Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Journal

A year ago, high levels of E. coli in the Lake of the Ozarks went unreported over a busy holiday weekend, for reasons that are still debated.   The Kansas City Star eventually reported on the failure to report the issue, and the apparent cover up.   Who was to blame still depends on who you ask.  It looks like some good has come of it though, as Missouri Department of Natural Resources (DNR) now has a better reporting plan in place:

The Department of Natural Resources has overhauled the way it sends an alarm about E. coli, which the government calls a serious health hazard. Also, a task force has been formed to consider a centralized sewer district around the lake, where thousands of septic tanks overflow into the water.

Reporting E. coli levels in public swimming places is important.   E. coli is the generic term for a family bacteria that includes E. coli O157:H7, and other pathogenic forms of E. coli.   The pathogenic forms of E. coli cause severe foodpoisoning symptoms, including bloody diarrhea and abdominal cramps.  In some cases, especially in children and the elderly, it can lead to hemolytic uremic syndrome (HUS).  HUS is a potentially fatal complication that can also cause permanent kidney damage.

Despite an increased awareness of the issue, the problem with the lake continues:

Recent readings show the E. coli problem has not gone away. Bacteria continues to spike, especially after rains wash feces into the lake.  While one major beach there remains open this weekend, Public Beach 1 at Lake of the Ozarks State Park has now been closed for two weekends.

In addition, a new focus on wastewater treatment plants in Missouri has uncovered more problems, but has not led to widespread action:

Inspectors cited 208 violations at 154 treatment facilities and this spring began a second sweep. As of May 21, inspectors had gone back to 142 facilities and issued 70 additional citations.  Some facilities voluntarily cleaned up their mess, state officials said. As for the rest, only two facilities have agreed to pay a total of $2,250 in penalties pending cleanup. Two others had $5,750 in penalties that were suspended pending the outcome of their cleanup.Only 26 cases so far have been referred to Attorney General Chris Koster for further action. The rest of the cases are pending, a DNR official said.

With summer just beginning, there is hope that the new warning system will at least keep swimmers away from the known dangerous locales.

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Ongoing outbreak and recall of Romaine Lettuce tainted with E. coli O145

Freshway Foods and the Food and Drug Administration announced yesterday. An a press release, Freshway Foods said the E. coli O145 - tainted Romaine Lettuce was sold to wholesalers, food service outlets, in-store salad bars and delis in Alabama, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia and Wisconsin. The affected lettuce has a "best if used by" date of May 12 or earlier. The recall also affects "grab and go" salads sold at Kroger, Giant Eagle, Ingles Markets and Marsh grocery stores.  The recall of Romaine Lettuce was prompted after illnesses were reported in Michigan, Ohio and New York - primarily impacting students at University of Michigan, The Ohio State university and Daemen University. The Food and Drug Administration reported the E. coli O145 illnesses included 12 people who have been hospitalized and with Hemolytic Uremic Syndrome (HUS).

What is Hemolytic Uremic Syndrome?  See, www.about-hus.com.

Hemolytic Uremic Syndrome is a severe, life-threatening complication that occurs in about 10 percent of those infected with E. coli O157:H7 or other Shiga toxin-producing E. coli.  HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly, who often succumb to the disease.

Ongoing Outbreak Investigation

Given the time of the year, the most likely area for growing Romaine Lettuce is Arizona – likely Yuma. The investigation is likely hampered by the failure of health departments throughout the United States from actually testing ill persons stools for E. coli O145.  For a bit(e) of history on lettuce and E. coli, visit www.outbreakdatabase.com.

More Information on E. coli O145

In 2009, Marler Clark Petitioned the USDA to define E. coli O145 and other Shiga toxin-producing E. coli as adulterants.  The Petition has a very complete explanation of the dangers of E. coli O145.

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Circumstances have long been ripe for calling all shiga-toxin producing strains of Escherichia coli (E. coli) “adulterants” in our food supply. The USDA’s Food Safety and Inspection Service, which is the entity that has the regulatory capacity to do just this, currently has in its possession two citizen petitions to take this action.  In our petition, we state:

Despite strong scientific evidence that many strains of non-O157 STEC are as pathogenic as E. coli O157:H7, FSIS has thus far failed to include all STEC as adulterants under the FMIA.  Recent studies have repeatedly shown that non-O157 STEC is a serious food safety hazard. According to one study, non-O157 STEC are prevalent in beef production systems at rates as high as 70.1%.5 A United States Department of Agriculture (USDA) study states that non-O157 STEC have been found in ground beef and on cattle hides and feces at levels comparable to E.coli O157:H7.6 Furthermore, European studies indicate that non-O157 STEC infections occur more frequently than E. coli O157:H7 infections.7 With such a ubiquitous presence, the potential risk for harm caused by non-O157 STEC may be on par with, or even greater than, the risk created by E. coli O157:H7. Indeed, another study concluded that “non-O157 STEC can cause severe illness that is comparable to the illness caused by STEC O157.”

Our petition has recently received the support of Senator Kirsten Gillibrand (D-NY). FSIS’s response, to date, is that they are considering the petition. Also currently on the federal government's to-do list is a Senate vote on S 510 "The Food Safety Modernization Act."  The Food Safety Modernization Act would amend the Food Drug and Cosmetic Act by giving the Food and Drug Administration better authority and ability to monitor the safety of our food supply, and take quicker and more effective action for food companies that don't adequately protect against foodpoisoning risks.

Readers may ask why these regulatory and legislative measures are ripe for action.

1.  Stephanie Smith

2.  Linda Rivera

3.  252 illnesses nationally linked to salami, black pepper, and red pepper

4.  Millions and millions of pounds of meat products recalled.

5.  HVP recall, which, although it caused no known illnesses, resulted in one of the largest food product recals in history.

6.  About 76,000,000 other reasons every year.

As for the regulatory action that has really got our eye, particularly in the wake of multiple outbreaks linked to non-O157 strains of E. coli. Currently, at least 60 people recently fell ill in Michigan, Ohio, and New York due to infection by E. coli O145. Also last month, at least11 inmates at a correctional institution in Colorado fell ill due to infection by E. coli O111. Word of exactly what food products were contaminated in the Michigan, Ohio, and New York E. coli O145 outbreak has not yet come.

To understand the significance of regulating non-O157 strains of E. coli, a little background information is useful. FSIS’s stated mission renders it “responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged.” To promote its mission, FSIS has the power—under the Federal Meat Inspection Act (FMIA)—to, among other things, seek the recall of products that have been deemed “adulterated.” FSIS drastically shifted how it interpreted and enforced the FMIA in 1994 when, following the Jack in the Box outbreak, the agency declared E. coli O157:H7 to be an adulterant.

The petition details the scientific and legal bases for the requested action, but perhaps more importantly it details the suffering that food contaminated with non-O157:H7 enterohemorrhagic E. coli inflicted upon three individuals: June Dunning, Megan Richards, and Shiloh Johnson. Ms. Dunning, whose infection was caused by E. coli O146:H21, unfortunately succumbed to her illness, passing in 2006. Ms. Richards and Ms. Johnson endured lengthy hospitalizations, kidney failure, and will both endure a lifetime of medical complications as a result of their E. coli O121:H19 and E. coli O111 infections (respectively).
 

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The country became conscious of E. coli in 1993 after an E. coli O157:H7 outbreak struck West Coast Jack in the Box restaurants. 700 people were sickened; many people developed hemolytic uremic syndrome; and at least 4 kids died. In direct response to the outbreak, the USDA deemed E. coli O157:H7 an adulterant per se on all non-intact cuts of meat, which includes ground beef and ground beef components. (Notably, however, the USDA does not currently consider E. coli O145, or any strain of E. coli other than O157:H7, to be an adulterant on meat.  It is well past time for the USDA to deem all shiga-toxin producing strains of E. coli "adulterants" on meat.)

I.    The law on contaminated food

In all states, companies that manufacture and sell food that is contaminated with Salmonella, E. coli,hepatitis A, campylobacter, or anything else that can cause illness or injury, is liable to anybody who becomes ill or injured as a result of the contamination. In some states, even companies that do nothing other than sell a contaminated food item that another company made—e.g. Peanut Corporation of America Salmonella Typhimurium outbreak—are liable to all people who become ill as a result of the contamination. This is called strict liability.

In application in the E. coli O145 outbreak being investigated in New York, Ohio, and Michigan, the law of strict liability will hold the companies that manufactured and sold the contaminated food item liable to all outbreak victims. The law does not discriminate on the basis of severity of injury and, as a result, a person who suffered a relatively mild illness has the same legal rights as a person who was hospitalized. This is not to say, however, that the jury verdict will be the same, because that is driven exclusively by the severity of injury.

II.     E. coli O145 characteristics and pathogenicity

E. coli O145 is another strain of enterohemorrhagic Escherichia coli (EHEC) or shiga-toxin producing Escherichia coli (STEC). The letters and numbers O145 refer to the specific markers found on the bacterium’s surface; these letters and numbers distinguish E. coli O145 from the 50+ other strains of EHEC/STEC.

E. coli O145 has emerged as one of the primary non-O157 serotypes—i.e. strains—of Escherichia coli in Europe, and has begun to appear more frequently in the United States as well. E. coli O145 was one of several strains found in bags of Dole baby spinach in September 2006, along with its more famous counterpart E. coli O157. And of course, in the month of April 2010, at least 50 people were sickened by E. coli O145 in an outbreak in Ohio, Michigan, and New York, for which no specific food vehicle has yet been announced.

E. coli O145 generally functions like other strains of EHEC/STEC, in that the bacteria typically enters the human body by consumption of contaminated food. Infecting the gastrointestinal tract, the bacteria causes symptoms between 1 and 5 days after ingestion, and symptoms typically include abdominal cramps, often-bloody diarrhea, and other gastrointestinal symptoms.

But, like any other strain of EHEC/STEC, the true virulence of E. coli O145 results from its ability to produce Shiga-like toxins. It has been theorized that generic E. coli picked up this deadly ability through horizontal transfer of virulence genes from the Shigella bacteria. Whatever the case, the toxins released by E. coli O145 enter the circulating blood stream through the inflamed bowel wall. There, the toxins attach to receptors on the inside surface of blood vessel cells (endothelial cells) and initiate a chemical cascade that results in the formation of tiny thrombi (blood clots or Thrombotic Microangiopathy - TMA) within these vessels.

Some organs seem more susceptible—perhaps due to the presence of increased numbers of receptors—including the kidneys, pancreas, and brain. By definition, when fully expressed, hemolytic uremic syndrome (HUS) presents with the triad of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute renal failure (loss of the filter function of the kidney).
 

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Cattlenetwork just reported that Wal-Mart, the biggest food retailer in the country, has taken a good step toward acheiving a significant reduction in E. coli contamination in the beef supply.  Cattlenetwork reports as follows:

Wal-Mart Stores, Inc., will require its beef suppliers use stricter tests for E. coli and other sickness-causing bacteria after U.S. meat recalls rose in recent years.

Beef suppliers must “significantly reduce potential contamination levels” and meet Wal-Mart’s new standards by June 2012, the Bentonville, Ark.-based company said in a statement today. The new standards also apply to suppliers for Wal-Mart’s Sam’s Club stores.

Wal-Mart’s heightened standards will provide an “additional layer” of protection for consumers beyond E. coli tests the meat industry already does, said Frank Yianna, Wal-Mart’s vice president for food safety.

“If you look at food recalls over the past two years, there’s been a significant increase,” Yianna said in a phone interview. “This is really a response to long-term trends in beef recalls.”

As the top U.S. food retailer, Wal-Mart’s new requirements are sure to affect many of the country’s biggest beef processors. Wal-Mart has “dozens” of beef suppliers, Yianna said, though he declined to name any.

Wal-Mart’s beef suppliers will be required to validate that the measures they’ve implemented are effective through specialized testing, today’s statement said.

Suppliers that don’t operate slaughterhouses must be in compliance with the new standards by June 2011, Wal-Mart said. Those that operate slaughterhouses have until June 2012.

If suppliers don’t meet the new standards, “we will stop doing business with them,” Yiannas said. “It is our intent that this is a firm deadline.”

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Is it mere coincidence that the Marler Clark firm's petition to FSIS asking it to declare non-O157 strains of E. coli as adulterants in meat (submitted October 2009) is being considered in the midst of at least two outbreaks of non-O157 E. coli (O111 and O145)?  Or is it proof that there is actually a problem with non-O157 in our food supply.  New York Senator Kirsten Gillibrand would, I think, agree that this is a real problem. 

On April 22, she sent the following letter to US Dept. of Agriculture Secretary Tom Vilsack asking for action on the petition:

April 22, 2010

Dear Secretary Vilsack,

I am writing to you today to urge you to respond formally to two petitions to the USDA’s Food Safety Inspection Services: 1) Petition for an Interpretive Rule Declaring all enterohemorrhagic Shiga Toxin-producing Serotypes of Escherichia coli (E. coli), including Non-O157 Serotypes, to be Adulterants Within the Meaning of 21 U.S.C. § 601(m)(1) - Petition #09-03; and, 2) S.T.O.P.-Safe Tables Our Priority’s Call to Action and Public Petition.

These petitions detail the scientific and legal bases for listing non-0157 STECs as adulterants. Such listings will avoid the same kind of large-scale disaster that precipitated the 1994 declaration of E. coli O157:H7 as an adulterant. S.T.O.P.’s petition also calls for the expansion of the definition of adulterant to include E. coli O157:H7 and these six other STEC when they are in any type of beef, not just ground beef or beef intended for ground beef. With these actions, USDA will take a significant leap forward in ensuring the safety of American consumers.

In light of current scientific and medical research, the health hazards posed by STEC are undeniable. The CDC recognized these hazards in 2000

when the agency made all STEC nationally notifiable. Since reporting was implemented in 2001, instances of non-O157 STEC have steadily increased year by year. In 2005 alone, 501 cases of non-O157 STEC were reported through the National Notifiable Diseases Surveillance System. This has become an issue that is too important and too urgent to ignore any longer. Indeed, in a presentation given on September 14, 2009, L. Hannah Gould, MS, PhD from the CDC stated that non-O157 STEC causes an estimated 36,700 illnesses, 1,100 hospitalizations, and 30 deaths annually.

As the numbers of reported illnesses from non-O157 STEC steadily increase, immediate action on this issue is critical. Please respond formally to these petitions, and send me a copy of this response.

Sincerely,

Kirsten E. Gillibrand
United States Senator

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Currently, there are at least two outbreaks nationally that involve dangerous strains of E. coli that are not E. coli O157:H7.  Michigan and Ohio are investigating at least 13 illnesses that occurred in mid-April, all of which are genetically indistinguishable strains of E. coli O145.  (Incidentally, this was one of the strains involved in the infamous Spinach E. coli outbreak in September 2006, which also included E. coli O157:H7).  And at a Colorado prison, at least 11 inmates were recently sickened with another strain of E. coli:  E. coli 0111. 

These recent outbreaks are just two in a series of outbreaks linked to non-O157, shiga-toxin producing E. coli (STEC).  Shiga-toxins are what can eventually lead to the devastating condition hemolytic uremic syndrome (HUS).  As mentioned, E. coli O145 was involved in the 2006 spinach outbreak, and was the strain that eventually caused the death of June Dunning.  And in August 2008, over 341 people were sickened, some critically, in an outbreak of E. coli O111 linked to Country Cottage restaurant in Locust Grove, Oklahoma.  Of these 341 people, 70 were hospitalized, including 22 children.  17 people required dialysis because of kidney failure, and one man died. 

On October 5, 2009, Marler Clark submitted a petition to the Food Safety and Inspection Service to declare all non-O157, shiga-toxin producing strains of E. coli in meat as adulterants per se, as E. coli O157:H7 already is.  The petition is currently being considered, as we recently learned from Dr. Phillip Derfler, Assistant Administrator at the Office of Policy and Program Development.  These recent outbreaks allow little room for the argument that there is no need to take this action.  Non-O157 strains of E. coli certainly are a problem in our food supply.

The petition received some well-deserved support today:

Continuing her commitment to keep all families safe from contaminated food, U.S. Senator Kirsten Gillibrand today urged U.S. Department of Agriculture (USDA) Secretary Tom Vilsack to include six additional strands of E. coli as hazardous adulterants that need to be tested by the USDA.

In addition to the most common form of E. coli that is already regulated, the Centers for Disease Control and Prevention (CDC) has identified six other strands, known as non-0157 STECs, that are just as hazardous as E. coli and need to be regulated. The CDC estimates that non-0157 STECs cause 36,700 illnesses, 1,100 hospitalizations and 30 deaths in America each year.

“In America, in 2010, it is unconscionable that food is still going straight to our kitchens, school cafeterias and restaurants without being properly tested to ensure its safety,” Senator Gillibrand said. “It’s spreading too many diseases and costing too many lives. The laws that are meant to keep us safe from hazardous foods are in critical need of updating. We need immediate action to keep our families safe.”
 

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A week ago, we reported on a developing E. coli outbreak in Washtenaw County, Michigan.  Notably, the outbreak is not attributable to E. coli O157:H7--the most notorious of all E. coli strains--but it does appear to be a shiga-toxin producing strain of E. coli.  Apparently, the outbreak is no longer confined to Washtenaw County, or even the state of Michigan, as Ohio has now reported illnesses in Columbus-area residents, including several students of Ohio State University. 

Certain press accounts have indicated that a single Washtenaw county restaurant is the source of the Washtenaw county portion of this outbreak, but the Ohio and OSU illnesses apparently match the Michigan illnesses, which means that we're probably dealing with an outbreak linked to a regionally distributed food product.  Could it be lettuce, as we saw in the September 2008 E. coli O157:H7 outbreak linked to Aunt Mid's and Santa Barbara Farms lettuce?  Ground beef?  Answers will likely, hopefully, come soon, as investigating health authorities compare the food histories of all infected people. 

The Columbus Post Dispatch reported as follows regarding the five Ohio and OSU E. coli illnesses:

Columbus Public Health has identified five cases of E. coli infection, some of them in Ohio State University students, and is looking into five others that might be connected to an outbreak in Washtenaw County, Michigan.

The five Columbus residents were sickened by the bacteria Escherichia coli starting in mid-April, said Dr. Mysheika LeMaile-Williams, the city's medical director.

Some were hospitalized, but none so far have developed hemolytic uremic syndrome, a potential complication that destroys red blood cells and can cause kidney failure and death.

The E. coli tests that have come back from the state indicate that its not E. coli 0157:H7, which is most commonly implicated in outbreaks, LeMaile-Williams said.

