop a strategy that the employee is comfortable with. Staff will come forward with problems if they feel that there is support of that kind from management, she told JEH. DTSC then considers, on a case-by-case basis, "what is appropriate, whether the employee wants to go back out, whether he or she wants to go out with a different buddy, whether he or she wants us to contact the people to talk to them." She sees this kind of engagement as an ethical duty.

"For management, we consider this one of our highest priorities. Of course we have a mission that's really important, but probably the most important thing is the safety of people while they're executing that mission."

Conclusion: Confront the Problem Honestly

The problem of abuse and violence directed at environmental health professionals is one that raises ethical issues for all stake-holders. What kind of society condones hatred of its public servants--even sometimes fans the flames? What kind of message does the profession send to the public if environmental health staff learn to treat everyone they encounter as a potential aggressor? Fearfulness, jumpiness, and aggression are contagious. How much trust really exists between department managers and field staff? Is management taking its duty to ensure a safe workplace seriously enough? Above all, how can the environmental health profession engage these issues without becoming overly armored and defensive--that is, without losing sight of its public health mission?

Editor's note: NEHA is committed to providing its members with information specific to the profession of environmental health. The Journal of Environmental Health has taken a major new step in this direction by employing a staff reporter. Rebecca Berg, who has long copy edited the Journal, will be writing in-depth reports on trends and events in the field. Her reports will provide Journal readers with important insights into the profession. They will also be designed to encourage discussion of controversies, challenges, and big-picture issues facing the profession. Readers are invited to participate in these discussions through letters to the editor: Please send your responses, opinions, or comments to Joanne Scigliano, Content Editor, [e-mail].

TABLE 1

Some Recommendations for Protecting Environmental Health Personnel from
Violence and Injury--Pros and Cons

Suggestion          Examples         Advantages        Pitfalls,
                                                       Drawbacks, and
                                                       Limitations

Better training     Train EH staff   Inspectors with   Some situations
                    to treat         people skills     can't be
                    members of the   can often         finessed.
                    public with      prevent           Violence can
                    respect.         dangerous         erupt before an
                    Train them in    situations from   inspector opens
                    ways of          developing.       his or her
                    defusing         Staff know        mouth. No
                    conflict.        unequivocally     matter how
                    Train them to    that management   perfectly EH
                    distinguish      allows (and       field staff
                    dangerous anger  wants) them to    behave, they do
                    from mere        remove            not have
                    venting (e.g.,   themselves from   control over
                    to read body     threatening       the other
                    language and     situations.       party's state
                    tone of voice,                     of mind.
                    also to
                    recognize
                    signals such as
                    sudden silence
                    following loud
                    behavior or
                    sudden
                    politeness
                    following
                    disrespect
                    (a)).
                    Train them to
                    "trust their
                    gut" and leave
                    if they feel
                    threatened in
                    any way.
                    Train them in
                    commonsense
                    self-defense
                    issues (e.g.,
                    look around
                    before getting
                    out of a car).
                    Provide staff
                    with physical
                    self-defense
                    training (i.e.,
                    ways of
                    deflecting an
                    assault).
                    Conduct role
                    playing and
                    discussion
                    based on actual
                    incidents
                    (e.g., the
                    sausage factory
                    murders in
                    California):
                    "Sometimes when
                    you use actual
                    examples, it
                    resonates with
                    people in a
                    more immediate
                    way." (b)

Increase the        Some behaviors   Knowledge of      Training
"cultural           that seem rude   behavioral norms  requires a
competence" of EH   to Americans     in a variety of   commitment of
personnel           are actually     cultures can      budget and
                    signs of         help EH staff     personnel
                    deference in     read situations   resources.
                    other cultures.  correctly.        One has to be
                    (c), (d)         Some knowledge    careful that
                    Conversely,      of how one's own  awareness of
                    some behaviors   behavior looks    cultural
                    that Americans   to members of     differences
                    think of as      other cultures    does not shade
                    friendly or      can help EH       into
                    "relaxed" are    staff avoid       old-fashioned
                    offensive to     committing        stereotyping.
                    people from      provocations.
                    other cultures.
                    (c), (d)

