Memorandum #04-10: PDF 20MB Adoption of the Proposed Southern Nevada Health District Regulations Governing the Sanitation of Food Establishments and Appendices
Chair Giunchigliani declared the public hearing open.
The following is a verbatim transcription of the public hearing concerning Memorandum #04-10.
Dr. Sands: The next item is Memorandum #04-10; this is the adoption of the proposed Southern Nevada Health District Regulations Governing the Sanitation of Food Establishments as well as supporting appendices. We have here Mary Hahn and Rose Henderson, supervisors with our environmental health division to present on this, as well as Steve Goode, environmental health program manager. I know many of you received a memo from Member Jimmy Vigilante and I also just want to echo his support and appreciation for staff and let everybody know that. This has been about a five or six year process and it’s quite an enormous task, as you can see just by the volume of the paper generated, because it’s quite a lot of detail – it’s been a long time since we had these updated and bring them into compliance with national standards, but also just how well they worked with industry and be able to address their issues and make sure that the package you receive today does represent by and large, I think, a good consensus of not only among staff but also the stakeholders with us. So with that, Mary, Rose and Steve will begin the presentation.
Steve Goode: Thank you, Dr. Sands. Good morning, Madam Chair, Board members. As Dr. Sands says, this has been quite a long process that we’ve been on, almost ten years, writing these regulations. And so we’re very proud of the product that we bring forward today. Before I turn it over to Rose and Mary, I’d like to just acknowledge some of the staff members that were involved in the process. I think that all of the operational staff were involved to some degree, but specifically I’d like to thank our training officers Ms. Christine Sylvis and Susan LaBay, who were very influential in our technical writing of this regulation. Also I’d like to thank Dr. Karl Hertz, who is one of our EHSs, who took the time to go through the regulation. And finally the three ladies that were most influential, who spent the yeoman’s time with the regulation, we had Rose Henderson here, who’s our operational supervisor from the Henderson office; Mary Hahn who’s the operational supervisor from the Spring Valley office; and the person who always keeps me on track, my administrative secretary Sandy Bigley. So with that I’ll turn it over to Rose and Mary and after the presentation I’m sure there’ll be some partners that we work with in the community that would like to come up and say a few words. And we’ll be here to answer any questions at the end. Thank you.
Mary Hahn: Good morning. I wanted to set the scene for what we are about to talk about and why food safety regulations are important and why they need to be updated. We all like to know that when Las Vegas hits national news we only want good things and occasionally when Las Vegas hits the national news we all need to pay attention and realize and deal with why Las Vegas would hit the national news. This is a video that was on TV (attachment #1 PDF).
VIDEO CLIP SHOWN FROM CBS NEWS: “Where America Stands” from January 9, 2010
Ms. Hahn: I believe all of you remember when the major casinos were pulling spinach off the buffets and ingredients – they were even pulling spinach out, fresh spinach out of the ingredients that were going to be cooked, which would have made any product safe. So it’s unfortunate that someone from Henderson, Nevada went through this; but I can tell you that I want to hire that young lady as a health inspector when she grows up because of the fact that she touched her jeans and she had to wash her hands – we could all learn from that. This is why we’re updating the food regulations. Another article was in the Las Vegas Sun recounting her story just this past month, in December, and it was basically recounting her story, about the pathogens of the bacteria are emerging and changing all the time. What used to kill them doesn’t necessarily kill them now – they become, they modify their genetic structures to change and there’s better science out there. The days of people saying, “oh I got sick” and never being able to trace it back to a food, the science is there and we can trace back some foodborne illness outbreaks to the exact food that caused it.
The food industry is very creative in what they’re doing and they’re always adding new items to their menu. Who would have thought ten years ago that emu would be on the menu, or that fallow deer would be on the menu. Heaven knows I don’t think…
Chair Giunchigliani: Half the world…
Ms. Hahn: …other than hunters who kill moose, I would have never thought moose tenders would be on the menu. Due to the emerging pathogens out there we have an ever-increasing list of potentially hazardous foods. Coming from the south when I went to a picnic watermelon sat out on the picnic table all day and we know now that that can’t be done because watermelon will grow bacteria. Cut tomatoes are now classified as potentially hazardous; bean sprouts, those…we’re having an ever-increasingly list of potentially hazardous foods. And the packaging changes…we’re finding that the packaging’s going to make the product look fresher longer, it’s going to be shelf-stable or whatever and they create packaging changes. So the food industry is a very creative and an ever-changing industry that the food regulations need to stay up on.
The process that we went through…the last time the regulations were updated were in 1996 and over that time period we have found out that the regulations have not been kept up with the times. So back in February 2007 we started meeting with industry, we had about forty-five industry partners from various associations, the major casinos, we had a Board member that was on the industry partnership and six environmental health staff met with industry for a period of about a year and half to two years to discuss every single chapter in the FDA Food Code. The FDA Food Code, if you’re not aware of, is developed by the Conference of Food Protection and approved by the FDA – the Conference of Food Protection is regulators, partners from industry, state and local health authorities and scientists, so it’s a compilation, it’s a very arduous task. We would like to get more closer to what they are doing so we don’t have to work as hard, maybe, because the science is there. We also had a request from our national franchises that we need to adopt the Food Code, but instead of adopting the FDA Food Code, which changes every five years, we decided to mirror the Food Code. So the first eight chapters of the Food Code are from the, excuse me, of our regulations that you had to review, are from the Food Code and then nine through fifteen were developed by environmental health staff for the peculiar issues in Las Vegas, to address our extremely long swimming pool season and people wanting their cocktails at the swimming pool…
Member Hardy: Madam Chair?
