.Really Slow Food

Alison Negrin traded in a glamorous chef career to reform abysmal hospital chow. Good luck with that.

Alison Negrin wanted to change the soup. And she succeeded. It took her three years.

On a Wednesday evening last November, the chef watched as hairnet-wearing kitchen workers ladled the new concoction, a brightly colored carrot-ginger purée, into thick plastic bowls on teal-colored trays. In a little while, the trays would make their way upstairs to about three hundred patients at John Muir Medical Center hospital in Walnut Creek.

Negrin is quick to admit the whole thing sounds crazy. A whopping 36 months to usher the simplest of soups, a recipe of half a dozen ingredients, from the lightbulb inside her head to the hard drive in the dieticians’ office — where it would be analyzed, edited, and tweaked ad infinitum — and then at long last get printed out, sheathed in plastic, and filed in a spiral-ring binder that sits on a stainless-steel shelf in this crowded industrial kitchen.

For Negrin, it was nonetheless a triumph, and so what if many people she meets just don’t get it. “When you’re out in the world and people say, ‘What do you do?’ and I say, ‘I’m the chef at John Muir,’ they go, ‘Oh, god, I was a patient there,'” she says. But Negrin’s five years as a hospital chef have been in service of a mission: to change the profile of hospital food from bland, starchy, and processed to something reasonably close to actual, healthy food. Oh, and to help save the world in the process.

Long ago in another life, in a restaurant kitchen designed especially for her, Negrin could change the soup whenever she liked based on a whim, some herb she’d picked up in Chinatown, or perhaps a cookbook that made her itch with curiosity. That was long before the John Muir gig, back when she was one of the Bay Area’s chefs to watch. One whom the San Francisco Chronicle would write about in that breathless style food critics reserve for an electric new talent.

On this fall evening, Negrin, now 54, lifts a lid to examine halibut baked over thinly sliced fennel. She walks next to the slow-moving conveyor belt that hospitals call the tray line, where each of half a dozen workers places a single item on the teal trays, looking more like factory workers than restaurant cooks. She tastes a broccoli floret. “This is supposed to have the flavoring reduction on it,” she protests to no one in particular.

Negrin has a presence that transcends her five-foot height. She’s dressed in a chef’s jacket with black trim, a note of edgy in a kitchen humming with pale fluorescent lighting. She has wide, Mediterranean features (her father is Greek and Jewish), and eyes so large they look Coptic. She wears dangling silver craft-fair earrings, and sports a bob with fashionably streaky highlights. Artsy, even in middle age.

It was art that got Negrin hooked on food in the first place. After college, she had a degree in sculpture and no clue what to do with her life. Cooking school was her lesser of evils, except that she hated the structure and the old-school European chefs at San Francisco’s California Culinary Academy. Ellen McCarty, who was one year behind her at the culinary academy, recalls that Negrin had an intimidating vibe. “Whatever she was doing would be impeccable,” she says.

That reputation opened the door to a place that’s still an elite finishing school for young phenoms: Chez Panisse. In 1988, Negrin was working the upstairs cafe line there when she got a call from a headhunter. The recruiter offered Negrin the title of executive chef in a restaurant that didn’t yet exist, in a town she’d never heard of. It intrigued her, so Negrin leaped.

That town was Danville, and the restaurant was Bridges. Wealthy Japanese chemical executive Kazuo Sugitani was indulging a fantasy. He wanted a place that would be both an abstract showcase for Japanese aesthetics and a collage of French and Asian food styles. “I thought, okay, it’s gonna be this bridge with East and West and I thought, I don’t know: cliché,” Negrin recalls. But creating Bridges proved to be anything but. For starters, Sugitani flew everyone to Japan — Negrin, the restaurant’s general manager, even the architect. “It was kind of like a fairy tale,” she says.

In Tokyo they ate kaiseki, a meal of highly stylized small dishes that go with the tea ceremony. Negrin was in epiphany land. A year later in Danville, she was the one inspiring the epiphanies. The Chronicle‘s food critic deemed Bridges the kind of restaurant you’d find in Paris or New York.