All types sicken people in the same way, she said. The primary symptoms are bloody diarrhea and abdominal cramps.

So far, the state lab has determined that two of the cases have genetic fingerprints that match an outbreak in Michigan, LeMaile-Williams said.

In Michigan, several cases have been linked to a restaurant, said Ohio Department of Health spokeswoman Jen House. She did not know the name of the restaurant. Calls to Michigan health officials were not immediately returned. Washtenaw County is home to Ann Arbor.

So far, there's no known source for the infections, nor any known risk for others in Columbus, LeMaile-Williams said.

OSU spokeswoman Liz Cook said the university is working closely with Columbus Public Health but would not provide any details about the students.
 

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A report out of Colorado today indicates that as many as 11 residents of a correctional facility may be ill with E coli infections.  The report does not make clear whether the strain has been confirmed to be E. coli O157:H7, or a different pathogenic strain of the bacteria:

Colorado Department of Corrections spokeswoman Katherine Sanguinetti says three cases have been confirmed, with eight more suspected cases at Four Mile Correctional Center.  Officials were working with the state health department to prevent the spread of the bacteria among inmates at the minimum security prison.  Sanguinetti says initial inspections of the kitchens have found no problems.

The origin of the outbreak is under investigation, but is not known at this time.

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Investigating the 13 Michigan cases in this outbreak, and identifying the source of infection, cost about $22,500: $1,697 in lab costs for personnel and supplies, and $12,201 for follow-up at the state level. A rough estimate of Michigan Department of Agriculture personnel costs is about $8,600.

This was a relatively small-scale outbreak that, fortunately, did not sicken too many people, although one illness is, of course, too many.  Also, the epidemiological circumstances were fairly clear from the get-go, as health officials investigating outbreaks of E. coli, campylobacter, and salmonella routinely ask about raw milk consumption for all such illnesses in their initial interviews with the sick people.  Thus, in this outbreak, health officials were probably able to hone in on the Family Farms Cooperative raw milk product early on in their investigation, thus eliminating lots of costs that are frequently associated with investigations of foodpoisoning or "milkpoisoning" illnesses.

Nonetheless, the costs attributable to the investigation of this outbreak are part and parcel of a problem--i.e.food and milkpoisoning generally--that costs this country an estimated $152 billion annually. 

In addition to the personal injury lawsuits that arise from such outbreaks, should state and local health officials seek reimbursement of the costs associated with food, water, and milkpoisoning?  Why not?  Sometimes, no injury claims emerge from outbreaks, even when a specific food or milk product is conclusively identified as the outbreak vehicle.  In those cases, what other mechanism is there to force accountability upon the manufacturers of the contaminated products? 

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The Washtenaw County Public Health is investigating 10 cases of a food-related illness possibly caused by E. coli, health officials said Monday.

"We are in the early stages of our investigation, and we are doing everything we can to identify probable cases and to prevent any additional illness," Dr. Diana Torres-Burgos, the county's medical director, said in a statement.

Officials are working to identify the strain of bacteria responsible, she said. It wasn't yet known if the illness was linked to a single location or food source. The Health Department didn't release other details Monday night.

Not everything is known yet about this cluster.  Is it just a cluster, or is it an outbreak--i.e. is there a common point or source of contamination?  What is the strain of E. coli involved?  Is it the infamous E. coli O157:H7, or is it another strain of shiga-toxin producing escherichia coli (or STEC)?  Or is it even STEC at all; I don't see any references to hemolytic uremic syndrome in the reports about those who are ill.

So clearly, this is a developing situation where public health needs to, and is, acting proactively and quickly.  Part of an investigator's job is to collect and analyze data.  This cannot happen, however, unless the relevant data is obtained--meaning specifically that doctors need to be testing individuals with diarrheal illness--and definitely people with bloody diarrhea--for shiga toxins and other strains of E. coli.  And of course, doctors can't test if there are no samples available to analyze.  This means that, whenever possible, people in Washtenaw county especially need to be seen by their doctors when suffering from a diarrheal illness.  Data is knowledge, and knowledge is king in the investigation of foodpoisoning outbreaks.

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Kristen Hansen, community columnist with the Milwaukee Journal Sentinel posted today on the raw milk debate that is brewing in Wisconsin over the state's upcoming vote on Senate Bill 434:

There is a trend toward healthy eating and natural foods in this country, and that is a good thing. Even though some labels of "organic" only mean "twice the price," we seem to be headed in the right direction. I am a particular fan of farmers markets for locally grown produce.

The quest for natural foods, however, can go too far. Raw milk is a perfect example. The Centers for Disease Control and Prevention is unequivocal in its findings that raw milk is dangerous and does not give benefits beyond those of pasteurized milk. The CDC lists 10 scary and unpronounceable bacteria found in raw milk, even if it comes from healthy animals. E. coli and salmonella are just the tip of the iceberg.

Remember the salmonella-tainted spinach of last year? The contaminated peanut butter? Here in the Milwaukee area, a child died of E. coli after eating contaminated food at a buffet restaurant. All of these outbreaks were from the same bacteria found in raw milk. Whole Foods has discontinued sales of raw milk following the hospitalization for renal failure of a previously healthy 7-year-old girl and 27-year-old woman in 2008. Both illnesses were traced to E. coli from raw milk purchased at Whole Foods.

And before you tell me that E. coli is commonly found in meat and produce, remember this: You can kill the bacteria by cooking the meat and washing the produce. You can't cook or wash milk.

Oh, wait - you can. It's called pasteurization, and it is considered one of the breakthrough scientific discoveries of the last century. Pasteurization is the only way to kill disease-causing bacteria while maintaining the healthful qualities of milk.

There are people who believe, based on isolated, anecdotal "evidence," that raw milk cures everything from autism to high blood pressure. But there is a huge difference between correlation and causation. That a child's autism symptoms decreased after drinking raw milk means absolutely nothing. You have to conduct real medical trials, where all other variables are removed to see if the raw milk can indeed be credited, and the Food and Drug Administration will not approve those trials because they are too dangerous.

Think about that. We're talking about legalizing sale of a product that is considered by the FDA to be too dangerous for medical trials. So dangerous that the very bill that would legalize its sale in Wisconsin, Senate Bill 434, exempts the sellers from liability for death or injury. Bill Keene, senior epidemiologist with the Oregon Division of Public Health, actually said, "I think after a few dead kids, people will lose their enthusiasm for raw milk." Who wants to volunteer their kids for this experiment?

It remains a fact that people do get very ill and die from drinking raw milk and that the same benefits can be obtained from drinking pasteurized milk. Raw milk is just not worth the risk.

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Yesterday, Montana Senator Jon Tester introduced a bill to amend the Federal Meat Inspection Act (FMIA) to require the USDA to conduct traceback investigations whenever a pathogen (called an "adulterant" under the FMIA) is found in meat distributed, or intended for distribtuion, in interstate commerce.

(Incidentally, in case anybody ever wondered about the significance of "interstate commerce," it is effectively the jurisdictional hook that gives federal agencies (here the USDA) the power to enact and enforce regulatory measures.  Article 1, section 8, clause 3 states that the US Congress shall have the power "To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes."  This "commerce clause" has become a particularly potent regulatory enabler due, in large part, to the broad reach of the Constitution's "necessary and proper clause," (Article I, section 8, clause 18) which authorizes the Congress "To make all laws which shall be necessary and proper for carrying into Execution the foregoing powers," including the power to regulate interstate commerce.)

But back to the meat of Senator Tester's bill.  The essential modifications to the existing regulatory framework set forth in the FMIA are two:  first, to trace any meat sample that tests positive for any adulterant back to its original source--not the cow or herd that originally harbored the bacteria, but the establishment that slaughtered and prepared the cow for introduction into the food supply.  And second, for any establishment that produces a product that does test positive for an adulterant, to require a 15 day (consecutive) period of product testing after the date on which the original positive test was generated. 

This is good legislation.  It's certainly not the answer to the problem of contamination in our meat supply, but it helps sharpen our focus to the original point of contamination, which is a major step in forcing slaughter establishments to clean up their act.  By and large, these establishments will not do it on their own.  Almost two decades have passed since the Jack in the Box outbreak that put E. coli and beef on everybody's radar screen, and companies like Nebraska Beef still treat the USDA, its regulatory framework, and its officials much like a fly buzzing annoyingly around its ear.  For the full story on the impunity with which Nebraska Beef has acted over the last decade, read this. 

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The Huffington Post today announced its list of the ten worst product recalls of all time.  The food recalls include melamine-tainted milk, worm-infested chocolates, and of course the September 2006 E. coli O157:H7 (and other serotypes) outbreak linked to Dole baby spinach.  The spinach outbreak was among the most devastating outbreaks ever to occur in this country. 

2006 Spinach Outbreak:  a short summary:

Official word of the spinach outbreak broke with the FDA’s announcement, on September 14, 2006, that a number of E. coli O157:H7 illnesses across the country “may be associated with the consumption of produce.” “Preliminary epidemiological evidence suggests,” the statement continued, “that bagged fresh spinach may be a possible cause of this outbreak.” By the date of the announcement, fifty cases had been reported to the CDC, including eight cases of hemolytic uremic syndrome (HUS) and one death. States reporting illness included Connecticut, Idaho, Indiana, Michigan, New Mexico, Oregon, Utah, and Wisconsin.

The much-publicized outbreak grew substantially over the next several days. By September 15, the FDA had confirmed 94 cases of illness, including fourteen cases of HUS and, sadly, one death. Recognizing the lethality of the developing outbreak, the FDA’s September 15 release warned people should “not eat fresh spinach or fresh spinach containing products.” 

Press Releases over the ensuing days announced steady growth in the number of people sickened, hospitalized, and with HUS as a result of the outbreak—109 cases from nineteen states by September 17, and 131 cases from twenty-one states just two days later. The latter statistic included 66 hospitalizations and twenty cases of HUS.

Meanwhile, the FDA and CDC, in conjunction with local and state health agencies from across the country, worked feverishly to figure out the brand names associated with illness. Early statistical analysis suggested that many brands were implicated, but the spinach sold under the several brand names had all come from the Natural Selection Foods processing center in San Juan Batista, California. Accordingly, Natural Selection recalled all of its spinach products with “use by” dates from August 17 to October 1, 2006. The recall, of course, included Dole brand spinach. But further data and study ultimately narrowed the possible sources of the outbreak down to one brand of packaged greens: Dole.

Though epidemiological evidence had already strongly linked Dole to the outbreak, the FDA found the proverbial “smoking gun” on September 20. The bag of Dole baby spinach had been purchased and consumed by an Albuquerque, New Mexico woman, and testing by the New Mexico State Health Department had confirmed that the product was contaminated with E. coli O157:H7 bearing the same genetic marker as the outbreak strain. The FDA announced the critical finding on September 21, 2006—also disclosing the “best by” date on the positive Dole bag of August 30—thereby giving a worried public a bit more information on what spinach products to eat, if any, and what to avoid.

By the date of the FDA’s September 21 announcement, the number of confirmed cases had swelled to 157 people from twenty-three states. Ultimately, the FDA confirmed 204 outbreak-related cases, with 102 hospitalizations, thirty-one cases of HUS, and three deaths, though the actual number of people affected by the outbreak was certainly much larger. In addition to an elderly Wisconsin resident, the FDA stated that the outbreak had claimed the lives of two-year-old Kyle Algood, from Chubbuck, Idaho, and also 81-year-old Ruby Trautz, from Bellevue, Nebraska. A Maryland woman named June Dunning, and a Washington woman named Betty Howard, ultimately died as a result of their illnesses as well. The tragedy of this outbreak can hardly be overstated.

Epidemiological and laboratory evidence, which had already proved the link to Natural Selection and Dole, soon revealed that the contaminated spinach had been grown at Paicines Ranch in San Benito County, California. More specifically, investigators had traced the source of the contaminated spinach to one field on the ranch that had been leased by Mission Organics.

Once identified as the likely source for the outbreak, Mission Organics became host to health officials looking for the outbreak strain of E. coli O157:H7. State and federal investigators took hundreds of environmental samples and swabs from the vicinity of the implicated spinach field, which was fifty acres in size, including from a nearby cattle pasture and water source. Investigators also sampled the intestinal lining of feral pigs that had been killed as part of the investigation. Samples from a variety of sources, including the pigs, the water, and cattle feces, tested positive for the same strain of E. coli O157:H7 that had now been isolated in over 200 people nationally. Finally, the outbreak strain of E. coli O157:H7 has been isolated in at least thirteen separate bags of Dole baby spinach.
 

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On February 12, 2010, Huntington Meat Packing, Inc., expanded its January 18, 2010 beef recall to include approximately 4.9 million pounds of beef and veal products that it produced in 2009 and the first few days of this year. This expanded recall brings the grand total of beef products recalled since November 2009 (just 3 and a half months) to 5,672,000 pounds. 

The expansion of the Huntington Meat recall is remarkable for both its size and the fact that it occurred based on evidence gathered during an ongoing criminal investigation being conducted by the Office of the Inspector General (OIG) with assistance from FSIS. This evidence shows that the products subject to this recall expansion were produced in a manner that did not follow the establishment's Hazard Analysis and Critical Control Points (HACCP) plan. A HACCP plan describes the process controls an establishment must take to prevent food safety hazards and create a safe and wholesome product. The investigation has uncovered evidence to show that the food safety records of the establishment cannot be relied upon to document compliance with the requirements.

This recall expansion continues the disturbing trend of major meat recalls over the last several months.  On February 4, West MissourI Beef, LLC, a Rockville, Missouri beef company, recalled 14,000 pounds of boneless beef products due to potential E. coli O157:H7 contamination. 

On January 11, 2010, Adams Farm Slaughterhouse, LLC., an Athol, Mass., stablishment, recalled approximately 2,574 pounds of beef products due to potential E. coli O157:H7 contamination. The recall occurred in the wake of an epidemiological investigation into the E. coli illness of at least one Massachusetts resident.

On Christmas Eve 2009, National Steak and Poultry recalled at least 124 tons of mechanically tenderized beef products. The National Steak and Poultry outbreak caused at least 21 E. coli O157:H7 illness in 16 states, including nine hospitalizations and one case of HUS.

And in November 2009, ground beef from a New York ground beef company called Fairbank Farms was recalled due to E. coli O157:H7 contamination. That outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS).

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Blake Morrison and Peter Eisler report in today's edition of the USA Today:

The U.S. Department of Agriculture announced sweeping steps Thursday to "assure the safety and quality of food" purchased for the National School Lunch Program.

The measures include tightening requirements on companies that supply ground beef to schools, testing the beef more often and more thoroughly, and improving communications within the USDA to "identify potential food safety issues" before children get sick.

The initiatives come in the wake of a USA TODAY investigation that revealed failures in government programs intended to protect students from food-borne illnesses. More than 31 million children participate in the school lunch program.

The newspaper found that McDonald's and other fast-food chains are far more rigorous than the government in checking for bacteria and dangerous pathogens in beef. USA TODAY also found that the government lacks ways to quickly alert schools when products have been recalled or implicated in safety investigations.

The measures outlined Thursday are intended to address each of those points, bringing the standards and testing protocols in line with those used by the most selective restaurants and retailers. "It's a big deal," food safety consultant David Theno said of the USDA measures. He said the moves will push companies to "play to a higher standard" if they want to continue to supply food to schools.

The USDA also pledged to review the safety records of its school lunch suppliers more carefully and bar companies that have had repeated problems with their commercial products.

Such a move could affect companies such as Beef Packers, a Fresno company that recalled 826,000 pounds of ground beef last summer because it contained a drug-resistant strain of salmonella. Public health officials warned consumers to discard products from the company, which had a history of salmonella problems, but USA TODAY found that the USDA paid Beef Packers hundreds of thousands of dollars for 450,000 pounds of ground beef made during the period covered by the commercial recall.

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The unfortunate trend for E. coli and beef in late 2009 and 2010 continues.  This evening, West MissourI Beef, LLC, a Rockville, Missouri beef company, recalled 14,000 pounds of boneless beef products due to potential E. coli O157:H7 contamination.  Today's recall brings the tally for recalled beef due to E. coli contamination to 1,636,000 pounds of beef products in the last three months. 

On January 18, 2010, the USDA's food inspection branch (FSIS) announced the recall of 846,000 pounds of ground beef products produced by a California company called Huntington Meat Packing, Inc., due to potential contamination by E. coli O157:H7.

On January 11, 2010, Adams Farm Slaughterhouse, LLC., an Athol, Mass., stablishment, recalled approximately 2,574 pounds of beef products due to potential E. coli O157:H7 contamination. The recall occurred in the wake of an epidemiological investigation into the E. coli illness of at least one Massachusetts resident.

In November 2009, ground beef from a New York ground beef company called Fairbank Farms was recalled due to E. coli O157:H7 contamination. That outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS).

And on Christmas Eve 2009, National Steak and Poultry recalled at least 124 tons of mechanically tenderized beef products. The National Steak and Poultry outbreak caused at least 21 E. coli O157:H7 illness in 16 states, including nine hospitalizations and one case of HUS.

Together, the recalls and outbreaks linked to beef from Adams Farm, National Steak and Poultry, Fairbank Farms, and now West Missouri Beef have caused at least 48 illnesses nationally. At least 1,636,000 pounds of beef have been recalled in total in the five recalls. .
 

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On February 5, 2004, the FDA wrote a letter to the lettuce and tomato industries to voice its concern about the frequent outbreaks linked to those products. In the letter, the FDA counted 14 such outbreaks since 1996 that it had investigated. Among other things, the letter stated:

In view of continuing outbreaks associated with fresh lettuce and fresh tomatoes, we strongly encourage firms in your industries to review their current operations in light of the agency’s guidance for minimizing microbial food safety hazards in fresh lettuce and fresh tomatoes, as well as other available information regarding pathogen reduction or elimination on fresh produce. We further encourage these firms to consider modifying their operations accordingly, to ensure that they are taking the appropriate measures to provide a safe product to the consumer. Since the available information concerning some of the recent outbreaks does not definitively identify the point of origin of the contamination, we recommend that firms from the farm level through the distribution level undertake these steps.

On September 30, 2005, a year and a half after the FDA’s 2004 letter to the lettuce industry, the Minnesota Department of Health issued a press release stating that 11 Minnesota residents had been infected by E. coli O157:H7 from contaminated Dole romaine lettuce. Two days later, the FDA issued a nationwide public health alert regarding Dole pre-packaged salads. Further investigation indicated that 22,321 cases of potentially contaminated Dole romaine lettuce had been sent to market from a processing facility in central California. Ultimately, at least 32 people were sickened in the outbreak.

