The following report is the result of a months-long investigation by Humboldt State University students enrolled in an advanced reporting class taught by Asst. Professor Marcy Burstiner.

Humboldt County loves to eat out. With more than 750 restaurants, food trucks, deli counters and cafeterias, we have almost as many places to get cooked meals per resident as more urban counties like Marin and Ventura. But when you eat out, can you trust what's going on behind the kitchen doors?

Consider: A stomach virus hit 166 people after they ate at the Baywood Golf and Country Club in Arcata back in December 2006. In Florida in 2009 a 32-year-old mother of two died of food poisoning after eating a beef chimichanga she had taken out from a Mexican restaurant. According to a story in the Miami New Times, the woman's spleen had been removed 10 years prior, so her body couldn't take the bacterial infection from the food. It turned out the restaurant had previously been cited for 53 food safety violations. Back in 2002 the Associated Press reported that one man died and more than 180 people got sick from salmonella after eating at a Red Lobster in Tennessee that had been previously cited for having a hand-washing sink inaccessible because it was blocked by garbage.

Restaurant-related health concerns have been in the local spotlight lately: In March, the county health department ordered the one restaurant in Fernbridge closed after inspectors found E. coli in the tap water.

In visits to more than 50 restaurants we found that many restaurant owners, managers and employees are unaware of a basic requirement of the California Retail Food Code. A survey of more than 700 health inspection records housed at the county's environmental health department revealed numerous restaurants with safety violations. But locating the most serious infractions required wading through a paper filing system that seemed archaic in the digital age.

 

Any number of things can get you sick after eating at a restaurant. Maybe the bacon was left out too long or the cook didn't wash his hands before slicing the turkey. But how would you know that when it comes time to order that club sandwich?

In Marin County, you could pull up the results of a restaurant's most recent food safety inspection online. In Los Angeles, restaurants must post a rating card from the department of health. Ventura County operates under a pass/fail system. "We don't do a grade or rank," says Betty Huff, manager of the environmental health department for Ventura County. "They're either substantially in compliance with the law or, if we find an imminent health hazard, then they fail the inspection."

Here in Humboldt County, you must ask at the restaurant to see a copy of the latest inspection report, which restaurants are legally required to provide upon request. Or you can go to the Humboldt County Division of Environmental Health office in Eureka to ask for it. The first option is uncomfortable; do you want to risk irritating the cook before he prepares your food or the waiter before he serves it? Few do.

Go Go Bistro in Eureka posts the required sign telling customers they can ask to see the inspection report. Owner Karen Hildebrandt said that in the year she has been open we were the only ones who asked to see it.

To view the reports at Environmental Health is a hassle (see sidebar, "How We Did It"). Some restaurant folders might leave you wondering whether they're up to date. Environmental Health officials say they inspect restaurants one to three times a year, but the latest report in the file for Plaza Grill in Arcata was from 2007.

All food facilities in the state must comply with the 106-page California Retail Food Code. Local enforcement rests with the Consumer Protection Program of the Humboldt County Division of Environmental Health.

At Big Blue Café in Arcata, co-owner Karen Martin-Kunkle said it is not hard to comply with food safety laws. She pokes a laser thermometer into the food she serves every day. On the steam table, her cooks give the gravy and soups about an hour to heat up and then they recheck the temperature. She makes sure her cafe is clean and organized. "I create to-do lists, and I email employees if something extra needs to be done that day," she said. She also constantly reminds and encourages her employees to be clean and organized. "They are responsible and capable employees," she said. Most have been there for years; the same could be said about her customers.

About every six months, a health inspector pays an unannounced visit to Big Blue. They check that the kitchen is clean. They, too, poke thermometers into meat and other food to check that it is properly chilled or heated. They measure how far off the floor food is kept and whether there are any signs of roaches or rodents. Ideally, health inspectors do this for every restaurant one to three times a year.

