A major revamping of the Illinois Department of Public Health is expected now that the nation`s worst salmonella epidemic, still plaguing the state, has exposed serious weaknesses in the department`s ability to handle emergencies. Growing evidence indicates that the department has been so weakened by budget cutbacks, primarily under Gov. James Thompson`s administration, and by a lack of leadership, that it was incapable of meeting the epidemic`s massive threat to public health and mishandled the response it did make.
More than 15,000 salmonella cases have been reported in Illinois and five nearby states since the outbreak was started by tainted milk from the Jewel Companies Inc.`s Hillfarm Dairy in Melrose Park. Four deaths have been linked to the infection and several others are being investigated.
Two investigations have been launched to determine whether thousands of salmonella infections could have been prevented if the department had moved more quickly and had been adequately staffed.
Among the major areas of inquiry are whether the department acted as quickly as it should have to warn the public against drinking the contaminated milk and whether it should have closed the dairy sooner.
Health authorities first realized that an outbreak was underway on March 29, and they informed Jewel that day that its Bluebrook 2 percent milk was the suspected source. But the public wasn`t warned of the outbreak until April 1, and the dairy wasn`t closed until April 9.
Last week, Shirley Randolph, an assistant department director, admitted to legislators that she would have been afraid to drink the Bluebrook 2 percent on March 31–a day before the public warning–on the basis of what the state investigation had found by then.
Those investigating the agency also want to know why department officials said that state inspectors descended on the Hillfarm plant on March 30 though, in fact, none went there until three days later.
In addition, other public health experts have criticized the department`s two-week delay in testing dairy workers to determine whether any of them was the source of the salmonella contamination.
”The department is not equipped or well-staffed enough to handle a major public health emergency,” said Rep. James McPike (D., Alton), a member of the state legislative committee investigating the health department`s handling of the outbreak. ”Their actions have been inept and bungled from the first.”
Dr. Bernard Turnock, who became the public health department`s acting director Wednesday, said he has started his own investigation into the handling of the epidemic.
”There is concern regarding the timeliness of some of the actions,”
Turnock said. ”By next week I should have a better idea of what happened and what might have been done better and the relevance of particular actions or lack of actions to the spread of the disease.”
Turnock said major investments in personnel and equipment will be needed for the department to adequately handle a severe public health emergency.
He said he is already planning the following major revisions:
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— Modernizing equipment and increasing the personnel in the state`s laboratory, which has been criticized as being ineffectual.
— Bringing the food and dairy inspection division ”up to snuff” by hiring more inspectors. The department now has only 15 full-time inspectors, who are responsible for checking 3,793 farms and 108 milk, ice cream and other dairy plants statewide.
— Increasing the number of communicable-disease investigators because
”this particular oubtreak severely stretched our resources.”
The state`s Chicago-based laboratory, once one of the largest in the country, has been unable to fulfill its primary function of adequately safeguarding the state`s food supply because of a severe reduction of funds and personnel, said Dr. Roy Upham, former chief of the health department`s food, drugs and dairies division.
The lab`s inadequacy was pointed out in a memo written in October, 1983, by Robert Flentge, current head of the dairies division, who warned that ”the laboratory`s ability to respond to any sort of public health emergency is almost nonexistent.” From 1981 to 1983 the laboratory lost 30 employees, he said.
From 1981 to 1984, when the total state budget increased by more than 12 percent, funding for the lab actually declined by nearly $50,000.
The lack of professional leadership in the department has come under attack by the legislative investigating committee, which is considering a bill to require the director to be a qualified public health expert.
Thompson`s appointment of Turnock, a doctor with years of solid public health experience, was viewed by many legislators as an attempt to blunt growing criticism of his administration`s downgrading of the health department.
In announcing Turnock`s appointment, Thompson acknowledged some problems in the department by authorizing the new director to ”look at the department in terms of leadership and recommend to me an assessment of who he wants in the department.” He also asked Turnock to determine whether the department has enough money to do its job.
On Friday, Thompson said that he will maintain an open mind on health department funding until Turnock reports to him.
Thompson fired Thomas Kirkpatrick as head of the state health department for going on vacation to Cancun, Mexico, during the epidemic. The governor said he took the action because Kirkpatrick indicated he was directing the department`s efforts to control the outbreak when he was actually vacationing. Critics, however, point out that, in leaving for vacation, Kirkpatrick, a lawyer and friend of Thompson, showed he lacked an understanding of the public health danger posed by the epidemic.
Upham said the department has become stagnant with politically connected workers who hinder the department`s ability to do its job.
”The place is loaded with these kinds of guys, and they`re drawing big salaries,” Upham said. ”An impartial committee should go through there and clean out that deadwood.
”You`d ask a technical or professional question, and you`d get a political answer,” he said. ”That just won`t do. It`s got to be a public health answer.”
Public health has become a budgetary stepchild of the state administration, and until it is restored to its former level of competence, Upham said, ”you`re going to have more things like this salmonella outbreak.”
As Kirkpatrick`s interim replacement, Thompson named Illinois Inspector Gen. Jeremy Margolis, another lawyer and longtime associate.
Margolis told the legislative committee at its first meeting April 24 that state inspectors ”descended on the Hillfarm Dairy on March 30th. They sampled everything they could get their hands on.”
But at the next committee meeting on May 1, state health officials said that no inspectors had gone to the plant until April 2, three days after Margolis said they had.
Also at that meeting, a witness from the federal Food and Drug Administration testified, ”This plant is extremely effective in terms of producing good-quality milk.”
But it was later learned that, on April 8, the FDA had presented the Hillfarm Dairy with a list of 13 violations, including an illegal connector line between raw milk and pasteurized milk lines that is one of the two prime suspects as the source of the salmonella contamination.
The other prime suspect is a blending tank that mixes milk components to make 2 percent fat milk. But health investigators acknowledge that the source of the contamination may never be definitely determined.