One month after the 2005 Dole lettuce outbreak, the FDA wrote the industry again. The November 4, 2005 letter began as follows: “This letter is intended to make you aware of the Food and Drug Administration's (FDA's) serious concern with the continuing outbreaks of foodborne illness associated with the consumption of fresh and fresh-cut lettuce and other leafy greens.” The letter continued:

FDA is aware of 18 outbreaks of foodborne illness since 1995 caused by Escherichia coli O157:H7 for which fresh or fresh-cut lettuce was implicated as the outbreak vehicle. In one additional case, fresh-cut spinach was implicated. These 19 outbreaks account for approximately 409 reported cases of illness and two deaths. Although tracebacks to growers were not completed in all 19 outbreak investigations, completed traceback investigations of eight of the outbreaks associated with lettuce and spinach, including the most recent lettuce outbreak in Minnesota, were traced back to Salinas, California.

After pointing its finger steadily at central California, the FDA closed its 2005 letter to the industry by encouraging action to correct the problems within the industry, specifically outlining certain steps that the industry needed to take.

September 2006 changed everything. It was the month that the word “outbreak” truly became part of everybody’s vocabulary. It was the month that E. coli O157:H7-contaminated spinach caused 204 confirmed illnesses nationally; left 102 people hospitalized, 31 with hemolytic uremic syndrome (HUS); and caused three deaths . . . at least by the CDC’s official count. Among the dead were an elderly Wisconsin resident; a two-year-old Idaho boy named Kyle Algood; 81-year-old Ruby Trautz; 86-year-old June Dunning; and 83-year-old Betty Howard. And for those who survived their acute HUS illnesses, many will require a life-time of medical care, including kidney transplants, that may cost well over one hundred million dollars in the end accounting.

The large-scale investigation that followed, complete with an armed FBI raid, ultimately proved that the spinach had been grown, packed, processed, and bagged in the Salinas Valley, California.

On the heels of this devastating outbreak, fresh spinach sales stopped entirely for almost two weeks while the nation was gripped by a panic bigger than any it had before seen with respect to a single food product. Sales over the next several months plummeted from pre-outbreak levels. Ultimately, spinach sales did not reach pre-recall levels until the end of January 2008.

But the heavy impact of California failures wasn’t over yet, not even for the year 2006. Before the year ended, at least two more major lettuce-associated outbreaks hit: one at Taco John’s restaurants in the Midwest, and one at Taco Bell restaurants in the East; both as a result of contaminated iceburg lettuce grown in California. The Taco John’s outbreak left 81 people ill, 26 hospitalized and two with HUS; and the Taco Bell outbreak caused 71 confirmed illnesses, 53 hospitalizations, and eight cases of HUS. Again, traceback investigation in both outbreaks proved that the lettuce had gone to Taco John from the Bakersfield area and to Taco Bell from near Huron in the Central Valley.

Out the other end of this vortex came the Leafy Greens Marketing Agreement (LGMA). The LGMA website, states as follows:

In 2007 California farmers came together to raise the bar for food safety. As a result the California Leafy Green Products Handler Marketing Agreement (LGMA) was formed. Members of the LGMA are working collaboratively to protect public health by reducing potential sources of contamination in California-grown leafy greens.

To date nearly 120 handlers, representing approximately 99% of the volume of California leafy greens, have joined the LGMA. These companies have committed themselves to sell products grown in compliance with the food safety practices accepted by the LGMA board. LGMA membership requires verification of compliance with the accepted food safety practices through mandatory government audits. These food safety practices were developed by university and industry scientists, food safety experts and farmers, shippers and processors. California leafy greens are now grown under a unique system that has become a model for leafy green growers in other states.

It is in everybody’s interests for Salinas Valley to produce a safer product. The area is one of the largest exporters of fresh produce anywhere, accounting for 570 million pounds of the world’s produce exports every year. http://www.salinaschamber.com/ag_industry.asp. Salinas Valley produce goes to consumers across the country, as well as many of the world’s other major economies, including Canada, Japan, Hong Kong, Taiwan, Mexico, and the European Union.

Critical questions remain unanswered on the efficacy of the LGMA, and Salinas area processors’ efforts to implement its principles. Has this 3.8 billion dollar a year agricultural Mecca come up with any solutions to its complex problems? How well have the LGMA, the many lawsuits that individual producers have faced, and the FDA-led governmental pressure really worked? If not, why not? And what is the price of failure? More to come on this major public health issue.

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In 2000, the drinking water in the Ontario town of Walkerton was contaminated with E. coli O157:H7 and campylobacter.  7 people died, and roughly 2,300 suffered illness as a result.   The large number of people involved in the outbreak has provided doctors and scientists an opportunity to look at the long term impacts of foodborne illness. 

According to this report, studies on Walkerton survivors are now revealing genetic risk factors associated with the likelihood of developing post-infectious irritable bowel syndrome:

Of the 2,300 people who were sickened, 36 per cent developed post-infectious irritable bowel syndrome or PI-IBS.

Patients suffer from chronic abdominal pain and discomfort, bloating, and defecation problems that develop suddenly after an episode of acute gastroenteritis or inflammation of the stomach and intestines. Doctors diagnose PI-IBS after ruling out structural and biochemical abnormalities and other known disorders like Crohn's disease or ulcerative colitis.

The study, which linked three particular genes to an increased risk of post-infectious irritable bowel syndrome, will be published in the March edition journal Gastroenterology.

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Counting Friday's sausage recall by Daniele International, Inc., food companies have recalled at least 2,880,000 pounds of meat products since November 2009 due to contamination by E. coli or Salmonella. 

Friday's recall:  (from FSIS press release)

Daniele International Inc., an establishment with operations in Pascoag and Mapleville, R.I., is recalling approximately 1,240,000 pounds of ready-to-eat (RTE) varieties of Italian sausage products, including salami/salame, in commerce and potentially available to customers in retail locations because they may be contaminated with Salmonella, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.

The Daniele Inc. sausage outbreak, due to contamination by Salmonella Montevideo, has caused at least 184 illnesses in residents of 38 states. 

On January 18, 2010, the USDA's food inspection branch (FSIS) announced the recall of 846,000 pounds of ground beef products produced by a California company called Huntington Meat Packing, Inc., due to potential contamination by E. coli O157:H7.

On January 11, 2010, Adams Farm Slaughterhouse, LLC., an Athol, Mass., establishment, recalled approximately 2,574 pounds of beef products that was potentially contaminated with E. coli O157:H7.  The beef was the cause of infection in at least one Massachusetts resident. 

On December 24, 2009 (The Christmas Eve sneak), an Oklahoma company called National Steak and Poultry recalled 248,000 pounds of tenderized beef products due to contamination by E. coli O157:H7.  The outbreak is known to have sickened at least 21 people in 16 states.  Last week, Marler Clark filed the first lawsuit arising from the outbreak on behalf of a Utah resident.

And in November 2009, A New York company called Fairbank Farms recalled 545,699 pounds of ground beef due to E. coli O157:H7 contamination. The outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS). 

 

 

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We hear about them so often these days--recalls of all kinds of products, from foods, to medications, to kids toys--that "recall" has become a working concept in everybody's vocabulary.  But what is a recall?  Who has the legal obligation to announce them?  And what legal ramifications are there ot being involved in one?  

First, despite not having the legal authority to actually recall products, the FDA and USDA are frequently involved.  In fact, the USDA's Food Safety and Inspection Service (the agency arm responsible for ensuring the safety of meat, poultry, and eggs) sets the standards for when, and what kind of, a recall is required.  

The FSIS defines three kinds of recall actions that can fairly be included under the same umbrella.  A "Class I recall" should occur in "a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death."  (Editor's note: "should" is italicized because sometimes food product manufacturers do not issue class I recalls even when circumstances require it.)  Under this definition, a Class I recall should occur any time a food product is known or suspected to be contaminated with any foodborne pathogen, whether bacterial or viral.  The reason:  bacteria and viruses make people sick, and as a result, food contaminated by them will make people sick.

A "Class II recall" should occur in "a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote."  This is a little less clear than the definition of a Class I recall, but I certainly believe that the consequences of foodborne disease are simply too extreme for food companies to play fast and loose under these definitions.  A Class I recall should occur every time a food manufacturer knows, or has reason to know, that a product it has produced is or may be contaminated with a foodborne pathogen.  Every time.

Finally, a "market withdrawal"

occurs when a product has a minor violation that would not be subject to FDA legal action. The firm removes the product from the market or corrects the violation. For example, a product removed from the market due to tampering, without evidence of manufacturing or distribution problems, would be a market withdrawal.

A "market withdrawal" has no place in the world of food contamination.  Again, salmonella and e. coli and campylobacter and hepatitis and every other foodborne pathogen are simply too dangerous for companies to try to avoid their obligations by calling what should be a recall a "market withdrawal"--something done purely to avoid the media ramifications of saying that you're product has been recalled.  This has been done before under circumstances where a Class I recall was surely warranted. 

Who has the legal obligation to recall a food product when it is known or suspected to be contaminated with something that will make people sick?  The unfortunate answer is that its not the USDA or FDA.  Nor is it any other state or federal regulatory body.  The answer is that the company who produced the contaminated product is the only entity with the legal authority to recall a product.  The CDC can announce that the product has caused an outbreak, but the company itself is the only entity that can truly and effectively act. 

A recall is a firm’s action to remove product from commerce (e.g., by manufacturers, distributors, or importers) to protect the public from consuming adulterated or misbranded products. Although it is a firm’s decision to recall product, the Food Safety and Inspection Service (FSIS) coordinates with the firm to ensure it has properly identified and removed recalled product from commerce by verifying the effectiveness of the firm’s recall activities. FSIS also notifies the public about product recalls.

See http://www.fsis.usda.gov/Search/Search_Results/Index.asp?q=%22market+withdrawal%22&mode=simple&num=10&as_occt=any&site=FSIS

Finally, with regard to the legal ramifications of announcing a recall, again the real threat comes from the private sector.  Penalties and fines are not necessarily assessed simply because a recall happens.  Often, it is only private citizens who have been injured by the contaminated product that take legal action against a company that has recalled its product. 

Aside from lawsuits (which are an insufficient check, by themselves, on food safety because they are largely reactive rather than preventative) FSIS may issue public health alerts or perform product detentions and seizures, to mitigate the risk to the public when firms have inadequately removed recalled product from commerce. The Agency will investigate if it appears that a firm’s recall strategy or execution of that strategy is ineffective and, based on its findings, FSIS may seek enforcement action against the recalling firm or its consignees.

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TradingMarkets.com reports another development in the food industry's fight against E. coli contamination:

Strategic Diagnostics Inc., a leading provider of biotechnology-based detection solutions for food safety and life science applications, today announced that its recently improved RapidChek(R) E. coli O157 (including H7) System has earned Performance-Tested Methods(SM) certification from the AOAC Research Institute (License Number # 070801) for testing composite samples of raw beef including ground beef and boneless beef trim.

Tim Lawruk, SDI Food Safety Marketing Manager, said about the test method:

"With the recent announcements of E. coli O157:H7 contamination in beef products, SDI has been working with leaders in the beef industry and regulatory agencies to understand testing requirements based on new sampling practices and industry testing concerns. The newly improved AOAC-certified RapidChek E. coli O157 test system, which includes improved materials and reagents, is designed to offer several advantages over competitive testing methods, including greater accuracy, faster results, reduced testing costs, and increased confidence in test results. This certification also confirms SDI's commitment to provide the food market with superior, complete pathogen testing solutions that provide rapid and accurate results."

Good timing for progress.  This announcement comes right on the heels of yesterday's announcement by the State of Wisconsin that the state is investigating a cluster of six E. coli O157:H7 illness in Belgium, Wisconsin. 

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Today, the USDA's food inspection branch (FSIS) announced the recall of 846,000 pounds of ground beef products produced by a California company called Huntington Meat Packing, Inc., due, of course, to potential contamination by E. coli O157:H7.  In addition to ground beef produced early this month (Jan 2010), the recall includes ground beef products produced as far back as February 19 to May 15, 2008, due to the concern that some of these products may still be frozen in consumers' homes.  For anybody keeping a running tally, with the addition of today's large recall, beef companies have recalled 1,640,000 pounds of beef products since November.  Its a little scary to think where this number may end up come December 2010. 

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FSIS reported today that Huntington Meat Packing Inc., a Montebello, Calif. establishment, is recalling approximately 864,000 pounds of beef products that may be contaminated with E. coli O157:H7.  Although the recall is Class I--i.e. associated with a very high risk to consumer health--there are no illnesses currently known to be associated with the potentially contaminated meat.  The recalled ground beef was produced between January 5, 2010, and January 15, 2010, and was shipped to distribution centers, restaurants, and hotels within the State of California.

The following products, consisting of all ground beef products produced by the plant from January 5, 2010 to January 15, 2010, are subject to recall:

40 lb. boxes of “Huntington Meats Ground Beef”
40 lb. boxes of “ HUNTINGTON MEAT PKG. INC. BEEF GROUND FOR FURTHER PROCESSING”
40 lb. boxes of “BEEF BURRITO FILLING MIX”
10 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
20 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
10 lb. boxes of “El Rancho MEAT & PROVISION ALL BEEF PATTIES”

Each box bears the establishment number "EST. 17967" inside the USDA mark of inspection on a label.

Interestingly, though, these are not the only products subject to the large recall.  FSIS investigation at Huntington Meat Packing, Inc., must have turned up some serious violations because the company is also recalling meat produced in 2008.  FSIS determined that the 2008 meat was adulterated because the ground beef products produced from February 19, 2008 to May 15, 2008 may have been contaminated with E. coli O157:H7.

As a result, the following products produced from February 19, 2008 to May 15, 2008, are subject to recall:

40 lb. boxes of “Huntington Meats Ground Beef”
40 lb. boxes of “ HUNTINGTON MEAT PKG. INC. BEEF GROUND FOR FURTHER PROCESSING”
40 lb. boxes of “BEEF BURRITO FILLING MIX”
10 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
20 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
10 lb. boxes of “El Rancho MEAT & PROVISION ALL BEEF PATTIES”

Each box bears the establishment number "EST. 17967" inside the USDA mark of inspection on a label.

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There is something about the term "cookie dough shortage" that doesn't quite sound serious.  Still, the recent events that may lead to such a storage are just that.  Elizabeth Weise of the USA Today is reporting that Nestle's cookie dough may be in short supply after making a change in its process to increase safety.

Nestle recently announced a move to heat treating the flour used in the cookie dough after two recent positive tests for E. coli O157:H7.    Last year an outbreak of the dangerous pathogen linked to Nestle cookie dough sickened at least 72 people in 30 states.

One issued raised by the developments is the level of risk of bacterial contamination of flour.  Ms. Weise states:

In general, flour is not considered dangerous. However, a 2007 study published in the Journal of Food Protection did find salmonella contamination in 0.14% to 1.32% of wheat flour samples. A 1993 study in the journal Cereal Foods World found that 12.8% of wheat samples were positive for generic E. coli, which is harmless but can indicate contamination with animal fecal matter.

One of our biggest food safety challenges is staying ahead of which foods are the most risky, and most in need of monitoring.  Some aspects of not-yet-passed food safety legislation tie the level of inspection required to the level of risk associated with the product.   To carry out such a regulatory scheme, however, we must first understand where our risks are coming from.

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So how does the principle of strict liability--i.e. liability without regard to fault--which is applicable in foodborne illness cases, apply to bottles of Tylenol that make people sick?  The answer:  very well.

For some background, Johnson & Johnson today expanded its recall of various Tylenol products, which, like many food items, are regulated by the FDA, due to potential contamination with a substance that produces a chemical odor that has made a bunch of people ill with gastrointestinal symptoms.  (see primer on strict liability). 

Despite some differences in the way the fifty states apply the doctrine, strict liability holds manufacturers of defective products liable to people injured by the product defect.  It's pretty simply applied in food cases.  A beef company that produces ground beef, or any meat, contaminated with E. coli O157:H7 is liable to the people who become ill because contaminated ground beef is defective.  Similarly, a restaurant that serves a meal that became contaminated with Salmonella because an infected foodworker prepared it is liable to the customer who then contracts the disease.  In both situations, it does not matter whether the defendant (i.e. the beef producer and the restaurant) was negligent.  Simply making and selling contaminated food makes the defendant liable. 

Tylenol, whether the bottle it is sold in or the indvidual pills themselves, that is contaminated with a substance that makes people ill is also defective.  Johnson and Johnson is strictly liable to the people who have become ill, as would be the company that made the pallets that were contaminated with the substance that has made people sick.  Both produced a defective product in the eyes of the law.

This concept sounds offensive to some people. But when you pause for a moment to think where the safety of our food and pharmaceutical supply might be without the media attention that these recalls and outbreaks have gotten, and without lawsuits that put the immense costs of illnesses and medical treatment squarely back in the food producer's hands, the concept begins to seem a little less grim.

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Federal and Massachusetts State officials continue to investigate the circumstances that led to the recall of 2,574 pounds of beef products from Adams Farm in Athol, Massachusetts.   The USDA announced the recall on Monday, January 11, saying the recall resulted from a ground beef sample that tested positive for E. coli O157:H7 during an illness investigation.  

The products involved were not Adams' own retail brand, but rather ground beef and other beef products produced at Adams' slaughterhouse for three farms/retailers.  The USDA stated:

The following products are subject to recall:

1,025-pounds of "Beef Cuts and Ground" packed for Mazzarese. (Warren, MA)
697-pounds of "Beef Cuts and Ground" packed for Side Hill Farm. (Ashfield, MA)
852-pounds of "Beef Cuts and Ground" packed for Sweet Water Farm. (Petersham, MA)

A follow up article in the Worcester Telegram yesterday focused on investigators' attempts to determine at which farm the E. coli O157:H7 "originated"  The two farms whose representatives provided comment for the story both indicated that they did not think their farm was the culprit:

Nicole Burton, a manager at Sweetwater Farm in Petersham, said state and federal health officials have not determined whether the beef came from a farm or the slaughterhouse.   “I want to be clear that tests have not been done on our farm or investigated,” Ms. Burton said.

Sidehill farm representatives had a similar message:

Amy Klippenstein, owner of Sidehill Farm in Ashfield, said someone from the USDA told her that someone got sick from the beef from an animal at a different farm.  “We have all the beef, and none of it has been sold,” Ms. Klippenstein said. “We are not concerned about people eating our beef.” 