Chair Giunchigliani: Mm-hmm, yes?
Ms. Hahn: …you know, wet houses and whatever. Yes, Dr. Hardy?
Member Hardy: When we mirror our Food Code, is that an on-going mirroring so that in regulation we have automatic updates or is it everything has to come back to us when the feds change their…
Ms. Hahn: No, not everything has to come back to you when the feds change. We are mirroring, we are not adopting the Food Code, by reference.
Member Hardy: …we basically are automatically updating as we go then…
Ms. Hahn: Yeah, in the things that change is the temperature requirement, what is a potentially hazardous food, chemical sanitizers, ones that are ever-changing – we reference the Food Code, the most current edition of the Food Code, so that will not need to come back because we reference it in the document.
Member Hardy: Thank you.
Chair Giunchigliani: And they’re based on the edition, so it’s like in work comp when you reference the updated amendment, OK. Correct?
Ms. Hahn: Correct. We have the last fifteenth chapter. We also included appendices. Staff hand out informational guidance documents at various times, so we added those to the appendix, and again those are guidance documents, not regulatory. So that is a basic decision of why we decided to update the regulations. If the regulations are approved today, we all know they have to go to the State Board of Health for approval and then they have to be recorded. Prior to implementing these regulations you can see that we’re going from a forty-nine page document, our current regulations, to one hundred eighty-four, is I think the last time I counted, so there’s going to be training involved. And not just training for our inspectors, but for industry and we already are getting partnerships with industry so that this training can operate and go simultaneously, so everybody’s being trained at the same point and in the same inspection process. We’re also currently working with industry to revise our inspection. As you well know, because I believe you approved it last month, we’re going to go with Decade software and we’re going to become computer-oriented, so our inspection has to be able to be placed on the computer. So we are working on a new inspection with industry right now, and that will be done prior to implementing the food regulations. We intend to give industry, and all of our permitted facilities, written notice as to when the regulations that you possibly approve today will be put in place.
Member Hardy: Madam Chair?
Chair Giunchigliani: Yes, Dr. Hardy.
Member Hardy: Then when we do the mirroring of the federal Food Code, industry obviously is aware of the federal and so they know that we are, or is there an ongoing educational commitment on our part with industry to make sure they are updated with the Food Code as it morphs and changes?
Ms. Hahn: Our industry partners are well aware of the Food Code, because if our regulations coincidently don’t happen to comply with what the Food Code says, they will tell us, “well the Food Code says it.” The current version of the 2009 Food Code just came out and as there will be a supplement probably in another year, and we stay on top of that and industry is aware of it. And often we do provide information to industry regarding the changes in the Food Code.
Member Hardy: So when we’re “dinging” somebody as we inspect or whatever, we’re flexible in that interim, because it may be us that’s “dinging” because they know something more than we do, because it’s more up-to-date, so there’s an educational process more than a punishment process.
Ms. Hahn: A good example of that is when our regulations were written in 1996, “time” wasn’t allowed as a public health control, but shortly after that the FDA Food Code allowed “time” as a public health control, and we allowed facilities, as long as they provided written documentation to us on how they were going to eventually either monitor the temperatures and throw it out at the end of four hours or their procedures…so yes, we have done that educational without “dinging” them.
Member Hardy: Thank you.
Member Ruscingno: Yeah, that…
Chair Giunchigliani: Barbara.
Member Ruscingno: …Madam Chair, that would be my question. Some of the high-risk foods that are out there that we already know that the public likes to consume, sushi being one of them. So how strict are we with the holding to temperature codes and everything else with that?
Ms. Hahn: Sushi’s another good example, which we do have an appendix in the back document for sushi, because those of you who are sushi aficionados like to eat your sushi at room temperature. And if you know the sushi process you know they’re adding vinegar to the rice, which is, the cooked rice, which is the potentially hazardous product…
Member Ruscingno: OK.
Ms. Hahn: …so the rice…we have an appendix that helps them through that. We require challenge studies to make sure that the rice is at the appropriate pH and as far as temperature. Now, those of you who like to eat the raw fish in your sushi, we have a consumer advisory in the regulations for years, so, yes, that…we try to address those issues by putting either advisories in there or helping with appendixes in the back.
Member Ruscingno: OK. Thank you.
Ms. Hahn: Another one would be the raw oyster.
Member Boutin: Yes, oh…
Chair Giunchigliani: Don’t take my oysters away.
Ms. Hahn: I’m sorry?
Chair Giunchigliani: Don’t take my oysters away.
Ms. Henderson: We’ll just make sure there’s an advisory there for you to read.
Chair Giunchigliani: If my husband shucks ‘em, I’ll eat ‘em. But I think that…I think you’ve done a very good job of working through a very cumbersome…
Member Ruscingno: It’s fabulous.
Chair Giunchigliani: …six hundred and some odd page, but working with the industry itself. And I’m looking at the business impact statement…it says that the enforcement and operational costs should be minimal. Is there an accompanying…oh boy…is there a fee schedule then that goes along with this as a fee increase of some sort or is this just simply, currently just the regulation and that’s a secondary issue?
Ms. Hahn: Excellent question, and industry has been asking that. The fee schedule…we have the term “applicable fees” in here, but we do not specify any fees because traditionally the fee schedule has been a separate document that you are familiar with and that would have to go through the workshops and approval process separate to the regulations.
Chair Giunchigliani: Whenever we do something, or is recommended to do something, then they’ll have another additional public opportunity to be able to deal with that.
Ms. Hahn: Yes, ma’am.
Chair Giunchigliani: And, yes, Tim. Go ahead.