Increase the        Use official     One's legal       A too-official
authoritative       cars, badges,    right to inspect  appearance can
appearance of EH    or uniforms.     a property is     detract from an
personnel                            immediately       inspector's
                                     apparent,         ability to
                                     eliminating the   establish
                                     danger of being   relationships,
                                     attacked as a     provide
                                     trespasser.       education,
                                     An official       elicit
                                     appearance may    constructive
                                     have a deterrent  engagement from
                                     effect.           regulated
                                     Driving an        parties, and
                                     official car      negotiate
                                     rather than       solutions to
                                     one's private     complex
                                     car makes it      problems.
                                     harder for angry  "Badge-flashing"
                                     members of the    can make one more
                                     public to stalk   vulnerable to
                                     an inspector or   hostile
                                     track down        interactions by
                                     personal          provoking fear
                                     information       and
                                     through license   defensiveness.
                                     plates.           Likewise, a
                                                       county insignia
                                                       on a car can
                                                       become a target
                                                       (one EH
                                                       professional,
                                                       after finishing
                                                       an inspection
                                                       in a rough area
                                                       of town, found
                                                       a bullet hole
                                                       shot through
                                                       the middle of
                                                       the insignia on
                                                       his county car
                                                       (g)).

The buddy system    Go in pairs to   Assaults are      If the buddy
                    any site with a  less likely if a  system is used
                    history of       second person is  as a default
                    volatile         present with the  mode, it places
                    interactions or  inspector--as a   a burden on
                    about which an   witness, if       staff and
                    inspector is     nothing else.     budget
                    uneasy.                            resources.
                                                       Very small
                                                       departments may
                                                       not have the
                                                       personnel (one
                                                       EH director who
                                                       is by herself
                                                       in her
                                                       jurisdiction
                                                       asks someone
                                                       from another
                                                       department,
                                                       such as a
                                                       building
                                                       inspector, to
                                                       accompany her
                                                       if she's
                                                       worried about a
                                                       particular
                                                       situation).
                                                       If the buddy
                                                       system is used
                                                       on an ad hoc
                                                       basis, it
                                                       requires prior
                                                       knowledge that
                                                       there might be
                                                       a problem at a
                                                       given site.
                                                       With volatile
                                                       personalities
                                                       who act before
                                                       thinking, the
                                                       presence of a
                                                       buddy may not
                                                       be a deterrent.
                                                       In extreme
                                                       situations, the
                                                       buddy system
                                                       provides little
                                                       protection
                                                       against an
                                                       armed
                                                       assailant. Four
                                                       inspectors went
                                                       to Stuart
                                                       Alexander's
                                                       sausage
                                                       factory.

Keep a database of  Some             Personnel making  This approach
"problem" sites     departments      future visits to  raises legal
and operators       have begun       problem sites     and ethical
                    keeping written  are forewarned.   issues: issues
                    records of       If necessary,     of
                    problematic      police backup     confidentiality
                    encounters.      can be brought    and potential
                    "We have a       in.               slander, for
                    paper database,                    example.
                    and it stays in                    "I want to be
                    the manager's                      careful that,
                    desk, under                        if I put
                    lock and key.                      something in a
                    Before going                       file, it's
                    out, the                           clear and it's
                    inspector                          factual ....
                    checks the file                    Not 'this guy's
                    to see if the                      a loony or
                    place being                        anything.'" (h)
                    inspected has                      "We found out
                    been                               from the city
                    red-flagged."                      attorney that
                    (e)                                we can't keep a
                                                       database like
                                                       that on our
                                                       computers
                                                       because of
                                                       potential
                                                       hackers [and
                                                       legal issues]."
                                                       The department
                                                       now keeps a
                                                       paper database.
                                                       (i)