New information in the Telegram  today does seem to point toward the third farm as the original source of the implicated beef:

Jennifer L. Manley, a spokeswoman for the state Department of Public Health, said that on Jan. 7, 13 meat samples from a family that received a quarter cow share from a farm in Warren [presumably Mazzarese] were tested. She said ground beef samples and a representative selection of the intact cuts tested positive for E. coli. DNA analysis needed to determine where the animal came from will not be completed until either tomorrow or Monday. 

The focus on the source of the actual cattle is interesting.  It is a well known fact that a significant portion of cattle harbor E. coli O157:H7.   The regulations and HACCP plans in place to eliminate E. coli O157:H7 from retail products are not currently aimed or designed at preventing such contamination at the farm level.  To the contrary these regulations and safety plans essentially ask that slaughterhouses work under the assumption of the presence of E. coli O157:H7 in cattle, and then call for steps to prevent the contamination of meet with the bacteria during the slaughtering process.

In other words, presumptively identifying the farm where the E. coli O157:H7 came from is not the end of the story.   Rather, what needs to be determined is why was this bacteria allowed access to finished raw product during the manufacturing process.  

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 Today's announcement by USDA-FSIS of another beef recall due to E. coli O157:H7 contamination bodes poorly for this new year.  Adams Farm Slaughterhouse, LLC., an Athol, Mass., establishment, is recalling approximately 2,574 pounds of beef products that may be contaminated with E. coli O157:H7.  The recall occurs in the wake of an epidemiological investigation into the E. coli illness of at least one Massachusetts resident.  The recall also marks the third beef recall in the last three months due to E. coli O157:H7 contamination.

In November 2009, ground beef from a New York ground beef company called Fairbank Farms was recalled due to E. coli O157:H7 contamination. That outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS).   

And on Christmas Eve 2009, National Steak and Poultry recalled at least 124 tons of mechanically tenderized beef products.  The National Steak and Poultry outbreak caused at least 21 E. coli O157:H7 illness in 16 states, including nine hospitalizations and one case of HUS.   

Together, the recalls and outbreaks linked to beef from Adams Farm, National Steak and Poultry, and Fairbank Farms, has caused at least 48 illnesses in nationally.  At least 776,000 pounds of beef have been recalled in total in the three outbreaks.  

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The Meat Trade News Daily misses only a couple major food safety issues (i.e. outbreaks) in yesterdays summary of ten major food stories in 2009.  In the blog post, titled "USA - Food Safety a Bloody Disgrace," MTND includes: 

1.  Stephanie Smith's E. coli O157:H7 and HUS illness from eating a contaminated Cargill ground beef patty.  Stephanie has sued Cargill for $100,000,000.

2.  Linda Rivera's E. coli O157:H7 and HUS illness from eating contaminated Nestle cookie dough.

3.  Peanut Corporation of America's Salmonella Typhimurium outbreak, remarkable for a lot of things, not least of which the depth of its seemingly utter disdain for the wellbeing of consumers.

4.  The Salmonella Newport (an antibiotic resistant strain) outbreak linked to Cargill ground beef.

5.  President Obama's failure to nominate somebody, despite having served for almost a year--a year marked by, well, see above and below--for the position of Undersecretary of Food Safety at the USDA.

6.  The Milan, Illinois McDonald's Hepatitis A outbreak, lacking only an ounce of intent in its comarability to the actions of PCA and Stewart Parnell.

7.  The Organic Pastures E. coli O157:H7 outbreak linked to raw milk.

8.  The E. coli O157:H7 outbreak linked to JBS beef.

9.  A Chinese court's acceptance of the first lawsuit to arise from the 2008 melamine scandal linked to tainted milk, which killed 6 babies and sickened about 300,000.

10.  The "food fight" sparked by the Center for Science in the Public Interest's report on the ten riskiest foods regulated by the FDA.

A good list.  I would add many more if there was room in a list of ten, but two are certainly worthy of emphasis:

1.  The E. coli O157:H7 outbreak, announced in a Christmas Eve press release, linked to tenderized beef products produced by National Steak and Poultry.

2.  The large Salmonella Saintpaul outbreak from January through April linked to contaminated sprouts.  Ultimately, at least 228 people were sickened in the outbreak from 13 states.

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Yes, even wooden shipping pallets.  These days, it seems that nothing is immune from being linked to an outbreak of foodborne disease.  Spinach, lettuce, sprouts, peanut butter, cookie dough, pizza, shellfish . . . everything.  And now, a pharmaceutical recall highlights the potential risks posed by something as seemingly innocuous as wooden shipping pallets. 

This news comes in the midst of a recall, by McNiel Consumer Healthcare, of Tylenol arthritis pain caplets that were shipped on wooden pallets treated with a chemical known to cause potentially severe gastrointestinal symptoms.  But this particular Tylenol recall highlights the broader problem of potential bacterial or viral contamination of products during the shipping process.  On December 16, 2009, Intelligent Global Pooling Systems announced that,

a random sampling of wood pallets used to ship food in Portland, ME, and Philadelphia, PA, numerous pallets tested positive for Listeria and abnormally high counts of bacteria that could potentially create health hazards for consumers. The new data bolster the findings of previous wood pallet testing conducted in the Washington-Baltimore area, further illustrating the unsanitary conditions and unacceptable risks to our nation’s food supply from wood pallets.

"How much more evidence does Congress and the FDA need?," Bob Moore, IGPS Chairman and CEO asked in an article on PR Newswire.  "The TYLENOL recall proves wooden pallet shipping platforms are a dangerous threat to the pharmaceuticals we depend on, while recent independent studies we've commissioned in four cities demonstrate the dangers they pose to our food supply," 

"The one to two billion wood pallets in circulation in the United States are the common denominator in the supply chain - practically every product we ingest is shipped on a wood pallet. Congress and FDA cannot afford to overlook them any longer as they consider ways to strengthen our national food safety law."

Well said.  The risks are clear, particularly for the select few (actually, pretty much all of us) who participate in an integrated, international food supply.  And even for locavores who would rather not rely on the spotty food safety records of foreign producers, the food still has to be shipped a certain distance.  Odds are, there's a wooden pallet somewhere in the chain. 

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Urinary tract infections (UTI) are a serious health problem affecting millions of people each year.  In fact, they are the second most common type of bodily infection, accounting for about 8.3 million doctor visits annually.  Escherichia coli--a family of bacteria that includes E. coli O157 and other shiga-toxin producing strains, as well as certain generic strains that can reside quite peacefully in the human colon--is the most common cause of urinary tract infections.  New research suggests that, even for strains associated with UTI rather than gastrointestinal disease, meat may be the ultimate reservoir. 

Researchers from Denmark conducted the study, and will soon publish the results in the publication "Foodborne Pathogens and Disease."  In the study, abstract available here, researchers studied the serogroups and antimicrobial resistance characteristics of E. coli isolates (pure bacteria examined for genetic characteristics and uniqueness) from various sources, including community-dwelling humans, broiler chicken meat, broiler chickens, pork, and pigs.

A total of 964 geographically and temporally matched E. coli isolates from UTI patients (n=102), community-dwelling humans (n=109), Danish (n=197) and imported broiler chicken meat (n=86), Danish broiler chickens (n=138), Danish (n=177) and imported pork (n=10), and Danish pigs (n=145) were tested for phylogroups (A, B1, B2, D, and nontypeable [NT] isolates) and antimicrobial susceptibility. Phylogroup A, B1, B2, D, and NT isolates were detected among all groups of isolates except for imported pork isolates. Antimicrobial resistance to three (for B2 isolates) or five antimicrobial agents (for A, B1, D, and NT isolates) was shared among isolates regardless of origin.

Using cluster analysis to investigate antimicrobial resistance data, the researchers found that UTI isolates always grouped with isolates from meat and/or animals. Researchers detected B2 and D isolates, that are associated to UTI, among isolates from broiler chicken meat, broiler chickens, pork, and pigs. Although B2 isolates were found in low prevalences in animals and meat, these sources could still pose a risk for acquiring uropathogenic E. coli. Further, E. coli from animals and meat were very similar to UTI isolates with respect to their antimicrobial resistance phenotype. The researchers believe that the study provides support for the hypothesis that a food animal and meat reservoir might exist for UTI-causing E. coli.

 

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In 1999, the USDA-FSIS asked the National Advisory Comittee for Microbiological for Foods whether tenderized beef presented increased risks of contamination by E. coli O157:H7.  The answer, of course, was that it does, and that risks to consumer health increased correspondingly.  See Recommendations. 

This is not surprising, of course, nor is it particularly newsworthy in and of itself given the recent outbreak linked to tenderized beef from National Steak and Poultry.  In other words, we already knew that.  What i am interested in at this point is what questions we need to ask of National Steak and Poultry in upcoming litigation over the outbreak.  Essentially, what did National Steak and Poultry, and the industry at large, know about the risks of tenderized beef, and what did they do in order to reduce these risks and make a safer product. 

FSIS recommended several such steps, which certainly do not exhaust the list of things that manufacturers of tenderized beef need to do, but are good first steps at least:

First, the FSIS asked each plant operater that mechanically tenderizes beef to specifically consider in their annual reassessment of their HACCP (hazard analysis and critical control points) plan the significance of E. coli outbreaks linked to tenderized beef as a hazard that is reasonably likely to occur. 

Second, FSIS asked that each of these processors implement purchase specifications requiring the incoming product to be treated to reduce or eliminate E. coli to an undetectable level or apply an approved antimicrobial treatment to the meat.  See yesterday's post on this subject.

Third, though not really a recommendaiton, FSIS was "considering" a requirement that raw, mechanically tenderized beef be labeled to show that it had undergone mechanical tenderization.  (A brilliant idea, and one that all state legislatures should consider independently of any FSIS commandment on the subject; consumers should, at the very least, know whether the meat they are about to consume has undergone a tenderization process that may require a different cooking approach to make the product safe to eat)

Further, in light of the FSIS research and recommendations, the Dairy and Food Protection Branch (Division of Environmental Health, Department of Environmental and Natural Resources) issued the following additional recommendations:

1.  All beef not labeled as intact and without buyer specifications to show that it is intact must be assumed to be a non-intact beef product based on the standard meat processing industry practices of pinning, tenderizing or injecting these products. This also includes comminuted beef steak (chopped, flaked, ground, minced, restructured or reformulated).

2. Cook non-intact beef products to a temperature of 155°F as measured by a properly calibrated food thermometer as required by the FDA Food Code.

3. If you currently tenderize beef steaks or other beef products in your restaurant kitchen, please stop this practice.

4. Educate your staff about the identified risks of mechanically tenderized (non-intact) beef products.

5. When possible, notify consumers about the risk of getting E. coli from mechanically tenderized (nonintact) beef steaks and roasts

I wholeheartedly agree, particularly with any recommendation aimed at achieving elimination of bacterial contamination by the slaughterhouses, as well as with any recommendation that aims to educate the consumer about the risks he or she faces by consuming tenderized beef.  National Steak and Poultry, which of these steps were you actively taking at the time of the outbreak?

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Certain circumstances surrounding the National Steak and Poultry E. coli O157:H7 outbreak have me worried.  The pathogen is incredibly dangerous; the vehicle (non-ground beef products) is often not cooked to a high enough temperature to kill E. coli; many of the beef products recalled are frozen, thus extending the shelf-life, putting more people at risk over a longer time frame, and frustrating public health detection efforts; and perhaps most concerning, the list of products is really long: 

4-ounce “NATIONAL STEAK AND POULTRY BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “SC68408.”

6-ounce “NATIONAL STEAK AND POULTRY BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “SP680608.”

8-ounce “NATIONAL STEAK AND POULTRY BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “SC68808”

9-ounce “NATIONAL STEAK AND POULTRY BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “SC68908.”

“NATIONAL STEAK AND POULTRY BONELESS BEEF TIPS,” with an identifying case code of “69108.”

“NATIONAL STEAK AND POULTRY BONELESS BEEF SIRLOIN STEAK” with an identifying case code of “XXSP68008.”

“NATIONAL STEAK AND POULTRY SAVORY SIRLOIN TIPS” with an identifying case code of “XX69008.”

5-ounce “NATIONAL STEAK AND POULTRY BACON WRAPPED BEEF FILLET,” with an identifying case code of “23508.”

“NATIONAL STEAK AND POULTRY USDA SELECT BEEF SHOULDER MARINATED TENDER MEDALLIONS” with an identifying case code of “23289.”

“NATIONAL STEAK AND POULTRY 75% BONELESS BEEF TRIMMINGS,” with an identifying case code of “33575.”

"NATIONAL STEAK AND POULTRY BEEF TRIMMINGS,” with an identifying case code of “36545.”

“NATIONAL STEAK AND POULTRY BEEF SIRLOIN PHILLY STEAK,” with an identifying case code of “88008.”

4-ounce “EGN BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “680425.”

7-ounce “EGN BONELESS BEEF SIRLOIN TRI TIP STEAK,” with an identifying case code of “69725.”

9-ounce “EGN BONELESS BEEF SIRLOIN TRI TIP STEAK,” with an identifying case code of “680925.”

7-ounce “KRM BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “680715.”

9-ounce “KRM BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “680915.”

12-ounce “KRM BONELESS BEEF SIRLOIN STEAK,” with an identifying case code of “680215.”

8-ounce “CARINO’S BONELESS BEEF OUTSIDE SKIRT STEAK,” with an identifying case code of “130874.”

“CARINO’S BONELESS BEEF OUTSIDE SKIRT STEAK PIECES,” with an identifying case code of “13074.”

“MOE’S BEEF STEAK,” with an identifying case code of “78027.”

I suppose that only time, and the CDC, will tell how many people since September have been sickened, or died, in this outbreak.  We already know that there are victims in six states, including Washington, Michigan, South Dakota, Iowa, Colorado, and Kansas.  Maybe the final destructive tally will not be as large as the circumstances of this outbreak suggest that they could be.  But it certainly seems like a perfect storm, of sorts, to me.

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E. coli O157:H7 strikes again, this time stealing some of Santa's thunder and delivering a pile of bad news (for the meat industry, the consumer, everybody) on Christmas Eve.  The outbreak linked to National Steak and Poultry, an Oklahoma-based purveyor of pre-portioned beef products, has sickened people in Colorado, Iowa, Kansas, Michigan, South Dakota, and Washington.  I havent' yet seen reference to how many are thought to have been sickened in the outbreak, but a listing of six states stretching from the eastern time zone all the way to the west coast portends some bad news on that front.

There is never "down time" at Marler Clark.  We are constantly busy, sometimes almost too busy, representing people who have been sickened in E. coli and other outbreaks.  But this outbreak adds more than a few "to dos" to our lists at Marler Clark.  The epidemiological evidence so far establishes that people were falling ill in this outbreak as far back as September 09; it also suggests that we're dealing with a possibly frozen product--i.e. one that does not necessarily have a short shelf life (all the more reason for National Steak and Poultry to heed Bill Marler's call to release its customer list so that people don't continue to get sick). 

I can think of more than a few people who have called me since September who were ill themselves, or were distraught over the illness of a family member.  We investigate even the illnesses of those who are not part of a recognized outbreak, but even the lawyers at Marler Clark are sometimes limited by the known epidemiological evidence.  Now, however, after announcement of the National Steak and Poultry outbreak, we've got a heck of a lot more to go on.  I know what I'll be doing this afternoon, tomorrow, and into next week:  sorting through the files of probably one hundred E. coli victims who have called since September, looking for possible exposures to national steak and poultry products.   

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New research suggests a connection between foodborne E. coli bacteria and urinary tract infections.   This report details the findings of Professor Amee R. Manges, McGill University, on the link.  The study was recently published in the January issue of Emerging Infectious Diseases.

E. coli is the generic term for a family of bacteria that includes a number of strains, most prominently E. coli O157:H7, that are known to cause severe food poisoning, as well as the risk of serious complications, in humans.   Dr. Manges research is now also suggesting a link to urinary tract infections: 

Researchers have found the same strains of the bacteria in chicken from stores and restaurants and in women with the infections.  In their study, Manges and her research colleagues wanted to find out if the same strains of E. coli were present in both meat and in women with urinary tract infections.  They studied 353 samples from Canadian women, ages 18 to 45, who had suspected urinary tract infections. They also examined samples of chicken and honeydew melon from stores and restaurants in Canada. The researchers found that several strains of E. coli found in the women and in the food were indistinguishable or closely related.

It does not appear that the bacteria was transmitted directly from the food into the urinary tract.  Rather,  "It's possible for bacteria to travel from the anus to the vagina and urethra, and that's where it ultimately causes the infection," Manges reports.  

Urinary tract infections of this sort are a particular risk in older people: 

Urinary tract infections caused by transmission from feces "are most common in older and debilitated individuals in whom the risk of fecal contamination of the urethral orifice is a significant risk, especially in a setting of fecal incontinence," added Dr. Pascal James Imperato, dean of the School of Public Health at the State University of New York Downstate Medical Center in Brooklyn, N.Y.

This report is more evidence that the breadth of the risk associated with contaminated foods is generally under-reported and under-rated.   Certainly more research is warranted.  Still, if any significant portion of urinary tract infections in the US are food related,  the impacts of food poisoning have not been fully tabulated.

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 The Washington State Departments of Health and Agriculture today released information linking recent E. coli illnesses in Washington State to raw milk produced by the Dungeness Valley Creamery in Sequim, WA.  See www.marlerblog.com.  I will point out up front that the Dungeness Valley Creamery, which appears to be where the milk was produced, is a dairy properly licensed in Washington to sell raw milk.  I would ban the sale of raw milk from any dairy in the country, personally, whether licensed or not, but that is not the point of this post.  Every time a raw milk outbreak happens, which is relatively frequently, it causes me to think how many options there really are for people who are looking to purchase the product . . . even in states that otherwise ban it.  

I talked recently in an article on foodsafetynews.com about the deceptive, transparent efforts of many unlicensed dairies to sell raw milk under the guise of cow-share agreements.  Read the article here.  First of all, these arrangements are patently illegal in most states, including Washington, and even states where the Legislature has not specifically condemned them.  Read Washington State Dept of Agriculture's views on cow-share agreements for a perfect example.  And second, it's really a little scary to think that, because these dairies are selling raw milk without having to meet state licensure requirements, some of them produce their product under some terrible conditions. 

