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Foodborne Illness Outbreaks

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A 2000 Minnesota and Wisconsin E. coli O157:H7 Outbreak Linked to Hamburger

meat-940x626On December 1, 2000, the Minnesota Department of Health (MDH) issued a press release stating that 17 Minnesota citizens had been infected with the same strain of the E. coli O157:H7 bacteria during November 2000. Most of the individuals consumed ground beef from SuperValu/Cub Food stores, and days later began to show signs of infection. At the urging of state health officials, SuperValu/Cub Foods removed all fresh ground beef products from its stores in affected areas within Minnesota.

Three days later, on December 4, USDA Food Safety and Inspection Service (“FSIS”), an agency within the United States Department of Agriculture (“USDA”), stated in a Class I alert that Green Bay Dressed Beef, Green Bay, Wisconsin the meat supplier doing business as American Foods Group (“AFG”), was, at the suggestion of the FSIS, recalling 1.1 million pounds of potentially contaminated ground beef. The recalled meat was manufactured at AFG’s Wisconsin meat plants, and supplied to stores throughout the Midwest and Southeast United States. The FSIS recall was initiated requested that after a preliminary investigations by both the MDH and the FSIS indicated that ground beef produced at the plant in early November 2000 was likely contaminated with E. coli O157:H7 bacteria.

On December 5, a preliminary Wisconsin Department of Public Health (“WDPH”), linked three reports of Wisconsin E. coli O157:H7 to the cases addressed in the MDH release of December 1. The WDPH release implicated the same source of the infections as the MDH and FSIS: ground beef processed by AFG in November 2000 and sold at Cub Food Stores.

The final report completed and released by the Minnesota Department of Public Health on the November 2000 outbreak was stated in its conclusion that:

This was a multi-state outbreak of E. coli O157:H7 infections caused by ground beef produced by American Foods Group…In Minnesota AFG was implicated through store grind records for retail ground beef from which E. coli O157:H7 had been isolated. In all five instances in which non-AFG product yielded E. coli O157:H7, a positive AFG product was ground within 35 minutes prior, suggesting cross-contamination only from AFG product to non-AFG product. The number of separate stores involved in Minnesota indicates that contamination did not originate within the individual stores. Since ground beef is shipped to individual stores in intact chubs from SuperValu’s warehouse, and two separate SuperValu warehouses were involved (in Minnesota and Wisconsin) the contamination of the ground beef could not have originated within the SuperValu distribution system. Rather, the AFG plant (establishment 410) was the only common point in the distribution system that could explain all of the cases associated with SuperValu. The Ohio cases [that] purchased ground beef from Krogers further implicated the AFG plant as the source of the contamination.

The November/December 2000 recall urged by the FSIS for meat products made by AFG and sold by Cub Foods was, unfortunately, not an isolated occurrence. Two years earlier, in December 1998, a recall was issued for 1,000 pounds of beef manufactured by AFG and distributed to Cub Foods stores in the Chicago, Illinois, area after random testing showed that meat in one of the stores was contaminated with E. coli O157:H7. Again, in December 1999, a recall of ground beef was made after government inspectors found contamination at the plant. Finally the most recent recall for over half a million pounds of ground beef manufactured by AFG, was in August 2001.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products. The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s. We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

Thw 2005 Senaca Lake Spraypark Cryptosporidium Outbreak

On Monday August 15, 2005, the Seneca Lake County Health Department called the manager of the Spraypark to find out whether Spraypark patrons had reported becoming ill. Behind that initial inquiry was State Department of Public Health recognition of the sudden spike in cases of cryptosporidiosis, especially in local day cares in the Seneca Lake area, and the emerging commonality that victims had recently attended the Seneca Lake Spraypark. By that afternoon the Spraypark was closed to the public for the balance of the year.

Over the next week, there was confirmation of a very large outbreak of cryptosporidiosis with the Spraypark as the epicenter. Water samples from the tanks at the Spraypark would reveal a high level of contamination with Cryptosporidium oocysts. The State Department of Health also investigated potential sources of the Cryptosporidium, both human and animal and began a review of the Spraypark’s design and water quality records.

By the end of September, the State Department of Health estimated that approximately 4,000 cases of reported illness were potentially linked to the Spraypark from 37 counties, including 743 confirmed cases.[1] Ultimately, the number of cases the State identified totaled 2,959, including 713 confirmed cases. The graph below depicts the onset dates for both confirmed and suspected cases in the outbreak. What is notable is the duration of the outbreak which includes cases from early July, over a month before the Spraypark was closed. The graph also reflects that cases continued to occur well after the Spraypark was closed. Because infected individuals continue to shed oocysts well after their symptoms end, secondary cases will continue to occur even though the original source of infection has been removed.The New York State Department of Health found that factors contributing to the outbreak included the design of the facility, operator education and awareness, and public awareness and behavior.[2] Given that public behavior is driven by knowledge, or lack of knowledge, of a particular risk, all of these contributing factors were within the control of the State.

