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A year in the life of inspection services, Mobile County Health Department.

The Mobile County Health Department addresses a wide array of public health issues through its environmental health activities with major programs focusing on food protection, lodging and onsite sewage. By legislative mandate, a number of environmental programs addressing air, land and water quality issues have been removed from health department oversight and delegated to a separate statewide agency. The Mobile County Health Department issues approximately 1,600 annual permits for operation of food service establishments which include full food and limited food service as well as retail and limited retail food stores. Fifty-seven hotels and motels are also regulated by the issuance of annual operating permits. In addition, the Health Department assesses the siting requirements and supervises the installation of approximately 1,000 onsite sewage systems per year. Based on 1990 census population projections, approximately 70 percent (271,817) of the county's total population utilize public water and approximately 60 percent (232,261) utilize municipal sewer services (1).

The purpose of the records review was 1) to assess the impact of revising complaint procedures which limited the receipt of anonymous complaints by telephone and 2) to determine the need for either a reallocation of existing resources or assigning new resources to address program inadequacies. In June of 1990, the Mobile County Health Department initiated a revision in administrative procedures which required anonymous public health complaints to be submitted in written format. Provisions were made to accept and conduct field investigations of anonymous telephone complaints that appeared related to imminent health hazards. Prior to these changes being implemented, complainants were requested, but not required, to provide their name, address and telephone number to allow environmentalists the opportunity to adequately inspect and provide the necessary documentation on all complaint investigations. Approximately 55 percent of all environmental related complaints received by the Mobile County Health Department were referred without the complainant providing this basic information. It was anticipated that the changes in administrative procedures would reduce the number of complaints referencing nonhealth related concerns or that were subsequently proven unfounded through field investigations.

Table I summarizes the frequency of complaints by program areas for calendar year 1989 and 1990. Sewage related complaints incorporated all references to unauthorized discharges irrespective of whether the initial problem stemmed from municipal sewer or onsite sewage disposal facilities. Some seasonal variations can be noted in the frequency of certain types of complaints as have been reported in other public health jurisdictions (2). This is most noticeable in sewage related complaints which tend to peak during the winter and spring months which typically record the highest rainfall amounts.

Figure I compares the number of complaints received by category during the last two quarters of 1989 with the identical time period in 1990. In every category but swimming pools, the number of complaints recorded in 1990 after the initiation of procedures limiting the receipt of anonymous complaints was less than the same time period of the previous year. Based upon this data, it was felt that the change in procedures did result in an overall reduction in number of complaints and subsequently reduced resources required for field investigation.

Because of the significant reduction in the number of food service related complaints, concerns were raised that changes in complaint procedures could limit receipt of specific types of complaints that would allow public health related problems to go unaddressed. As a result, the records review was broadened to assess the possible impact on either a particular type of food service establishment or a specific problem area typically associated with the food service industry.

In an effort to discern the type of establishment typically associated with food related problems, complaints from calendar year 1989 and 1990 were sorted to reflect their origination from either a food service establishment, retail market, caterer, or prepackaged food. Even though the 1990 complaints referencing food service reflect a 26 percent decrease when compared to 1989, Figure II illustrates that the ratio of complaints by establishment type remained essentially identical.

Food service complaints were then categorized by specific problem area prompting referral by the public. While most categories are self-explanatory, it is pertinent to recognize that the Mobile County Health Department has a long established regulation regarding mandatory training for all food service workers. Reported violations of this local regulation were combined with other reported instances of inadequate utensil use, lack of food protection measures or hair restraint and hand washing violations into the food handling category. In addition, all complaints referencing insanitary facilities or an apparent need for facility maintenance were placed into the sanitation category unless they specifically referenced inadequate sewage disposal, refuse handling or the presence of insects or vermin. Figure III documents this information and illustrates that while the actual number of complaints reported in 1990 reflected an overall decrease, the same type of problems were consistently being reported.

Since the potential impact of the changes in complaint procedures was limited to a portion of calendar year 1990, data used to generate Figures II and III were reviewed and a similar comparison focused on the last half of 1990 and the identical time period in 1989 was completed. The results were similar to the total year analysis with no significant deviation documented in the ratio of complaints referencing either the type of establishment or problem.