Member Jones: I think we do see that through the new regulation there are going to be some processes for waiver with HACCP plans and operational plans and that will come about with some fees for health district staff to review – that’s well-known now to the industry. So that’s looks to be an OK situation.
Chair Giunchigliani: And when you said that forty-five vendors, that I believe there are places that actually have folks that deliver to the back of the house, so they’re all included in that part of it as well, transporting food from one place to another and so forth?
Ms. Hahn: We have included, that’s one of the chapters that we sort of developed, because we have “waiters on wheels,” as a good example, “food on the run,” because they are employees of a permitted food facility, they basically pick it up. We’ve added some language to include those operators.
Chair Giunchigliani: And, OK. I commend you. I think you’ve done a good job. I still think, personally, that a little bacteria actually helps us fight off a little bit, so glad to see that we didn’t go so overboard that people…the waiver component…the other exceptions of changes that come in culturally with food that we have to recognize, but make sure that people are still safe, so I think that you tried to maintain that balance there. I will open the public hearing. Is there anyone here that wishes to testify or make any additional comment to the proposed regulations? Yes, please come forward. Good morning.
Alexis Barajas: Hello. I’m Alexis Barajas. I wanted to comment on the catering section specifically of the proposed regulations in that it does not specify about the hand-washing sinks being at the food preparation area, but rather it makes a general statement that the hand-washing sinks would have to be at any site where catering is going on. And so I’d like to address that.
Ms. Hahn: Thank you, Alexis. I met with Alexis basically to inquire how her two-year old was doing, but we talked about this issue at…hand-washing stations or whatever. And she pointed out the section that she was referring to was in the catering, chapter 12-305.11and in talking with Alexis, we wanted to add that all food items…a catering food establishment shall assure that food is delivered to a remote service site location and to an event location at required temperatures and protected from contamination. And her issue, she had an issue about the hand sinks, so we wanted to add at the end of “B,” “adequate hand-washing sinks shall be provided at remote service sites or at the event location where open food preparation or dish-up is occurring.” And Alexis felt that, in talking with her, that was her concern that yes, we’ll have hand sinks in those areas, but it doesn’t address the dining room areas where people are actually serving food already to the customers.
Chair Giunchigliani: It will not deal with the dining room area, is what…and that makes sense…
Ms. Hahn: And that’s why we added that statement…
Chair Giunchigliani: …so what you’re saying is that they cater to a person’s individual home, that there needs to be a sink available? I mean, we’re not making them install something different no separate, correct?
Ms. Henderson: There’s some circumstances where they might have a large banquet hall which they’re servicing and I believe that Alexis wanted to add a little bit more detail as far as where the employees would be washing their hands, and of course where that would be necessary is if they’re doing any on-site preparation or if they’re dishing up from bulk. It would not be reasonable to change the general lay-out of the banquet room where they’re actually bringing the plates in to serve. So that we’re providing more definition to that section…
Chair Giunchigliani: From more of the back-of-the house is what the clarification is…
Ms. Henderson: Absolutely. Absolutely. But we just added a bit more clarity due to the concern.
Chair Giunchigliani: OK. Does that answer your question as far as…
Ms. Barajas: Yes.
Chair Giunchigliani: OK. So if in approving this we would accept those changes the Board would consider the acceptance of that additional language to clarify the idea of the hand-washing access.
Ms. Henderson: Please consider the section.
Chair Giunchigliani: Thank you very much. Is there anyone else who wishes to make a comment or testify? Please come forward. Good morning.
Alex Stokes: Alex Stokes. I’m the director of health and food safety for Wynn Resorts. I have a couple items here I’d like to discuss today. First I’d like to commend everyone on the regulation – I’ve worked on the committee for almost two years, right down to the last draft, I even had 132 comments on the last draft – most of them got implemented. Industry’s doing a good job in helping it along, but I do have a couple things that I’m concerned about. In chapter 3-502.13(c)(4) when it’s talking about “except that FISH is frozen before, during and after REDUCED OXYGEN PACKAGING shall require submission of a HACCP PLAN for review and approval by the HEALTH AUTHORITY.” My contention about, I’ve had several discussions with the staff, my background is just about as thorough as theirs – I worked twenty-two years in the military in food inspection, six years with food safety inspection service, and also with the health department here for seven years – I know the importance of food safety. But when we’re talking about processing fish, it’s very specific. If you’re processing fish to be, for storage, it has to be vacuum-packed after it’s frozen, during frozen, and you can’t even thaw it in the vacuum package. But what I’m concerned about is an operation. For instance, I have a fine dining staff, I have a chef that wants to take an 8-ounce portion of fish, put the seasonings in with it, with some oil, vacuum pack it and immediately drop it in to water, boiling water, to enhance and seal all those flavors of the fish, open it up and service immediately. So that’s my contention is that their definition of what they’re referring to is implying a process procedure for storage…
Chair Giunchigliani: Mm-hmm.
Mr. Stokes: …any length of time. I’m talking about a process for immediate service to the customer and there should be a way that we can have a waiver to where we do not have to maintain a HACCP program. I’ve worked with HACCP, I’m a certified HACCP manager, and if you’re truly doing a HACCP program you’re going to document time and temperature, you start the operation, time and temperature, it came out of what you’re doing and you’re going to maintain your records, you’re going to maintain your viability as far as the process that you’re doing, you’re going to maintain the records, you have to lab test the [indistinguishable comment] to validate, so you’re talking about a cost for a procedure that’s the cook and immediately serve to the customer. I think there’s a little disconnect between all of us in general. I just attended a two-day workshop with the FDA. Even in the workshop with fifty-five people present, Tim being one of ‘em, we disagreed on the terminology or the procedures on whether or not it’s going to be a storage process, whether it’s a cook/chill or whether it’s a sous-vide or whether it’s a cook and serve immediately. So I’m just asking that they would add that you would be able to grant a waiver for the requirement of HACCP, if you do the initial test or whatever they’re wanting us to do to incur the cost to send off to a processing lab. We do not have processing procedures or authorities in the state of Nevada. I’ve reviewed the list that they give me – three-fourths of the list refers to low-acid, hermetically sealed items. So you’re talking about a long-term storage process, not a cook and serve item.
