What if roaches outnumber employees in the kitchen of your favorite restaurant? Or ready-to-serve sushi festers in a faulty cooler? Or the buffet table serves lukewarm foods poised to make you sick? Someone would find out, someone would do something, right?

If you dine out in Allegheny County, that's not necessarily so.

The Post-Gazette recently reviewed inspection reports for the last three years for 94 restaurants in Ross, one of the largest concentrations of eateries overseen by county health inspectors. In addition, as a kind of check, the paper reviewed the most recent inspections for a sampling of 27 restaurants in other parts of the county.

Among the findings:

• Many restaurants are not being inspected a minimum of once per year, as promised by Allegheny County Executive Dan Onorato two years ago.

• When inspectors do show up, they typically find multiple critical food safety violations, indicating restaurants are putting customers at increased risk for food-related illnesses.

• What's more, the health department almost never takes action against restaurants for repeated violations, giving restaurant operators little incentive to do better.

Mr. Onorato's promise of once-a-year checks came as he announced the addition of three people to the health department's restaurant inspection team after a task force recommended the hires.

Despite the increase in staff, Mr. Onorato said at the time, "I want the public to know there has been absolutely no cut, and no slacking, on the inspections of restaurants in Allegheny County."

But according to the most recent inspection reports, 32 of the 94 restaurants in Ross, or roughly one in three, went more than a year between inspections. Of those, the average time between inspections was 19 1/2 months. Inspections at 10 of the overdue restaurants were performed immediately after the newspaper made its request to look at the files.

Among the sampling of 27 restaurants from around the county, results were even worse. Roughly half (12 of 27) were not inspected annually. On average, those restaurants went 18 months between inspections.

"If one-in-three aren't being inspected even once a year, that is shocking," said Sarah Klein, author of a recent report by the Center for Science in the Public Interest that was critical of restaurant inspections nationwide.

"If you think about the number of people eating in restaurants every day ... the idea that nobody is checking to see that the law is followed is pretty concerning."

Mr. Onorato did not return a telephone call seeking comment.

Bruce Dixon, longtime director of the Allegheny County Health Department, which is responsible for the inpsections, said he was surprised by the findings. The results of several audits, most recently in 2005, showed inspections were "pretty much on target," he said.

Dr. Dixon said that early this decade the county started prioritizing inspections by giving some restaurants a "category 2" ranking and inspecting them less frequently than once a year.

Eight of the 32 Ross restaurants that went more than a year between inspections were ranked in that category. The other 24 were supposed to be inspected once or twice a year.

Still, two years ago, Mr. Onorato said that the three new inspectors he was adding would enable the department to inspect all category 2 restaurants annually, too.

When county inspectors arrive to examine restaurant kitchens, they typically discover serious food handling violations, the newspaper's review found. These are the types of conditions that pose "a significant public health risk," according to county regulations.

The violations include: sanitization problems, which can result in infected workers transmitting the potentially deadly hepatitis A virus or staph bacteria; and food temperature violations, which can allow pathogens that cause botulism and salmonella poisoning and other illnesses to grow in foods not kept hot or cold enough.

Inspectors turned up at least one critical violation at 91 of the 94 Ross area restaurants they visited on their most recent regular inspections, the newspaper found. What's more, 74 restaurants, or nearly 80 percent, chalked up three or more critical violations.

"That's very significant," said Nancy Donley, president of the suburban Chicago-based advocacy group Safe Tables Our Priority (S.T.O.P.) "These are violations that can lead to illness and to death, and these are only the ones they managed to catch."

Numerous attempts to reach the president of the Pennsylvania Restaurant Association for comment were unsuccessful.

Ms. Klein of the consumer watchdog group Center for Science in the Public Interest called the incidence of dangerous food handling practices "very alarming."

"Having a single critical violation is bad, and at the same time may not suggest there is a pervasive problem in the restaurant," she said. "However, having three critical violations suggests food safety is not a priority."

Critical violations "are not just things that gross us out. They can make us sick," she said.

The health department's Dr. Dixon said careless food handling practices were not unique to Pittsburgh.

"That is pretty much the problem around the country," he said. "There are a lot of things considered critical that are commonplace at restaurants. That's what we are trying to get people to understand -- that food preparation is important."

Each year, 76 million people nationwide get sick on the food they eat, according to government estimates. Those estimates are based on the presumed tiny fraction of cases that are reported. A precise count is impossible because most victims don't go to the doctor's, often blaming a queasy stomach or bout of diarrhea on the 24-hour flu. Among those stricken, about 5,000 die. Roughly 40 percent of foodborne illnesses can be traced to restaurants; 22 percent are linked to in-home cooking.

Many people don't suspect they have been sickened by contaminated food because they don't fall ill immediately. While food-related problems can occur within hours or days, it sometimes can take weeks to get sick.

In Allegheny County, the health department has the power to issue fines and consumer alerts against restaurants for uncorrected critical food safety violations. But the newspaper's review found the department almost never takes those steps, allowing restaurants to repeatedly violate the law and leaving local restaurant patrons unaware.

Among the 94 Ross restaurants reviewed, the department issued just one fine and posted a "Consumer Alert" decal in the window of just one restaurant during the last three years.

Countywide, the department issued just four consumer alerts this year among some 7,500 food establishments, which in addition to about 5,500 restaurants include caterers, mobile vendors, retail snack counters and grocery store delis.

Inspection reports reviewed by the Post-Gazette revealed numerous instances of restaurants consistently bungling safe food handling practices without facing penalties.