An Introduction to Cryptosporidium, A Microscopic Parasite

Cryptosporidium[3] is a protozoan, a single celled parasite. There are many species of Cryptosporidium, but it is now recognized that the most important for human infection is C. hominis.[4] Cryptosporidia are protected by an outer shell that allows them to survive outside the body for long periods of time and makes them very resistant to chlorine-based disinfectants. The disease Cryptosporidium cause is called cryptosporidiosis. Both the parasite and the disease it causes are commonly referred to as “Crypto.” During the past 2 decades, Crypto has become recognized as one of the most common causes of waterborne disease (recreational water and drinking water) in humans in the United States.

The inactive form of Cryptosporidium is called the oocyst. Microscopic but thick-walled, oocysts can survive in a variety of environmental conditions. Once ingested in food or water, Cryptosporidium oocysts multiple rapidly in the intestines triggering the intense diarrhea that characterizes infection with this parasite. As the oocysts replicate and complete their life cycle they are expelled in the bowel movements of infected individuals. A single bowel movement may contain millions of new oocysts. One of the important characteristics of Cryptosporidia oocysts are their extremely small size: 4-6μm[5] or about half the size of a red blood cell.

The life cycle of C. hominis is depicted below and begins with ingestion of the sporulated oocyst, the resistant stage found in the environment. Each oocyst contains 4 infective stages termed sporozoites, which exit from a suture located along one side of the oocyst. The most common site of infection is the last section of the small intestine where sporozoites penetrate individual cells that line the surface where they continue the cycle of division.

Cryptosporidium parvum oocysts in wet mount, under differential interference contrast (DIC) microscopy.  The oocysts are rounded and measure 4.2 µm – 5.4 µm in diameter.  Sporozoites are visible inside the oocysts, indicating that sporulation has occurred.[6]

 Cryptosporidiosis Becomes A Major Problem In The 1980’s

Cryptosporidiosis has long been a veterinary problem, predominantly in young farm animals such as calves. Cryptosporidium was first recognized as a cause of human disease in 1976 but was rarely reported in humans until 1982. The number of detected cases began to rise rapidly along with the AIDS epidemic and the development of methods to identify the parasite in stool samples. The earliest cases of human cryptosporidiosis were diagnosed in animal handlers. An outbreak at a day care center was first documented in 1983.

In 1987, 13,000 people in Carrollton, Georgia, became ill with cryptosporidiosis. This was the first report of its spread through a municipal water system. In the spring of 1993 in Milwaukee, Wisconsin, municipal drinking water was found to be contaminated with Cryptosporidium. An estimated 400,000 people became ill, and the disease contributed to the deaths of numerous immunocompromised persons. These outbreaks focused attention on the risk of waterborne cryptosporidiosis and the need for stricter drinking water standards.

Because of its prominence as an infectious disease, cryptosporidiosis has long been recognized as a public health hazard. As with other well-known diseases, cryptosporidiosis must be reported to public health entities whenever a medical professional or laboratory diagnoses a case.   Cryptosporidiosis was added to the list of reportable diseases in New York State in 1994. By the end 1997 46 states had made cryptosporidiosis a reportable disease.[7] The CDC has long listed it as a nationally notifiable infectious disease.[8]

Cryptosporidiosis Was a Well Known Problem for Recreational Water Features Long Before the Seneca Lake Spraypark Was Built

Since the Milwaukee outbreak in 1993, Crypto has become increasingly associated with recreational water facilities, including pools, water parks, and sprayparks. In a 1999 CDC publication[9] dozens of recreational water outbreaks of Crypto were specifically cited.

The same article, published before ground was even broken on the Seneca Lake Spraypark, offered a variety of defenses against Cryptosporidium:

Prevention plans that combine engineering changes (improved filtration and turnover rates, separate plumbing and filtration for high-risk “kiddie” pools), pool policy modifications (fecal accident response policies, test efficacy of barrier garments such as swim diapers), and patron and staff education should reduce the risk for waterborne disease transmission in public recreational water venues. Education efforts should stress current knowledge about waterborne disease transmission and suggest simple prevention measures such as refraining from pool use during a current or recent diarrheal episode, not swallowing recreational water, using proper diaper changing and handwashing practices, instituting frequent timed bathroom breaks for younger children, and promoting a shower before pool use to remove fecal residue.[10]

As discussed below, none of these basic preventive efforts were followed at Seneca Lake.