Chair Giunchigliani: So may I ask you then, why, if that’s a consideration, why would we put it under 3-502, which is a processing category versus what you’re talking about, which could actually in 3-501, if…I’m reading this very quickly, which is more a serving section.
Ms. Hahn: In dealing with this processing aspect that we at first quoted right out of the FDA Food Code at the request of our partners, we re-worded it. And in dealing with this particular section on “C” fish was pulled out because of the dangers of fish. When you’re talking about reduced oxygen-packaging, we’re talking a lot about of things, and in fish, when we’re talking for fish, we’re talking Clostridium Botulinum and Listeria. And we’re talking Clostridium Botulinum is a vegetative cell that possibly can turn into a spore and that spore can possibly turn into, produce toxin. Now we know botulism is, it’s potentially fatal, it’s food poisoning – symptoms are general weakness, dizzy…
Chair Giunchigliani: Let me go back to my question…
Ms. Hahn: OK.
Chair Giunchigliani: …I’m not talking about botulism. I’m talking about the issue of apparently preparedness – preparation versus a processing. And I think what the gentleman is delineating, and maybe I didn’t get that correctly, is a method of preparing something for service. It’s a marination is what you’re talking about, and so you’re enhancing the marination very quickly and then you’re doing your service versus the packaging, which is intended to “vac” it and then hold it for later distribution. Am I understanding that correctly?
Ms. Henderson: If I may qualify, can you hear me on this?
Chair Giunchigliani: Yes we can.
Ms. Henderson: OK, very good. If I may qualify, with the reduced oxygen packaging, you are taking oxygen out of the element…
Chair Giunchigliani: Mm-hmm.
Ms. Henderson: …so, and botulism grows in what’s called an anaerobic environment…
Chair Giunchigliani: Mm-hmm.
Ms. Henderson: …now none of us in this room are processing authorities. FDA historically has dealt with processing where they’re packaging for later service, that is correct and that is why the wording here is reflective of that. However none of us in here can guarantee that with this particular procedure that Alex is speaking, once you take oxygen out of the element there isn’t going to be some spore development. A processing authority would have to determine that, just because of the fish product being so indicative of having the possibility of having botulism in there.
Ms. Hahn: When…and…
Ms. Henderson: So that we don’t know, we can’t guarantee that his process is safe – all we’re saying is that it should be a documented procedure, which goes to an authority, particularly with this type of bacteria, because this is a relatively new thing that he’s talking about – the creative and new things which Mary had discussed earlier in this…
Chair Giunchigliani: Now I think that’s why the question came…could there not be a waiver which there’s documentation…
Ms. Henderson: He could apply for a waiver, give us the process, and then an expert having reviewed the process can validate that this would be safe. That keeps the district at lower liability for approving that waiver and also protects industry if someone consumes that product it was an authority that said the process was safe. The regulations do allow for that, but due to the risk of botulism, and I’ve heard audios, as has Mr. Jones and Mr. Stokes, from an individual that got botulism. I’ve got that audio with me in case you want to hear what happens to an individual. This is something so severe that we have to err on the side of caution and make sure it’s an authority. We’re not just looking at different internet papers on this, because it is new. People haven’t been doing this and people that have been doing this have not been aware of the risk in this.
Chair Giunchigliani: And there’s liability to the health district in what way?
Ms. Henderson: If what Alex is saying, he wants to have this type of cook and serve procedure just approved, and…
Chair Giunchigliani: He was asking for a waiver.
Ms. Henderson: Are you saying…
Mr. Stokes: I was asking for a waiver for a requirement to maintain all the HACCP requirements, which cost us FTE, time and delivery. I’m not saying, I’m not agreeing with what you’re saying, but I’ve been around for quite awhile and I know that you can’t grow C-BOT, Botulinum, in thirty minutes, you’re not going to grow it in ten minutes, from the time that it’s dropped into the boiling water, taken out, opened up and served on the plate. I mean, you know, you can caution to the extreme all you want, but there’s practicality…when you put on the requirement “maintain HACCP documentation,” for a cook procedure, we’re not talking about a storage procedure, I’m talking about a cook procedure – you’re talking about time, temperature monitoring, lab results, an individual’s time to do this, and I gave them an example just today. We have a seating of 450 people, that was fish special. They come in, it’s fish special that we cook in a vac-bag, customer order and request. First round of orders was fifty-five. If I were doing a HACCP program, I would be doing immersion technique, taking the bottle dropping in it with the filet at the time, I would have to have a pre-chilled bottle showing that it started at the temperature that the first portion was starting with and drop it in, you bring it up to a temperature of 145 so it’s cooked, you open the bag and serve it, I would then have to have someone document all of that, I would have to take that bottle or immersion probe back and pre-chill it back down to 45° at the time that I want to do the next filet. So I’m just saying, you know, that it’s…I want a waiver for that portion. I’m not saying a waiver for what we’re doing is preparing something new…sous-vide has been done for over twenty-seven years in France, and it’s an advanced technique…
Chair Giunchigliani: Ah, I love sous-vide…
Mr. Stokes: …even there’s a lot of things we can do. I don’t have a problem with documenting how we’re doing it, SOPs for sous-vide, cook/chill, whatever, but when it’s a specific cook-process, it’s not going to take more than three to four minutes I think we should be able to exempt the requirements of HACCP.