 Dee Creek Farm in Woodland Washington was a prime example. Prior to the December 2005 outbreak, Washington State Department of Agriculture (WSDA) had learned of Dee Creek Farm’s cow-share program, and had ordered the farm to cease the dispensing, giving, trading, or selling of milk or to meet requirements for selling milk that had been laid out by WSDA. The letter was sent in August, 2005, and WSDA received a response from Dee Creek Farm in September, 2005, stating that the farm was not selling milk but that the farm’s owners intended to meet requirements for a milk producer and retail raw milk processor in the future.

During the December investigation into the E. coli outbreak, WSDA noted several milk processing violations that would have been addressed during the licensing process had Dee Creek applied for the license. Among the violations were the following:

1. No animal health testing documentation for brucellosis and tuberculosis or health permits
2. Beef cattle contact with wild elk
3. No water or waste water system available at milk barn for milking operations or cleaning
4. No hand washing sinks available for cleaning and sanitizing
5. No bacteriological test results available for the farm’s well-water system
6. Mud/manure with standing water at the entrance to the milk barn parlor
7. Milking bucket in direct contact with unclean surfaces during milk production
8. Multiple instances providing for the opportunity for cross-contamination
9. No separate milk processing area from domestic kitchen
10. No raw milk warning label provided on containers

In addition, sample testing confirmed the presence of E. coli O157:H7 in two milk samples provided by Dee Creek Farm and in five environmental samples taken from Dee Creek Farm milk-barn areas by investigators.

When its investigation was completed, WSDA had identified eighteen people who had consumed raw milk purchased from Dee Creek Farm through the cow-share program and developed symptoms consistent with E. coli infection. Five Clark County, Washington, children were hospitalized, with two developing hemolytic uremic syndrome and requiring critical care and life support for kidney failure as a result of their E. coli infections.

Maybe none of these illnesses would have been prevented had the dairy met the licensing requirements of the state. But maybe the entire outbreak wouldn't have happened. Had Dee Creek become properly licensed before the outbreak, many of the violations noted above would have been far less likely to have occurred.

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Fairbank Farms recently recalled over 500,000 pounds of ground beef due to contamination with E. coli O157:H7.   The contaminated beef led to 25 illnesses, including two deaths, in 10 states.  In light of this Rep. Rosa DeLauro (D. Conn) is calling for an investigation into the method of sampling ground beef for the deadly bacteria currently approved by the USDA. 

The sampling method, referred to as N-60, dictates what proportion of ground beef is sampled in a company's E. coli O157:H7 testing program.  According to Agriculture Online, Rep DeLauo says:  "I am troubled by the shortcomings of the N-60 test ... and that is why I am requesting an investigation into the scientific merits of this beef-testing protocol."    DeLauro says that even though  Fairbank Farms "samples product every 10 to 20 minutes to check for contamination ... it was not enough to prevent contamination."

The meat industry defended its practice to Agriculture Online:

James Hodges, executive vice president of the American Meat Institute, said the AMI doesn't oppose an investigation, but he stressed the testing method is sound. He called the testing method "a scientifically recognized statistical sampling method that is widely used in the industry to test for the presence of pathogens in meat products."

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 The CDC did not provide any updated statistics today about the number of people sickened in the ongoing E. coli O157:H7 outbreaks linked to ground beef (still 26 illness in 11 states, with 2 deaths and 3 HUS), but the Food Safety and Inspection Service (FSIS) did update the list of retail stores who may have received contaminated ground beef.  The list is long and comprehensive and, to me at least, suggests that the number of people who may be involved in at least the Fairbank Farms outbreak may continue to grow.  See the FSIS update here.

 Here is the short version:  

Shaws in Connecticut, Maine, Massachussetts, Rhode Island, New Hampshire and Vermont

Price Chopper in Connecticut, Pennsylvania, Rhode Island, and Vermont

Acme in Delaware, Maryland, New Jersey, and Pennsylvania

Giant in Pennsylvania

Pathmark in Delaware, New Jersey, New York, and Pennsylvania

Food Lion in North Carolina, South Carolina, Virginia and West Virginia

Trader Joe in Connecticut, Delaware, Maryland, Massachussetts, New Jersey, New York, and North Carolina

BJ in New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Virginia

Martins in Maryland, Pennsylvania, Virginia, and West Virginia

Great American in New York

IGA in Maine, New York, and Vermont

Surefresh in Delaware, Maryland, and Pennsylvania

Grand Union in Connecticut and New York

A&P in New Jersey and New York

Waldbaum in New York

C&S in Vermont

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 The CDC reports today that there are currently only 26 illnesses in 11 states that are linked to the Fairbank Farms E. coli O157:H7 ground beef outbreak and recall.  This represents a reduction in the number of cases attributed to the outbreak by two.  

Here is the outbreak rundown:

On October 31, 2009, FSIS issued a notice about a recall of over 500,000 pounds of beef products from Fairbank Farms that may be contaminated with E. coli O157:H7. Health officials in several states who were investigating a cluster of E. coli O157:H7 illnesses, with isolates that match by “DNA fingerprinting” analyses, found that most ill persons had consumed ground beef, with several purchasing the same or similar product from a common retail chain. At least some of the illnesses appear to be associated with products subject to these recalls. A sample from an opened package of ground beef recovered from a patient's home was tested by the Massachusetts Department of Health and yielded an E. coli O157:H7 isolate that matched the patient isolates by DNA analysis.

The cluster includes 26 persons from 11 states infected with matching strains of E. coli O157:H7. The number of ill persons identified in each state is as follows: California (1), Connecticut (4), Massachusetts (8), Maryland (1), Maine (2), Minnesota (1), New Hampshire (4), New Jersey (1), New York (1), Pennsylvania (2), and Vermont (1). Of these, the genetic association of 13 human isolates and the product isolate have been confirmed by an advanced secondary DNA test; secondary tests are pending on others. Depending on the results of continuing laboratory testing and ongoing case finding, the number of persons determined to be in this cluster may increase or decrease.

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Recently, certain sectors have argued that the incidence of E. coli O157:H7, and other shiga-toxin producing strains of E. coli, in ground beef has dropped precipitously, and that our food safety system is, as a result, working very well.  At Marler Clark, over the last several years—in fact, beginning with the infamous Dole baby spinach outbreak in September 2006—fully 90% of the people we have represented have been victims of severe E. coli O157:H7 infections, sometimes resulting in hemolytic uremic syndrome; and aside from approximately 100 spinach victims, 95% of these folks were sickened by contaminated ground beef.  In fact, with the recent, virtually simultaneous recalls of about 546,000 pounds of ground beef by South Shore Meats and Fairbank Farms, 45,000,000 pounds of ground beef have been recalled in the last two years.  These statistics sure don’t jibe well with any optimism about our food safety system, as a whole, or ground beef more specifically. 

As recently as the beginning of 2007, the beef industry touted that the incidence of E. coli O157 in meat had plummeted since the 1990s, dropping nearly 80%. The rate of actual illnesses in people, it was said, was also way down. It appeared, by both statistics and the profiles of our clients at Marler Clark, that the meat industry had indeed cleaned up its act—that big beef finally would put Bill Marler's firm in Seattle out of business.

If the first several years of this millennium showed progress by the beef industry, 2007, 2008, and 2009 are years that it would rather forget. Beef companies recalled over twenty-nine million pounds of meat in 2007. 2008 saw at least sixteen recalls of beef products, totaling at least 2,361,295 pounds of meat. And to date in 2009, beef companies have recalled close to two million pounds of product, if not more. True enough, these are just bare numbers—courtesy of the USDA website—but a simple contrast with the first five or six years of this millennium are illustrative. Progress? Optimism? I don’t see it.

Ultimately, these numbers may serve the opposing perspective directly: more recalls may mean more testing, but it does not necessarily mean more illness. To that, all we can really say is that, well, we’ve sure as heck seen a lot more sick people in the last three years than we did the six previous ones. Indeed, there are more than a few families that I can think of around the country who would be shocked—probably even dismayed—to learn that our “food-safety system is working, even though the number of recalls is rising.”

Let me make a different assessment; perhaps it will be a better platform from which to build a national, and international, food-safety system that’s more in keeping with what consumers expect: no, we are not making good enough progress; and no, I don’t agree that the increased number of food recalls (ground beef in particular) is just because of better testing, and more surveillance within the public health community. Take it for what you will, but we have represented more victims of foodborne disease in the last three years alone that we did in the entirety of this firm’s first decade of existence.

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 Tuesday morning, we will be filing lawsuits on behalf of the families of two children sickened in the ongoing, likely developing, outbreaks of E. coli O157:H7 linked to ground beef.  The lawsuits will be filed in Plymouth County Superior Court for the Commonwealth of Massachussetts against Brockton, Mass.-based Crocetti-Oakdale Packing, Inc., doing business as South Shore Meats Inc., and Ashville, NY-based Fairbank Farms, Inc. Both companies recalled meat last week after their products were identified as the source of a national E. coli outbreak.

The medical complications associated with E. coli O157:H7 infection are many.  Most infections are characterized by 7-10 days of diarrhea, frequently bloody, severe abdominal cramps, and a host of other painful symptoms.  Infection by this dangerous pathogen frequently results in hospitalization, and kills with frightening efficiency and regularity.  Those who are acutely susceptible to severe infection whether by age or immuno-compromisation frequently have dangerously severe medical courses.  

Far and away the most frightening medical complication associated with infection by E. coli O157:H7, however, is hemolytic uremic syndrome, or HUS.  The chain of events leading to HUS begins with ingestion of Stx producing E. coli (e.g., E. coli 0157: H7) in contaminated food, beverages or through person to person transmission. These E. coli rapidly multiply in the intestines causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin. Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).

Once Stx attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade which results in the formation of clots in the very small vessels of the kidney resulting in acute kidney injury and failure. The red blood cells are hemolyized (destroyed) by Stx and/or damaged as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.

 

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Earlier today, the CDC posted the following update on the E. coli O157:H7 ground beef outbreak and recall on its website:

Several state health departments, CDC, and the United States Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS) are investigating a multi-state outbreak of Escherichia coli O157:H7 infections. On October 31, 2009, FSIS issued a notice about a recall of 545,699 pounds of beef products from Fairbank Farms that may be contaminated with E. coli O157:H7. Health officials in several states who were investigating a cluster of E. coli O157:H7 illnesses, with isolates that match by “DNA fingerprinting” analyses, found that most ill persons had consumed ground beef, with several purchasing the same or similar product from a common retail chain. At least some of the illnesses appear to be associated with products subject to these recalls. A sample from an opened package of ground beef recovered from a patient's home was tested by the Massachusetts Department of Health and yielded an E. coli O157:H7 isolate that matched the patient isolates by DNA analysis.

The cluster includes twenty-eight persons from 12 states infected with matching strains of E. coli O157:H7. Of these, the genetic association of 7 human isolates and the product isolate have been confirmed by an advanced secondary DNA test ; secondary tests are pending on others. The number of ill persons identified in each state is as follows: California (1), Connecticut (4), Massachusetts (8), Maryland (1), Maine (2), Minnesota (1), New Hampshire (4), New Jersey (1), New York (1), Pennsylvania (2), South Dakota (2), and Vermont (1).

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FSIS today released the identities of retail stores that may have received E. coli O157:H7-contaminated ground beef involved in the current recall by Fairbank Farm.  All Shaw's stores in Connecticut, Maine, New Hampshire, Rhode Island, Massachussets, and Vermont may have received contaminated meat; and all Price Chopper stores in Connecticut, Pennsylvania, New York and Vermont may have received contaminated meat.  The CDC now reports that 2 deaths and 26 illnesses may be linked to the Fairbank Farm recall, with the majority of illnesses coming from New England residents.  Fairbank Farm has recalled approximately 546,000 pounds of fresh ground beef. 

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New information on the cluster of E. coli O157:H7 illnesses among Rhode Island students sickened through consumption of ground beef at a camp in Massachusetts, as reported on by the Rhode Island Department of Health:

The Rhode Island Department of Health (HEALTH) advises Rhode Islanders that the South Shore Meat packing plant in Brockton has initiated a voluntary recall on certain ground beef products based on confirmed laboratory evidence of the presence of E. coli O157:H7 in leftover ground beef samples obtained from Camp Bournedale in Plymouth, Massachusetts. The ground beef was tested by the Massachusetts Department of Public Health (MDPH) after more than 20 students and chaperones from Lincoln Middle School became ill.

Still no indication where else the ground beef may have gone, or what lot codes or production days might be involved.   As a result, this ground beef may still be on shelves and in freezers in consumers' homes.

 

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It's not much good to announce the recall of 4,000 pounds of ground beef for E. coli O157:H7 contamination when no one knows where the beef went.  According to this report, state health officials in Texas are working with the owner of Culebra Meat Market No. 1 in San Antonio to determine which restaurants purchased meat there that may be contaminated with E. coli O157:H7.  The report states that:

State health services officials said a routine lab test detected E. coli O157:H7 in samples collected from the meat company.  The volume of beef in recall is about 4,000 pounds, the Texas Department of State Health Services said in a statement, and includes three cuts: beef asada, beef stew meat and ground beef produced by the company from Oct. 2 through Saturday.

Likely because there is uncertainty as to where the meat went, a list of restaurants that may have purchased the beef has not been released.  This is a common problem with recalls that greatly reduces their effectiveness in getting full information to consumers.

The products involved, according to the report:

• Products sold to consumers at the company's retail store were packaged in various weights and wrapped in white butcher paper with no markings.
• Products sold to restaurants were packed in 10-pound boxes labeled with the company and product names and lot codes 100209 through 101709. The boxes have the inspection label “TEXAS INSP. & PSD. 740” located inside an outline of the state of Texas.

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 A Florida woman who runs an organization called Miami Real Food has petitioned Whole Foods, one of the nation's largest organic grocers, to continue selling raw milk.  See the entire petition here.  The petition states, in part, 

[R]aw milk from grass-fed cows is infinitely healthier than those that are kept in confinement dairies. Times have changed and modern stainless steel tanks, milking machines, refrigerated trucks and inspection methods make pasteurization absolutely unnecessary for public protection.

Our firm's thoughts on the sale and consumption of raw milk have been stated loudly and clearly for years.  If you haven't read the first two parts of Bill Marler's recent four part series on the safety of pasteurized milk versus raw (unpasteurized) milk, please do so.  See Part I, and Part II.  The reality , and the reason why so many states have made the sale of raw milk illegal, is that there really is no way to produce the product safely.  

Think about where milk comes from, and the proximity of that anatomical area to where E. coli O157:H7 and other pathogens in a cows digestive tract comes from.  And aside from this admittedly simplistic analysis, occasionally some of these harmful bacteria cause mastitis (infection and inflammation of the udder), and may be shed directly into the milk.  Moreover, milk is not always drawn from a cow or other animal in a sterile environment--particularly in the case of raw milk, which is often produced and sold by small-scale, oftentimes unlicensed farmers, who simply do not have the resources to ensure that their product is being produced in a sterile, safe environment.  

My point is not that small, local farms should be targeted or branded as unsafe, or unconcerned with the production of safe food products.  I'm sure that the truth is exactly the opposite, for the most part.  But that does not alter the truth about raw milk, and it doesn't make the product any safer if the farmer who produced it simply lacked the resources to ensure a safe and sanitary milking environment.  

Thus, returning to the Florida woman's petition to Whole Foods to continue selling raw milk, she shouldn't be begrudged for having a devotion to more natural foods.  But her petition is indisputably misleading.  "Times have changed," true enough, but not so much that the production methods employed by many raw milk producers "make pasteurization absolutely unnecessary for public protection."  

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New research conducted in Israel suggests that the method that some bacteria, including Sallmonella, are enetering leafy greens is connected to light exposure, as reported today on an L.A. Times blog. 

The new study was published in the journal "Applied and Environmental Microbiology."  The findings, as reported by the L.A. Times:

Salmonella penetrates the lettuce leaf's deeper surfaces by entering little pores called stomata. These are the pores plants use to obtain and release gases during photosynthesis--the vital process by which light energy is captured and turned into sugars. There are rather nasty pictures in the article of rod-like salmonella clustered all around these stomata, seemingly going down into them and thus into the inner parts of the leaf.

The infromation could prove useful in limiting bacteria's access to leafy greens.  Such a step might help stem the tide of foodborne illness outbreaks tied to spinach, lettuce and other greens, involving pathogens like E. coli O157:H7, Salmonella, and Hepatitis A.

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New information in a continuing story we have been following here: Susan Medley, the former spokeswoman for the Missouri Department of Natural Resources (DNR)  told Senate investigators that the delay in the release of information about high bacteria levels at Lake of the Ozarks "stemmed from a department failure to quickly gather information to put the contamination levels into a historical context" according to a Columbia Daily Tribune report.

I am nor really sure what that is supposed to mean.  It has been previously reported that the delays were aimed at protecting local businesses.  Medley did say she was in contact during the delay in the release of the information with officials at Gov. Jay Nixon's office. 

Also according to the report:

The delay in releasing the data was caused, Medley said, by the failure of other DNR officials to provide additional data she sought — information on rainfall that could affect the samples and a history of the data collection. Medley said that despite repeated requests to DNR Director Mark Templeton and then-deputy director Joe Bindbeutel, she didn't get the information she needed. Bindbeutel has since left the agency and has said he made a mistake by not getting the information out sooner.

E. coli is the term for a family of bacteria that include the dangerous and pathogenic E. coli O157:H7.   Generally, water testing conducted to ascertain levels of E. coli is not specific enough to differentiate among various strains. 

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According to the results of a study recently published by the CDC, the incidence of dangerous and under-reported non-O157 E. coli infection is on the rise. E. coli is the term given to a large family of bacteria. Within that family, E. coli O157:H7 has been recognized as pathogenic to humans. As a result, E. coli O157:H7 is a reportable disease in the U.S. The dangerous pathogen is credited with more than 70,000 illnesses, over 2,000 hospitalizations and 61 deaths each year.

This may only be half the story. There is mounting evidence that other non-O157 strains of E. coli are responsible for a significant numbers of illnesses in the U.S. These other strains, referred to as non O157 STECs, or shiga-toxin producing Escherichia coli, cause illness just like E. coli O157:H7, but are currently under-reported, and, as a result, under-regulated.

The study, conducted by a team of scientists lead by Sarah Lathrop, consisted of a review of data collected in New Mexico from 2004 to 2007. The results revealed that non-O157 STEC present a significant threat to public health:

The data collected by New Mexico's FoodNet surveillance network indicate that sporadic STEC cases increased substantially from 2004 through 2007. Reports of STEC O157 infection doubled from 7 to 14 from 2004 to 2006 but dropped to 9 in 2007. However, the number of non-O157 STEC cases continued to climb and accounted for most of the increase in overall STEC rates in New Mexico during this time, similar to rates in Connecticut.