But after years of success at Bridges and Ginger Island, a high-profile fusion bistro on Berkeley’s Fourth Street, Negrin’s inner art student began to question whether she wanted to be a fine-dining chef. After birthing a couple of restaurants, Negrin wanted to give birth to a kid — except that she couldn’t, so she adopted. Nurturing her baby son gave Negrin the urge to go on nurturing. She taught the ABCs of cooking to inner-city kids, did yoga at a meditation center above the fog line in West Marin, and studied at a New Age nutrition institute whose slogan was “healing from the ground up.” Negrin steeped herself in Ayurveda, Chinese cures, and herbal remedy home brews the way she’d once steeped herself in beurre blanc and demiglace.

Negrin heard about the John Muir job from a neighbor. During the interview process, Sandi Rigney, the hospital’s nutrition services director, said she’d want Negrin to make some improvements. It was a challenge that clicked with her sense of food as a healing force, and of the chef as a kind of shaman in a cook’s jacket. A chance to redeem the cooking in a soulless high-rise packed with the weak and the vulnerable, where food had come to mean little more than mystery meat and Jell-O cups. Negrin, who’d taken blind leaps before, said yes.

She didn’t know then just how blind this one would prove to be. As Bridges executive chef, Negrin harvested kaffir lime leaves from a garden planted just for her. She’d never worked in an institutional kitchen, never even seen the massive tilting sauté tables like the ones at John Muir. And she’d be overseeing not just one hospital kitchen, but three: the 320-bed Walnut Creek acute-care center, John Muir Health’s 260-bed Concord hospital, and an 80-bed behavioral center in Brentwood. With a headful of ideas about what she calls the “spiritual-emotional” side of eating, Negrin suddenly had responsibility for kitchens that couldn’t even afford prep cooks. In Concord, she’d have a union to contend with; in Walnut Creek, a kitchen where some workers’ daily routines hadn’t changed in two decades. These were places where Stouffer’s lasagna on a patient menu represented a good night, and a welter of complex dietary restrictions favored food with zero flavor. Places where locked-in purchasing contracts meant patients ate the very same chicken breasts served to inmates of California prisons. In short, a culinary black hole.

Perhaps this time she’d leaped too fast.

Compared with the healthy-school-lunch movement, hospital food reform is still the preemie in the incubator, but the idea has created buzz. It is being discussed all over the country, and has penetrated as far as CEO inboxes. Changes are percolating up from small regional chains like John Muir. They are creeping tentatively via carefully circumscribed pilot programs such as Kaiser Permanente’s local sourcing initiative, where the hospital chain’s Northern California food service division is bringing in a tiny percentage of its produce from small Central Valley farmers. Or Dominican Hospital in Santa Cruz, where chef Deane Bussière began swapping out fried chicken with chicken mole in the cafeteria. Or Marin General, where executive chef Lorenzo Wimmer started bringing in weekly produce hauls from the Marin Farmers’ Market.

It all sounds nice. Who, after all, wouldn’t want to improve hospital food, a term that has come to denote something grim and tasteless? But moving beyond the superficial has proved problematic. To really overhaul hospital chow, a food service director has to circumvent an entrenched institutional supply chain, and spend money that isn’t in the food budget. Those two things keep fundamental change firmly at the discussion level, even as hospital PR departments tout relatively easy fixes, such as swap-outs for hormone-free milk and fair-trade coffee. Chef Wimmer, incidentally, got canned after six months because he bucked the hospital supply chain without management’s buy-in.

Advocates for fundamental change have nonetheless targeted the Bay Area as fertile ground to grow their movement. In November 2005, a group of food service directors, healthcare workers, and environmental advocates met in a windowless ballroom of the Oakland Marriott City Center to begin the public conversation about change. Dubbed FoodMed, the conference was cobbled together by a national coalition of nonprofits calling itself Health Care Without Harm. Two of Northern California’s biggest hospital players — Catholic Healthcare West and Kaiser —agreed to be sponsors. The third big player, Sacramento-based Sutter Health, gave it the cold shoulder.

As with school-lunch reform, “healthy” has a meaning that caroms around the complex issues that cluster together under the banner of sustainability. It means eating better — whole grains, less fat, and plenty of nutrients from fruits and vegetables — but also doing business in a way that doesn’t ravage the planet. Healthy means buying produce from farmers you can reasonably argue are local; reducing waste; and using less carbon fuels than in a system that counts on, say, importing red flame grapes from Chile in February.

