The recent confirmation of Nirav R. Shah, M.D., and M.P.H. as the Commissioner of Health in New York State is a landmark, placing the youngest person ever, and the first Indian-American, in the post.

The 38 year-old Buffalo, New York-born doctor is an acknowledged leader in health care as the field retools itself. The former attending physician at Bellevue Health Center in Manhattan was also associate investigator at the Geisinger Center for Health Research in Pennsylvania, and taught at the School of Medicine at NYU.  His skills in evaluating hospitals and health care systems will be applied as he works with the state’s newly created Medicaid Redesign Team.

The Medicaid Redesign Team is composed of 27 people, including Dr. Shah, legislators, and the representatives of many health care organizations. The group was established to reduce Medicaid costs for the 2011-2012 budget, and the task just got tougher. Last week, Governor Andrew Cuomo announced budget cuts of 10 billion dollars across the state, charging the Medicaid team with cutting $2.85 billion from the budget they are currently formulating. That amount would eliminate federal matching funds, and result in $5.9 billion fewer dollars.

Daniel Sisto, president of the Healthcare Association of New York State and member of the team, noted that the proposed cuts amount to approximately $15 billion over two years. 

“HANYS wants to be explicitly clear that hospitals and other providers in New York State cannot absorb these cuts, provide quality care to our citizens, and transform health care delivery all at the same time,” Sisto said in response to the governor.

The new commissioner has not issued a statement regarding the financial demands, but told a reporter the work was “going well.”

Representatives from the Department of Health could not comment on how the budget cuts might affect food safety. However, Michael Cambridge, director for the Bureau of Community Environmental Health and Food Protection, stepped out of meetings to explain his bureau’s work.

The Department of Health develops and implements food safety standards and regulations for places where food is served. Restaurants, schools, mobile food vendor carts, and temporary food stands are among the eateries covered. Working with county health departments in New York City and district offices throughout the state, the bureau trains sanitarians in how to complete inspections and handle identified hazards.   

“We have approximately 100,000 facilities across the state that we visit each year. We have inspection frequencies set up based on the type of foods that are served. Let’s say you have a large banquet facility where 1000 people are served all at once. There’s a lot of preparation in that place, a lot of holding of hot foods. Those kind of places we like to inspect more often than a place such as a corner bar that has an occasional sandwich served,” said Cambridge.

Field staff is also trained in how to conduct an investigation in the case of an outbreak.

“We work with our disease control epidemiologists and watch for any kind of reported illness,” said Cambridge. “(We) start going back to those individuals asking questions–where’d you eat in the last seven days, where did you go–to see if they can pinpoint what’s causing the problem. We work with our public health laboratory, the Wadsworth Center, (give them) food samples and patient samples and look for specific pathogens.”

When a problem is identified, DOH staff makes sure the people who are ill get treated properly. Staff also follows up with the facility, to make sure whatever they did wrong has been corrected, and that any hazards have been removed. In instances where the commercial food chain is involved, the department works with its federal partners, the FDA and the CDC. 

The Department of Health also works closely with the Department of Agriculture and Markets on food safety. Ag & Markets inspects the roughly 28,000 retail and production sites in the state, including grocery stores, convenience stores, bodegas, food processors and warehouses. Farms are inspected as their products become a part of the food chain, and the department also oversees plant nurseries.  

“For example we do an extensive survey for plum pox virus, a disease of stone fruit (that) doesn’t make it inedible, but debilitates the tree and makes the fruit unsalable for fresh market.  We have been actively trying to get rid of that disease in New York State, and we’re the last state in the U.S. that has it.  However Canada does have it. It’s not necessarily a food safety issue but a production and quality issue that has economic consequences to farmers,” said Jessica Ziehm, communications director with the Department of Agriculture & Markets.

The department also regulates what kinds of potatoes can be planted in Western New York and on Long Island, where the golden nematode is a problem. Only varieties that are resistant are allowed. These measures help ensure a farm’s viability, which in turn ensures that farm’s ability to maintain good standards with regard to safely handling food.  

Anytime Ag & Markets finds a problem with a product sold in a store, or with an animal inspection, they communicate with the Department of Health, and the two arenas are in contact by email or phone almost daily. 

Regarding budget concerns, Ziehm noted that all state agencies would be affected. However, the department has been evaluating operations with regard to its core mission, which is to protect public health and safety.   

“Therefore, those food safety inspections, the animal health inspections that we conduct, we are doing all that we can to minimize the impact the budget implications to those core functions,” said Ziehm.  “We’ve been able to do that by identifying other areas of responsibilities that we’ve picked up over the years, whether it’s marketing, or for example dog licensing.”

The state returned dog-licensing control back to the towns, freeing up more resources to focus on regulatory functions.