State environmental health manager expands efforts to ensure Hawaii food safety

Peter Oshiro was a newbie food inspector on the North Shore when he got staph poisoning after eating maki sushi from a gas station. He’s learned a lot since then.

“I was so stupid. … It smelled funny, but I was so hungry, I just ate it,” said Oshiro, who now oversees a staff of 41 as the state’s environmental health program manager for the Health Department’s Sanitation Branch.

Most of his staff are sanitarians out in the field inspecting everything from food establishments to tattoo parlors.

Oshiro, 54, said his office often fields complaints from confused callers.

“Nobody knows what a sanitarian is, and nobody knows that a sanitation branch is. We get calls all the time, ‘Why didn’t you pick up our rubbish?’”

What his staff does do is help to protect the public’s health.

While the food industry — retail food establishments, food manufacturers — is the staff’s main priority, another key component is post-disaster relief. Oshiro, who started as a sanitarian in 1988, said he was three years on the job when he was dispatched to Kauai in the aftermath of Hurricane Iniki.

“No water, no power. It was very challenging. It was a learning experience that I think will stay with me for the rest of my life,” Oshiro said. “Everything circles around making sure residents and visitors have a safe food supply, a safe water supply and sheltering.”

Up until recently, he and his staff were in the thick of a hepatitis A investigation that epidemiologists traced back to contaminated raw scallops from the Philippines served at Genki Sushi restaurants. There have been 284 confirmed hepatitis A cases as of Wednesday.

Despite the risks connected to eating raw foods, Oshiro doesn’t shy away from them. He even likes his steaks cooked medium-rare.

Oshiro received a bachelor’s degree in biology from the University of Hawaii at Manoa. He said he was pre-med “but wasn’t even close to getting into med school.”

He and his wife, Jennifer, live in Mililani. They have one child, now 25 years old, who recently graduated with a doctorate in pharmacy from the University of Hawaii-Hilo School of Pharmacy.

Question: How many people do you supervise?

Answer: When I came in in 2011, this is one of the big things we did. I had 13 positions, but only nine were allowed to be filled. I only had a staff of nine to cover over 6,000 establishments (on Oahu). My No. 1 focus was to get staffing levels increased.

The way we went about that is we had to pass legislation. All the restaurant permit fees go into a special fund. When the special fund was created you could only use those monies for education. I needed to change the law where we had to use those monies for operating costs, anything to do with food safety. …

We had a lot of good cooperation from our local food industry to help push this bill along. The whole purpose of the bill again was to generate enough revenue so that we could get resources to run … a world-class food-safety program. We went from nine in the field to currently … 31 positions available (on Oahu). …

At 31 positions, the ratio of restaurants to my inspectors is about 200 to 1. The ideal, ideal gold standard is probably 100 to 151. My staff is very efficient. I think that they can manage that.

Q: The number of establishments, does that wax and wane?

A: It has steady growth, maybe 1 to 2 percent each year. In 2011 I think we were at about, maybe statewide, just about 9,500. I think right now there’s about 10,300 statewide.

Q: Still focusing on the establishments, what are some of the major things you see that make them non-compliant?

A: The two top things we see are personal hygiene violations, which is handwashing and anything to do with handwashing. If the person is not washing their hands before they start work, that’s a violation. If the sink is blocked with a cutting board, that’s a violation. If there’s no soap, hand towels, that’s a violation. All of these are major critical violations because handwashing, again, that’s one of the major things you have to do to prevent spread of food illness. …

The second major violation is in 2014 we passed new food regulations. We adopted the food code. That made the refrigeration temperature requirement go from 45 degrees to 41. The rest of the nation has been at 41 since 2005. We were a little bit behind. … There are a lot of cold-temperature violations.

Q: How has the industry responded to the new placard system?

A: They’ve been absolutely fabulous, because I think we lobbied them so heavily. Before we even passed the rule and before we even went to public hearings, I made sure I attended all their board meetings and introduced what I was planning to do. So they all knew what was happening even before we did the public hearings.

I think that is key for any regulatory program. You have to be able to talk to the regulated industry and get their buy-in. They may not agree with you, but you have to tell them why you are doing things.

Basically (in Hawaii), they realize that this is almost like an endorsement from the Health Department. It raises public confidence a lot, that Health Department was here, they passed, you should be OK to eat here.

This pass doesn’t guarantee that you won’t get a foodborne illness. What it does show is they’ve lowered the risk; at the time of inspection, all critical violations were corrected or non-existent.

Q: That kind of is a good way to get into the whole Genki-hepatitis A situation. They always had green placards, correct?

A: Genki had great back-of-the house procedures. They are very conscious about handwashing and glove-changing. Their refrigeration has never been an issue.

Q: Maybe you can tell me at what point in your inspection or in your work with them could you give them the all-clear. What had to be done in order for them to reopen?

