L.A. County’s restaurant rating system, which includes letter scores, has cut hospitalizations for food-borne diseases by 13%, study finds.
By Jia-Rui Chong and Hector Becerra, Times Staff Writers
March 11, 2005
Fewer people have been hospitalized with food-borne diseases in the last few years, in large part because of the restaurant-grading system in Los Angeles County, according to a new study in the Journal of Environmental Health.
The study, published in the March issue, associated a 13.1% decrease in hospitalizations for the most common food-borne illnesses with the county’s revamping of its restaurant inspection system in 1998.
Dr. Jonathan Fielding, the county’s public health director and an author of the study, said it was the first scientific proof that the grading system resulted in a “demonstrable public health benefit.”

“What’s really important here is we were able to show a reduction in hospitalizations due to food-borne illnesses, compared to state trends,” he said.
The authors used hospital data for infections from bacteria such as salmonella and campylobacter. They analyzed 2,927 hospitalizations in Los Angeles County and 6,449 elsewhere in California from 1993 to 2000.
Food-borne illness causes an estimated 325,000 hospitalizations a year in the United States, the study said. About half of those infections come from restaurants. Contamination from bacteria can happen, for example, when cooks use cutting boards or knives with raw meat and then use the same tools for salad. Or it can happen if some food is kept at 60 degrees rather than 40.
Those are the kinds of violations on inspection reports that restaurants must make available to customers, Fielding said. They also must post their letter grade for hygiene near the entrance.
“We wanted to provide better information to the consumers, provide clear incentives to restaurants to pay attention every single minute to use good hygiene practices,” he said.
But some restaurant industry officials said they doubted the grading system was responsible for the decline in hospitalizations.
“The inspection process has just gotten so much better. That’s the reason,” said Andrew Casana, an official for the California Restaurant Assn. “I would disagree that the letter grades have anything to do with this. Most food-borne illness occurs at home anyway.”
Casana said restaurant inspections used to be performed by an understaffed health department and tended to be less comprehensive than they are now.
The impetus for many of Southern California’s grading systems was an undercover report by former KCBS-TV newsman Joel Grover. Hidden cameras captured unsanitary practices and rodent infestations.
Critics have said that letter grades may only provide a one-day snapshot of a business and that the grades can be easily misinterpreted by customers. Others complained that inspectors were sometimes arbitrary and lowered restaurants’ grades for violations that did not have anything to do with customer health.
Some owners complained that customers were staying away from restaurants that scored a B because they thought it was a reflection of unsanitary conditions.
Jeff Benedict, an official for the Long Beach Department of Health and Human Services, lauded the study’s conclusion.
“I’ve talked to L.A. County people, and they swear by their system,” he said. “They say they feel restaurants are cleaner today than they were before the grading system was instituted. I can say ours are too.”
Benedict said Long Beach chose to require restaurants to display signs alerting customers to past corrective actions because they give more information than grades about the problems.
The general manager of the Wolfgang Puck Cafe in Universal City said she was all for the grading system.
“The inspectors are very fair, and they tell you what the expectations are — although you should already know them,” said Elizabeth Pavlik. “I like to walk around with the inspector and learn as much as I can.”
But she said for some customers, the restaurant’s A grade is not enough.
“A lot of people ask me to see the report,” Pavlik said. “It’s pretty cool. I’m not ashamed.”
Rubina Sookazian, owner of Kabab and More, a restaurant in downtown’s Grand Central Market, said the grading system was necessary.
“Health is a serious thing,” she said. “I’ve seen people in the restaurant business drop things on the floor and pick them up and use them.”
Although she said she has always gotten an A grade, Sookazian said health department inspectors can at times be overzealous.
“They should worry about the food temperature, but sometimes they worry about small things,” she said. “Sometimes they see a small drop of something on the floor and that’s enough to lose a lot of points.”
Johnny Bathish, who owns the Avalon Fish Market in Grand Central Market, said the grading system was “good for my business because the customers trust the food. Also, it helps me to know how the place is run when I’m not here.”