Associating itself with FoodMed’s healthy eating ethos was a no-brainer for Kaiser. As both an insurer and a provider, the Oakland-based HMO has a financial interest in keeping its clients out of the hospital. The move was also consistent with its Thrive advertising campaign, which since 2004 has branded Kaiser as responsible, life-affirming, and just plain friendly. But incorporating the fresh broccoli and blueberries from its billboards into its actual food service is less straightforward. “When the Thrive campaign first came out, we realized they were highlighting broccoli,” said Eirin Hilton, Kaiser’s nutrition health educator. “Then we realized we weren’t serving broccoli anywhere in our hospitals.”

Alison Negrin was in the audience at FoodMed, which she called “amazing.” It gave voice to changes she had been trying to effect, haphazardly, since taking the hospital job. And FoodMed was where Negrin met Lucia Sayre.

Lithe and perennially sunburned, with thick, metal-rimmed specs, Lucia Sayre looks like some scrappy, ageless graduate teaching assistant. In fact she’s an activist in the Berkeley office of Physicians for Social Responsibility and, in the fifteen months since FoodMed, Negrin’s mentor, ally, and confidante. She listens to Negrin bitch, gives her stuff to read, and puts her in touch with kindred spirits at other hospitals. John Muir has become Sayre’s Petri dish experiment in change, Alison Negrin her star biology student. But Sayre knows she doesn’t have forever to succeed with Negrin. “I just worry how long she’s gonna hang on and keep doing this,” she said last fall, right about the time the carrot-ginger soup was making its uncertain debut.

The causes of Negrin’s frustrations were on display one afternoon last fall, a week after the new menu rollout. The chef hung out at a table in the Vista Cafe, a drab eating space at the Walnut Creek campus, waiting for other members of the hospital food service management team to arrive. She’d brought along a plate from that day’s tray line: a piece of seared salmon flecked with bits of dried herbs and sesame seeds; a pile of grains that included barley and Tibetan red rice; and a little tangle of plain, steamed vegetables: soft carrots, firm zucchini sticks, and long slices of yellow squash.

In the makeover, every item on the breakfast, lunch, and dinner menus had been revamped based on new recipes that, like the soup, spent years crawling through the hospital bureaucracy. Negrin was working eleven-hour days. “For me it was seven in a row, and then luckily a Jewish holiday came in the middle so I could take off,” she said. The cooks, meanwhile, were grumbling. “They think we’re crazy,” Negrin said. “I think sometimes because I’m not cooking side-by-side with them they like to think, ‘Oh, she doesn’t know anything.'”

Relations with the cooks had been tense ever since Negrin started making changes. After FoodMed, she’d posted an article about Kaiser’s local-produce pilot program, but someone ripped it off the bulletin board. Negrin hoped the article would inspire them, and let the cooks and tray line workers know the changes she was trying to make at John Muir were happening at other hospitals. Instead, she says, they saw it as a rebuke: What they’d been doing all these years was crap.

Jean-Pierre Metivier, the campus’ nutrition services manager, arrived at the Vista Cafe and sat down. Despite the French name, Metivier is a Brit, with a graying goatee and a fleshy face like some ruddy character out of Dickens. Prior to this gig, he had trained as a chef in London, taught at CCA (Negrin’s alma mater), and served as executive chef at Cal Dining, UC Berkeley’s food service. “They haven’t really cooked like this before,” Metivier noted of the fifty or so kitchen workers he supervises. “The salmon. Before, you know, it was just thrown in the oven and baked. Now it’s seared.”

Then there’s portobello mushroom ravioli. It’s cooked in small batches throughout serve-up on the tray line, not quite to order, but an improvement over what the kitchen used to do. Before, Metivier said, “you’d cook it and sauce it and throw it in the steamer for two hours.”

Pat Morris joined them. The clinical nutrition manager has a meticulously downswept hairdo and a bright, honeyed way of speaking that can quickly turn icy. She’s John Muir’s chief dietician, the hospital’s final authority on food. The Web site of the American Dietetic Association describes its members thus: “ADA members are the nation’s food and nutrition experts, translating the science of nutrition into practical solutions for healthy living.” What it doesn’t mention is flavor.

Most patients at hospitals like John Muir have no doctor-imposed dietary restrictions, which leaves them free to circle what they want from paper menus marked “regular.” Then there’s the unmarked menu, a default for patients who don’t want to be bothered with choosing, or who can’t choose. Feeding the rest of the patients requires a battalion of dieticians who control a complex and rigid set of restrictions that span six additional menus, which Morris calls “select.” There’s the renal menu for patients with struggling kidneys, the cardiac menu, and the diabetic menu, each with its own rules for what dieticians call “nutritionals” — calories, carbs, grams of protein, sodium, fat, and potassium.