Chair Giunchigliani: OK, let me have Dr. Joe, questions, OK?
Member Hardy: Realistically what happens with regulations and rules is they’re invented by people on the ground and not at the federal government level. And so we’re basically hearing common sense as a potential waiver that will be expanded into a food code that we will mirror that we actually created and allowed to happen because it makes sense. And, you know the C-botulinum isn’t going to happen quickly obviously, so I concur with the concept of the waiver, it just makes sense. But the storage, obviously, is a different issue and that I think is a different issue as the Chair has pointed out and depending on where you put it in your layout than there’s where I would be comfortable.
Chair Giunchigliani: Donna, did you have a comment?
Member Fairchild: No.
Chair Giunchigliani: So, yes?
Ms. Henderson: In speaking with Mr. Goode, we did look at Alex’ concern…
Chair Giunchigliani: Mm-hmm.
Ms. Henderson: …due to not knowing with all assurance that with this process, and of course with his business of monitoring as far as how long the product will be between that cook and the service, may be very precise. We have to write regulations that will serve all of the community. One thing that I would possible bring forward for both industry consideration and of course the Board, is if you’re looking at that particular section which Alex is speaking of, which is section 3-502.13(c) and the most troublesome in that, I believe, is number three. A HACCP plan can be as detailed as what Alex has stated; however when he’s speaking of that particular procedure where it is put in immediate service, often times they will have studied how long it takes that fish to cook in that bag – they know what the final temperature’s going to be. The critical limit with that would not be the final temperature so much as the amount of time between when they take it out of that package it was cooking and when they serve it. That would be the procedure that would need to be reviewed. But again, as an assurance, since he would go to the processing authority a single time with this particular procedure, there would be an assurance both for his employer and for the health district that that is safe, because we can’t say with all assurance it is. What I would ask for possible consideration under number three, which is the most restrictive part of that, is preempt what is said there “unless otherwise determined by processing authority to be safe” and that we “would defer to that authority of that particular type of bacteria that that process is safe,” so we would like to have that for consideration.
Chair Giunchigliani: Who’s the authority? I’m not sure I’m understanding…
Ms. Henderson: Again, there are a number of processing authorities…
Member Jones: Could be a third party laboratory that…
Ms. Hahn: Third party laboratory, many universities do it in their science department. The Desert Research Institute could do it if they chose to go that way…
Member Jones: I would say another option which was seemingly done in San Francisco for ducks was just to have an industry group put together and this is a common practice we could do an industry group to go to one authority and come up with a cook process that would be acceptable in our area.
Chair Giunchigliani: OK, Kathleen?
Member Boutin: How long have you been using this certain procedure in preparing this dish or similar dishes?
Mr. Stokes: Five years, since we opened the Alex restaurant, five-star fine dining restaurant.
Chair Giunchigliani: And sous-vide and…
Member Boutin: So you do serve…
Mr. Stokes: But I’m not talking per se sous-vide in general, because normally sous-vide is a long-term process – it could be eighteen to twenty hours cook time and you’re preparing the day before, slow-cooking process, you might shock-chill it, brought down to maintain 34°, you may not serve it out of that bag for two or three days. You know, three days normally is the max seventy-two hours. I’m talking about for immediate consumption – immediate vac-packing with the seasonings, cooked in the bag and served immediately. Now to me that’s the distinction between a true sous-vide process as far as how you’re doing it proper. And there’s a difference between cook procedure and storage or a packaging procedure and when you’re talking about hermetically sealed and cooked in place, that’s a lot different between an actual cooking process.
Member Boutin: It seems to me that if he’s been doing this for five years and his industry counterparts have as well, if we had an incident where we had a severe outbreak we would be able to track that if were caused by this procedure, correct? Have we…do we know of anything that has been so profound that we should put this in regulation?
Ms. Henderson: Councilwoman, I can’t guarantee you that this process, without a processing authority looking at it, that will be safe, and it would just take one case of botulism to impact that individual and the industry here in Las Vegas that I have a concern that I can’t recommend that without a processing authority looking at it. If a number of industry partners go to a processing authority with this particular process with certain control limits on it, with the time between when they open up the package post-cooking and when they serve that product there would be an assurance for everyone in this community, and that’s what I’m saying…
Chair Giunchigliani: I believe her question was…
Member Boutin: Yeah, I did ask that…and do you know of any instances that have occurred recently as a result of using this technique?
Ms. Henderson: No, not with his particular business with his particular technique.
Member Boutin: What about in Clark County at large? I mean, do we have any numbers that can indicate to the Board that this may indeed be a viable health risk for our tourists?
Ms. Henderson: Thank goodness we don’t have many – we had one that was not with this particular process. We have had one up north, which I have the audio of that individual and how she was affected. I’m concerned because we’re not talking about salmonella, we’re not talking about Norovirus where people might have some intestinal difficulties for a few days if they’re not immune-compromised – I’m talking about botulism where they either die or they know what’s going on around them but they’re totally paralyzed. So I worry about that and that’s why, you know, I’m taking such a strong stance on it. If it happens once, that’s all it’s going to take.
Chair Giunchigliani: I don’t think anybody’s questioning your concern; however part of our job as regulators is to be reasonable while promoting safety. And I think a five year history of no incidents…and in the long run they’re at risk of losing far more but not doing it the right way, I think we have to listen to the industry to some extent…
Mr. Stokes: I’m not talking about exempting the procedure…
Chair Giunchigliani: You’re just…
Mr. Stokes: …I’m just talking about them exempting the requirement for the HACCP and the procedure…because HACCP can get very, very detailed, you know. If you’re not familiar with what, how far you want to go with it and as the regulations change and HACCP is mandated and how far do they want to take it. I’m just saying that we should be able to substitute an operational-reviewed procedure in lieu of a mandated HACCP program.