In the July/August 2000 issue of Environmental Health, the leading environmental health periodical in the United States, the cover and feature article spotlighted crypto and studies which confirmed the efficacy of UV light in inactivating it.

A 2002 publication noted that 31 outbreaks affecting over 10,000 people had associated cryptosporidiosis with exposure to recreational water.[11] Outbreaks of cryptosporidiosis associated with recreational water facilities continued; indeed, they became more common during the Seneca Lake Spraypark’s years of operations before the outbreak.

The CDC surveillance data for disease outbreaks associate with recreational water for the years 2001-2002 reported that of a total of 65 waterborne disease outbreaks, 30 involved gastroenteritis. And the leading cause of those outbreaks involving gastroenteritis: Cryptosporidium. “Cryptosporidium species remained the most common cause of outbreak associated with treated swimming water (50%)…”[12](emphasis added).

The CDC surveillance data for 2003-2004, identified another 30 outbreaks of gastroenteritis associated with recreational water facilities. Of that number Cryptosporidium was confirmed as the causal agent in 36.7%, and in treated water venues, like the Seneca Lake spray park, Cryptosporidium caused 55.6% (10 or 18) of the gastroenteritis outbreaks.[13] Indeed, Cryptosporidium was identified as the leading cause of outbreaks associated with recreation water in the years 1971 to 2000.[14] Simply put, Cryptosporidium was the number one cause of disease outbreaks in treated recreational water venues for decades prior to the Seneca Lake Crypto outbreak.

Thus, between 2000 and 2005 cryptosporidiosis remained a significant and common public health risk. During that time it was the number one cause of all recreational water illnesses. It had long been on public health radar in the United States, and was widely discussed both in public health circles and within the recreational water industry as a problem that needed to be confronted and dealt with.

Cryptosporidiosis: Symptoms And Person To Person Transmission

Infection with Cryptosporidium results in a wide range of outcomes, from asymptomatic infections to severe, life-threatening illness. The incubation period (time from ingestion to start of symptoms) is an average of 7 days (but can range from 2 to 15 days[15]).  Watery diarrhea is the most frequent symptom of cryptosporidiosis, and can be accompanied by dehydration, weight loss, intense abdominal pain, fever, nausea and vomiting.  In healthy persons, symptoms are usually relatively short lived (1 to 2 weeks), but they can be chronic and far more severe in immunocompromised patients.[16]  While the small intestine is the site most commonly affected, symptomatic Cryptosporidium infections have also been found in other organs including other digestive tract organs, the lungs, and possibly conjunctiva, the clear membrane that covers the eyes.

The most common site of infection is the last section of the small intestine where sporozoites penetrate individual epithelial cells where they continue the cycle of division.

There is currently no drug that can cure cryptosporidiosis. People with competent immune systems will recover on their own and appear to develop some immunity to subsequent infections.

Because of the numbers of oocysts produced by an infected individual and the low infectious dose of Cryptosporidium, person to person or secondary infections are very common during outbreaks. One large study of cryptosporidiosis showed that a significant risk factor is contact with children 4 years and younger due to the increased likelihood of person to person transmission.[17]  The likelihood of secondary infections is large because infected person will continue to shed oocysts weeks after their symptoms resolve.[18] It is also likely that cryptosporidiosis is under recognized and underreported because most physicians will not order the testing needed to identify the parasite even when presented with a symptomatic patient.[19]

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[1]           A “confirmed” case is one in which laboratory testing has confirmed the presence of Cryptosporidium oocysts in the victim who must also have an epidemiological link to the source.

[2]           Schaffzin JK, Keithly J, Johnson G, et al. 2006. Large outbreak of cryptosporidiosis associated with a recreational water — New York, 2005 [Abstract]. In: Proceedings of the 55th Annual Conference of the Epidemic Intelligence Service. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2006.

[3]           Cryptosporidium translates into “hidden spore” (or perhaps more specifically in Latin “underground spore”) reflecting that the spores are indistinguishable or perhaps absent from the oocyst.

[4]           In recent years, other species of Cryptosporidium have been found in humans. C. hominis (formerly C. parvum genotype I), is relatively specific to humans and is morphologically indistinguishable from C. parvum

[5]           A micrometer (also referred to as micron), symbol μm, is one millionth of a meter.

[6]           See, http://www.dpd.cdc.gov/dpdx/HTML/ImageLibrary/Cryptosporidiosis_il.htm.

[7]           Dietz VJ, et. al. National Surveillance for Infection with Cryptosporidium Parvum, 1995-1998: What Have We Learned? PUBLIC HEALTH REPORTS. Vol. 115, 2000.

[8]           See, http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm.

[9]           Carpenter C, et. al. Chlorine Disinfection of Recreational Water for Cryptosporidium parvum. EMERGING INFECTIOUS DISEASES. Vol.5, No. 4 July-August 1999.