It gets even more complicated. Patients can suffer from a combination of conditions, such as the guy who’s diabetic, has a cardiac condition, can’t tolerate sodium, and is recovering from surgery. The breathing tube has left his esophagus so raw that it hurts to swallow anything that isn’t either puréed or a mass of soft flakes. That last condition would make the patient a “dysphagia.”

For Negrin, these variations and cross-variations constitute a logistical Rubik’s cube. As tray lines go, Walnut Creek’s is tiny. “A cook can’t do that many variations,” she says. “There’s really only one cook making all the food for any one meal, and there’s only so much space on the tray line to have, like, three versions of one thing.”

That’s three versions when there are really seven basic variations. And one cook for about three hundred patients — roughly the same number of diners who might show up on a Saturday night at Lark Creek Walnut Creek. The swank restaurant, however, has a couple of prep guys pumping stuff out all day, and half a dozen line cooks to make things happen.

Hospitals have traditionally cut down on menu variations by cooking to the least common denominator: serving everyone the bland pap any patient can swallow, even if few would really want to. Negrin tries to cut down on variations, too, but does her utmost to avoid the latter.

But she still has to compromise often. Debbie Stevens, the clinical dietician who filtered Negrin’s recipes through the nutritionals calculus, described the process by which she modified the chef’s curried vegetable soup. “She might have had milk or real cream in it,” Stevens said in a chirpy voice. “Well, a lot of our patients are lactose-intolerant, and milk is high in potassium. You’ve got your milk-intolerant, you’ve got your renal patients who can’t have the potassium. And then, of course, the milk she uses might have too much fat. It wouldn’t be allowed on a cardiac diet, it wouldn’t be allowed on a diet for someone that needed a strict low-fat diet for gall-bladder disease or pancreatitis. Culinary Cream is actually a product that’s low-potassium, low-fat, and so I would substitute that.”

Manufactured by a subsidiary of Nestlé, Culinary Cream is what’s called an “aseptic cream substitute,” in this case a blend of water, dry milk solids, whey, and xanthan gum. From a dietician’s point of view, it gives great nutritionals. But for a chef steeped in the ingredients-driven, farm-to-table style of Chez Panisse, it’s a pretty big adjustment.

Stevens largely modified Negrin’s recipes without ever tasting them — a purely mathematical exercise to balance the nutritionals. Sure, for patients who are listless or depressed, or those on drugs that dull the taste buds, flavor may not be a priority. And Stevens did taste the food after the new menu rollout, making changes to certain recipes here and there. Still, when it comes to patient food, a chef’s desire is the opening play in a negotiation that’s firmly in the dietician’s control.

Back at the Vista Cafe, Stevens’ boss, Pat Morris, examined the salmon plate. “That’s a regular,” Negrin said. “Less Salt can have that, and Heart Healthy can have that, and — I wanna say every single person in the hospital could have that.”

Morris prickled like a teacher correcting a particularly dense student. “Now the grain mixture: Everybody could have it except the Softs,” she said, referring to patients who can’t chew, “and the Dysphagias, because they can’t swallow something like that. The salmon, same thing. The Softs and the Dysphagias can’t have that because there’s little seeds on top.”

Morris reared suddenly. “Actually, there isn’t any sauce. The teriyaki sauce?”

Negrin shook her head, fanning the air as if to wave Morris off. “Yeah, I don’t — I’m not really wanting to put it on that.”

“Oh,” Morris responded.

“Yeah,” Negrin said. “It’s a long story.”

“Al-riiiight,” Morris said peevishly, drawing out the word as if to say: We’ll talk about this later.

Sauces were a bone of contention. Negrin put a simple grilled chicken breast on the menu, something that absorbed flavor from herbs it marinated with, not to mention the char marks it picked up on the grill. But the dieticians demanded a sauce. “Whether they have poor teeth or dysphagia,” Stevens later explained, “a lot of people need sauces and gravies.”

The cooks obliged, whipping up the quintessential hospital gravy: cornstarch, water, and a low-salt version of what’s known as chicken base, the poultry equivalent of Culinary Cream. Even the dieticians admitted the result was flavorless.