"It was weird having someone come in for a surprise inspection," said Martin-Kunkle, "They don't want people to have time to prepare. The inspectors are actually helpful. They have to be strict because bacteria can grow and you don't want to feed people that food."

 

Steve Gustafson pulled up to a Subway on Fourth Street in Eureka in his county-issued green Taurus. He surveyed the place. With a clipboard in hand, he walked behind the counter, probed a bin of sliced tomatoes with a thermometer and scribbled notes on a form. He knelt down, ran his finger along a spot of caulking between two tiles and scribbled again.

A 1990 graduate of Humboldt State with a degree in environmental engineering, Gustafson has been inspecting restaurants for the county for 13 years. He wouldn't normally do them these days. He manages Consumer Protection, which is responsible for inspecting rental housing, organized camps, public swimming and spa pools, state small water systems and the jail. It also monitors recreational waters and investigates household garbage complaints. He is the county's only lead paint inspector and he trains incoming employees. Then there's the recent problem with bed bugs, which has demanded increased inspections of hotels and motels.

But in March his team was understaffed. In fact, it had been understaffed for several years. At the end of the month Environmental Health would hire two more inspectors. But on this day he was back at his old job, driving the Taurus from one food place to another.

Environmental Health has struggled for several years to meet its goal of inspecting every restaurant one to three times a year. When someone complains about a restaurant, the department tries to get an inspector there within three days. Sometimes that's not possible. "It depends on the fire, how big of a fire it is," Gustafson said. In 2010 the department responded to 71 complaints, according to a spreadsheet the department provided with the names of complainants redacted.

Even with five full-time inspectors the department is strapped tight. This year the county will spend $850,000 on the Consumer Protection Program -- that's down $133,000 from what it spent in 2009. At full staffing, each inspector is responsible for more than 150 food facilities in addition to inspections for water systems, hazardous materials and bed bugs. Kevin Metcalfe, a supervising environmental health specialist with the county, said it makes sense having inspectors do more than just restaurants. "You can cover more than one program when a person is in the area," he said. "Humboldt county is big and spread out."

There is no uniformity across California counties in the number of restaurants tasked to an inspector. San Diego, for example, has 12,000 food facilities and 60 health inspectors, or about 200 food facilities per inspector. Ventura County has 18 health inspectors for 1,700 food facilities, or about 94 per inspector. Modoc County has 90 restaurants and two inspectors -- only 45 food places each.

Understaffing is a nationwide trend, said Laura Anderko, professor in the School of Nursing and Health Studies at Georgetown University. "'I compare [the nation's] food safety system to having a city like New Orleans with one police officer," said Anderko.

 

Gustafson and his team at environmental health see some disgusting health violations: Mouse droppings behind the ice machine at Abruzzi in Arcata and on ceiling panels at Applebee's in Eureka; German cockroaches in a vending machine at Kentucky Fried Chicken; a floor at the Tip Top Club so dirty the inspector couldn't tell if rats had been there (see sidebar: "Seven stomach-churners").

It wasn't all bad. While we reviewed the restaurant inspection sheets one by one, we found that many of the businesses were up to health standards. Inspectors noted and thanked the exceptionally clean restaurants, which included the Go Go Bistro in Eureka; Couple Cups, Luke's Joint, McIntosh Farm Country Store and McDonald's in Arcata; and Silver Lining and Don Juan's in McKinleyville. (Like the list of infractions, this list is not comprehensive.)

The health risks posed by unsafe food conditions or handling practices can be severe. The Centers for Disease Control and Prevention estimates that each year some 48 million people contract foodborne illnesses. About 128,000 require hospitalization and 3,000 people die. The agency doesn't distinguish between illnesses originated in the home or in restaurants, but one unsafe practice in a restaurant can cause a disproportionate number of people to get sick.

Art Reingold, an epidemiologist from U.C. Berkeley, said it is a question of scale. "If I'm serving my family, the number of people at risk is tiny," he said. The scale is quite different with people handling food for dozens of customers.