[10]          Id.

[11]          Dillingham RA ,et. al. Cryptosporidiosis: epidemiology and impact. MICROBES AND INFECT. 4:1059-1066 (2002).

[12]          Yoder JS, et al. Surveillance for Waterborne-Disease Outbreaks Associated with Recreational Water—United States, 2001-2002. MMWR Surveillance Summaries Vol. 53/33-8:1-45; October 22, 2004.

[13]          Dziuban EJ, et al. Surveillance for Waterborne Disease and Outbreaks Associated with Recreatonal Water—United States, 2003-2004. MMWR Surveillance Summaries 55(ss12):1-24; 2006.

[14]          Craun GF, et al., Outbreaks associated with recreational water in the United States. INTERNATL J ENVIRON HEALTH RESEARCH, Vol. 15, Issue 4:243-262; 2005.

[15]          MMWR October 16, 1998 / 47(40);856-860; http://www.cdc.gov/mmwr/preview/mmwrhtml/00055289.htm.

[16]          See CDC Fact Sheet on cryptosporidiosis: http://www.cdc.gov/crypto/disease.html.

[17]          Lake IR, et al., Case-control study of environmental and social factors influencing cryptosporidiosis. EUR J EPIDEMIOL; 22(11): 805–811; 2007.

[18]          Id.

[19]          Morin CA, et al., What do physicians know about cryptosporidiosis? A survey of Connecticut physicians. ARCH INTERN MED;157(9):1017-22; 1997.

Pulled Pork Cause of North Carolina Salmonella Outbreak

PulledPorkAccording to N.C. Department of Health and Human Services and Gaston County, pulled pork served at a church convention is most likely to blame for a Salmonella outbreak that sickened nearly 70 people last fall.

The investigation began after multiple people sought treatment in early October. The local health department collected information and found that many of the patients had attended a conference between Oct. 1 and 5 at Living Word Tabernacle Church in Bessemer City.

The N.C. Department of Health and Human Services partnered with the local health department to investigate the outbreak.

A report released this week found that Boston butts prepared by a church member was the likely cause.

The pork was cooked overnight in a smoker a day before it was served. Then it was returned to the smoker the day of the meals.

Some of the pork hadn’t cooked all the way through in time for lunch so it was cooked longer then taken to the church for dinner.

The church member who cooked the meat said it was cooked at 350 degrees the first night, but no cooking temperature was given for when the pork was put back on the grill the next day.

About 400 people attended the church conference, and Salmonella was confirmed in 69 patients. Three people were hospitalized.

THE 2007 CASTLEBERRY FARMS BOTULISM OUTBREAK

50961_1On July 7, 2007, the Centers for Disease Control and Prevention (“CDC”) learned that two siblings in Texas were critically ill with botulism and that their illnesses were likely acquired by eating contaminated food. The two children were admitted to pediatric intensive care, and there required mechanical ventilation. The CDC released doses of botulinum antitoxin,[1] which was administered to the children the next morning. [2]

Four days later on July 11, public health officials in Indiana reported to the CDC that a married couple in Indiana were suspected of having foodborne botulism. Serum samples were collected from each of them on July 10 and then sent to the Botulism Reference Laboratory at the CDC. On July 16, one day after the lab received the serum samples, botulinum toxin type A was detected by mouse bioassay in the man’s serum sample. Botulinum toxin was also detected by mouse bioassay in serum submitted by the wife, but the sample volume was insufficient to determine the toxin type. Investigations conducted by state and local health departments in both Texas and Indiana revealed that all four patients had eaten types of Castleberry’s hot dog chili before symptom onset.

Texas investigators found an unopened can of Castleberry’s Austex Hot dog Chili Sauce Original date stamped with a manufacture date and time of May 7 at 9:41 p.m. at the children’s home and tested it for botulism. The Texas Department of Health Services laboratory tested an aliquot from this can using an enzyme-linked immunosorbent assay (ELISA) for botulinum toxin and did not detect the toxin.

The Indiana couple had an unlabeled, sealed plastic bag of leftover chili mixture in their refrigerator that local health officials collected and sent to the CDC for C. botulinum toxin testing. On July 16 the CDC detected botulinum toxin type A by mouse bioassay in the chili mixture. Empty, well-rinsed cans of Castleberry’s Hot Dog Chili Sauce Original and chili made by another company were found in the couple’s recycling bin. CDC re-rinsed the two cans and tested the rinse water for botulinum toxin by mouse bioassay; both were negative. The label on the can of Castleberry’s Hot Dog Chili Sauce Original indicated a production-date of May 8, and a time of 2:23 AM—less than five hours after the production-time indicated on the can collected from the Texas home.