Work with the       Alert police     Protection,       One of the
police              before going to  enhanced          inspectors in
                    a site where     authority,        the sausage
                    problems are     perhaps           factory murders
                    anticipated.     prevention of     did call 911;
                    Bring police     incidents         however,
                    along for        through the mere  because there
                    enforcement      presence of law   was no violence
                    actions against  enforcement.      at the time and
                    uncooperative                      the caller
                    proprietors.                       sounded calm,
                    San Francisco                      the call was
                    public health                      coded as
                    staff have met                     "priority
                    with district                      four." The
                    police captains                    police did not
                    to discuss the                     arrive until
                    mechanics of                       after the
                    requests for                       shootings, 18
                    police                             minutes later.
                    assistance.                        (j)
                    They learned                       EH personnel
                    what words they                    need to make
                    should use to                      their calls to
                    describe                           stand out in
                    situations and                     the deluge the
                    what numbers                       police are
                    they should                        constantly
                    call. To                           receiving.
                    establish a                        On the other
                    personal                           hand, one has
                    relationship                       to beware of
                    between                            "crying wolf."
                    department                         If the police
                    personnel and                      do not
                    the district                       understand what
                    police                             EH is or the
                    captains, each                     nature of the
                    EH manager or                      work--or if
                    supervisor was                     there have been
                    advised to make                    no personal
                    an appointment                     contacts with
                    with the police                    EH
                    captain of the                     management--they
                    relevant                           may not be
                    geographic                         responsive.
                    area. (f)                          The quality of
                                                       the protection
                                                       and cooperation
                                                       EH staff get
                                                       from the police
                                                       depends on
                                                       management's
                                                       proactive
                                                       establishment
                                                       of
                                                       communication
                                                       channels
                                                       beforehand.

Better equipment    Radios set to    Quick             Cell phones are
                    emergency        communication in  not always
                    frequencies,     case of           reliable,
                    cell phones,     emergencies,      especially in
                    bullet-proof     some protection   remote areas.
                    vests.           from gunfire.     Use of
                                                       emergency
                                                       radios requires
                                                       training.
                                                       Bulletproof
                                                       vests add a
                                                       layer of
                                                       protection, but
                                                       they are not
                                                       panaceas.
                                                       If worn
                                                       ostentatiously
                                                       (i.e., outside
                                                       clothing)
                                                       bulletproof
                                                       vests can send
                                                       a hostile
                                                       message.

(a) Personal communication by Rick Whimple, code enforcement officer in
Churchill County, Nevada.
(b) Personal communication by Joan Markoff, Office of Legal Counsel,
California Department of Toxic Substances Control.
(c) Pong (2002a, 2002b, 2004).
(d) Shatara (2002a, 2002b).
(e) Personal communication by Lawrence Pong, principal environmental
health inspector for the city and county of San Francisco.
(f) Thanks go to Lawrence Pong for sharing a departmental memo that
described the meeting.
(g) Personal communication by Jorge Goitia, senior environmental health
specialist in Alameda County, California.
(h) Personal communication by Dick Pantages, NEHA Region 2 vice
president.
(i) Personal communication by Lawrence Pong.
(j) Lickteig (2000) and Pimentel and DeFao (2000).

Acknowledgements: JEH thanks the many environmental health professionals and code enforcement officers who shared their experiences for this article. Special thanks are due to Suzanne Du Vall Knorr of the Ventura County Environmental Health Division for providing extensive information on the history of legislative efforts in California, as well as for putting JEH in touch with many members of the profession. The idea for the article originated with NEHA Executive Director Nelson Fabian.

References

Anderson, B. (2000, October 17). Media sees video of 3 being shot. Contra Costa Times, p. A6.

Ashley, G. (2004, June 10). Inspector tells of escape from sausage maker. Contra Costa Times, p. A4.

Associated Press. (2004, October 13). Calif. sausage maker's attorneys say he was provoked into killing inspectors. http://ap.tbo.com/ap/breaking/MGB5RI52A0E.html (21 Feb. 2005).

California [Health & Safety] Code. [section][section] 106600-106735 [Registered environmental health specialists]. (1994-2005). http://www.findlaw.com (21 Feb. 2005).

California [Penal] Code [section][section] 241 (b) (9) (A) and 243 (b) (11) (A). (1994-2005a). http://caselaw.lp.findlaw (17 Jan. 2005).

California [Penal] Code [section][section] 241 (b) and 243 (b). (1994-2005b). http://caselaw.lp.findlaw.com (17 Jan. 2005).

Chapman, G. (2004a, May 13). Expert undermines defense's stance; Conditions were horrid at Santos Linguisa Factory, witness says. Daily Review [Hayward, CA], www.Lexisnexis.com (18 Jan. 2005).

Chapman, G. (2004b, October 14). Defense closing blames victims. Oakland Tribune, www.Lexisnexis.com (18 Jan. 2005).

Jeung, M. (2001, Nov.). First person: The dog story. Enviro Times: San Francisco Environmental Health, 2(3), 7-8.

Holbrook, D., & Marshall, S. (2000, June 23). A life of opposing the rules. Contra Costa Times, p. A1

Lee, T. (2001, November). Inspector field safety. Enviro Times: San Francisco Environmental Health, 2(3), 1-4.