There are many causes of foodborne illness -- bacteria, parasites and viruses. One of the most common and easily spread is a family of viruses referred to as norovirus (see norovirus fact sheet). It's responsible for at least 50 percent of foodborne illnesses, and it's believed to have caused the last several outbreaks in Humboldt County, said Gustafson.

Aron Hall, an epidemiologist for the Centers for Disease Control, recently published updated norovirus outbreak management guidelines. He said that restaurant inspections are one important step toward preventing outbreaks, but they don't necessarily ensure compliance. It can't ensure that restaurant workers stay home if sick, for example. "You might have a sink and soap adequately placed, but if the workers are not washing [their] hands properly, you can have big problems with norovirus outbreaks," he said. According to inspection reports from March and April, inspector Harriet Hill observed an employee washing gloved hands at both Wendy's and Applebee's. Regulations say employees must first wash their hands and then put on a new glove.

 

Most violations that inspectors find are minor and easily corrected: food stored at the wrong temperature; substandard or unclean equipment; unclean food-contact surfaces; food stored too close to the floor or on substandard shelving. Even for more difficult problems, like vermin infestations, the county tries to work with restaurants to correct the violations. Sometimes the facilities require a second inspection. Restaurant owners are assessed an hourly fee for these reinspections. After a second inspection most restaurants are cleared. Some, however, are not.

Metcalfe said the county will pull a restaurant's license if conditions pose an "imminent threat to health and safety that require immediate correction or cessation of operation to protect public health." Those conditions include a lack of water, loss of power, sewage backup, a foodborne illness outbreak, contamination of food or food contact surfaces, or a vermin infestation.

Restaurant customers are sometimes angered more by the closure of a restaurant for health violations than by the violations themselves. Take the case of the Fernbridge Market. The Division of Environmental Health suspended the restaurant's license to operate after inspectors found Escherichia coli, or E. coli, in the tap water, but owner Steve Sterback refused to stop serving food to customers. As a result, he was handcuffed and taken to jail for operating without a permit. "I think that was a little extreme," Sterback said. "We've never been an imminent danger to the health of the public."

E. coli is a rod-shaped coliform bacterium that can be found in feces. It can also be found in water, vegetation and on soil. In some cases it can cause serious illness and/or death. Director of Environmental Health Melissa Martel said the county has zero tolerance for E. coli contamination. Test results for the water at the Fernbridge Market also showed that it had high levels of turbidity, which means it was cloudy. And the level of chlorine was 30 times below the recommended amount for treating unfiltered surface water.

Inspector Hill said the department received no complaints before the license suspension and that there were no reports of illness caused from the restaurant's tap water. One customer complained afterward, worried that the restaurant was relying on bottled water to wash hands and dishes. Sterback said water contamination has been a problem at the market since before he became the owner. He said the whole town has contaminated water and the problem should have been fixed a long time ago.

Sterback and his wife, Deb Woods, say they just want to bring people together by serving good food and giving the community a place to play live music together. Woods said that protecting the health of her customers is important to her.

After the closure, loyal customers rallied. To help prevent E. coli contamination in the water they donated bottled water. One loyal customer of the Fernbridge Market is Humboldt County First District Supervisor Jimmy Smith. He said he went to the restaurant when the bottled water was being used and liked eating there. "I didn't have a problem with that," he said. Smith also offered to pay Sterback's bail. "I offered to help Steve as a friend," he said. "He is a longtime friend. I think he is a good person and I want to see his business restart."

Food psychologist James Painter, of Eastern Illinois University, said that people choose a particular restaurant because of the food it serves, advertisements on TV or even suggestions from dietitians. Health is low on the priority list. "Research shows that 80 percent of the time when you choose a restaurant, the place that you actually go to is determined by where your family and friends tell you," Painter said. Research doesn't explain why people would eat at a restaurant found to be unsafe, he said. But it could be because we just don't like it when the government tells us what to do.

Bon appetit.