On July 17, CDC staff provided information regarding the production-dates and times to the FDA. The evidence strongly suggested that brands of Castleberry’s hot dog chili sauce were the common source of the four ill persons with botulism. On July 18, FDA issued a consumer advisory. On that same day, after being informed about the outbreak, and findings from the FDA investigation of the canning facility, Castleberry’s Food Company issued a voluntary recall that included a limited number of production dates of Castleberry’s Hot Dog Chili Sauce Original, Castleberry’s Austex Hot Dog Chili Sauce Original, and Kroger Hot Dog Chili Sauce. The recall was expanded on July 21 to include all production dates for 91 types of canned chili sauce, chili, other meat products, chicken products, and dog food that were manufactured in the same set of cookers, or “retorts” as the hot dog chili sauce at the Castleberry’s facility in Augusta, Georgia.

By August 24, eight cases of botulism had been reported to the CDC. In addition to the Indiana couple, the mother of the children in Texas had developed symptoms of botulism, which brought the total number of Castleberry-associated cases in Texas to three. There were also three unrelated residents of Ohio who had developed botulism consuming Castleberry’s hot dog chili sauce in the week before symptom onsets. Botulinum toxin was identified in leftover chili sauce collected from the refrigerator belonging to one of the Ohio cases.

The Castleberry’s manufacturing facility in Georgia produces products regulated both by the FDA and USDA-FSIS. Initial reports of illnesses were linked to meatless hot dog chili sauce and thus, fell under the jurisdiction of the FDA. The agency’s Atlanta District Office took the lead in the investigation of facilities.

The inspection started on the evening of July 17. FDA investigators requested company maintenance records, which were not immediately available because they were stored on a laptop of a vacationing employee. Finally, three days later, under threat of severe penalty, the company produced some of the requested records. Included in records provided to federal investigators was a 42-page report written by a consultant hired by Castleberry’s to investigate swollen cans of stew, chili, and hash produced in April and May 2007. The consultant had attributed spoilage to post-process handling operations in one of the plant’s cooking equipment. Reports by two other company-hired consultants would also implicate post processing as the reason for swollen cans. Unfortunately, Castleberry’s had not investigated the issues further.

On July 18 and 19, a team of federal investigators were sent to the firm’s warehouse. Samples of Castleberry’s Austex and Castleberry’s brand Hot Dog Chili Sauce with the “best by May 7, 2009” and “best by May 8, 2009” lot codes were collected and sent to FDA laboratories for testing.[3] FDA testing of sample 428113, consisting of 17 swollen cans, found C. Botulinum toxin in 16 of the cans. This sample included the same time-stamp and lot code from the May 8, 2007 production as the can found in the Indiana home. FDA testing of sample 420352, consisting of six swollen cans, found C. Botulinum in four cans. FDA sample 420353 included one swollen can, and its contents tested positive for C. Botulinum toxin.

Federal investigators conducted extensive tests on Castleberry equipment. Noted observations include:

  • The system, equipment, and procedures used for thermal processing of foods in hermetically sealed containers were not operated and administered in a manner that ensures commercial sterility is achieved.
  • Each retort did not have an accurate temperature records device.
  • Failure to supply a suitable water valve used for water cooling to prevent leakage of water into the retort during processing.
  • The condensate bleeder was not checked with sufficient frequency to ensure removal of condensate or equipped with an automatic alarm system for the continuous monitoring of condensate bleeder functioning.
  • Required information was not entered on designated forms at the time the observation was made by the retort or processing system operator or designated person.
  • Failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.
  • Failure to properly adjust the temperature-recording device. The temperature recorded on the temperature-recording device chart was higher than the mercury-in-glass thermometer during processing.

The report ultimately placed blame on Castleberry management saying there was no commitment from employees in making the products and there was not adequate management oversight. As one Castleberry employee noted: “Two years ago the [implicated reports] were maintained very well, but they are maintained poorly now.” The FDA plainly agreed, citing Castleberry’s for the “failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.”

Castleberry made substantial fixes at its plant and then reopened in the fall of 2007. The company re-branded its line to American Originals, and redesigned product labels. But in March, 2008, the plant was forced to close again after a February 27 joint-inspection by the FDA and USDA revealed deviations in some equipment operations on the processing line. The line was not related to deficiencies noted in the summer of 2007 but because under-processing caused the botulism outbreak, the plant’s operating permit was suspended.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Botulism outbreaks. The Botulism lawyers of Marler Clark have represented thousands of victims of Botulism and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Botulism lawyers have litigated Botulism cases stemming from outbreaks traced to carrot juice and chili.

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[1]           The CDC is the only source of the therapeutic antitoxin, which is stocked in locations around the country for rapid release. See Sobel, supra note 2, at 1607.