Lee, H.K. (2004, June 10). Terrifying testimony on deadly rampage: Survivor recounts tale of inspectors' deaths. San Francisco Chronicle, p. B5.

Ng, R. (2000, September). Are public safety officials worthy of special protection and confidentiality? CEHA Bulletin, 6(2), 1, 7-9.

LaMacchia, J. (2004, Winter). First person stories: A good report, or else! Enviro Times: San Francisco Environmental Health, 2(7) 4.

Lickteig, M.A. (2000, June 23). Report: Victims in sausage factory shooting sought police backup. Associated Press. Lexisnexis. com (18 Jan. 2005).

Marshall, S., Jokelson, A., Holbrook, D., & McMillan, C. (2000, June 23). State says plant is unlicensed. Contra Costa Times, p. A1.

Ong, T. (2001, August). First person: Knowing when to get out. Enviro Times: San Francisco Environmental Health, 2(2) 6.

Pimental, B., & DeFao, J. (2000, June 24). Victim's son rips police inaction: Turns out sausage-maker also called for assistance. San Francisco Chronicle, p. A17.

Pong, L.W. (2002a, Spring). Cultural diversity & perceived ill will: Part 1. Enviro Times: San Francisco Environmental Health, 2(4), 1-5.

Pong, L.W. (2002b, November). Cultural diversity & perceived ill will: Part 2. Enviro Times: San Francisco Environmental Health, 2(5), 6-7.

Pong, L.W. (2004, Winter). Cultural diversity & perceived ill will: Part 4. Enviro Times: San Francisco Environmental Health, 2(7), 5-7.

Shatara, N. (2002b, November). Cultural diversity relative to Arab Americans: Part 2. Enviro Times: San Francisco Environmental Health, 2(5), 8-10.

Shatara, N. (2002a, Spring). Cultural diversity relative to Arab Americans: Part 1. Enviro Times: San Francisco Environmental Health, 2(4), 4-5.

St. Jean, V. (2002, Spring). First person: Trusting your instincts. Enviro Times: San Francisco Environmental Health, 2(4), 8.

RELATED ARTICLE: In Their Own Words: The Beauty of the Clip-on Tie 

Lawrence Pong, principal environmental health inspector for the city and county of San Francisco, told JEH a story that illustrates the extent to which abusive behavior can be about posturing and power struggles rather than more tangible issues like expense or inconvenience:

    I started out with the health department in '75. Back in those days,
  they didn't give us too much training. They assumed that we knew what
  we were supposed to do. After a couple of weeks of sitting at a desk
  reading the standard operating procedures--how to conduct ourselves in
  and out of the office and how to dress and how we were supposed to do
  things by the book--we were shoved out there .... By the time summer
  came around, I was replacing people in the field who had gone out for
  military duty. So I got to see different parts of the city very early
  on. There was one place in Haight-Ashbury ....
    I was dressed in a leisure suit in those days, this funky leisure
  suit with platform shoes, and my hair was kind of shoulder length; I
  looked kind of like a hippie myself. But we were supposed to wear
  ties. I was not used to wearing ties; I said, "Well, I hate ties,
  because it's like having a noose around my neck." So I went to a tie
  shop and bought a number of clip-ons. And clip-ons are ug-ly, but they
  feel comfortable.
    This resident in Haight-Ashbury had complaints against him for
  unsanitary premises--filth and debris and garbage buildup. So I went
  there and knocked on the door, and no one answered. I stood there, and
  I finally put my finger against the doorbell and just kept ringing.
  After a while, I decided no one was there. So I went down the stairs
  to the sidewalk. And this door was flung open, and this young,
  bearded, hippie-looking guy with his young son came out and called me
  all kinds of names.
    "A-hole, da-da-da-da-dah, you do that again, and I'm going to do
  something to shove in your face. Da-da-da-daaah."
    I could tell he was doing it for the benefit of his son, because his
  son was looking up at him. He suddenly grabbed my tie and yanked,
  because he wanted to yank me toward him.
    And, you know, it was a clip-on tie, which doesn't hold up too well.
  He fell on his behind and looked mighty foolish in front of his son!
    I don't know. I should have been in a fighting mood, but I couldn't
  help laughing. He was sitting there, staring up at me with the tie
  still in his hand.
    And when I finished laughing, I said, "Oh, are you all right? I'm
  from the health department. We've had complaints against your
  backyard. So will you please show me your backyard."
    And he complied.

