THE MISSISSIPPI LEGISLATURE

PEER sought to determine whether the Mississippi State Department of Health (MSDH) effectively protects public health and welfare through its wastewater disposal system and food protection regulatory programs. PEER examined whether MSDH:

• uniformly administers these regulatory programs in accordance with policy and procedure;


• conducts inspections of locations and facilities in a timely manner; and,


• assures the quality of the regulatory programs by randomly inspecting regulatory actions and systematically investigating complaints.

The State Department of Health is a multifaceted agency whose mission is to promote and protect the health of the citizens of Mississippi. For purposes of program delivery, MSDH’s eighty-two county health departments are organized into nine districts. Each district employs a district environmentalist and county environmentalists to implement and deliver the onsite wastewater disposal and food protection programs, as well as other programs. Most environmentalists perform a variety of inspections and do not work in only one regulatory program.

The Department of Health’s Onsite Wastewater Disposal System Program is responsible for recommending and approving individual wastewater disposal systems. The overall goal of the program is to reduce, as much as possible, the potential for the spread of disease through water and improper disposal of human waste and disease vectors. Districts are responsible for implementation of the program and receive technical assistance from the state office.

The Department of Health’s Food Protection Program is responsible for inspection of food establishments (other than those of churches, church-related and private schools, and other nonprofit or charitable organizations) to ensure compliance with state and federal laws, rules, and regulations. The department’s regulations governing food protection require that all permitted food establishments be inspected at least once annually to receive or renew a food permit. County environmentalists are responsible for conducting inspections of food establishments and receive training and technical assistance from MSDH’s food protection program specialists.

State law does not require homeowners to use the county health department for soil/site evaluation in preparation for an onsite wastewater disposal system. The law permits a professional engineer to conduct the soil/site evaluation and to recommend or design an appropriate wastewater disposal system.

If wastewater disposal systems designed and installed by professional engineers do not meet regulatory standards, the Department of Health does not require correction of those systems. This has affected the consistency of the quality of wastewater disposal systems, possibly resulting in systems that do not meet state requirements, with potential health hazards and possible expense of replacing systems.

Since July 2003, MSDH has operated an automated wastewater disposal system approval process that has improved uniformity in selection (and recommendation) of appropriate wastewater disposal systems and compliance with rules and regulations. Also since that time, the onsite wastewater disposal system program has utilized a computerized complaint administration system whereby complaints are systematically logged, investigated, and tracked to resolution.

In February 2003, MSDH implemented a centralized quality assurance function to ensure that environmentalists conduct all inspections uniformly and according to regulations.

MSDH requires food facilities to be inspected from one to four times per year, according to the risk level of the establishment. (Risk levels range from 1 to 5, with 1 being the facilities with the lowest risk [e.g., coffee carts] and 5 being the facilities with the highest risk [e.g., continuous operation buffets].) In FY 2003, MSDH environmentalists did not always adhere to program policy governing frequency of inspections. For example, in one district, 118, or approximately 58%, of the 204 risk level 4 facilities did not receive the required number of inspections.

MSDH policy directs environmentalists to conduct a follow-up inspection of a food establishment when a routine inspection reveals a violation of any critical item. However, MSDH environmentalists do not always conduct follow-up inspections in a timely manner. For example, in Fiscal Year 2003, in one district, 29% of follow-up inspections were not conducted within thirty days of the initial inspection that found the violation.

MSDH policy requires renewal inspections of food facilities within a period of up to sixty days prior to the permit date and no longer than five days after the permit date. Of the total 11,064 facilities requiring renewal permit inspections in FY 2003, PEER identified 2,526 for which the department did not adhere to its policy governing the timeliness of permit inspections.

The Food Protection Program began a quality assurance program about a year ago to ensure uniformity among regulatory staff in interpretation and application. Both Food Protection Program staff and MSDH’s Division of Internal Audits staff now conduct quality assurance reviews to ensure that staff comply with policies and procedures regarding regulation of food facilities.

1. MSDH should increase its regulatory oversight of professionally engineered wastewater systems by requiring engineers to submit a plan of corrective action on deficient systems. MSDH should amend its policy and require issuance of a letter from the department addressing any concerns or problems with engineer-designed and installed systems that need final approval. In response to the letter, the engineer should submit a written corrective action plan to illustrate how he or she intends to correct the problem.


2. The Legislature should amend MISS. CODE ANN. § 41-67-3 (1972) to require that MSDH approve all onsite wastewater disposal systems to any dwelling house, mobile home or residence prior to the connection of electricity, water, or natural gas.

Food Protection Program

3. MSDH should inspect food establishments with the frequency required by regulations and adhere to the timeliness standards specified in regulations.


4. MSDH should review district resources to determine why some districts are not performing to regulatory guidelines. MSDH should evaluate staffing requirements to determine whether resources should be reallocated to fill vacant district environmentalists’ positions to enhance program performance.


5. MSDH should require district environmentalists to utilize the restaurant inspection computer program monthly as a quality assurance tool to ensure that environmentalists are performing both renewal and minimum required inspections on a timely basis.


6. The MSDH Food Protection Program should implement a risk control plan for follow-up inspections to ensure that facilities are inspected in a timely manner. Depending on the severity of a non-critical violation, the program’s staff should establish general guidelines and time frames for follow-up inspection. The food facility should submit a corrective action plan if the non-critical violation cannot be corrected during thirty days.