Negrin had already been working out more complicated sauce-flavoring systems. She was reducing wine and broths with shallots, peppercorns, cloves, and browned garlic, and straining them out later — in other words, taking a chef’s approach. Privately she bristled at the all-purpose gravy. “They have to have a sauce on everything,” she said, rolling her eyes. “If you’re gonna just take water and chicken base and flour, you’re not gonna come up with anything that’s —” She stopped short. “Sometimes I have to kind of pinch myself.”

The gravy was missing from Negrin’s agenda in mid-November, when she spoke to an audience of hospital food service managers in Berkeley about the changes she was making at John Muir. She talked about getting the staff on board, and showed slides of brightly colored salads. Here she was Lucia Sayre’s best pupil, addressing an audience Sayre hoped to inspire with a pep talk about one hospital’s successes.

Actually, Negrin was merely an opening act. The real purpose of the gathering was a roundtable to discuss large-scale purchasing. Specifically, how hospitals could move more locally grown and organic foods through systems set up to handle commodity produce from Big Agriculture.

Hospital purchasing comes with a hefty tangle of restrictions. Most buys are funneled through large corporations called Group Purchasing Organizations. Nearly all US hospitals source most of their supplies — including food — through GPOs. Popularized in the early 1990s, GPOs pool institutional purchasing power, which gives them the clout to negotiate better lower-cost contracts, which is especially important to small, regional chains like John Muir.

Nowadays, big players like Catholic Healthcare West and Kaiser Permanente use GPOs, too. And because hospitals are locked into contracts with a select group of large-scale distributors, most food service directors don’t have the discretion to buy locally. The typical contract requires a hospital to make 85 percent of its purchases through the GPO, and that can be fatal for the ambitions of chefs like Negrin.

Negrin is among the lucky few, however. With support from Sandi Rigney, John Muir’s food service director, she’s focused her division’s non-GPO spending on produce. Negrin buys from Bay Cities, a San Leandro wholesaler with access to small local farms and a big in-house processing facility, where a couple of dozen workers in smocks and hairnets hand-cut everything from fruit salad to butternut squash cubes. At peak season, Bay Cities sales rep Jason Troia says, about 80 percent of John Muir’s produce was harvested within a hundred-mile radius of Walnut Creek. And, because the cost of labor in hospitals is about double the cost of restaurant labor, Bay Cities pre-preps most of the produce Negrin buys.

Meats and poultry, however, are a problem even Negrin can’t solve. John Muir is wedded to Novation, its Group Purchasing Organization. Novation, in turn, is wedded to US Foodservice, one of the industry’s behemoth distributors. The limits of such marriages were uncomfortably obvious at the November roundtable, where food service managers came face to face with their distribution company reps.

The latter were easy to spot. Next to the mostly female activists who sported big dangly earrings and hand knits, the US Foodservice guys looked all buttoned up. Tom Leonardelli was there to talk about the distributor’s new push into sustainables, and looked as if he’d rather be anywhere else. An affable guy with lacquered hair and a mustache, he wore a necktie and stiff-looking dress shirt with a plastic nametag.

Affability soon turned to agony. Under pressure from Novation, US Foodservice had begun a pilot sustainables program, but its offerings amounted to fifteen organic produce items from huge growers: items such as Sara Lee fair-trade coffee, Campbell organic soups, and Dannon organic yogurt. Negrin expressed her disappointment that the rep didn’t even touch on finding California sources for meat and poultry. Looking pissed, she asked him about the canned soups and yogurt: “Why did you choose those products first?”

Leonardelli shrugged. “It’s the easiest, basically,” he admitted.

“Obviously he doesn’t get the distinction between small local producers of organic foods and the industrial organic question,” Lena Brook, a coordinator for the Health Care Without Harm coalition, said later. “I suggested that he read some of Michael Pollan’s writings, just to spark his thinking a little bit.”

Neither Leonardelli nor US Foodservice’s vice president for communications returned calls for this story — an indication, perhaps, that the company isn’t exactly psyched about its commitment to healthier foods.

The problem, Lucia Sayre notes, is that big distributors such as US Foodservice and Sysco are still treating sustainables like a niche market. “It’s really sort of a placating thing,” she said. “How worth it is it for us to spend our time trying to convert US Foods? Maybe we should be spending our time setting up an alternative distribution system and offering them the competition that will finally get them to finally pay attention to the issue.”

Someone less idealistic might say the latter is about as likely as Tom Leonardelli rushing to the bookstore for a copy of The Omnivore’s Dilemma.