Some examples:

• Tokyo Sushi Buffet, McKnight Road. An inspector repeatedly cited the restaurant for serving and storing food at dangerous temperatures, noting in his report in mid-July that the buffet table was not set up to hold foods at safe temperatures. Nearly two months later an inspector returned, noting that "conditions have not been corrected." He revisited a week later, reporting that deficiencies had been "significantly corrected," although the restaurant was again cited for foods held at unsafe temperatures. A call to the owner was not returned.

• Panera Bread, McKnight Road. The health department sent a letter to the restaurant in March last year warning it for failing to fix cold holding and sanitization problems "cited consistently since 2004." The restaurant also was repeatedly warned about not having at least one worker on duty certified in the basics of safe food handling practices as required.

"We have a reputation in our 30 years of being in the restaurant business of having the highest standards in cleanliness and service," said Allen Ryan, Panera's director of corporate affairs. "Obviously, any violations are taken seriously."

• The Grove, Jacks Run Road. For the last three years this bar was repeatedly cited for the same multiple critical violations, including failing to have a certified food manager, cross-contamination violations such as storing raw beef over cooked foods, and other critical problems, including storing food at unsafe temperatures and storing meat and other foods in a refrigerator meant only for bottled beverages. A call to the owner was not returned.

• El Campesino Restaurante, McKnight Road. The restaurant received a letter from the health department in mid-September requesting an on-site conference to review numerous critical violations, including sanitization and food temperature problems. The restaurant had a history of the same violations dating to 2006, when it also received a warning letter about repeated violations. A call to the owner was not returned.

• China Star, McKnight Road. The health department conducted at least 12 inspections over the last three years without issuing any fines or consumer alerts. In 2006, the restaurant was warned about repeated serious violations, including improper food cooling procedures, cross-contamination and sanitization problems and foods kept at unsafe temperatures.

In mid-2007 an inspector investigating a complaint about flies migrating to a nearby business found foods throughout the kitchen and in coolers at dangerous temperatures, sanitization problems, a live roach at the cookline and numerous other critical violations.

The inspector also noted greasy/dirty dishes, utensils and pans being reused in a kitchen "in need of an overall cleaning." The inspector returned two weeks later, and again six months after that, to find the same problems. When a inspector visited this September, he noted conditions still had not changed. In addition to a bad cooler, the three-door refrigerator wasn't working properly. Roaches crawled across the floor and on the cabinets and dead ones were noted in multiple places, including inside pans and on food storage shelves.

An inspector did not return until early this month, after the newspaper inquired about a follow-up. His report said past violations had been "significantly corrected," noting dead roaches as the only critical violation. A call to the owner was not returned.

Ms. Klein called those reports "shocking" and "a complete failure of the system."

"When you have repeated violations of this intensity, it's a real danger to people," she said.

"The public hopefully will respond to their elected officials in the spirit that this should not, and can not continue to happen because it is jeopardizing our families," S.T.O.P.'s Ms. Donley said.

Dr. Dixon said he would meet with food safety officials about the lack of enforcement actions "to hear their side of it."

"These sound like recurring problems that haven't been dealt with very well," he said. "We certainly don't condone that kind of performance."

In numerous instances, the health department sent warning letters to restaurants for repeatedly performing poorly on inspections and failing to correct serious violations.

Nevertheless, area diners were kept in the dark.

If violations were considered serious enough to trigger warning letters, why didn't the department post consumer alerts to warn the public?

"I think they should be doing [consumer alerts] more often," Dr. Dixon said. "I think they are sometimes loath to do them."

"We are in the process of looking at all our programs, and [food safety] is one of them," he said. "This is something we need to ask."

Many local health departments struggle to do their job of protecting the public because they are woefully underfunded and understaffed, Ms. Donley said.

A study by the Center for Science in the Public Interest found Pittsburgh area restaurant inspectors had the second highest caseload among the 20 cities it reviewed: 440 restaurants per inspector compared with between 200 and 300 handled by inspectors in the majority of other regions.

Dr. Dixon said the key to improving food handling practices at restaurants was "continuing education, and a little more surveillance and some punitive action."

The Center for Science says the most powerful incentive for restaurants to care enough to follow the rules is for health departments to post inspection results publicly.

The center is pushing food safety programs nationwide to display letter grades in restaurant windows reflecting how those businesses did on their latest inspections as a warning to diners about hidden dangers. Restaurants would earn an "A," "B," or "C," depending on a weighted measure of the number and severity of food safety violations. Restaurants scoring below a "C" would be closed.

"If you can walk by a restaurant and see what credit cards it takes and how Zagat rates it, you certainly should be able to see what the health department thinks about the cleanliness of the restaurant," Ms. Klein said.

Earlier this year, the county health department said it was opposed to such scoring systems, saying it was too difficult to translate inspection results into a letter grade or numerical score.

Dr. Dixon said he may have to rethink that position.

"You have to balance the work load of doing it that way and making sure it is fair, but I do see some merit in that," he said.

Dr. Dixon said the county plans to start allowing the public to view inspection reports online sometime next year using the system the state Department of Agriculture implemented in 2007 to post reports for restaurants the state inspects outside of Allegheny County. Currently, people who want to see county inspection reports must visit the health department or make a written request for copies by mail at 50 cents per page.

But Ms. Klein said online access isn't nearly as useful as putting grades in windows. For one thing, going online requires people to act in advance of dining out. The reports also typically are filled with technical jargon and can be hard for people to interpret, she said.

"You might as well not have anything if it's something you can't recognize."