RELATED ARTICLE: Most Often Requested: Confidentiality Legislation

The murders of Cynthia Volpe and her family in her home raised the question: How did Robert Courtney know where she lived? Many people in the field suspected that he was able to track the information down through the Department of Motor Vehicles. CEHA and the California Association of Code Enforcement (CACE) have been trying for years to craft legislation that would protect the home addresses and phone numbers of environmental health professionals and code enforcement officers. So far, legislators and the governor's office have either been reluctant to make exceptions to California's open-records policies or have questioned the feasibility of proposed legislation. In 2005, there are now many ways to obtain personal information, not the least of which is the Internet.

So Gerald Rettela of CACE is looking for new, creative ways of writing confidentiality into state law.

"I could put language in a bill saying that anyone using the Internet to secure names and addresses and so forth of code enforcement officers would be committing a misdemeanor," he told JEH.

What would be the chances of getting something like that passed?

"That's a good question," he said. "I tried it." The legislators did not consider the provision enforceable. Still, Rettela thinks that even without strict enforcement, having such a law on the books would give prosecutors a tool in cases of Internet searches conducted with malicious intent.

Many of the environmental health professionals interviewed for this story--especially in California--feel extremely vulnerable knowing that their personal contact information is easily accessible to anyone with a vendetta against "government bureaucrats." When asked about possible solutions to the problem of violence, most told JEH that confidentiality legislation was what they most wanted.

RELATED ARTICLE: "Peace Officer" Status for Environmental Health Inspectors?

Some environmental health professionals interviewed for this article expressed a desire to see environmental health inspectors included in legal definitions of "safety officers" or "peace officers." One advantage of such classification is that personnel in those categories have special legal protections, enhanced pensions, and early retirement.

"I think we certainly could qualify," Suzanne Du Vall Knorr told JEH. "We're not taking as many physical risks as police and fire, so I can see that [objection]." But, she pointed out, "when I need to put on a full moonsuit, and I'm out there opening containers and pulling samples and testing, I'm putting myself at risk. And I'm doing it in the interest of the public. So to me those activities would justify a safety retirement."

One environmental health specialist from an urban area sees the option to retire at the age of 55 as a matter of personal safety. He has been in situations where he had to run for his life. (Similarly, Earl Willis, the inspector who escaped Stuart Alexander's gunfire by running away is quoted as saying that he ran "'like (track superstar) Michael Johnson'" [Lee, 2004, p. B5]).

"Put it this way," said JEH's source, who asked to remain anonymous, "I know some people who are 55 and can't run anymore."

Others are more dubious about transforming their profession in this way. After the sausage factory murders, Pantages told JEH, there were environmental health professionals who wanted to carry guns on the job. "And to be honest with you," he added, "I'm not sure I'd like to work in a building full of people running around with guns."

Jim Balsamo, president of NEHA, reacted with dismay at the idea of including environmental health officers under a safety classification. He told JEH that when he first started working in the New Orleans health department in the 1960s, a lot of environmental health inspectors were not educated in the profession. "The guys who came before us were sort of grandfathered in after they came back from World War II," he said. Many had no college education, and no certifications were required for the profession. "They acted more like police" than public health personnel. He and some of his young colleagues poured a lot of idealistic energy into reforming the profession. "We decided ... we were going to do the education avenue. We did not want to be seen as policemen."

In other words, from this point of view, a move toward "peace officer" status would constitute a major step backward--over hard-won territory.

Balsamo acknowledged that environmental health professionals do have to enforce laws. "But rather than just walk in and make a list of all the violations and say, 'You've got 15 days to correct them--I'll be back,' we sit down with them and say, 'This is why this is a problem.'" Ultimately, enforcement of laws is not the goal of environmental health work. It is a tool that is sometimes used in service to a different goal: protection of public health and the environment.

"We felt you draw more bears with honey," Balsamo added.

At any rate, lawmakers have been resistant. Any legislation expanding the "safety" category would have significant budget implications.

In Massachusetts, a more modest goal is being pursued. Government employees are currently categorized into four groups. Police are in Group 4. Environmental health professionals are in Group 1, along with office personnel and support staff. Massachusetts environmental health professionals are proposing legislation that would raise health inspectors from Group 1 to Group 2.