It’s late January, and the John Muir Healthy Food Committee is holding its monthly meeting in a windowless basement conference room at the Concord campus. Negrin is wearing a fluffy wool sweater that looks a little like a sheep’s pelt, a reminder of nature that seems almost startling here. They may call this the Sequoia Room, but it’s hard to imagine a space more insulated from the outside. It’s a strange place to be talking about saving the world.

More than a dozen people are crammed into the beige, fluorescently lit chamber. Four tables are arranged in a square, and Jean-Pierre Metivier is passing out lunch: plates of moist, pinkish turkey breast, with gravy, mashed potatoes, and steamed vegetables from an old-school tray line, a reminder that Concord hasn’t yet had its makeover. Negrin got the idea for this committee at FoodMed, and Sayre helped organize its first meeting. That was a year ago, when Negrin realized she would need allies in order to make any significant changes.

Today’s meeting feels a bit like the end of a road. The committee has just finished writing a strategic plan, which includes a mission statement that casts an improbably wide net: “John Muir Health’s patients, staff, and surrounding community will consume healthy, sustainably produced food.”

It reflects the committee’s idealism, and the six pages that follow offer a single-spaced list of strategies and tactics that seem thoroughly benign. The changes — such as offering whole fruit and low-sugar snacks in the hospital vending machines and planting herbs in pots on the cafeteria’s patio — would need to be accomplished within the existing budget. Lynn Baskett, who runs John Muir’s community outreach arm, says if administrators could be sold on the concept this year, they just might be persuaded to boost Negrin’s budget for 2008. Who knows? It might just mean money for something like grass-fed beef.

Lucia Sayre, too, seems to be moving onward. Lately she’s been working with Kaiser, which has approved its own food policy document, and has asked her to analyze the feasibility of sourcing sustainable meats and poultry for a potential new pilot program. With Negrin’s recipes finally making their way down the Walnut Creek tray line, Sayre can focus on bigger players whose buying power might actually influence the big distributors.

After the meeting, Negrin walked upstairs to her office, a closet-size room carved out of the big industrial kitchen. A bumper sticker on the door reads “Don’t Postpone Joy,” and the kind of cookbooks that inspire restaurant chefs line shelves above her desk, surrounding her like a security blanket. She could use one, with the challenges that now loom.

The new menu rollout at the Concord campus — scheduled for June — could prove messy if members of Local 250 regard new procedures for batch cooking as a work speed-up. Nerves have been frayed since the union staged a six-month walkout in Concord last year. SEIU administrative vice president Dana Simon took pains to sound neutral, even as he offered a glimpse of a path strewn with issues — starting with the wholegrain breads from Vital Vittles that Negrin has already introduced. “A lot of people think that the new organic menu tastes terrible,” Simon said. “They’re getting requests from patients, saying, ‘I’m not going to eat this rock you gave me as a roll.'” On the other side, Negrin is still sometimes embarrassed to tell people she’s a hospital chef.

But things are better than they’ve ever been. John Muir is buying only fresh produce now, with a significant amount of it grown locally. The chef just signed an agreement with the Community Alliance with Family Farmers to promote Brentwood growers in the cafeterias. And kitchen workers at Walnut Creek have made peace with the new menu. Even the gravy issue got settled, thanks to a version Negrin can live with — thickened with cornstarch, but also flavored with herbs. “It’s kind of like being a parent,” she says. “You can’t sweat the small stuff.”

Just ask John Turenne, a chef who got national attention when he piloted a sustainable-foods program at Yale University. Everything’s small, he says, until you come smack up against sourcing. “There’s a lot of wonderful little islands of success out there,” he explains. “People that have started to figure it out, willing to go the extra mile, work extra hard to get this to work. But that’s all they are. Until we really get some of the big guys on board, the distributors and larger food companies that are responsible for some volume, these little islands are going to remain nothing but little islands.”

Fixing hospital food, in other words, has less to do with a nation of talented chefs, each fighting a separate stubborn bureaucracy to overhaul a few dozen recipes, and everything to do with the public’s appetite for change. Because the only thing the big boys respond to is pressure from the marketplace.

Turenne is less than optimistic. Unable to convince Aramark (the food service company behind Yale’s dining halls) to expand its sustainables program, he simply quit. After only two years. “I’m afraid it’s going to end when people really wake up and say, ‘We’re in trouble,'” he says.

Until then, hospital patients who’d prefer not to eat industrial slop are marooned on tiny archipelagos like Negrin’s.


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