an informal enforcement conference, Dr. Lakey says. The agreed-to penalties gen- erally are an amount necessary to make the offender comply with regulations. If an establishment can’t comply and if the violation threatens the public’s health or has caused injuries or illnesses, he says, DSHS seeks maximum penalties. Texas law also allows DSHS, through


the Attorney General’s Office or a district, county, or city attorney, to seek civil pen- alties of up to $25,000 per day per viola- tion of the regulations. The legislature didn’t appropriate


more funding to DSHS for 2012–13 to conduct additional inspections, issue additional licenses, and oversee compli- ance and enforcement activities related to food safety. In fact, the appropriation to the department’s food and drug strat- egy decreased by about $4 million per year. The budget reserves $24.2 million each year to fund all food and drug pro- grams within DSHS. Dr. Lakey says the legislature passed a rider that instructs DSHS to work with HHSC to address food safety. The Leg- islative Budget Board estimates that ap- proximately $500,000 in additional rev- enue will result from DSHS issuing more licenses. Dr. Lakey explains DSHS will inspect licensed establishments and determine how often follow-up inspections are needed.


“Establishments that have good documentation, that use appropriate food safety techniques, and that have well-trained staff generally need fewer inspections as they adhere to sanita- tion and food safety practices,” he said. “Those establishments that fail to meet the proper standards, that don’t docu- ment their practices well, or that have areas of concern will generally be in- spected more frequently.”


DSHS inspections focus on sanitation and food safety. While on site, inspectors provide food safety education, Dr. Lakey says.


Physicians vital


The Centers for Disease Control and Pre- vention (CDC) estimates that one out of six Americans gets sick from a food- borne illness every year. Most cases go


Kim Avila-Edwards, MD


Medicine opposes raw milk sales expansion


When raw milk producers wanted to start selling their product in farmers’ markets across the state, physicians mobilized to stop them. Their efforts paid off when two bills that would have granted raw milk producers the authority to expand their sales never made it out of the legislature. House Bill 75 by Rep. Dan Flynn (R–Van) and its companion,


Senate Bill 237 by Sen. Bob Deuell, MD (R-Greenville), would have increased access to unpasteurized, raw milk. Neither bill made it out of committee. Kim Avila Edwards, MD, medical director of the Texas Center for


the Prevention and Treatment of Childhood Obesity at Dell Chil- dren’s Medical Center in Austin, testified against HB 75 before the House Committee on Public Health on behalf of TMA, the Texas Pediatric Society, and the Texas Academy of Family Physicians. TMA’s public health committees reviewed the legislation. Had either bill passed, Dr. Avila Edwards says, the consequences would have been significantly detrimental to Texans’ health. “Unpasteurized milk can contain bacteria that cause serious ill-


ness in pregnant women, infants, children, and anyone with a weak- ened immune system,” she said. Senator Deuell says he felt compelled to file legislation that


would have expanded access to unpasteurized, raw milk because “raw milk is safe and healthy.” He adds that a group of his constitu- ents who produce raw milk asked him to file SB 237. He explains many of the family farmers in his district want to sell raw milk at farmers’ markets and have a vested interest in providing a safe product. “I was disappointed that there was so much misinformation and lack of support [for the bill] from the medical community,” he said. “I do plan to file the legislation again in the future.” For now, Texans who want raw milk can purchase it directly from farms that produce it.


Dr. Avila Edwards says expanding access to raw


milk to a commonly visited locale is contrary to the goal of public health. “Pasteurization is one of the hallmark lifesav- ing achievements in the history of public health. Expanding the sales of raw milk and raw milk products would have resulted in greater costs to an already burdened health care system,” Dr. Avila Edwards said.


November 2011 TEXAS MEDICINE 27


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