FACT BOX: Norovirus characteristics and how to respond to outbreaks

Norovirus typically sets in 12-48 hours after contact.

It is spread through ingestion of the virus. Sick people shed virus in vomit and feces. Improper handwashing transfers these viruses to food surfaces and your dinner.

Norovirus infection can occur from exposure to as few as 18 viral particles. About five billion virus particles per gram of feces are shed during infection.

Norovirus disease is characterized by abdominal cramps, diarrhea, vomiting and nausea. It typically lasts one to three days but can be more severe in elderly, children and people with weakened immune systems.

Though the norovirus shedding is most concentrated in the first five days of illness, it can be present weeks after symptoms go away.

The best prevention of norovirus comes from frequent, thorough handwashing. Wash with soap and warm water for at least 20 seconds. Experts also suggest avoiding bare hand contact with food and use of appropriate environmental disinfectants.

SIDEBAR: Seven stomach-churners

Below is a list of some violations that caught our eye. It is not a comprehensive list, nor can it be said to include the most serious violations as we may have missed some in reviewing the documents. We were unable to determine whether the reports made available to us were the latest ones, and so in some cases further inspections may have found that the restaurant in question had corrected the problem.

1. Rodents: Inspectors found evidence of mice or rats in Chin's Café, Applebee's, Eureka Natural Foods, the Far East Café, South Bay Elementary School Cafeteria and the Schooner Saloon, all in Eureka, and at Abruzzi and Porter Street Barbecue in Arcata. In her March 29, 2010, inspection of Applebee's, Inspector Harriet Hill found evidence of "a rodent infestation in [the] ceiling area," according to her report.

Abruzzi owner Chris Smith told us his restaurant has a monthly pest service that keeps down any potential problem. "We try to stay on top of these things and fix the problems when we come up short," he said.

2. Hands not properly washed: Inspectors found this problem at Rita's in Arcata, the Depot on HSU's campus and Wendy's in Eureka. In May 2010, inspectors noted in their report that they'd witnessed "NO active handwashing" at Rita's. They returned a few days later and "observed food handler preparing raw chicken with band-aid on finger, non-proper use of gloves. Improper handwashing observed by same food handler, then change of operation preparing hot food with band aid and non proper use of gloves. This observance includes three major violations, and presents a risk to the health and safety of customers."

Three days later they wrote: "Handwash station was clear. Heated water was readily available at mixing faucet. Food preparer was observed wearing gloves. This facility was observed as clean and well organized. Thank you for this excellent demonstration!"

3. Improper handling or storage of meat: This showed up in reports for Eureka facilities China Buffet, Mekong, the cafeteria at College of the Redwoods, Gonsea, Roy's Club, Rita's on West Harris and Adele's. At Adele's on June 16, 2010, Inspector Morgan Cook wrote, "Uncooked beef dripping juices into lettuce stored below. Lettuce discarded on site voluntarily today."

4. Bulging cans: In April, Cook had employees at Oriental Food and Spice in Eureka remove 45 jars of Dragonfly brand vacuum-sealed jars of food, including fermented bean curd and bean curd in rice sauce, when he found bulging lids on some jars.

5. Mold: Inspectors found mold in the holsters of speed guns used for filling bar drinks at Jambalaya and Abruzzi in Arcata; on a tomato and cheese at Mama's Kitchen in Eureka and on ice machines at Gold Rush Coffee in Eureka, Big Pete's in Arcata and Seascape in Trinidad.

6. Food stored at the wrong temperatures: Inspectors cited this violation in a refrigerator at Chinese Gourmet Express and on the buffet at China Buffet, both in Eureka. In August 2010, Hill responded to a complaint that a diner had gotten sick after eating at the latter establishment and found "at least [three quarters] of the food on the middle (hot) buffet were being held at insufficient temperatures."

