Why Most Counties Aren’t Doing All Required Restaurant Inspections

When she pulled into a parking space at Boss Hog’s Chicken & BBQ in Washington, North Carolina, two days before Thanksgiving, Beaufort County health inspector Vera McConnell knew she couldn’t dawdle. The county seal and “ENVIRONMENTAL HEALTH” sticker on her car door quickly give away the reason for her visit.

“They know I’m here, so let’s get moving,” she said, slinging on her backpack and tucking her hair into a leopard-print cap.

In 2023, Beaufort was one of just 26 counties statewide to complete every restaurant inspection required by state law. Environmental health departments in other parts of North Carolina, particularly rural areas, have struggled to hire and keep inspectors, state lawmakers, federal regulators, and food science experts and are looking for ways to ease the caseload burden and develop new talent. 

McConnell, one of three long-tenured inspectors on Beaufort County’s team, has been inspecting restaurants there for a quarter-century. As she entered Boss Hog’s, she exchanged warm greetings with the women serving meat-and-three plates from a steam table, as well as the manager who popped out of her small office when she heard McConnell’s voice.

For the next 45 minutes, McConnell moved through Boss Hog’s like, well, a boss. She stuck her digital thermometer into hot pans of beans and cold fillets of catfish, wiping it clean with alcohol swabs between measurements. She washed her hands at every sink, checking that the water was hot enough and the drains fast enough. She greeted back-of-house staff like old friends (“Don’t I remember you from Little Caesar’s?”) and quizzed a cook about where a plastic tub of oysters in the refrigerator came from.

“How long’s this food been out?” she said at one point, pointing her thermometer at stainless steel pans of pulled pork and baked chicken in the glass-front hot bar from which customers order.

It wasn’t a new question for McConnell or Boss Hog’s staff. A faulty burner in the hot bar had cost the restaurant three points the last time she was here for an inspection back in July. And the time before that, in April. And the time before that, in October 2023.

As a server and manager conferred over the pork and poultry’s tenure, McConnell checked the thick thigh meat of a chicken quarter: 110 degrees. She wiped the probe clean and dipped it into the barbecue: 97 degrees. Both were short of 135 degrees, the minimum legal temperature for safe storage of hot food.

The answer to McConnell’s question came from a chef back in the kitchen: The barbecue had been out for more than an hour. Too cool, too long; it had to be thrown out. The chicken could stay, but it needed to be reheated. And the burner itself needed some attention.

“There’s something wrong with this [heating] element,” McConnell told Dale Nava, a Boss Hog’s manager. “I don’t know what it is. I’m wondering if maybe we need to flip-flop stuff. Put the meats over here and cold stuff down there.”

“Might need to,” Nava conceded. 

“Or y’all just need to put some money into it,” McConnell replied.

After finishing her tour of the kitchen, the bathrooms, the walk-in fridges, and the storage sheds out back, McConnell grabbed a booth, pulled out her laptop and filed her inspection report on the spot. Before leaving, she helped Nava hang a sign with the new sanitation score: 92.5, up two points from July.

Simple Number, Complex System

Whether it’s on a restaurant wall or several paragraphs into a clickbaity local news story (“Live mice found in kitchen! See where!”), a sanitation score appears straightforward to customers seeking validation of their dinnertime decisions. But it’s the product of multiple layers of food safety systems that connect the federal government, state regulators, and county health departments. 

Health inspectors nationwide assess five risk factors: cooking temperature, holding temperature, equipment contamination, staff hygiene, and food source safety. It entails 54 variables derived from The Food Code, 668 pages of guidance created by the Food and Drug Administration, tweaked to fit the state’s unique food culture—the N.C. version of the food code includes guidelines for barbecue pits, for example—and, ultimately, executed by inspectors like McConnell.

McConnell’s three-person team is responsible for inspecting roughly 240 facilities a year, according to Beaufort County Environmental Health Director Stacey Harris. That includes more than 20 types of establishments where people eat or buy food, including restaurants, food trucks, grocery store delis, and cafeterias at hospitals, schools, and nursing homes. 

Environmental health specialists are also responsible for childcare and wastewater inspections in North Carolina, so they also inspect public swimming pools and licensed child care centers (for food safety, as well as general sanitation).  

“Unless you’re in a county the size of Wake or Mecklenburg, you’re probably wearing more than one hat,” said Harris.

Harris attributes Beaufort County’s inspection success to his fully staffed team’s stability. McConnell’s a 25-year veteran, and her two teammates have been on staff for at least 10 years each. Harris said he’s kept people by pressing for competitive pay; their most recent raises came in 2021, and the food inspectors’ salaries range from $62,000 to nearly $77,000. The average household in Beaufort County earns about $60,000 a year, according to U.S. Census data. 

Resources vary wildly between the state’s largest and smallest counties. Mecklenburg County, which completed 94 percent of required 2023–24 inspections, has 80 environmental health specialists, according to a directory maintained by the N.C. Department of Health Human Services’ Environmental Health Section. 

Martin, Tyrrell, and Washington counties—combined population: about 35,000—form a combined district with one environmental health director and one specialist. The three-county district made all its mandated 2023–24 inspections.

Greene County (76 percent completion) supplements its one-person inspection team by contracting with neighboring Wayne County (80 percent). Across the state, the completion average was about 80 percent. Eleven counties or districts fall below 50 percent, with rates ranging from 3 percent (Avery County) to 47 percent (Caldwell County). Other counties outsource services to private contractors.