A: After we closed the restaurant, we actually communicated very closely with Genki as to what they needed to do.

There are two avenues. One is the physical-inspection side and one is the medical- clearance side.

The physical-inspection side, what they were ordered to do was make sure that all the existing food supplies that were in the facility that were exposed, needed to be all thrown out.

If it was Cryopaked, they could easily be surface-sanitized and be used. All the single-service items — things like straws, napkins, cups, chopsticks — those all had to be dumped if they were open packages. If there were sealed, unopened packages where no human touched it, then they were OK to keep those.

Then they were told to disinfect all hard surfaces: floors, walls, ceilings, tables; anything that could be washed and sanitized had to be sanitized. …

We required all the Genki employees to be tested. They had to be tested as to whether they were infected with hepatitis A or they had to be vaccinated. They have a lot of employees. I think it was well over 300 employees. That’s why it took a little while.

Q: Do you recall anything that comes close to this outbreak?

A: I don’t know if you remember Sekiya’s when we closed them down. That was E. coli. They had to do the same thing. E. coli is one of those that necessitates a strip-down. They had to remove everything from the restaurant.

Q: The hepatitis A outbreak was kind of a crash course then for some of your inspectors?

A: It was real critical that we worked closely with DOCD (Disease Outbreak Control Division). Their job is to deduce through the interview process of ill people: Where you were, where you ate, that kind of thing.

Our job is we had to grab the invoices, their distribution records, all these things. We would take all of that to DOCD, they would input this into all their computers. It was painstaking. Literally hundreds and hundreds of pages of invoices.

At the time when we were investigating we were looking at all ingredients, what the possibilities were. There were millions of permutations. Literally.

Q: That’s so labor-intensive for the restaurants.

A: But we have to do it. It’s good that some restaurants … have a lot of computerized stuff. A lot of the other restaurants, some small businesses, it’s very invasive. That comes to the thing about traceback and how restaurants really need to know who their suppliers are and where their food is coming from.

Q: How do you ensure that your distributors are providing clean product? You can’t really control that, right?

A: Other large businesses require from their suppliers documents saying that the product — if they think it’s a dangerous product — has been tested.

Typically with hamburger, right, we all know there’s E. coli in there. A lot of large suppliers will not buy hamburger from their vendor unless it comes with a certification that says it’s been tested and it’s free of E. coli. That’s one thing you can do as a retailer. These things are not required now by the Health Department so that’s all internal quality control, if they want to do such.

Q: So there are ways to reduce risk, but it is expensive. Barring that, it goes then to the procedures, the handwashing, temps, so on and so forth. Anything else you can suggest to the establishments and patrons?

A: When we passed the new set of rules in 2014, one of the big changes was the requirement for a consumer advisory. Any restaurant that served undercooked or raw food has to warn the public that eating undercooked raw food places you at greater risk of contracting foodborne illnesses.

Once you decide to eat raw or uncooked food, the restaurant is off the hook. You chose to eat it raw.

There would be no hepatitis outbreak if everybody said I wanted these scallops cooked before you serve them. You kill 100 percent. Because people either decide to eat things raw or rare steaks, whatever, you are putting yourself at risk of contracting food illness and there’s nothing the restaurant can do to help you.

That’s why the consumer advisory is there.

Q: Now you have all these lawsuits. I know you can’t comment on the lawsuits, but as consumers we also should be responsible for what we put in our bodies. There’s that inherent risk, right?

A: We’re a litigious society, right? We want to sue everybody for everything regardless if we have responsibility or not. That’s just the world we live in, right. It’s up to the courts to decide who’s responsible and who’s not — if anybody is at fault.

Q: In the Genki case, the only way to have prevented that would have been to cook the scallops?

A: Yes. Or to have done such extensive QC (quality control) testing beforehand …

And another thing is we have a global food supply. We don’t grow enough food in the United States to feed everybody, so guess where we’ve got to go? We’ve got to go to developing countries … that can provide cheap, large volumes of food.

We’ve never seen outbreaks, especially in our produce. All of a sudden we get salmonella in cantaloupes, in lettuce. What happens is instead of everybody buying from the local farmer, we all go to Costco. Costco gets it from one mega supplier that supplies 50 states. We never used to see multi-state outbreaks. In the last 10 years it’s so often.

Now you have huge industries where they wash produce or they process it so that it goes through a lot of hands, a huge amount of volume gets spread out throughout the country, the potential to make a lot of people sick very quickly … that’s what we’re facing right now. …

That’s why this push for sustainability is so important because if we can grow our own food, we can manage it a lot better. I can’t inspect places overseas.

We have a real vibrant shellfish program right now … That’s another big, big accomplishment that our program did. Our shellfish industry sat dormant for decades. … Kualoa was one of the first ones who were successful. … They are one of the first large-scale operations for oysters to get off the ground. The demand is so high. … We have to say yes, it’s possible, instead of no, it’s too much work for us.