Member Barlow: I agree.
Member Jones: I think…
Chair Giunchigliani: Tim?
Member Jones: …if I could make a point. I think that we are using the term “HACCP plan” and what the health district is looking at in this particular cooking procedure may not be as extensive as what you are perceiving it to be. There would be a HACCP plan that would be submitted to the health authority, approved by the health authority, I think that that HACCP plan may not be more extensive than just showing the critical limits of time, cooking, things of that nature – it would not necessarily have to be something that would be laboratory testing in terms of the HACCP plan. So I think I have a comfort that we’re not asking industry to be at an extreme level in this…another point I would bring up in terms of the botulinum type of infection is that it is certainly not common but it is a very severe type of outcome in the industry so that it’s worth protecting the public against having that type of exposure, even though it is a very rare type of exposure, when it does occur it would be a devastating type of outcome. And I think that we’re not putting just a big control on it that it would be onerous for industry to have a HACCP plan that would be reviewed by the health authority.
Chair Giunchigliani: Dr. Joe?
Member Hardy: Thank you, Madam Chair. I had a PowerPoint presentation recently that said that France was 1% of their food problems and sous-vide sounds very French.
Chair Giunchigliani: Sous-vide is an old French technique, actually if you read Waverly Root’s Foods of France, which is a phenomenal book in and of itself, it gives you the entire history of everything from butter to lard to every kind of preparation that you can…
Member Hardy: I never actually had the chance to digest that book.
Chair Giunchigliani: I’ll get you a copy for your present.
Member Hardy: I’m having too much fun, aren’t I?
Member Weekly: Yes you are.
Member Hardy: So one of my concerns that I look at is if the…it seems to me that the initial preparation or processing of the fish, in this case, would be where the contamination source would take place and so I think we have to go back to the first part of that and make sure that we’re doing all of the first things because if you don’t have contamination at first, then you’re not going to get it later on.
Mr. Stokes: Sir?
Member Hardy: Yes.
Mr. Stokes: May I clarify? C-Bot is naturally occurring in about 60% of all fish in the waters wherever you harvest it from.
Member Hardy: So it’s there.
Mr. Stokes: It’s there.
Member Hardy: We know it’s there.
Mr. Stokes: It’s there. So I mean I understand that portion.
Member Hardy: So…
Mr. Stokes: I’m just saying when we go to the cooked version how we’re handling it, and maintained all the waivers and the HACCP…I’m just saying I’d like to be able to say this is our procedure – I’d like to have the waiver for requirement for mandating HACCP. That’s all.
Member Barlow: And I agree.
Member Hardy: And I think the other question that I have is when we talk about the time to serve after you’re done your waiver, as it were, and the time from the time you cook to the time you serve, it brings me to what I think is the obvious question…how fast do we tell people to eat their meal? I mean that…are we getting food poisoning because somebody’s taking too long to eat.
Ms. Henderson: No sir, that’s not what’s happening.
Member Hardy: So it’s only in that window of time, and if we can document by some processing authority that the process is safe, then we have the opportunity to do a waiver that’s appropriate. And it seems to me that’s what we want to do – have some process authority say, give their blessing as it were, that this is an appropriate thing to do. Thank you, Madam Chair.
Chair Giunchigliani: Donna?
Member Fairchild: Thank you, Madam Chair. May I bring up one point, too? If the fish is packaged this way and then cooked to the appropriate temperature, doesn’t that cut off…
Ms. Henderson: Not the spores…it will actually shock the spores so that they would germinate.
Member Fairchild: So that’s why that serve…
Ms. Henderson: That’s what the concern is.
Member Fairchild: …cook to serve time is critical.
Mr. Stokes: Well then once you shock the spores and they start to develop, you have to have a time period for them to develop the toxin.
Chair Giunchigliani: Mm-hmm.
Member Fairchild: And how long would that take?
(Unknown voice): Four hours.
Mr. Stokes: Well that’s just it. You can look at anywhere from the least amount of time I’ve seen in very rare cases in C-Bot C I think it was like four hours for measurable to have an impact, up to ten days in some cases. And some different types can be up to twenty days, hermetically sealed. So I mean it just depends on what you’re looking at, which species A, B, C or D is actually what affects the humans and there’s three other species that affects others – there’s actually seven different species that we know of right now that, or types I should be saying, for C-Bot.
Member Fairchild: Thank you.
Mr. Goode: Madam Chair, if I may?
Chair Giunchigliani: Barbara? Barbara has a question. Go ahead.
Member Ruscingno: Well, thank you, Madam Chair. Cooking has really taken on, like medicine, it’s like cover your butt. But anyway, you have, I mean, research takes years and you have done this exact procedure for five years?
Mr. Stokes: Yes ma’am.
Member Ruscingno: Without any consequences?
Mr. Stokes: No consequences. And we do not save…if we make it and someone cancels the order, it gets thrown in the trash…
Member Ruscingno: OK.
Mr. Stokes: …it’s not like you save, it’s for immediate use. You take the fish raw, place it in the bag with your seasonings and spices, you vac-pack it, you drop it into the boiling water so it enhances all of the flavors into the fish, cut the bag open, and once the bag is cut open, C-Bot can’t produce – it can only produce toxin in an anaerobic state.
Member Ruscingno: OK. Right. Thank you.