Shane Smith, head of the Food Protection and Facilities Branch of the N.C. Division of Public Health, said staff shortages are a main reason counties haven’t made all the required inspections. As of October 2024, there were 26 vacant environmental health specialist or supervisor positions across the state, according to the statewide directory. Three counties were without environmental health directors.

Recruiting and retaining inspectors is a challenge in many counties, Smith said. Good candidates would rather work in Raleigh or Charlotte, where the pay is higher and staffers can specialize in just one discipline, rather than conducting food, childcare, and wastewater inspections. 

Even when they find the right candidates, onboarding them takes some time. New inspectors must complete a six-week state training course. They then serve as interns, working under experienced inspectors for up to two years. Once they’ve been cleared to work independently by a trainer, interns must pass a written exam before they can become full-fledged inspectors.

“It’s probably going to be, at a minimum, a good six months before [a new inspector] is even ready to sign their name to anything,” said Harris, the Beaufort County environmental health director. “And that’s the best-case scenario.”

Cultivating More Inspectors

In 2024, N.C. State University, the U.S. Food and Drug Administration, and the National Association of State Departments of Agriculture began developing the first university curriculum in the country to train new inspectors for local, state, and federal roles. 

They’re starting with a single graduate-level class, “An Introduction to Public Health Food Inspectors,” that shows students the full range of inspection work, from globetrotting FDA jobs to county-level roles like McConnell’s. 

The class, an elective taught for the first time in fall 2024, included lectures, field trips, and guest speakers. Most of the students in the first cohort were graduate students in food science or other science fields. Taking the class doesn’t add a credential to their master’s or doctoral degrees, but there are plans to add other food safety inspection courses in the future, according to Ben Chapman, professor and head of agricultural and human sciences at NC State.

“There’s still regulatory training for all of these inspection roles,” said Chapman, who teaches the course. “But what we’re really trying to do is expose our students to what that world looks like.”

One of the lectures for fall 2024 students was a panel discussion with top FDA officials, including Michael C. Rogers, a 1989 N.C. State chemistry graduate who now oversees 1,700 FDA investigators scrutinizing food, drug, and cosmetic producers all over the world. Rogers, the FDA’s associate commissioner for inspections and investigations, recounted his formative experiences as an inspector. That included dumpster-diving for incriminating documents in a pharmaceutical fraud case and inspecting overseas factories where he may not have known the language, but he did know the FDA’s standards. 

He said he hopes the new course and the planned curriculum will help students learn to handle similar circumstances.

“If you graduate with a degree in science, you successfully complete this course, you want a job with the FDA, and you can travel, I would like to know about it,” Rogers told the students.

Local health inspections might be less exciting, but life as a small-town regulator has its own challenges. The restaurateur who takes the county to court over an order to throw out food (a real example from Washington) may sit in the next pew at church. And he’ll almost certainly be on site when the next inspection comes around.

“When you’re a regulator, you’ve got to have a thick skin,” said Harris, McConnell’s longtime supervisor.

Fewer Inspections, More Safety?

An alternative to adding more potential inspectors to the pipeline is cutting back the number of inspections. 

As part of a broad October 2023 rewrite of state regulations, the General Assembly replaced one of four required yearly health inspections at full-service restaurants with an “educational visit.” Inspectors can’t visit the kitchen or address any issues that weren’t raised during the most recent previous inspection during these visits, and they usually don’t generate the follow-up and documentation that inspections can.

State Sen. Mike Lazzara (R-Onslow), a restaurant owner for 35 years, co-sponsored the change. He believes swapping one inspection for a “no pressure” teaching visit allows inspectors and restaurant workers to focus on improving the food storage and handling practices that affect public health. 

Education on those core safety practices does more for public health, Lazzara said, than inspections that penalize restaurants for things that “don’t equate to safety,” like having open lids on outdoor dumpsters. That’s something Lazzara said his six eastern North Carolina pizza restaurants have been docked for.

“One health inspection every four months is not unreasonable,” he said. “At the end of the day, safety is a result of proper temperature, proper storage, and proper handling of food.”

Harris said his team in Beaufort County makes the most of the educational visits, but he’d have preferred to continue inspecting full-service restaurants four times a year.

“That’s one less time we’re really doing a deep dive and looking at everything going on,” he said.

Assessing the actual food safety of a county is difficult. The federal Centers for Disease Control estimates that 48 million people contract foodborne illnesses each year and 3,000 die from them. In 2023, North Carolina saw 2,515 illnesses and four deaths from outbreaks traced to restaurants and other establishments overseen by local health inspectors, according to CDC data.

Those numbers likely undercount the actual incidence of foodborne illness associated with restaurants. In a 2020 paper, researchers from Tulane University and the University of Alabama at Birmingham noted that people rarely seek treatment for mild sickness caused by what they eat.

But the study also indicated that illnesses may not originate exclusively in restaurants with poor inspection scores. The researchers compared food from two sets of restaurants in Jefferson County. One group had repeatedly lost points on their restaurant inspections for critical violations, such as inadequate handwashing by employees or poor sanitation. The other group had no record of critical violations.

The researchers found the bacteria Staphylococcus aureus in more than one-third of samples from each set of restaurants, with no significant difference between the two. Poor hand hygiene among restaurant staff is a significant contributor to the growth of the bacteria in restaurants, the authors wrote, and “food workers are more likely to practice good hand washing in the presence of inspectors.” Elsewhere in the paper, the researchers said the Jefferson County inspections program “seems to be working.”

Chapman’s familiar with the Jefferson County study. He’s also convinced, as a scholar and an extension expert focused on food safety, that inspectors are essential as regulators and educators.

“Having competent, technically backed individuals in the field, working alongside the industry, can only make food safer,” he said.