A few months ago, the auditor’s office in Louisiana issued a report about inspections of dental offices. The state requires inspectors to check out dental facilities once every three years. This is important stuff. If dental instruments aren’t properly cleaned, for example, the first patient of the day can easily spread a flu bug to the second patient and then on to the third, fourth and so on. “These inspections are an important way to protect the public’s safety,” says Chris Magee, a senior performance auditor for Louisiana.
Between 2012 and 2014, violations were found in some 40 percent of inspections, the most common of which was “undocumented or lack of sterilization and disinfection techniques.” Another important finding was that more than a third of all dental offices weren’t inspected at all. What’s more, about a quarter of the time the state didn’t even let dentists know about violations uncovered.
Welcome to the generally unnoticed world of safety inspections in the states. Though there has been very little coverage of the topic in studies or articles, performance auditors in state after state regularly discover significant backlogs of inspections. This shortcoming can be found in inspections of restaurants for food safety, elevators, buildings for fire codes and assisted living facilities.
While most of the time inspections may only pick up minor infractions such as the lack of properly posted licenses, the dangers of insufficient coverage are very real. An outbreak of hepatitis in Oklahoma, for instance, emanated from an uninspected dental office. In December, some 36 lives were lost in the deadliest fire in the history of Oakland, Calif. Though cause and effect isn’t entirely clear, the California Grand Jurors’ Association reported that “two years before the ... fire, the Alameda County civil grand jury sounded the alarm about deficiencies in the Oakland Fire Department’s inspection bureau -- saying the city wasn’t even trying to check a third of the 12,000 commercial properties that were supposed to be examined every year.”
Most of the time, inspections are conducted too infrequently because of budgetary shortages that lead to insufficient staff. A November report from the audit division of the Oregon Secretary of State’s office found that “the Oregon Department of Agriculture’s Food Safety Program is struggling with a backlog of establishments needing inspection.” Nearly a quarter of food businesses in the state, ranging from groceries to dairies, were overdue for their inspections, the auditor found.
Why has this sad state of affairs come to pass? According to the report, the backlog was caused by “an increase in the number of licensed businesses and complexity of business practices and an inspection staff busy with other duties.”
One interesting wrinkle: According to Kyle Rossi, lead on the Oregon audit, the Food and Drug Administration (FDA) requires a great abundance of training for food inspectors, including schooling in tasks in which specialized inspectors don’t engage. Rossi hastens to add that training is critical. But he points out that “just about everyone is doing all the FDA training [for everything],” which takes many hours away from the time they could use searching for bacteria in the prepared foods department.
In many states, lagging inspections are not a new problem. As Marc Owen, performance audit manager in Arizona’s Office of the Auditor General, points out, the Arizona Radiation Regulatory Agency has been unable to meet its inspection time frames for more than three decades. As of June 2015, nearly half of all X-ray facilities were overdue for an inspection. That’s a problem because X-ray machines that aren’t appropriately calibrated to deliver the proper amount of radiation -- not just to the patients, but to the people operating the machines -- are a serious hazard. Of course, this is a problem that can easily escape scrutiny, as improper doses of radiation may not result in health problems right away. “It’s hard to identify the immediate concerns,” says Owen.
Getting more money into inspection programs isn’t easy. State budgets are tight, and raising fees on facilities to cover the cost is a tough road to take. Food businesses, for example, aren’t necessarily thrilled with required inspections in the first place. Asking them to pay for the pleasure can raise the hackles of members of a multibillion-dollar industry.
In fairness, there may well be instances in which state boards are requiring more inspections than are genuinely helpful, and one solution could be safely cutting back on requirements. Ken Levine, the director of Texas’ Sunset Advisory Commission, says that “if the inspections aren’t uncovering very much, they can start focusing on the outliers.” He recommends that if a particular entity is inspected every two or three years, and no violations are found over a 20-year period, it may well be reasonable to cut down on the required frequency. “We recommend a risk-based inspection process that takes into account previous problems,” says Levine.
*This column was updated to correct the misspelling of Kyle Rossi's name.