[2]           The information about the outbreak comes primarily from the CDC-published report issued July 30, 2007. See MMWR, supra note 1, at 1-2. The information specific to the Castleberry’s manufacturing facility is taken from the FDA Establishment Inspection Report, FEI No. 1010894.

[3]           This was despite Castleberry’s questionable efforts to apparently destroy evidence. As noted in the FDA Inspection Report, “Castleberry’s personnel had sorted through lots and destroyed most of the swollen cans prior to our visit.” Although the FDA has not imposed any specific penalty for this conduct yet, it is safe to assume that the conduct would be scrutinized by a court as potential spoliation.

First Lawsuit Filed on Behalf of Texas Woman Sickened By Salmonella Tainted Food from The X In Texas Wood Fired Grill

Dallum County resident Frances Childers has filed a lawsuit against The X In Texas Wood Fired Grill, LLC over a severe case of salmonella poisoning she suffered after eating at the restaurant located in Dalhart, TX. Childers is represented by John C. Ramsey and Justin A. Hill of Ramsey Hill, LLP in Houston, TX, and Bill Marler of Marler Clark, a Seattle-based firm specializing in food safety.

Childers, who dined at and consumed food from the X in Texas Wood Fired Grill on February 6, 2015, began feeling ill the very next day. For the next several days, she experienced agonizing symptoms, including excruciating abdominal pain, muscle aches, fatigue, uncontrollable diarrhea, nausea, and vomiting. She could only keep food and water down momentarily, before bringing it up again. Her symptoms continued for the next three days.

On February 10, Childers could not take anymore and went to High Country Community Health Clinic, where she was given medication to aid her nausea. She was told to purchase over-the-counter probiotics to aid her digestion and was advised to acquire a stool sample.

Her condition worsened and her two sons immediately took her to Dalhart Emergency Room. There, she received three bags of fluid intravenously. Because her kidneys were failing and she could need life-saving dialysis, she was sent to BSA Hospital in Amarillo, where she stayed for 4 days. It was there that she was told of the recent instances of Salmonella poisoning.

Sure enough, Childers’ stool sample, which was submitted to Coon Memorial Hospital Lab, tested positive for Salmonella. It was reported to the Texas Department of Health, who had already begun an investigation to identify and isolate the source of the recent Salmonella outbreak.

In early February of 2015, the X in Texas Wood Fired Grill voluntarily closed its doors after the Texas Department of State Health Services confirmed their connection to the outbreak. The restaurant was cleaned and sanitized and cleared for reopening. The restaurant reopened on February 19, 2015. The source of the outbreak has not been confirmed and all environmental and food samples tested negative for Salmonella.

“It sounds like the Wood Fired Grill is not only putting the X in Texas, but the S in Salmonella,” said Bill Marler, who has been working to help improve food safety standards since representing victims of the Jack In The Box E. coli outbreak in the early 1990s. “Contrary to popular belief, it is very worrisome when environmental and food samples test negative, because this could mean that the source of the outbreak is an infected employee.”

Salmonella is transmitted by food, water, or surfaces that have been contaminated with the feces of an infected animal or person. Symptoms develop 6 to 72 hours after infection. One of the best ways to prevent the spread of Salmonella is to have proper hygiene and hand washing practices in place, especially after using the bathroom and before handling or preparing food.

“It is extremely frustrating to have to repeat, and repeat, and repeat myself about the importance of hand washing,” said Marler. “It is a scary thought to think that such a simple life-saving act is not being done properly or at all.”

Ramsey Hill LLP is a Texas based law firm with offices in Houston and San Antonio, Texas.  The Texas Trial Attorneys at Ramsey Hill LLP have litigated and tried lawsuits all over the State of Texas and in many other states.  The Texas Personal Injury Lawyers at Ramsey Hill LLP practice primarily in the areas of personal injury, product liability, oil & gas, and commercial litigation.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

Dalhart Texas X10 Restaurant Cause of Nearly 60 Salmonella Cases

10868011_1537591776489189_8491316100590439212_nThe Texas Department of State Health Services has confirmed a total of 59 cases of Salmonella in Dalhart.

52 of those cases are associated with the X10 in Texas Restaurant. X10 in Texas voluntarily closed during the second week of February.

Officials say all of the new cases are linked to the initial outbreak prior to the restaurant voluntarily closing.

Officials say they have not identified the original source inside the restaurant.

All environmental and food samples tested negative for salmonella.

Dalhart’s Ten in Texas Link in Salmonella Outbreak

12Last week’s Salmonella outbreak in Dalhart Texas now stands at 42. According to press reports, in Dalhart, the Coon Memorial Hospital has seen all 42 confirmed cases of Salmonella, 30 are linked to the Ten in Texas restaurant. Health investigators have not yet determined the exact origin of the bacteria.