A reinspection found only one item at the wrong temperature, but required employees to begin a log recording temperatures of buffet food every few hours. At Chapala Cafe in Eureka, Hill required the restaurant to set up a labeling system for food outside of a refrigerator after a "very large container" of refried beans was found left out for 24 hours. At Sbarro in the Bayshore Mall Hill found a repeat violation: "All items on the salad prep table holding @ 56 degrees F or greater."

7. Insects: In December, inspectors found a live roach and roach feces on top of the automatic dishwasher, and roach casts behind the ice machine, at Rita's on West Harris in Eureka.

SIDEBAR: How We Did It

On April 17, three of the HSU students who contributed to this report -- Derek Lactaoen, Melissa Hutsell and Dylan Baumann -- met for Sunday brunch at Big Blue, a restaurant on the Arcata Plaza.

The place was packed. Beams of natural light highlighted the walls. There were walnut zucchini muffins in a glass display at the counter. You could hear a hum of conversations, the clink of silverware and, over the speaker system, songs by the Jackson Five. It seemed a comfortable place to socialize. Hung on a wall in the back was a handmade poster from kindergartners thanking the restaurant for a tour.

They ordered the Karen's Potatoes, a roast beef sandwich on focaccia, corn chowder and a salad. The food was great, but when they asked to see the latest inspection report from the Divisionof Environmental Health, they found it was a bit stale.

In January, the 14 students enrolled in JMC 326 -- an undergraduate course in the Journalism & Mass Communication department called "Interpreting Contemporary Affairs" -- had decided to examine the system for monitoring food safety in Humboldt County restaurants. In pairs, they would visit some 50 restaurants in Arcata, McKinleyville, Eureka and Fortuna, and ask to see the latest inspection reports, which by law the restaurants are required to produce upon request. They would also request a copy of the database for all local inspection reports from the Humboldt County Division of Environmental Health. Both tasks proved difficult.

The inspection report Big Blue produced was an old one. An employee said that the most recent copy was locked in an office and only the manager had the key. When the students and their classmates visited other restaurants, the results were even less successful. At Arcata Pizza and Deli, a woman behind the counter told two students they would have to ask the owner for the report. When they pointed out the sign behind the counter that said the report was available upon request, she looked at it with surprise and said she had no idea where to find it.

In Fortuna, a restaurant owner asked to see student IDs and then refused to bring out the report. When two students made the request at a McKinleyville restaurant, the owner said they were rude. At a place off of Giuntoli Lane in Arcata, an owner chased two others out the door and accused them of being government agents.

The Division of Environmental Health does not have a database of inspection reports available for download. Instead the documents are stored on paper; if you want to look at all of them, you need to go through more than 700 files. (See sidebar: "Making the Grade.")

Director of Environmental Health Melissa Martel said that the county has used software called Envision to help with electronic filing for a year. She says there is not enough public demand for an online database to justify the cost for making it available through a website. 

So the students started doing it themselves. During the course of their investigation, they scanned reports from about 100 restaurants, uploaded them to Google Documents and linked them to a map. The entire process took several hours.

The interactive map is available here. There you can view scanned copies of inspection reports for 100-or-so restaurants scattered throughout the county. Simply click on any of the markers, then click the name of the restaurant to view the county's report.

Getting access to all 700 reports was not easy. The County Department of Environmental Health office sits at the corner of H and First streets in Eureka. Student Kaci Poor was one of the first in the class to visit the office. On first impression it seemed a claustrophobic maze of cubicles and florescent lights.

"The office workers were so tense," said Poor of her visit. "It was obvious they didn't want to help us as soon they heard we were from Humboldt State." Poor had hoped to look through a few of the restaurant inspection forms that day, but instead she was only allowed access to one. The Abruzzi file she was given hadn't been updated since 2007. The employees were unable to tell her where the more recent reports were.

Obtaining access to all the files took a California Public Records Act request and some negotiation with Environmental Health Public Information Officer Heather Muller. She said a staff member would need to be available to monitor the students to ensure that they did not tamper with the files. The staff time for that could only be allocated between 8:30 and 10:30 each morning, during which time college students are generally expected to be in class. The county also required compensation for the staff time at $32.58 an hour.