Chair Giunchigliani: Mr. Goode, did you have a comment?
Mr. Goode: I do, thank you, Madam Chair. Although it sounds as though we’re not agreeing, we certainly are. But what we’re saying here is that Alex has already agreed to do the initial testing, and that’s what we’re asking him to do. But what he’s asking for, and which isn’t as clear as it can be in our regulation, is that he’s asking for a waiver as opposed to having a complete HACCP plan.
Chair Giunchigliani: So he’s still giving you the plan of the test, but it’s not…
Mr. Goode: Yes.
Chair Giunchigliani: …the HACCP test and it doesn’t say it that way…
Mr. Goode: Correct.
Chair Giunchigliani: …so that’s the clarification that you’re asking for.
Mr. Stokes: Yes, ma’am.
Mr. Goode: Yes, and the language that Ms. Henderson brought forth, I thought, clarified that with the processing authority, given us written documentation in their opinion that the process is safe, then the waiver can be issued and he would not have to have a HACCP program.
Chair Giunchigliani: OK. And so, could you restate the suggested compromise language to clarify, because it still would require a plan to go to the authority, which would be you all, to say yes, you’ve measured the temperature and you did this, you did that and they could approve that. Is that a waiver, then or is that a variance, that’s what I was trying to say.
(Whispered conversations)
Mr. Stokes: I want the option of not being mandated to have a HACCP program…
Chair Giunchigliani: But in lieu to perhaps, then to present a plan it would have to be…
Mr. Stokes: Right, operational plan.
Chair Giunchigliani: Gotcha.
Mr. Stokes: Operational procedure.
(Whispered conversations)
Member Jones: But again, it would be specific to prepare and immediately cook…
Mr. Stokes: Immediate service. I’m only talking for immediate service.
Member Jones: Right.
Mr. Stokes: You know, no type of storage…
Member Jones: Prepare and immediate cook and serve, something…
Mr. Stokes: Right.
Member Jones: …another person who doesn’t see it your way may want to cook and then store it.
Chair Giunchigliani: Correct.
Mr. Stokes: So it has to be for immediate service.
Chair Giunchigliani: OK.
(Whispered conversations)
Chair Giunchigliani: Immediate is defined, where did I find it…there’s a…I believe…Steve, there’s a definition, isn’t there, of “immediate,” but I didn’t find it…it was throughout it…
Member Jones: From an FDA science stand-point, that would all occur within four hours, to prepare it, to cook it, to serve it. Quality of service would go faster than that.
Chair Giunchigliani: But in one different section it says that service of food shall not exceed, that’s in six…
(Whispered conversations)
Ms. Henderson: To ensure that we are addressing everything that industry is asking concerning having a procedure which is reviewed by the processing authority, but may not include a HACCP evaluation and implementation, we would request that we could just table section C only of this and then come back with wording in thirty days. Would that be something that the Board would like to entertain?
Chair Giunchigliani: That would be reasonable, I don’t think…that way we’re doing it the right way. So you’re comfortable, you’re comfortable, and we’re comfortable so I think that’s…
Ms. Henderson: I’d rather not…
Chair Giunchigliani: Yeah, try to do it off the cuff…
Ms. Henderson: …I want to make sure that it addresses all concerns, plus having the implication of having the processing authority, until the science is more established in this area.
Chair Giunchigliani: And then you had another comment.
Mr. Stokes: The other comments I’d like to have a caveat statement for appendices that they’re guidelines in nature and not regulatory. I don’t mind finding the guidelines, but defining a guideline is better. If you look at their guidelines, in several of them it says you must and you shall. So I don’t want an inspector or someone down the line open up the appendix and say this is the law. So I just want to be able to stipulate…
Chair Giunchigliani: Regulation versus the appendices and the appendices are guidelines on how to implement and what to look for. They should not contain mandatory language is what…
Mr. Stokes: Correct.
Chair Giunchigliani: …you’re suggesting. OK.
Ms. Hahn: And throughout the document whenever we reference any of the appendices, in fact, we did add in that applicable section a statement saying similar to a guidance document is provided in Appendix C or whenever an appendix was referenced that guidance document is…and since Alex and I had the wording and we can definitely add that wording to the front of the document if we…
Chair Giunchigliani: Or just before you start your appendices you could put a caption that says “these are guidelines…”
Ms. Hahn: Yes.
Chair Giunchigliani: …and just keep it simple.
Mr. Stokes: And non-regulatory in nature. I just want that totally stipulated to where it doesn’t migrate over the years.
Chair Giunchigliani: OK.
Ms. Hahn: We can do that.
Chair Giunchigliani: Yeah, OK. Thank you, sir. Is there anything else?
Mr. Stokes: One other thing. I hate to take up everyone’s time, but I’m concerned that the point system that we maintain from many year’s past…an “A” is ten points; a “B” is from eleven points to twenty points; a “C” is from twenty-one to forty points…we’re going from a forty-seven page document currently to a hundred and eighty-four pages. Many, many things we address, and I think it’s very, very strict and limited when you stay with a ten-point violation. You know, I don’t know what the new inspection document’s going to be as far as how many points each item is, what the criteria is, but when you put four times the information you’ve been found in violation of, and even though we’re going to training sessions, I think that ten points is very, very strict.
Ms. Henderson: May I comment on this, Madam Chair?
Chair Giunchigliani: Mm-hmm.