The study also noted that non-O157 STEC made up a majority of all of STEC infections identified: “Non-O157 STEC infections ranged from 52% to 74% of all Shiga toxin–positive cases diagnosed each year and 64% of all identified STEC cases."

Information indicating that Non-O157 STECs might make up half, or more, of all STEC infection, is consistent with previously reported results from Europe.

What does this mean? It means that we are likely tracking and responding to only a fraction of actual STEC illness in the U.S. To adequately protect the population, non-O157 STEC needs to be treated like the equally dangerous, and apparently equally common O157:H7 strain.

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The "World of Animal Life" exhibit in Devon, England, has closed as health officials investigate links to  three more people with E. coli O157:H7 infections.   According to a BBC report: 

In a statement, the Health Protection Agency said: "East Devon District Council and the Health Protection Agency this afternoon advised the precautionary closure of the World of Country Life farm, Exmouth, acting on information that potentially linked the farm with three individuals with confirmed E.coli O157 infection.

The exhibit is the fourth to shut in recent days.   As reported on this blog, 49 cases of E. coli O157:H7 have been linked to the Godstone Farm in Surrey.  A related farm shut over hygiene concerns.  The fourth farm was closed pending an investigation of an apparently unrelated cluster of illnesses.

Outbreaks of E. coli O157:H7 at petting zoos are far from a new phenomenon.  More than two dozen outbreaks of illness from various pathogens have been linked to animal exhibits in the U.S. and U.K.  For more information see www.fair-safety.com

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I haven't been in half as many living rooms as the partners at Marler Clark have, but I've certainly seen a lot of suffering over the past six years, doing what we do.  Kids on dialysis; adults suffering in the miserable comfort of a hospital bed after having big pieces of their intestines surgically removed; and the permanently reddened eyes of elderly widows who have lost their World War II hero husbands of 50 years.  And, today I visited Stephanie Smith.  

When you see in living color what these people have endured, you can't help but think what life would be like had things turned out just a little different--if I had chosen one package of ground beef or spinach over another; or if it was my mom or dad who had died.  What if I was the one who could no longer do something as simple as run my dogs after getting home from work?

More often than not, when I think about the people we represent at Marler Clark, I can't help but frame my thoughts against the backdrop of one particular remark that I overheard from an executive of a national organic grocery chain.  It was during the legislative debate in California over the passage of a bill concerning bacteria levels in raw milk.  

I was lucky enough to sit two chairs away from him, and unlucky enough to hear what he said quietly to his friend beside him in response to testimony questioning the health benefits of raw milk.  After somebody testified about the particular vulnerability of the young, elderly, or immune-compromised, the guy said with a roll of his eyes, "Oh here we go, the straw man argument"--as if it were junk science of the sort typically espoused over the "benefits" of consuming raw milk.  

My guess is that this particular person had never seen the inside of an intensive care unit.  He's never seen a young mother who was just told that her first born will lose his kidneys by the time he's 21, and he's sure as hell never come face to face with a girl who can't even walk because she ate a hamburger.

Though it may not sound like it, I certainly don't fault food manufacturers for their typically human responses.  It's natural, sometimes, for people to fail to be moved until they are forced to confront an uncomfortable reality.  And I also admit to being more than a little on edge as I write this on the plane back to Seattle after visiting Stephanie Smith.

But I do fault the people, like the executive from the raw milk hearing in California, who apparently are simply unwilling to confront the reality of foodborne disease--that people do get more than a few days of diarrhea, and that young and old people, and sometimes even supremely healthy teenagers, can suffer devastating, life-altering injuries.  The truth of the matter is that there is no room for even the slightest bit of jocularity or passivity when it comes to this stuff. 

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 The 2000 movie called “The Perfect Storm” loosely chronicled the destruction of an Atlantic nor’easter that formed due to the random convergence of several destructive weather patterns. Twelve people died in the storm, including six sword fishermen aboard the Andrea Gail (captained by George Clooney’s in the movie). Today is September 14, 2009, marking three years since the convergence of another set of tragic circumstances, ending in hundreds of millions of dollars in damages, many lives lost, and many more lives changed forever:  the 2006 Spinach E. coli outbreak.

Though there were no rough-hewn sword fishermen dying in the Grand Banks, perhaps more than any other outbreak of foodborne disease that we have seen, the spinach outbreak in September 2006 really was the perfect storm. The vehicle, Dole baby spinach, was a nationally-distributed, high-volume product eaten raw by people in every age group, including the young and the old. Contamination on the product was widespread, as is apparent from the severity and number of illnesses caused. And the strains of shiga-toxin producing E. coli involved, again as judged by the severity and number of illnesses caused, were simply more virulent than the strains we typically see.

But just like George Clooney’s movie, the spinach outbreak is truly memorable because of the suffering it caused. Ultimately, the outbreak cost the leafy greens industry over $175 million, maybe more, ruining a brand name; and more importantly, over 200 people were sickened, 102 were hospitalized, and at least thirty-one people developed HUS, five of whom died. Among the five who passed away were Betty Howard, Ruby Trautz, and June Dunning. All three were beloved mothers and grandmothers, and all three died undeservedly shameful, protracted deaths.

The deaths of these three women have been described often enough, however. So it is thus in tribute to Betty, Ruby, and June, and their families, on this third anniversary of the spinach outbreak, that we remind everybody just briefly about these wonderful ladies’ lives.

Betty Howard was born on September 14, 1923 in Sharon Springs, Kansas. She graduated high school in Salina, Kansas in 1941. Like others of the GI Generation, during World War II Betty did her part by working in a gunpowder plant in Oklahoma. After the war, she moved to Yakima, Washington, where she met John W. Howard. The striking young couple married on February 26, 1947.

John and Betty Howard raised four sons: Kim, Paul, Brian, and Darryl. Kim, the Howard’s first son, died in 1998. Paul, Brian, and Darryl are independent, successful men with families of their own. And to a man, each reflects on his childhood, and his mother more specifically, as idyllic in both appearance and reality.

The Howard boys’ mother left an indelible impression on each from day one, most significantly the way in which she lived and conducted her life. Darryl Howard eulogized his mother on February 1, 2007. He stated:

As I thought back this morning, it reminded me of the movie Second Hand Lions.

Two uncles raise a son of a relative. They tell him of their unbelievable adventures. Adventures in the Foreign Legion, tales of saving a girl, and wittingly getting a reward of gold offered for their own heads from a Saudi Prince.

In the end after the two 90-year old uncles pass away by flying their bi-plane into a barn, the boy returns to the farm and this helicopter lands. There is the son of the Saudi Prince with his son. They had heard of the uncles’ passing. The Prince looks over at a large yacht in a small pond and comments: “I see they spent my father’s money well.” Hearing this, the Prince’s son exclaims “So the stories grandfather told of the men are true, they really lived.” To which the boy who the uncles raised, now a man, says: “Yeah, they really lived, boy how they lived.”

My mom and dad really lived.

June Dunning was born on June 20, 1920 in Catford, England. She met her future husband, Arthur Gordon Dunning, a US citizen born to British parents, some years later while working in London. Arthur was then working at Scotland Yard. June and Arthur married in Sussex, England on April 24, 1943.

Arthur thereafter joined the U.S. Army, and he and June spent the majority of the next 20 years living in and around Europe. Their army life resulted in frequent moves, and June held numerous jobs over the years at various Army Base stores. They were eventually transferred to Fort Ritchie, Maryland, where Arthur retired. June and Arthur moved to Hagerstown, Maryland in the mid seventies.

For the last seven years of her life, June lived in Hagerstown, Maryland with her daughter, Corinne Swartz, and her son-in-law, Warren Swartz. Corinne recalls her mother as “a proper British lady that loved her tea, meticulously cared for her flowers and plants and adored our Yorkshire Terrier ”Roxie” whom she walked almost every day until the day she became ill. Neighbors often commented on how they enjoyed watching her walk around the neighborhood with the Yorkie by her side."

June remained independent to the last. She enjoyed heading into town on her own. In fact, Corinne and Warren purchased their home at its location in part due to its proximity to a Hagerstown bus stop. This allowed June to pack a bag for the day, scurry to the bus stop, make a transfer in the downtown square and then ride a second bus to the Mall for a day of shopping, or for an evening of Bingo.
“She never complained about anything,” Corinne recalls, “unless it was raining. The rain always made her mad because she would probably not go out that day. She was an avid shopper. I’m sure the department stores at the Mall have felt the effects of the sudden lack of sales. Finding bargains was a favorite past-time of hers. She often came home after riding the bus from the mall with her arms full of the day’s ‘good buys’.”

Ruby LaFon Trautz was born in the back seat of a car on February 2, 1925 in Manzanar, California. She was the second of four girls born to working class parents, Maude and Paul LaFon. Typical of the era, Maude was a homemaker and Paul, Ruby’s much-beloved father, worked construction.

Ruby and her sisters lived their formative years in a home on Settle Avenue in San Jose, California. The girls sprouted from their humble origins to become cultured, ambitious young women. The personal history of each is remarkable; and Ruby’s, in particular, shows an early bent toward the vibrant and confident persona that she carried throughout her life.

Characteristically, Ruby was not enamored with many of the “social constraints” extant during her adolescent and early adult years. She was, and so remained until the day she died, determined to shape her own life. Thus, she was consistently employed from her adolescent years, through high school, and, after a respite of fifteen years to care for her two girls, consistently until retirement at age 65. Most of her early jobs were military in some fashion, or related to the war effort at least, and she quickly found her calling in the nursing field.

Ruby began training for her nursing career at Santa Clara County Hospital in 1943. She would remain there until 1946, when she transferred to a program at Queen of Angels Hospital in Los Angeles, where she worked in obstetrics and orthopedics. The picture below is of Ruby shortly after graduation from nursing school. Afterward, she returned to Santa Clara County Hospital, where she worked in surgery until commissioned as a 1st Lieutenant in the Air Force in 1950.

It was in her capacity as an Air Force Lieutenant that Ruby served as a flight nurse aboard planes flying wounded Korean War soldiers from base to base—a role that Ruby considered the single-most important of her distinguished medical career. By chance, or perhaps provenance, Ruby’s thoughts about the time she spent in that critical role are memorialized. Students from Conestoga School District in Murray, Nebraska recorded them in an interview several years ago about female war veterans:

Ruby’s job was to help the wounded [] soldiers get on the planes and to help medically while they were transported back to a hospital closest to their homes to continue their medical care or to die. The soldiers would come in on Navy planes to Travis AFB, CA and the nurses would fly on Navy or Air Force planes to get them closer to homes.

The nurses were very much in charge once the patients were on the plane. . . . Nurses essentially had power over the pilots because they could request that the pilots find an airfield to land at anytime if they felt a patient needed to be at a hospital or with a doctor. She requested a plane be taken down to Ft. Knox, KY.

Ruby would often sign in at 3 a.m. and take off at 7 a.m. Her days were typically 12-14 hours. They would land in 7-8 places a day. Sometimes nurses were left at the last stop and it might take 2-3 days to hitch a ride on another plane home. . . .

I asked Ruby what the injury types were. She said it was very sad, they were young kids. They usually had bad injuries like amputations, gun shot wounds, and schizophrenia caused by the war.

Many who knew Ruby Trautz would say that she remained vibrant until she was sickened in the spinach outbreak. Confident, independent, and informed are other adjectives not unfamiliar to Ruby’s description—some might even say feisty. To a person, however, no matter the adjective used, everybody who knew Ruby Trautz agrees that, even at age 81, she remained the dominant force in her own life. As Polly Costello, one of Ruby’s two daughters stated, “my mom was living her life, not waiting for death.”

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A lab worker at the Center for Nanoscale Science and Engineering at North Dakota State who works with E. coli has developed a gastrointestinal illness, according to "In Forum" out of Fargo, North Dakota.

There has not been confirmation as to whether the illness is in fact an E. coli infection.   University officials, are however, taking precautions.

E. coli is a family bacteria, some of whose members cause severe gastrointestinal illness.  Best known among these is E. coli O157:H7.   E. coli O157:H7 infection can lead to a complication known as hemolytic uremic syndrome (HUS).   HUS is a potentially fatal condition that also may leave survivors with permanent kidney injury.

I was not able to find evidence of a reported incidence of E. coli infection linked to laboratory research previous to this potential case.

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The majority of the E. coli O157:H7 cases we pursue involve the consumption of contaminated food or drink.   It is possible though, for E. coli O157:H7 to be transmitted from person to person, through fecal-oral transmission.   Such transmission is more likely in a day-care settings. 

BBC news is reporting on the closure of the "Going Places Day Nursery" in the UK after 3 children fell ill with E. coli O157:H7 infections.  One child is hospitalized.

The apparent link between these E. coli O157:H7 infections and the day-care do not rule out contaminated food or drink as the source.  Food or drink served at the day-care may be the source.   It is also possible, though, that the illness was spread among ill children.  A third possibility is that illnesses can be attributed both to contaminated food (in one or more primary illnesses) followed by person-to-person (secondary) illnesses. 

The nursery says "an inspection had shown no links to the nursery kitchen "or any of our procedures".

Marler Clark has previously represented the families of children that developed E. coli O157:H7 infections in day-care settings.

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The Wisconsin State Journal recently published an excerpt from an interview on the increased number of food recalls we have seen in the last few years.  In the interview, Dr. Kathleen Glass of the Food Research Institute at UW-Madison concluded, in part at least, "That the food-safety system is working, even though the number of recalls is rising."  This inspired me to respond with a slightly different take on the safety of our food safety system as a whole.

Over the last several years—in fact, beginning with the infamous Dole baby spinach outbreak in September 2006—fully 90% of the people we, at Marler Clark, have represented have been victims of severe E. coli O157:H7 infections, sometimes resulting in hemolytic uremic syndrome. And aside from approximately 100 spinach victims, close to 95% of these folks were sickened by contaminated ground beef. This may be nothing more than a real world application of non-scientific fact. Whatever the case, it sure doesn’t jibe well with Dr. Glass’s optimism about our food safety system, as a whole, or ground beef more specifically.

Certain sectors expressed sentiments similar to Dr. Glass’s as recently as the beginning of 2007, touting that the incidence of E. coli O157 in meat had plummeted since the 1990s, dropping nearly 80%. The rate of actual illnesses in people, it was said, was also way down. It appeared, by both statistics and the profiles of our clients, that the meat industry had indeed cleaned up its act—that big beef finally would put Bill Marler and his firm in Seattle out of business.

If the first several years of this millennium showed progress by the beef industry, 2007, 2008, and 2009 are years that it would rather forget. Beef companies recalled over twenty-nine million pounds of meat in 2007. 2008 saw at least sixteen recalls of beef products, totaling at least 2,361,295 pounds of meat. And to date in 2009, beef companies have recalled close to one million pounds of product, including the recent recall of 825,000 pounds due to possible Salmonella contamination. True enough, these are just bare numbers—courtesy of the USDA website—but a simple contrast with the first five or six years of this millennium is illustrative. Progress? Optimism? I don’t see it.

Ultimately, these numbers may serve Dr. Glass’s points directly: more recalls may mean more testing, but it does not necessarily mean more illness. To that, all we can really say is that, well, we’ve sure as heck seen a lot more sick people in the last three years than we did the six previous ones. Indeed, there are more than a few families that I can think of around the country who would be shocked—probably even dismayed—to learn that our “food-safety system is working, even though the number of recalls is rising.”

Let me make a different assessment; perhaps it will be a better platform from which to build a national, and international, food-safety system that’s more in keeping with what consumers expect: no, we are not making good enough progress; and no, I don’t agree that the increased number of food recalls (ground beef in particular) is just because of better testing, and more surveillance within the public health community. Take it for what you will, but we have represented more victims of foodborne disease in the last three years alone that we did in the entirety of this firm’s first decade of existence. 

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BBC has been following an E. coli O157:H7 outbreak among attendees of a dance camp held in Cresselly, Wales.  At least thirteen people who attended the dance camp have reported symptoms consistent with E. coli infection since the camp's conclusion on August 9.  

While the investigation is ongoing and a source has

not yet been identified, the current outbreak resembles a 2002 E. coli outbreak among attendees at a dance camp held at Eastern Washington University (EWU) in Cheney, Washington.  That outbreak was ultimately traced to contaminated romaine lettuce sold by Spokane Produce, and included cases from a cafeteria dinner on a Spokane campus, lunch the following day from the same cafeteria, a restaurant salad in Spokane County, romaine lettuce purchased at several Spokane-area grocery stores, two restaurant salads in Walla Walla County, and romaine served at a restaurant in a Midwestern State.

We trust that educational institutions serve safe food, but the reality is that the E. coli outbreak associated with lettuce served at EWU was not an anomaly.  In 2003, an E. coli outbreak associated with prepackaged lettuce included victims from school districts in San Diego County.  Last year, another lettuce-associated E. coli outbreak sickened students at Michigan State University and the University of Michigan.  The lettuce was supplied to the schools by Aunt Mid's Produce Company of Detroit, Michigan.

It will be interesting to learn what Welsh public health authorities determine to be the source of the current dance camp-related E. coli outbreak.  Whether the source is lettuce or some other food, it is a good reminder for educational institutions to review their food safety policies and take a close look at their suppliers.  As they say, an ounce of prevention is worth a pound of cure.

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I wrote on this site previously about the decision of the Missouri Department of Natural Resources not to release information about dangerously high levels of E. coli in the Lake of the Ozarks until after a busy tourist weekend.

Good reporting by the Kansas City Star brought the issue to light, and the Missouri Attorney General opened an investigation.   According to the Star, the AG report is out now.    Karen Dillon and Chad Day report:

A Missouri agency made a mistake but broke no laws when it didn’t release Lake of the Ozarks water quality data for weeks, according to an investigation released Thursday.

Attorney General Chris Koster said Missouri Department of Natural Resources employees did not violate the state’s Sunshine Law when they failed to release data that showed dangerously high levels of E. coli, a bacteria, earlier this summer.

The response to the AG's toothless reaction has not been supportive:

Open records advocates and environmentalist were quick to criticize the report Thursday.

“It raises the question of whether you can violate the Sunshine Law at all,” said Charles Davis, executive director of the National Freedom of Information Coalition and an associate professor at the Missouri School of Journalism.