"It wouldn't give us those very good benefits that police and fire have, but it would move us up," said Greg Erickson, director of public health in Wilmington, Massachusetts, who has been working on this proposal. The most concrete effect of such legislation would be to make it possible for some environmental health professionals (those who had accumulated enough years in the system) to retire a couple of years early. The rationale for pursuing this rather slight improvement in benefits is partly, Erickson admitted, that "everyone would like to retire earlier." But he also sees it as a simple matter of fairness. "We're not clerks. We're not custodial staff .... The nature of the job is to go out with jeans and boots."

"Health inspectors go to the same neighborhoods that some of the detectives go to. Deal with some of the same property owners, the same group of tenants that the police officers do," added Lou-Ann Clement of the Methuen Board of Health.

Phyllis Boucher of the Norwood Board of Health believes that such legislation would "give people a different perspective on who we are." In other words, it would enhance the public profile of the profession.

Erickson also believes that the possibility of a slightly early retirement might make the field of environmental health more attractive to potential recruits.

What are the chances of the bill becoming law?

"That bill is filed in this state every year," said Boucher. She thinks it will eventually pass, but that it will take "years."

RELATED ARTICLE: Most Frequently Mentioned Dangers

* Dogs: JEH heard many stories of dogs being deliberately set on environmental health inspectors in an effort to intimidate.

* Injuries: Environmental health professionals routinely encounter a wide variety of hazards. Here are just a few examples of injuries, hazards, and narrow misses:

--"Sanitarians take water samples from swimming pools, and sometimes they fall in. That happened at least twice while I was there," said NEHA President Jim Balsamo.

--"When I was inspecting a building, a stairway gave way," said Greg Erickson, director of public health in Wilmington, Massachusetts, "and I threw my knee out. I ended up having orthoscopic surgery. It was a building that people were actually living in, and I was doing an inspection because they were complaining that it was substandard."

--"I remember opening a stuck drawer in a bar, and a cocked 45 comes slamming out," said Dick Pantages, NEHA Region 2 vice president. "Fortunately, it was aimed the other way, and it didn't go off."

* Rough neighborhoods: Ronald Dong, an environmental health specialist in Alameda County, California, reminded JEH that the work of environmental health professionals may take them into dangerous places (for a striking example, see the sidebar on page 76).

--Dong added that people have pointed guns at him or threatened him with knives simply because they think he is on "their turf."

--Suzanne Du Vall Knorr used to do night sweeps for the vector program in Los Angeles County: "I was walking the alleys, and there were people sleeping in the alleys, defecating in the alleys, doing drugs in the alleys. At night, it's a whole different universe." She had many uncomfortable encounters while setting bait: "Sometimes they wanted to know what we were doing, sometimes they wanted to sell us protection. Sometimes there would be veiled threats: 'Is that your truck over there? Do you want it to be there when you come back?'"

RELATED ARTICLE: In Their Own Words: The Power of Sweet Talk

Jim Balsamo, NEHA president and formerly an environmental health professional with the city of New Orleans, told JEH that he sometimes found himself in the difficult position of doing health inspections at so-called "massage parlors":

    Everybody knew what they were, but it's up to the police to worry
  about that. I remember one of the inspections was over on Basin
  Street. I'm in there inspecting, and I tell them why I'm there, and
  the people are being sort of friendly--it was no problem. And then all
  of a sudden, the door opens, and here comes this guy; he must have
  stood six-foot-eight. And he had his long overcoat--looked like what
  you stereotypically think of as a pimp. And he came walking in--I'm
  five-foot-six--and I looked at this guy, and he said, "What are you
  doing in my place?"
    I said, "Well, we're here to make an inspection."
    "Oh, nobody makes inspections."
    I said, "Yeah, well, you know we have to do this. I can leave, but
  what I'll do is deny the permit, and then you'll be out of business,
  and I don't want to do that." [Balsamo let his voice crack earnestly
  at this point.] "I'm here just to make sure the public's health is
  safe," I said. "That's all."
    Anyway, he finally calmed down. He was a little irate, but he calmed
  down, became--I don't want to say good friends, but we reached a sort
  of understanding: I have my job to do, you have your job, and we're
  not here to do anything else but to check to make sure the place is
  clean and you have all the proper accoutrements for a massage parlor.
  We got along with him, and he walked us out to the car.
    When we got back to the office, someone said, "You're lucky he
  didn't throw you through the window or something."
    I said, "What?"
    "Yash, he's been known to get really fiesty with people."
    I said, "Well, I just talked to him right, I guess."