Ms. Henderson: Yes, our training officers have been very much involved in trying to develop an inspection report form that would be both good with the Decade software, but also take in these considerations in line. They have, I believe, shared some of the preliminary documents associated with an inspection report form to one of the members of the Board, and they have also taken a previous inspection reports and for the types of violations which one might see, they did a correlation between what the operator received on the existing health inspection report and what they would receive on the new inspection report form and they found that in every case it would benefit the operator, and that actually when it came to a grade point difference, it would either be the same or it would be a more advantageous grade. Certain violations which were much higher, the six and ten demerit violations, there will be no violation, if we go with this report form, that will exceed five demerits.
Chair Giunchigliani: OK, is that part of what we’re adopting today?
Ms. Henderson: No, it is a separate document that is still under development and we are involving industry as part of that process, but we’re still developing the document so that it would be conducive to using with the software. And in addition to that, more mirror this type of regulation where it is more risk-based and as I said, the demerit values are going to be less on that form than it is on our current form.
Chair Giunchigliani: Then may I suggest, if there’s not objection from the Board, that when you, that you make sure you’re doing the industry and looking at how that compares to the new regulations to bring that back for a public hearing when that way, if there’s additional changes or corrections. When this is adopted when’s the effective date of it, this new regulation?
Ms. Henderson: We do anticipate with the training and so on that we would not be implementing this until about mid-year.
Chair Giunchigliani: OK, so because this still has to go to the State Board of Health, you can begin your training now but you don’t have to sit in abeyance and wait until they do that, or do you have to wait until they do their adoption?
Ms. Hahn: We are already developing…
Chair Giunchigliani: OK, so you’re anticipating…
Ms. Hahn: …the procedures…
Ms. Henderson: We’re working on that.
Ms. Hahn: …it’s easier to deal with the ones that might be changed, the few that might be changed, so we are already working on those documents.
Chair Giunchigliani: Alright, so then, I think you still have an opportunity to take a look at the point system, the demerit system and make sure that that is reflective of the new documentation, but not more cumbersome, and you may want to change it or not, and so that’s we would do. So we’ll still do that through a public hearing.
Mr. Stokes: We’re just concerned from my standpoint in industry, Madam, that the point system, the downgrades, later on doesn’t become an issue for revenue-generating…
Chair Giunchigliani: OK.
Mr. Stokes: …I just read an article the other day where they started the article off that the health departments generates $22 million a year in revenues and the state of, I mean New York City. The point is it should be public health and not generating revenue. So if you start your article off about the number of inspections they’re doing, the findings they’re having and all of a sudden you’re talking about revenue, while I know things are tough, it’s tough for us in industry, it’s tough from a budget standpoint for public health, but I don’t want the regulation to come to the point where you have two five-points and a light bulb out and all of a sudden you’ve got a downgrade. You know, let’s be practical.
Chair Giunchigliani: And that will be reflected, but I think staff, I’ve always felt, at least, this health district tends to do things based on what the public and the business folks need in a balanced manner and hopefully we can maintain that. I think that’s probably indicative…we’re not as, in spite all this, usually bureaucratic as some of the other larger states can be as far as trying to chase fees, so I think we’ve been pretty reasonable on that.
Mr. Stokes: Thank you for your time.
Chair Giunchigliani: Thank you very much. Is there anyone else…oh I’m sorry. Donna?
Member Fairchild: Oh, thank you very much. Just a question on section 2-301.12 when it’s talking about cleaning procedures for food handlers. I notice here that we are requesting fifteen seconds when all the supporting documentation I’ve been reading and science says you should wash for at least thirty seconds. Are we just going to sing “Happy Birthday” much quicker?
Ms. Hahn: The FDA Food Code changed from thirty seconds down to twenty and now it’s down to fifteen seconds.
Member Fairchild: And that’s the 2009?
Ms. Hahn: Yes, that’s the 2009 Food Code. And again what people find confusing is medical, you know hospital hand-washing as opposed to food handler hand-washing, whatever. So that’s why the change down to fifteen seconds.
Member Fairchild: I would think that, as much as all these concerns you brought up about food safety, that it’s as imperative that the food is safe as it is in the medical profession. So I just wanted to see where the balance was.
Ms. Henderson: Being a nurse for thirty years, I certainly agree. I like everyone to wash their hands properly and it doesn’t matter how many seconds if they’re not using friction and then really washing their hands properly and that’s something that our inspection staff do look for in the food establishments, the simple rinse and run is not appropriate in food service any more than it is for the medical field.
Chair Giunchigliani: And unfortunately with the use of the gels now people are under the false assumption that they…it’s almost you need to get rid of those and focus on what really needs to be, because it’s diverted the attention in my mind.
Member Ruscingno: Well I also know that the gels don’t work necessarily.
Chair Giunchigliani: The general public I don’t think realizes that, Barbara. OK, is there anyone that wishes to testify in the public hearing? Seeing none, we’ll close the public hearing. Let me offer a suggestion for a motion from the Board, is it adopt or approve…I guess adopt the regulation with the following clarifications: we will set aside 3-502.13(c) for further discussion to bring back to the Board; we will clarify that appendices are guidelines and not regulatory in nature; and we will take clarification regarding the caterers and the sink location. Dr. Joe?
Member Hardy: And then the adoption includes the mirroring language?
Chair Giunchigliani: And the adoption includes the mirroring language.
Member Fairchild: Move for approval.
Chair Giunchigliani: OK, it’s been moved for approval. Is there a second?
Member Strickland: Second.
Chair Giunchigliani: Seconded. All those in favor say “aye.”
Board members: Aye.
Chair Giunchigliani: Opposed? Motion carries. Alright. Thank you very much. I know that two, maybe three years of work is…staff should be commended. Thank you for working with the industry.
Ms. Hahn: My hair was brown when I first started.
Chair Giunchigliani: That’s my husband’s story before marrying me. Thank you ladies, you did an excellent job.