Eventually they reached a compromise. The students would come in six shifts, no more than two at a time. They would have to pay for any copies they requested at 10 cents a page, but they would not have to pay for the staff time. In six two-hour sessions they skimmed through 50 files each and asked for copies of any files they deemed noteworthy; in other words, any file in which an inspector noted numerous problems or noted a problem that seemed significant.

Once the process was underway, officials became more cooperative. Lactaoen joined Environmental Health Inspector Steve Gustafson on a pleasant ride-along to a Subway shop in Eureka. Muller said that the initial requests seemed daunting to an already strapped department. But the importance of the request and mutual understanding made the project easier for both parties. "If food safety is a big deal -- and we think it is -- transparency, accountability and responsiveness to the public are huge," Muller said in an email. "We're really pleased that we were able to accommodate each other and to develop a mutually respectful process."

Ultimately the students found in the inspection reports a number of stomach-churning violations. And they found that many restaurants in the county are not aware of basic California Retail Food Code regulations. At a minimum the law requires that food facilities post a visible notice informing customers that the most recent inspection report is available upon request. The inspection report must be shown to customers if they ask for it.

Fewer than half of the food facilities that the teams visited had this notice posted in a visible spot. Even fewer were able to produce the report upon request. The students also found that the food-monitoring process differs greatly from county to county. Finally, they found that the monitoring process in Humboldt County is under-resourced and often understaffed. This can have serious implications on public health.

The students involved in the project were Dylan Baumann, David Broome, Kenneth Dorset, Rebecca Gallegos, Torrey Hartman, Melissa Hutsell, Derek Lactoaen, Katherine Leonard, David Percival, Kaci Poor, Eli Rohl, Grant Scott-Goforth, Angela Tsai, and Catherine Wong.

SIDEBAR: Making the Grade

Humboldt isn't the only county where it is difficult to find restaurant health reports. But unlike Humboldt, Marin is working to improve its system.

It's unreasonable for a family to visit the county health department before going out for dinner. And as we discovered, many restaurants don't like to turn over the reports. In 2008, a grand jury in Marin County recognized these problems and said that Marin needed a consumer website. It also recommended a publicly displayed ratings system. Most urgent, it said, was strict enforcement of the law dictating that notices must be posted informing customers that they can see the latest report on site.

In our review of more than 700 Humboldt County inspection reports we found few citations for failure to post the notice. But when we personally visited more than 50 local restaurants, less than half had the proper notice posted.

The Marin grand jury report estimated it would cost $150,000 to set up the website and $30,000 a year to maintain. Marin County could afford that, the grand jury ruled, and it now has a convenient, comprehensive website. Click on a map and you get a list of a town's restaurants and violations from the most recent inspections. In many cases, it displays a history of a restaurant's violations and resolution to problems.

A rating system is more complicated. Los Angeles County uses an A, B, C grade or a scorecard that they must post in a visible spot. Customers can access the inspection reports online as well. Sacramento uses a green/yellow/red light system. The signs, posted on a restaurant's facade, give consumers an idea of the restaurant's health report at a quick glance. The idea is that restaurants will be cleaner if there's an eye-catching display of their cleanliness.

Peter Hedtke, the only registered health inspector for Trinity County, said that a rating system is inconvenient for rural, understaffed counties. If a restaurant gets anything less than an "A" or a "green light," the staff is going to do everything it can to correct the problems and then ask the health department to come back immediately. In a stressed department, that's nearly impossible.

The Marin County grand jury echoed this fear. It found that a rating system could boost the cost of health inspections by 25 percent. So even a relatively well-staffed and resourced county would struggle with ratings.

In Humboldt County an efficient website could give consumers accurate, convenient information on local restaurants. It would take the awkwardness out of protecting our health and might make restaurants more accountable.