“We are getting a little too technical when we are splitting hairs about whether something in a request says ‘Sunshine request,’ ” Davis said. “It’s not like it needs a magic sticker on top of it.”

Ken Midkiff, chairman of the Missouri Clean Water Campaign, who filed the open records complaint with the attorney general’s office, said he was “extremely disappointed” in the report’s conclusions.

“It now appears that the AG’s office conducted the investigation in a shabby manner and in a partisan snow job fashion,” Midkiff said in a press release.

The issue really isn't a "sunshine law" or freedom of information issue, though.  Whatever regulations govern the DNR with respect to E. coli testing ought simply to require immediate public disclosure when levels are high.  It doesn't matter how or when reporters asked for the information - the DNR should be actively educating the public on the results.    Why are they even testing if they aren't going to alert the public when there is a problem?   

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According to a CDC update on the multistate outbreak of E. coli O157:H7 linked to Nestle cookie dough, the agency is working with public health officials in several states and collaborating with the FDA and FSIS to investigate the outbreak.

Preliminary results of the investigation “indicate a strong association with eating raw prepackaged cookie dough,” though the agency is still trying to figure out the exact cause of the contamination. In late June, the FDA announced that it found a strain of E. coli O157:H7 in a sample of the recalled cookie dough, but the culture did not match the outbreak strain.

At last count, 80 persons from 31 states have been sickened. Of those cases, 70 have been confirmed by advanced DNA testing as having the outbreak strain, 35 have been hospitalized, and 10 developed hemolytic uremic syndrome. In response to the outbreak, Nestle recalled 3.6 million packages of cookie dough.

The Danville Nestle cookie dough plant linked to the outbreak received clearance to restart manufacturing cookie dough July 9 and shipped out its first shipment of cookie dough since the outbreak last week.

The agency continues to recommend that consumers not eat any variety of the recalled dough. Of Nestle cookie dough packages have a “new batch” label then they were not a part of the outbreak. The agency also reminds consumers that they should not eat raw products that are meant to be cooked or baked before consumption.

Here is the CDC’s updated map:

The number of ill persons identified in each state is as follows: Arizona (2), California (5), Colorado (6), Connecticut (1), Delaware (1), Georgia (2), Iowa (2), Idaho (1), Illinois (7), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (8), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).

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The news media has been full of reports concerning the arrests of more than 40 people folllowing  a corruption investigation in New Jersey.  Among the more startling aspects of the story are the allegations that those arrested were involved in the trafficking of human kidneys.   An op-ed by Sally Satel in yesterday's Wall Street Journal, provided an interesting take on the story.  Satel argued that the extreme lack of available kidneys for those on transplant lists make this type of black market all but inevitable.  She wrote:

When I needed a kidney several years ago and had no donor in sight, I would have considered doing business with someone like Mr. Rosenbaum. The current law—the National Organ Transplant Act of 1984—gave me little choice. I would be a felon if I compensated a donor who was willing to spare me years of life-draining dialysis and premature death.

The illicit organ trade is booming across the globe. It will only recede when the critical shortage of organs for transplants disappears. The best way to make that happen is to give legitimate incentives to people who might be willing to donate. Instead, I fear that Congress will merely raise the penalties for underground organ sales without simultaneously establishing a legal mechanism to incentivize donors.

Satel concludes by arguing that any new legislation to crack down on organ trafficking should include incentives to increase the availability of organs for transplant recipients.

The point here is not to join the policy debate on organ donor regulation, but rather to recognize the depth of the risks faced by HUS survivors.  HUS is a somewhat rare, but devastating complication of E. coli O157:H7 infection.  Renal failure is a primary element of the acute stage of HUS.   Most of those who develop HUS recover renal function, at least temporarily.   Many, however, are left with permanent damage that can eventually necessitate placement on the long transplant lists that Satel describes.

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ABC News reported today that three separate strains of E. coli O157:H7 have been found in a Nestle USA cookie dough processing plant.  ABC's Briant Hartman writes about the E. coli testing:

Those tests, according to sources familiar with the investigation and confirmed by the FDA, determined the genetic fingerprint of the E. coli found at the plant is different than E. coli that has been linked to a 30-state outbreak that has sickened at least 72 people.

Sources also say an altogether different strain of E. coli was found in dough recovered from the home of a victim - E. coli O124.

FDA inspectors and CDC investigators have used several different testing methods during the outbreak.  Among them is Pulsed Field Gel Electrophoresis, or PFGE.  PFGE involves finding a bacteria's "fingerprint" by cutting the bacteria's DNA into tiny pieces and using a gel to separate the pieces from one another, creating a pattern, or fingerprint for each strain of bacteria. Scientists from public health laboratories around the nation are able to compare fingerprints isolated from patients and from food. When PFGE patterns from bacteria isolated from a person's stool and from food are indistinguishable, this strong evidence is combined with epidemiologic and environmental data to prove that a food, like cookie dough, is the source of a person's illness.

Investigators have not yet been able to determine how the cookie dough became contaminated with E. coli - whether it was from an ingredient or from environmental contamination is yet to be determined, and may never be known.

"There should be no confusion.  The finding of multiple strains of pathogenetic E. coli in either retained samples or someones home does not diminish the link between Nestle and the illnesses of 72 people", said William Marler, attorney for two dozen of the victims.

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KSFY in Sioux Falls, South Dakota, reports that a one-year-old boy from Sioux Center, Iowa is currently hospitalized with hemolytic uremic syndrome at a Sioux Falls area hospital.  There are no reported "confirmed" cases in the JBS outbreak from Iowa . . . Yet.  But these outbreaks tend to evolve.  After all, we're talking about a product that many people buy and simply throw into their freezers until they're ready to consume it.  That means that these products can last months.  All the more reason for concerted public health efforts to spread the word about developing outbreaks and assist retailers in getting recalled products off their shelves . . . and out of consumers houses.

We've seen hundreds of kids in Isaiah Romero's exact medical circumstances.   I hope to see a news report soon saying that his illness was not as bad as it could have been.  Too many have gone the other way over the last few years.  In the meantime, we'll keep moving in discovery against JBS Swift in the New Mexico case that we filed yesterday (filed in Colorado). 

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 At 10:30 AM today, Agriculture Secretary Vilsack, HHS Secretary Sebelius, and Vice-President Biden will issue “key finding,” according to an email from Nick Shapiro, Office of the Press Secretary, in The White House, that was sent to several media outlets. According to press release, entitled President’s Food Safety Working Group: Delivering Results, the Obama administration is going to implement “a new public health-focused approach to food safety based on three core principles: (1) prioritizing prevention; (2) strengthening surveillance and enforcement; and (3) improving response and recovery.” Although these principles are laudable, and anything would be an improvement over the Bush administration’s efforts to put industry profits above the public health, most of what is being announced today is recycled from Clinton years, and all are incremental steps that seek improvements around the edges rather than the much needed structural change to the U.S. food safety system.

What follows is a point-by-point commentary and critique of today’s announced policy changes and renewed initiatives. As I think you will see, there is not a lot radical going on here. (Please click on the Continue Reading link to read more.)

Preventing Salmonella Contamination: Here the press release notes that,” Despite support from consumer advocates and the egg industry, the Federal government has been unable to finalize basic rules on egg safety to prevent contamination.” And this is true, but eggs stopped being the biggest cause of Salmonella infection quite some time ago. In 2007, for Salmonella infections attributed to a food source, the outbreaks were caused by contaminated peanut butter, frozen pot pies, and puffed snack food. Moreover, hard data does not exist with regard to the prevalence of Salmonella in eggs in the United States, making the estimates about potential savings and illness-reduction speculative at best. As the USDA Agricultural Research Service pointed out in a report issued in 2007:

Market egg sampling data has never been collected in the United States on a national basis and no regional sampling data has been collected in 10 years. Salmonella outbreaks continue to be attributed to eggs and no progress has been made in several years in decreasing incidence.

The report then concluded: “USDA does not believe that this project is feasible given current budgets, limited extramural funding sources, and the existence of more pressing food safety issues such as attribution of illness to produce.” Full report here: www.ars.usda.gov/research/publications/publications.htm

The press release also touts an effort of the USDA to, by the end of the year, “develop new standards to reduce the prevalence of Salmonella in turkeys and poultry.” But here, again, the approach is incremental (if not merely symbolic), and fails to consider a better alternative: namely, the ELIMINATION of Salmonella (and Campylobacter) from eggs and poultry, something that was years ago achieved in other countries, like Denmark.

Reducing the Threat of E. coli O157:H7: According the press release, there is going to be “stepped up enforcement in beef facilities,” including “ issuing improved instructions to [inspectors]…to find this pathogen, focusing largely on the components that go into making ground beef.” There is no lack of irony in this announcement given that it is being made as we are in the midst of the second huge recall in two years of intact cuts of beef linked to large numbers of serious E. coli O157:H7 infection—the current recall being that linked to JBS Swift meat processed in Greeley, Colorado, and the previous one involving Nebraska Beef Ltd.

The release also touts the fact that USDA Food Safety and Inspection Service (FSIS) is “increasing its sampling to find this pathogen.” But as a senior FSIS official has already admitted about this increase in E. coli testing, the sampling plan does not even come close to attaining statistically significant results. (I have previously blogged about the largely symbolic nature of this increased testing, and that blog-post can be found here: www.foodpoisonjournal.com/tags/zero-tolerance/

Preventing Contamination of Leafy Greens, Melons, and Tomatoes: And perhaps in what is my favorite bit of tap-dancing and window-dressing, the press release announces that, “[b]y the end of the month, FDA will issue commodity-specific draft guidance on preventive controls that industry can implement to reduce the risk of microbial contamination in the production and distribution of tomatoes, melons, and leafy greens. These proposals will help the Federal government establish a minimum standard for production across the country. Over the next two years, FDA will seek public comment and work to require adoption of these approaches through regulation.” OH, YIPPEE!!! Yet another “draft guidance” from the FDA on produce safety, and a promise that, in two years or so, the agency will “work to require adoption of these approaches.” In other words, no change here. And if you would like to have a look at just how long the FDA has been making“suggestions” on produce safety, have a look at the produce safety initiative announced on May 6, 1998, and the issuance of ‘‘Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables,’’ which was the FDA’s first attempt to the same thing it says it is going to this time try to do again. See here: www.fda.gov/ohrms/dockets/98fr/050698b.pdf And: www.foodsafety.gov/~dms/prodguid.html

One other suggestion of my own: If the FDA wants to get serious about produce safety, then it should read the multiple reports issued by the Food Safety Project at Georgetown University, which can be found here: www.producesafetyproject.org/reports

The press release announces other mostly recycled initiatives, which I will address in a follow-up post. So let me end here by saying that increased food safety efforts are nice, but results are all that matters. And the initiatives announced today may sound good, but they are unlikely to change much.  What is needed is a structural overhaul of the US food safety system. 
 

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Over the 4th of July holiday, many Americans will get together for picnics, barbeques, and other gatherings.  For many, food will take center stage, and hopefully proper food safety practices will ensure that in the days following these gatherings people will not be doubled-over in pain, running to and from the bathroom because of something they ate.  The FDA has published recommendations for keeping food safe when eating outdoors that could be useful in helping prevent foodborne illness among your friends and family. 

For some, water - not drinking water - will take center stage.  And water sources can contain some of the same pathogens as food sources.  Pools, recreational water, and even municipal water sources have been pinpointed as the source of E. coli, cryptosporidium, Salmonella, and other outbreaks in recent years.   (See Cryptosporidiosis: A Recreational Water Threat That Hasn’t Gone Away)

Water sources can become contaminated with E. coli and other pathogens in a variety of ways. Water that is downstream from cattle pastures, feed lots, or barns can easily become contaminated with pathogens from runoff. When lakes become contaminated, several weeks or months can pass before water quality conditions improve or return to normal.  

Pools can become contaminated with E. coli by animal feces or through fecal contamination from an infected person. Children who are not yet toilet trained and soil diapers while playing in water have been identified as the source of several outbreaks. Proper chlorine levels must be maintained to prevent the spread of E. coli in pools and at water parks. 

In 1998, an E. coli O157:H7 outbreak was traced to an infected toddler who played in a pool at the White Water Water Park outside Atlanta, Georgia. Although the pool was chlorinated, the chlorine concentration and contact time was presumably insufficient to kill the E. coli resulting from fecal contamination by the toddler, and other children who were in the pool ingested E. coli bacteria while playing in the pool. Twenty-six culture-confirmed E. coli cases were identified during the outbreak, and 40 percent of children under five years of age with recognized E. coli infections were diagnosed with hemolytic uremic syndrome (HUS).

In 2005, thousands of people fell ill with cryptosporidiosis, a gastrointestinal illness that causes diarrhea and vomiting, after visiting the spraypark at the Seneca Lake State Park in New York State.  By the time the public health investigation had concluded, at least 3,900 people in New York had reported becoming ill with cryptosporidiosis after taking part in recreational activities at the spraypark, which is located near Geneva. Cryptosporidium was found in two water storage tanks that supplied the 11,000-square-foot spraypark.  Since that time, the spraypark has undergone a renovation for its water storage devices. 

When municipal water sources become contaminated, systems must be flushed to ensure all bacteria has been eliminated from the system, and chlorine levels high enough to kill any bacteria, parasites, or viruses must be introduced.

In 2008, the Colorado Department of Public Health and Environment (CDPHE) reported that 417 people became ill with Salmonella after drinking water from the Alamosa municipal water system, and one resident died. The Centers for Disease Control and Prevention (CDC) and CDPHE confirmed the presence of Salmonella in five out of six water samples taken from various areas around Alamosa, and laboratory results confirmed the presence of Salmonella in the water system, which was flushed in a three-stage water treatment process beginning March 25.

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There are a few key elements to having a good 4th of July.  First, don't shoot off your fireworks by hand.  Second, illegal fireworks are fun, but they're illegal for a reason, so see #1 if you're planning to light any M 1000's.  Third, watch the Seattle fireworks from our offices, where you can simultaneously see the shows at the Space Needle, Lake Union, and maybe even Bill's house (Marler, not Gates, though Gates has been known to put on quite a show too)  Finally, and far more importantly than the size or amount of fireworks you light, grill safely.

Sounds easy, right?  Well, it may be, but you can't simply do things the way good ole dad used to do them, thinking "well, i never got sick, so none of my family will either."  Famous last words.

Take the advice of the CDC.  These are important steps to prevent the transmission of foodborne disease . . . to you and your family.  But these steps are stated so plainly as to almost, not quite, but almost lack significance when read by the casual consumer.  

Hopefully, digesting a few additional details will encourage even the casual consumer that these CDC steps to preventing foodborne disease this 4th of July are not some empty mantra.  First, consider the size and lethality of the several known STEC serotypes, including the infamous E. coli O157:H7.  "So small that a million would fit on the head of a pin."  And it is estimated that 15 to 100 individual bacteria are enough to kill you.  The point?  Don't take the issue of cross-contamination (which the CDC strangely addresses with only the example of a plate holding raw hamburgers) lightly.  Have utensils, serving pieces, in fact entire countertops or cutting boards that you use only for raw products; and have another set entirely for cooked products.  Keep in mind that it's not always bacteria on the inside of the burger that kills.

My only other "detail" before wishing you a safe 4th of July is to consider that good ole dad's methods for checking "doneness" need to be trashed along with the contaminated celophane wrap that your ground beef came in.  Color (whether its grey or pink) is not always a reliable indicator of doneness, so you should never rely on it.  What does it take, an extra 15 seconds to go get the meat thermometer and check for internal doneness (160 degrees F)?  You're not doing anything else on the 4th, so you might as well spend it making sure that your kids don't lose their kidneys.  And along with discarding the notion that color is reliable, the manufacturers instructions on pre-formed beef patties shouldn't be relied on exclusively either.  Marler Clark sponsored a very important study

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E. coli O157:H7 was found today at the Danville, Virginia plant Nestle makes Toll House Cookie Dough.  According to Brian Hartman of ABC News and the Associated Press,

According to an FDA official,  the bacteria was found at the plant in an unopened package of raw chocolate chip cookie dough. The package had been manufactured on February 10, 2009 (but had not yet been shipped.)

Investigators are still trying to determine how the toxic pathogen E. coli got into the dough. But finding this “smoking gun” package confirms they pushed for a recall of the correct product.
 

Well done Brian.

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This Saturday, I met three friends for lunch.  As the conversation got underway, one of them asked me how working at Marler Clark had changed my eating habits.  It's a question I hear all the time, and one I have a ready answer for. 

1. I don't eat sprouts.  I love a lot of food items that contain sprouts, and I always ask service staff at restaurants to, "hold the sprouts" since the only safe sprouts - in my opinion - are irradiated. 
2. I don't cook ground beef very often, and have not cooked a hamburger since I started working for Marler Clark in 2002.
3. I use a digital food thermometer to measure the temperature of any meat product I cook. 
4. I always order my hamburgers well-done. 

As I expected, my friends were shocked that I would "ruin" a hamburger by fully cooking it.  They enjoy their burgers cooked medium, and two of them swore that they had eaten the best hamburger they had ever had the night before meeting me for lunch. 

Our conversation continued, and they kept coming back to my advice to always order hamburgers well-done.  Conceptually, they understood that grinding beef provides more surface area for E. coli contamination and that E. coli can be mixed into the middle of a burger - the place that takes the longest to reach 160 degrees and become safe.  But they aren't ready to start ordering their burgers well-done, and asked me what I would do if I was in their position and wanted to continue eating my burgers medium.  I explained to my friends that the safest hamburger not cooked to 160 degrees - and not irradiated - is probably a burger that is ground in-house, from one cut of beef, that is ground and prepared under the strictest of food safety standards. 

Today, as I read about the JBS Swift meat recall that includes intact cuts of beef that may have been ground into hamburger at restaurants and retail establishments nationwide, I re-thought my advice.  I'll be emailing my friends today and letting them know that the only safe medium-cooked hamburger is one that is irradiated.  I hope they pay attention.

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 In the early morning hours of Sunday, June 28, the JBS Swift Beef Company expanded the earlier recall of 41,280 pounds of beef contaminated with the highly toxic pathogen E. coli O157:H7 to include an additional 380,000 pounds. The beef recalls are FSIS Class I, meaning the “use of the product will cause serious, adverse health consequences or death.” The company and The Food Safety and Inspection Service (FSIS) have made available a list of recalled products, but so far have refused to reveal where those products were shipped, even in light of illnesses linked to the meat.