RELATED ARTICLE

--There are also, Du Vall Knorr said, housing inspections in some areas where "you don't know what you're going to walk into. You might walk into the middle of a drug deal."

* Sexual harassment and intolerance of women in positions of authority: Women environmental health professionals are sometimes subjected to sexually explicit verbal abuse or attempts at intimidation.

--Lawrence Pong, principal environmental health inspector in San Francisco, told JEH that the owner of a bar "started treating a female inspector like some high school kid--talking down to her, verbally abusing her, shouting at her. She came back to the office and said she couldn't finish the inspection because of his attitude. I went back with her, and before we went back, I told her to prepare a citation .... And we went there, and I had a good talking to him, and I handed him the citation, and he said, 'What's this?' I said, 'It's a one-way ticket to our kangaroo court. Please show up or you will be arrested.' And he showed up and he apologized." Pong added: "It doesn't matter who goes to your place. If they identify themselves as a city inspector, you will be respectful."

--Several people interviewed for this article observed that as more restaurants are opened by people from cultures "where women are not equal," as Phyllis Boucher of Norwood Massachusetts put it, there is an increasing incidence of operators who are "not interested in talking to women or don't believe that women have any ability to tell them anything."

--Pong believes, however, that while there is a difference in the way women environmental health professionals are received, the difference is less than it used to be. His workforce is now at least 50 percent women, and "in the eyes of certain operators, we're all evil. In the Chinese vernacular: 'Oh, there's the health devil.'"

* Intimidation by owners with mob or gang affiliation: Mob activity has not yet been relegated to the movies. "Once I was in a restaurant," Pantages told JEH. "A guy said, 'You know, you've got to walk out to your car. I've got some friends waiting for you.'" JEH heard several similar stories; for a striking example, see Lee (2001).

RELATED ARTICLE: In Their Own Words: A Bunch of Tough Regulars

Jorge Goitia, an environmental health specialist in Alameda County, California, told JEH that sometimes the danger comes not from conflicts with owners or managers, but simply from walking into the wrong place at the wrong time:

    1989 or 1990. A large Hispanic area that was kind of depressed. They
  had little stores, groceries. One day I walked into one of the grocery
  stores to do an inspection, and all of a sudden these guys run in with
  their guns out. And they jump into the walk-in refrigerator. Good
  thing I wasn't in there inspecting.
    And I look at the owner, and she looks at me.
    And she says, "They're hiding in my refrigerator."
    And I said, "I know that."
    And I ran out, and not even two seconds after that, four or five cop
  cars arrive, and they look at me, and they say, "Where are they?"
    I said, "They're in there."
    So they run in. I go into my car, and a cop comes and stops me. He
  says, "Wait a minute. Where are you going?"
    I said, "I'm an inspector. I'm getting out of here."
    Maybe they wanted a witness. But then he said, "Okay, get out of
    here."
    That story, to this day, when I remember it, sends goosebumps all
  over my back. Like wow, that was close. Later, when I went back to
  finish my insepction, I asked her [the grocery store owner], "Does
  this happen often?" She said, "Well, it's happened a few times
  already. This is where they come to hide."

RELATED ARTICLE: In Their Own Words: The Importance of Listening to Field Staff

Deborah Smith-Cooke could sense the potential for violence at the site she was inspecting, even though there were no explicit threats. But, she says, she had some trouble convincing management that the problem was serious:

  [A] facility operator proceeded to place increasing stipulations on
  how I could perform my job in his facility, when my inspections could
  occur, how I was to relate to his staff, how I was to treat him, etc.
  Performing inspections at this facility became so intimidating that I
  began to dread performing this task, although I would not stop doing
  my job. The increased stress began to manifest as physical symptoms.
  Because he did not harm me, or threaten harm, my [superiors] did not
  think it was a serious matter; besides this operator was antagonistic
  toward all inspectors (this was considered an excuse for his
  behavior). It was not until this operator "imprisoned" me in my
  vehicle and refused me entry to the facility that he was brought in
  for an office hearing regarding his interference with the duties of a
  health inspector.

Rebecca Berg, Ph.D.