The restaurant voluntarily shut down for one week. The building was cleaned and sanitized, and workers were re-tested for Salmonella and on food safety.

Nearly 60 miles south in Potter and Randall counties 10 cases of Salmonella have been confirmed in the last six weeks. Four were found in students who live in Bushland, the other 6 were reported throughout Amarillo.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants. The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

X-10 Woodfire Steakhouse Link in Texas Salmonella Outbreak

According to myhighplains.com, 30 patrons of a Dalhart, TX restaurant, X-10 Woodfire Steakhouse have salmonellosis. That’s about all the info that’s out there.

The Texas Department of State Health Services tells KAMR Local 4 News the X-10 Woodfire Steakhouse in Dalhart has been connected to the salmonella cases.

Last week, that restaurant voluntarily closed.

Officials say since then, the restaurant was cleaned and sanitized and has been cleared for reopening.

Officials say they have not identified the original source inside the restaurant.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

2012 Salmonella Illness Linked to Microbiology Class

On May 30, 2012 Brianna Dannen, Public Health Nurse at the Clark County Health District (CCHD), received a call from Bob Williamson at Clark College.  Mr. Williamson called to report that a child of a Clark College student enrolled in a microbiology class, BIOL&260, taught by Travis Kibota was ill with Salmonella.  The student, Cameron Ross, had recently conducted tests on an “unknown organism” as part of a class assignment to identify the organism.  The organism Ms. Ross had been assigned to identify was pathogenic Salmonella Typhimurium.  Mr. Williamson and Mr. Kibota thought there might be a connection between Ms. Ross’s work in the laboratory and the Salmonella infection diagnosed in her son, Braden Linkenheimer.

Their concern was not without precedent.  In October 2010 PulseNet detected a multistate outbreak of Salmonella Typhimurium infections with PFGE Pattern JPXX01.0014. The source of the outbreak remained unsolved until December 2010 when the New Mexico Department of Health identified three patients with strain JPXX01.0014.  One patient was a student and the two other patients were children of students in microbiology courses held at two community college campuses. This finding prompted an epidemiologic study of patients infected with Salmonella Typhimurium Strain JPXX01.0014.  In total 109 patients residing in 38 states were identified as being infected with Strain JPXX01.0014.  Ill persons were significantly more likely than non-ill persons to report exposure to a microbiology laboratory in the week before illness onset.  NM DOH investigators connected the strain of Salmonella Typhimurium isolated in patients with a commercially available Salmonella Typhimurium strain used in laboratory settings.[1]

It would not be long before CCHD learned that Braden Linkenheimer, Cameron’s son, was also infected with Salmonella Typhimurium. The Oregon Health Division (OHD) Public Health Laboratory (PHL) conducted PFGE on the isolate cultured from Braden’s stool specimen (OHD PHL ID#12053002562). Results showed that Braden was infected with PulseNet Pattern JPXX01.0014, the same strain identified in the previous outbreak associated with exposure to microbiology laboratories. Instructor Travis Kibota confirmed that the strain used by his students in his microbiology laboratory was Salmonella Typhimurium ATCC strain 14028.  Thus, the connection between Braden Linkenheimer’s salmonellosis and his mother’s exposure to Salmonella in the microbiology laboratory was definite.

Public health investigators explored ways Braden Linkenheimer was exposed to the laboratory strain of Salmonella Typhimurium.  Based on the usual incubation period for a Salmonella infection (6-72 hours), two routes of transmission seemed possible.  Cameron Ross first had contact with her “unknown organism” in the laboratory on Monday, May 14. She continued her laboratory experiment on May 16, May 21 and May 30.  Ms. Ross reported having several episodes of diarrhea starting May 18.  Braden became ill on May 24.  Based on her report of diarrheal symptoms on May 18, it is possible that Ms. Ross was infected on May 14 or May 16 during her laboratory work and that Braden became ill secondarily through person-to-person spread with his mother while she was ill.  However, a stool specimen collected from Ms. Ross on June 1 was negative for Salmonella.

Investigators also posited that Braden became ill as a result of contact with classroom materials that Ms. Ross used in the laboratory and subsequently brought home with her, i.e., fomite transmission.  Investigators reviewed Ms. Ross’ laboratory practices.  She stated that she followed protocols provided to students at the start of the term.  Students were allowed to bring personal items such as pens, pencils and laptops into the lab with them.  The instructions provided to students by Mr. Kibota did not clearly state that personal items should not be in allowed in the lab.  In fact, Mr. Kibota told health department investigators that “we do not have official policies regarding fomites such as pencils, pens, cell phones, etc.”  Students were advised to wear “old clothes” and lab coats were described as “optional.”  Students were tested on their knowledge of lab procedures and safety rules.  Cameron Ross received 100% on her test.

