Prison Commissaries: The Hidden Public Health Problem

When we think of “food services,” prison commissaries don’t immediately come to mind. That’s probably because prison life in general is kept to the margins of social consciousness. While it is true that inmates are denied certain freedoms as part of their sentences, they continue to claim the human right to health and wellness, and rightfully so. Unfortunately, this population is half forgotten when it comes to foodborne illness (in addition to basic human expectations, but that’s a conversation for another time).

“Correctional inmates are more than 6 times more likely to suffer from a food-related illness than the general population”
- Mariel A. Marlow, Ruth E. Luna-Gierke, Patricia M. Griffin, Antonio R. Vieira, “Foodborne Disease Outbreaks in Correctional Institutions—United States, 1998–2014”, American Journal of Public Health 107, no. 7 (July 1, 2017): pp. 1150-1156.

According to the study, between 1998 to 2014, there were 200 foodborne outbreaks in correctional institutions, resulting in 20,625 illnesses, 204 hospitalizations, and 5 deaths. Moreover, inmates suffered from foodborne illness at a rate of 45 per 100,000 people annually, compared to only 7 per 100,000 in the general population. And 6% of all confirmed outbreaks took place in prisons – which is noteworthy, considering that less than 1% of the country’s population is incarcerated. These data indicate that food processing and services in prison commissaries has been a hidden public health crisis.

The Real Issue with Food Safety in Commissaries

Compared to the general population, inmates have an increased risk for infection because of the following factors:

• Over-population: Crowded prisons result in more meal shifts than the staff can handle safely.
• Underfunding: The budget to feed prisoners is kept to a minimum, resulting in lower quality food resourcing, processing and handling, and the use of free inmate labor.
• Untrained staff: Most inmates don’t have experience working in kitchens, and many lack basic food-handling skills and food safety training.
• Shoddy kitchens: Constructed for maximum efficiency rather than safety, they are typically too small and poorly equipped.
• Poor hygiene: Inadequate hand washing facilities and lack of training in sanitation and disease prevention among inmates can lead to epidemics in close quarters.
• Lack of consistent regulations: State and federal prisons don’t follow the same guidelines, while local facilities (which house 10 times the number of inmates as federal facilities) can create their own rules.
• Non-uniform inspection process: There are no nationwide rules that govern how and when federal, state, and local prison commissaries are inspected, and even when an inspector does file a citation, penalties are typically lenient or ignored.
• Lack of reporting: Inmates have highly restricted access to state or local health departments if they wish to file an official report of foodborne illness.

In general, the fundamental problem is that prison infrastructures cannot execute a proper food safety management system (FSMS) more typically found in corporate commissaries. Inevitably, when mistakes are made, absent or inconsistent protocols fail to correct them.

Improper Temperature Monitoring: The Biggest FSMS Oversight

According to the CDC report, 37% of outbreaks with a known contributing factor began because food was left out at room temperature for longer than is safe. For reasons of security and overcrowding, many commissaries can’t feed their entire populations in one sitting, but do so over several meal shifts. Food is typically prepared all at once prior to the first shift, and then left out during the remaining shifts. This means hot food isn’t kept hot, and cold food isn’t kept cold. Worse, no one is monitoring temperatures to ensure the prepared foods remain in the safe zone (41 - 135°F).

Even the Food Service Manual published for federal facilities by the Bureau of Prisons allows for potentially unsafe temperature excursions, as defined by the FDA, CDC, and ISO. Here are some examples:

• Logs documenting the receiving temperatures of food delivered by distributors are not required.
• Time only, rather than time in conjunction with temperature, can be used as a public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service.
• Foods that should not be held outside of the safe temperature zone for more than 2 hours before being reheated, refrigerated or frozen (FDA guidelines) can be held outside the zone up to 4 hours, according to the manual.
• The section on requirements for temperature monitoring devices “does not apply to equipment for which a temperature measuring device is not practical for measuring ambient air because of the design, type, and use of the equipment, such as heat lamps, cold plates, steam tables, insulated food transport containers, and salad bars.”

It’s no wonder that, given these exemptions, temperature excursions are the most common cause of foodborne illness in prisons.

Solving for Food Safety

Clearly, one solution to this problem would be the introduction of automatic, continuous temperature monitoring technologies to cover all areas where pathogens are most likely to thrive, as well as in receiving areas so that digital records can document whether or not incoming food was handled properly during transportation.

Of course, enforced regulations, training, and proper funding are also required to rectify this social problem. Since inmates have no choice but to consume foods served by the correctional institution, it’s imperative that public health leaders, correctional officials, and food suppliers work together to ensure prison commissary food is safe to eat.

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