Two other trends unassociated with the changes in complaint procedures became evident during the records review and were also of interest. During the latter half of 1990, a local newspaper initiated several articles pertaining to food service inspection activities and began routine publishing of numerical scores posted during food inspections. It was initially felt that the increased awareness of food protection issues on the part of the public would result in additional consumer complaints, especially in the reporting of suspected foodborne illness and food handling problems. No increase in the number of complaints associated with either of these two areas was documented.

The second point of interest centered on the number of consumer complaints associated with franchised food service operations. Complaints attributed to food service establishments and retail markets in Figure II were further segregated to distinguish franchise operations which had more than one establishment in the county or were affiliated with a regional or national food chain. While franchise operations having complaints referenced to their establishment represented only 20 percent of TABULAR DATA OMITTED the total permitted food service establishments, these same operations accounted for 42 percent of the total complaints. Quite obviously this reflects the significant volume of food sales in these establishments.

Conclusion

After completing the review of the 1989 and 1990 environmental complaint records, it became apparent that the administrative changes in the complaint protocols had been effective in minimizing anonymous complaints and thereby reducing the actual number of complaints requiring documentation and field investigation. The initial concern that excluding a portion of anonymous complaints would cause certain problem areas of public health importance to be under-reported appears to be unfounded. However, this short-term trend will be followed to ensure that traditional problem areas are not being selectively excluded and that concerns reported by anonymous complainants involving imminent health hazards will continue to be investigated. In view of the significant percentages of food service complaints associated with franchise operations in the county, the possibility of instituting a training course to be presented in the food service establishment will also be considered. This program would augment the annual one-hour mandatory food handler training of all food service workers and the more extensive (20 to 26 contact hours) food sanitation and management training course offered under the auspices of the Alabama Department of Public Health.

The significant increase in sewage related complaints documented for 1990 which represented a total departure from the anticipated overall decrease in complaint numbers will also be addressed by instituting a computerized complaint tracking system. The new system is expected to document recurring failures of both onsite and public sewer facilities which will allow for more comprehensive resolutions where previous corrective actions have failed to provide long-term abatement of public health problems. The complaint tracking system will also incorporate a geographical reference which will provide an appropriate data base to project long-term community needs for expansion of existing public sewer systems.

Record reviews of this type not only allow for an assessment of resource utilization but they also permit a projection of resource requirements based on present and future public concerns. Increased awareness of the potential transmission of foodborne illnesses like Hepatitis A, the growing "green" movement propelling recycling efforts in the food service industry and a possible return to reusable service items may legitimately increase public concerns regarding food handling procedures (3). Acknowledgement of the potential for groundwater contamination and misuse of wetlands along with possible decreased federal and state funding of municipal water and sewer facilities may also prompt closer scrutiny of the siting and utilization of onsite sewage disposal options (4). These and similar concerns will require environmental health programs to continue to develop strategies to maximize resources allocated to the investigation and abatement of public health complaints.

References

1. ...(1985), Alabama Municipal Data Book, Alabama Dept. of Economic and Community Affairs, Office of State Planning and Federal Programs, Montgomery, AL.

2. Cantrell, R.D. (1980), A method for investigation of environmental complaints, J. Environ. Health 43(1):14-18.

3. ...(1983), Comparison of Microbiological Contamination of Disposable and Reusable Food Service Items in Their Intended Use Environment, National Sanitation Foundation, Ann Arbor, MI.

4. Bauman, B.J. and W.M. Schafer (1985), Estimated Ground Water Quality Impacts from On-Site Sewage Treatment Systems, In: On-Site Wastewater Treatment, Proc. 4th National Symposium, Am. Soc. Agric. Eng., Pub. 7-85, St. Joseph, MI.

Bernard H. Eichold II, M.D., Dr. P.H., Mobile County Health Dept., 251 N. Bayou Street, P.O. Box 2867, Mobile, AL 36652-2867.
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Title Annotation:Alabama
Author:Eichold, Bernard H., II
Publication:Journal of Environmental Health
Date:Jan 1, 1994
Words:1633
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