Ultimately, investigators were not able to determine if Braden acquired his infection via person-to-person transmission from his mother or through contact with a contaminated item she brought home with her.  What was clear is that Braden was infected with the strain of Salmonella Typhimurium used in his mother’s microbiology class just before he became ill.

CCHD staff referred Mr. Kibota to guidelines recommended by the CDC following the 2010-2011 outbreak of laboratory acquired Salmonella Typhimurium.[2]  Mr. Kibota was advised to add a component about signs and symptoms of bacterial infection to safety instructions provided to students and to require use of lab coats by students.  Dr. Alan Melnick, CCHD Health Officer, went so far as to question why “students (or faculty) in a community college lab should be working with human pathogens….”

Among the CDC recommendations for laboratory directors, managers, and faculty involved with clinical and teaching microbiology laboratories, were the obvious:

  • Non-pathogenic (attenuated) bacteria strains should be used when possible, especially in teaching laboratories.  This will help reduce the risk of student and/or their family members becoming ill (emphasis added).
  • Place dedicated writing utensils, paper, and other supplies at each laboratory station.  These items should not be allowed to leave the laboratory.

These recommendations were made over a year before Braden’s Salmonella infection.[3]

Dr. Sandra McLellan, Associate Professor and Senior Scientist, Great Lakes WATER Institute at the University of Wisconsin-Milwaukee, reviewed laboratory protocols provided to students in Travis Kibota’s microbiology class.  Dr. McLellan noted several factors that contributed to the Salmonella infection experienced by Braden Linkenheimer.

  • Lack of sufficient instructions in the safety procedures for the lab for working with pathogens.
  • Information about signs and symptoms of infection by the pathogens being studied and utilized at the laboratory would have resulted in students taking proper precautions against both infection and secondary transmission of disease.
  • As recommended by the Centers for Disease Control and Prevention, the lab should have been using a non-virulent strain of Salmonella in the classroom setting.
  • Personal items should not have been allowed in the laboratory.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.


[1]           See Final Update: Human Salmonella Typhimurium Infections Associated with Exposure to Clinical and Teaching Laboratories, CDC, January 17, 2012, http://www.cdc.gov/Salmonella/typhimurium-laboratory/011712/index.html.

[2]           Id.

[3]           Investigation Announcement: Multistate Outbreak of Human Salmonella Typhimurium Infections Associated with Exposure to Clinical and Teaching Microbiology Laboratories. CDC April 28, 2011. Online: http://www.cdc.gov/salmonella/typhimurium-laboratory/042711/index.html#advice-directors.

Shigella Outbreak Linked to California Restaurant in 2014

In August 2014 staff at the Health Care Agency of Orange County (HCAOC) investigated an outbreak of Shigella among customers of True Food Kitchen, a restaurant located in Newport Beach, California. A total of 7 restaurant patrons and one restaurant employee were laboratory confirmed with Shigella.  All reported eating at the restaurant between August 21 and August 25. According to Denise Fennessy, director of Environmental Health at HCAOC, spread of the bacteria was believed to be person-to-person since none of the ill patrons ate the same dish. All employees were required to submit stool specimens for testing for Shigella before they could return to work. The restaurant was closed on August 28 for what county inspectors labeled as an “imminent health risk”. During the two day closure, True Food was required to discard all ready-to-eat foods and open beverage bottles.  Unsealed linens and ice were also disposed.[1]

True Food Kitchen in Newport Beach has a history of poor food safety practices.  The restaurant was inspected 4 times in 2013; once in response to an illness complaint.  Each time serious food handling practices were observed and required correction.  An inspection conducted on June 9, 2014 showed a lack of sanitary conditions including evidence of “vermin activity,” improper food storage and inadequate hygiene.  Even after the August 2014 outbreak, the restaurant continued to perform poorly on inspection.  On December 2, 2014 a county inspector identified vegetables held at improper temperatures. Employees were directed to discard sweet potato cubes that had been held on the cook’s line in ambient air for 5 hours.  Roasted onion slices were held at 65oF instead of the required 165oF.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Shigella outbreaks. The Shigella lawyers of Marler Clark have represented thousands of victims of Shigella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Shigella lawyers have litigated Shigella cases stemming from outbreaks traced to a variety of sources, such as tomatoes, airplane and restaurant food.


[1] Luna, N. (2014, September 17). Illness investigation of True Food Kitchen in Newport continues.  Orange County Register. Retrieved January 5, 2015, from http://www.ocregister.com/articles/true-635362-food-restaurant.html