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We are in the midst of another sprouts recall.    Sprouts from Kowalke Organics from Culver City, California are being pulled from shelves over potential contamination with Salmonella.    According to the LA Times:  "Mike Matthews, Kowalke’s owner, told the Associated Press that only one package -- with the sell-by date of June 21 -- tested positive for salmonella, so far."   There is not yet confirmation of illness associated with this latest recall.  Still, Mr. Matthews comment brings up again how misleading statements like this can be.

A perfect example is last summer's E. coli O157:H7 outbreak traced to lettuce.  Health officials gathered overwhelming  epidemiological evidence to implicate the product.   The producer, though, kept crowing to the press about how none of the lettuce tested from its plant tested positive.  Of course, health officials were forced to point out that the product tested was CURRENT PRODUCT, i.e. the product in the plant at the time the outbreak was recognized.   Thank goodness there wasn't STILL contaminated product on hand.  The product actually implicated in the outbreak was long gone, and could not be tested.

In outbreaks involving perishable items, such as produce, finding product produced and packaged at a time that coincides with product implicated in an outbreak is very unusual.  Think about this very plausible, but hypothetical, time line.   Produce goes out, lets say lettuce, processed on July 1.   It hits the shelves on July 5.   On July 7 its purchased, and then consumed two days later on July 9.  The incubation period for E. coli O157:H7 generally runs 2 days to a week.   So let's say the consumer has onset of symptoms on July 12.  By July 14, the consumer is sick enough to go to the doctor.  If we are lucky, a stool culture is ordered the first day of medical care.  Results return 48 hours later, and now it is July 16.   A good health department is notified of the illness, and interviews the consumer for a food history immediately.  It's now July 17.  Before health officials are testing product, there usually need to be multiple illnesses that suggest a product as a culprit.  Even assuming the best time line, it is probably nearly three weeks from processing to the opportunity to test product.  By then, product processed on July 1 has been consumed or discarded.

So, the next time you hear a produce supplier tell you that "none of our product has tested positive," bear this in mind.  Such proclamations are essentially worthless at best, and more likely misleading.

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We filed suit yesterday in Federal Court for the District of Colorado on behalf of Madison Sedbrook, who is six years old, and her parents Tristan and Cindy.  Madison ate cookie dough on multiple occasions in April 2009 and developed a severe gastrointestinal illness.  She bounced from hospital to hospital, doctor to doctor, while nobody could really figure out what was wrong with her. 

In the meantime, toxins released by the E. coli O157:H7 bacteria that she had ingested, along with the cookie dough, began to cause a cascading, destructive process in her blood stream that culminated in the development of hemolytic uremic syndrome.  See www.about-hus.com.  Ultimately, Madison was hospitalized for 9 days and suffered from hemolytic anemia severe enough to require a blood transfusion. 

Madison Sedbrook, and the six other known HUS victims in this outbreak, not to mention the likely hundreds of people sickened from Nestle cookie dough, is the reason that we fight this fight every time another serious outbreak occurs.  View the complaint that we filed on Madison's behalf here:

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An E. coli lawsuit was filed yesterday on behalf of a Denver-area child who became gravely ill with E. coli O157:H7 after eating refrigerated Nestle Toll House cookie dough. The lawsuit was filed on behalf of the family of Madison Sedbrook by her attorneys, William Marler of the Seattle-based foodborne illness law firm Marler Clark and Kara Knowles of the Denver firm Montgomery, Little, Soran, & Murray.

Six-year-old Madison ate Nestle Toll House refrigerated cookie dough several times in mid-April, 2009. She began to experience flu-like symptoms including fatigue, fever, nausea, and vomiting. Not knowing the source of her illness, she continued to eat Nestle cookie dough, and by the first week of May, she had abdominal cramps, fever, and bloody diarrhea. Over the next several weeks, the family sought medical care several times for Madison’s illness, which deepened in severity. She was admitted to the hospital and then released before being rushed back and admitted to pediatric intensive care. It was determined that Madison had hemolytic uremic syndrome, or HUS, a complication of her E. coli infection, which was not diagnosed until her second hospital stay. The genetic fingerprint of the E. coli O157:H7 found in her stool matches that of the nationwide outbreak tied to cookie dough.

“This child – and this family – have been through a terrible ordeal, not the least of which is how many times they sought care before E. coli was detected,” said Marler, who spoke from the National Environmental Health Association (NEHA) convention.. “In order to detect and limit foodborne illness outbreaks, we have to make changes in our healthcare system; doctors and emergency health providers need to be encouraged to test for foodborne pathogens any time these symptoms – especially bloody diarrhea - are present.”

On Monday, the CDC released updated information on the nationwide outbreak, which now encompasses 70 ill in 30 states. Thirty people have been hospitalized, and 7 have developed HUS. Almost seventy percent of the victims are female and under the age of 19. Nestle USA has voluntarily recalled the product, has stopped production at the facility that made it and are cooperating with FDA and CDC to pinpoint the cause.

“State health departments did a great job of getting to the bottom of this outbreak, and getting the word out,” continued Marler. “But more resources are needed to speed the process up. Every day saved means dozens, maybe hundreds of families spared the Sedbrook family experience.”

 

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We have already heard from several families whose children have developed hemolytic uremic syndrome (HUS) after contracting E. coli O157:H7 from Nestle cookie dough.  Most often, though we certainly see cases where the pathalogic process described below affects other organs, HUS affects the kidneys.  Here is a short explanation of what HUS is, and why it is so lethal. 

                                              

The toxins that are released by E. coli O157:H7 bacteria (called shiga-toxins) are so potent, in fact lethal, that the Department of Homeland Security lists it as a potential bioterrorist agent. (Although E. coli O157:H7 are responsible for the majority of cases in America, there are many additional shiga-toxin producing E. coli that can cause HUS. 

The chain of events leading to HUS begins with ingestion of E. coli 0157: H7 bacteria in contaminated food. These E. coli rapidly multiply in the intestines causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys, or other organs, where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin. Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).

Once shiga-toxin attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade which results in the formation of clots in the very small vessels of the kidney resulting in acute kidney injury and failure. The red blood cells are hemolyized (destroyed) by shiga-toxins and/or damaged as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.
 

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A young woman who was hospitalized for seven days after eating raw cookie dough made by Nestle USA filed suit today against the company in California Superior Court, San Mateo County. The lawsuit was filed on behalf of 18-year-old Jillian Collins by her attorneys, William Marler of the Seattle-based foodborne illness law firm Marler Clark and Terry O’ Reilly of the San Mateo firm O'Reilly Collins.

San Mateo resident Jillian Collins ate Nestle Toll House refrigerated cookie dough in late May, 2009. On May 26, she fell ill with painful abdominal cramps and diarrhea that soon turned bloody. Her symptoms worsened to the point where she sought urgent care. She was later admitted to the hospital, where tests revealed that she was infected with E. coli O157:H7. The genetic fingerprint of her test matched that of the outbreak strain which has infected 65 people in 29 states to date. 

“This outbreak is an example of how virulent E. coli bacteria can be, and how many people can be affected when it enters the national food supply,” said Marler, who was traveling between food safety speeches. “Nestle USA is a company with a good food safety record, andupon learning of the CDC investigationthey worked very quickly to get a voluntary recall of the product started. But even that isn’t enough for those who were sickened in this outbreak. It points to how vigilant we need to be in our food safety regulation and oversight.”

The first announcement about the multi-state outbreak was made on Thursday, June 18 by the Colorado Department of Health and Environment (CDPHE), warning consumers about consuming the uncooked Nestle Toll House cookie dough product, and revealing that more than sixty were confirmed ill in 28 states. It wasn’t until late Friday, June 19 that the CDC released their outbreak information, which updated the totals to 65 ill in 29 states. 

“Nestle has stopped production at the Virginia facility that produced the cookie dough,” continued Marler. “Everyone I talk to is stumped by how a bacteria normally associated with cattle feces made its way into the facility, and then into such a highly processed product. We may not solve that mystery; what we can do is work to prevent this type of event from happening again.  The way to do that is better food safety surveillance – and that comes down to legislation and funding.” 

 

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State health departments have taken the lead in releasing news about the E. coli outbreak tied to Nestle Toll House raw cookie dough.  The Colorado Department of Public Health and Environment (CDPHE) put out the first official information about the outbreak late on June 18.  The CDPHE release revealed that 66 people in 28 states were infected with the same genetic fingerprint of E. coli O157:H7, and that epidemiological evidence was strong that the infection vehicle was Nestle Toll House raw cookie dough.  Five Coloradans were part of the outbreak; two had been hospitalized and one had contracted HUS (Hemolytic Uremic Syndrome).

On June 19 the Minnesota Department of Health (MDH),  a leader in foodborne illness outbreak investigation, put out a release urging consumers to avoid the Nestle Toll House raw product.  The MDH release indicated that routine monitoring by the Minnesota Department of Health found that the cases of illness were all caused by E. coli O157:H7 with the same DNA fingerprint. The individuals became ill between May 3 and June 11. All six reported eating raw cookie dough of the Nestle’s Toll House brand. The cases ranged in age from 2 to 18 years of age; five (83 percent) were female. One was hospitalized. All recovered.

The Texas Department of State Health Services (DSHS) also put out a release on Friday, June 19.   The DSHS release indicated that three Texans had been infected with the outbreak strain of E. coli O157:H7, and that all three had recovered.

Although Washington State Department of Health has not yet put out a release, information they shared with the Seattle Post-Intelligencer was that five Washingtonians were part of the outbreak.

The CDC has not released information on the complete breakdown of how many cases each state is reporting, but that announcement is expected shortly.

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With reports of 66 cases of E. coli O157:H7 across 28 states, Nestle has announced a recall of its Cookie Dough Products.  The illnesses include 25 hospitalizations, and 7 cases of hemolytic uremic syndrome (HUS).  HUS is a life-threatening complication of E. coli O157:H7 infection, that recently was reported as the cause of death in two young children in the U.S not appearing to be related to this outbreak.

On its website, Nestle apologizes, sort of, for the "inconvenience" it has caused.   Inconvenience?  Being late to work is inconvenient.   Fighting for your life on dialysis is something else. That "apology" doesn't come until after Nestle has taken the time for blaming the victims:  "Nestlé Toll House cookies made from refrigerated and frozen dough are perfectly safe for consumption when prepared according to the instructions on the label. These clearly state that the raw dough must be baked before consumption."

Here is the actual information on the label: 

Cookie Dough is Filled by Weight.   Use or Freeze by Date Indicated on the Package.  Cookie Dough Contains Raw Ingredients.  Bake Before Consuming.

None of this excuses Nestle from having a product on the shelves with E. coli O157:H7 in it.   As an initial matter, baking of the dough comes AFTER handling of the product, and therefore after exposure of the bakers (likely including families with children) to E. coli O157:H7.  More importantly, there are many products on the market right now, labeling themselves as cookie dough products, that are ready to eat, including ice cream, and breakfast pastries.  

 

This "Yahoo Answers" page, from before today's recall, shows a majority of respondents indicating that consuming raw cookie dough is just fine.   

 

All of this, and we are expected to believe that Nestle had no idea that people might be eating the dough raw?  And that Nestle was doing everything it could to discourage such a practice?

 

C'mon.

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I am now in possession of potentially E. coli-contaminated Nestle Toll House cookie dough.  In an attempt to learn more about the warning labels Nestle prints on its cookie dough packaging, I set out for the supermarket closest to my house.  That store happens to be a Fred Meyer.  When I arrived, I was surprised by a few things:

• The refrigerated Cookie Dough section is so big, it has a sign - kind of like what you'd see over the egg, ice cream, or frozen pizza section.  I was stunned, mostly because I've never purchased refrigerated cookie dough before and I would never have guessed that there would be a big enough market for refrigerated cookie dough that it would command its own section.  It is a true tribute to Nestle and other companies' marketing departments that this section is necessary.
• Fred Meyer had not posted any recall notices in the refrigerated cookie section.
• A mother and daughter were trying to decide which refrigerated cookies to buy, and were leaning toward buying Kroger brand cookies, but were debating on whether to splurge and buy Nestle cookies.  I told them about the Nestle refrigerated cookie dough recall that was announced this morning, and they decided not to buy any cookie dough at all.  I can't say I would have made a different choice.

After purchasing recalled product, I notified a woman at the service desk that the cookie dough I had just purchased was recalled for potential E. coli contamination.  She seemed surprised, but told me she'd look up the Nestle cookie dough recall information on the FDA Website and would make sure the product was dealt with appropriately.

Since arriving home with the potentially E. coli-contaminated cookie dough, I have washed my hands at least 20 times and have sanitized my counters 4-5 times.  The Nestle cookie dough is currently in my freezer and I'm terrified.  I'm treating cookie dough, of all things, like I treat ground beef.  I assume that all ground beef is contaminated with E. coli and that all eggs are contaminated with Salmonella.  But cookie dough contains pasteurized egg products and should not be hazardous to our health - or at least that's what I thought until yesterday.

My roommates are out of town and know about the recall, but in case they forget by the time they get home on Sunday and I haven't yet thrown the cookie dough away, I've properly labeled it and am keeping it in the freezer. 

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 Today's recall of Nestle cookie dough got me thinking about other E. coli O157:H7 cases that we've recently handled.  John McDonald was a 5-year-old boy who we represented in a ground beef outbreak that occurred in 2007.  Unfortunately, John's illness was about as bad as an illness can get without causing a death.  (it is unbelievable how many times I find myself saying that about our clients) 

John was hospitalized at East Tennessee Children's Hospital from October 4 through 12, then was transferred to the University of Tennessee Medical Center where he remained until October 29.  During his hospitalization, John's kidneys failed requiring extensive dialysis to cleanse his blood, and he became badly anemic requiring many blood transfusions.

But these conditions, though in and of themselves potentially lethal, were just the beginning.  What truly separates John's illness from most of the hemolytic uremic syndrome illnesses that we see was the extent of injury to his gastrointestinal tract. 

Jim McDonald, John's father, was present at the moment it became apparent just how severe John's illness was.  It occurred in the early morning hours of Thursday, October 11, 2007.  He recalls: 

As usual, I got up to help as much as possible when the nurses came in and woke us up. When we opened his diaper, I got excited since it looked like he had had dark brown diarrhea, which told me that his digestive system was finally starting to kick in again. Realizing how liquidy the diaper was, we turned on an extra light to help us while changing him.

 

I will never forget what I saw. To my dismay, the diaper was not full of a bowel movement like I had desperately hoped. It was full of blood. An entire bowel movement of blood. Maybe an entire cup of blood. I got light-headed and almost passed out. I immediately sat down and grasped my head, apologizing to the nurses and telling them that I could no longer help them treat my son. This was the first of five grossly bloody stools that day.

Now bloody diarrhea is typical in the setting of an E. coli O157:H7 illness.  But this was another animal altogether.  John was losing blood from his gastrointestinal tract like he was bleeding from an opened artery.  In fact, over the course of the day on October 11, John was given two transfusions of packed red blood cells to address the significant blood loss he had suffered.  John was transferred to The University of Tennessee Medical Center the next day, where he endured, hopefully, the fight of his life. 

After transfer to UT, it became apparent that John was suffering from an infection somewhere in his body.  Coupled with the fact that he was bleeding heavily from his rectum and was constantly complaining of severe abdominal pain, doctors began to suspect that the infection was in his abdomen.  Heavy duty antibiotics were administered, but with no effect.  John continued for several days to exhibit signs of severe infection. 

The afternoon of October 16, 2007, doctors began to suspect that John had suffered a perforation (e.g. a puncture) somewhere in his gastrointestinal tract.  Besides the immense pain, the concern was that the contents of John's gastrointestinal tract, including the shiga-toxin producing E. coli O157:H7 bacteria, would escape and cause severe, potentially lethal infection elsewhere in his body. 

At around 8:00 PM on October 16, John was rushed to the Operating Room for an emergency exploratory laparotomy—i.e., an incision through the abdominal wall to gain access to the abdominal cavity. What the pediatric surgeon found inside was a mess of fecal material and grossly swollen bowel loops. The surgeon also found a portion of John’s rectum to be necrotic (i.e. diseased and dead) and there he located the perforation through the rectal wall that had allowed the contents of John’s bowel to spill into his abdomen, thus causing the severe infection in his peritoneal cavity.  

Ultimately, the surgeon decided that the necrotic and damaged portions of John’s colon and rectum stood no chance of recovery or survival, and so he removed about five inches of John's colon and rectum. After cutting and removing the damaged tissues, the surgeon washed John’s peritoneum copiously with normal saline. He then took a portion of John's colon outside of the peritoneal cavity and formed a pouch out of John's own tissue.  This pouch was then connected a colostomy bag to drain feces from John's abdominal cavity. 

It goes without saying that John's illness was severe.  After his surgery to remove part of his colon, John had to be sedated and kept on mechanical ventilation for many days.  He was hardly able to walk at discharge on October 29, 2007.  About John's discharge, his father recalls:

October 29, 2007: John got to come home today. He came home to a new house. He still couldn’t walk, but was trying to very hard. It was difficult for him (like Michaela) to rebuild his strength in his atrophied and skinny legs. We carried him when he couldn’t crawl. Nonetheless, everybody, including John, was thrilled that he was home. There were many tears of joy shed by all.
 

John's recovery is still ongoing.  He has done well since discharge, and has proved to be an extremely tough little customer.  We were honored to represent him and his family (by the way, his younger sister Michaela had HUS too), and have truly been inspired by his story. 

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We have been investigating several seemingly unrelated E. coli O157:H7 illnesses that may not be so unrelated.  There are 63 confirmed illnesses possibly linked to Nestle's Toll House Cookies.  Before you say, "No way, cookies can't be contaminated" or "E. coli is just a ground beef problem," realize that if these illnesses are, in fact, linked to cookies, it wouldn't be the first time that a sweet treat turned lethal.

On June 30, 2005 the Minnesota Department of Health notified the federal Centers for Disease Control and Prevention (CDC) that four cases of Salmonella Typhimurium (S. Typhimurium) with an indistinguishable Pulsed Field Gel Electrophoresis (PFGE) subtype (CDC PulseNet pattern JPXX01.1173) had been identified. The only common exposure among the four ill individuals was that all had eaten at one of two Cold Stone Creamery stores. All cases had eaten cake batter flavor ice cream in the week before onset of symptoms.

We represented several injured people in the outbreak, including a young girl named Diana Mckune, who suffered a particularly severe Salmonella infection.  It landed her in Seattle Children's Hospital for a week.  Fortunately for Diana, she wasn't part of an E. coli O157:H7 outbreak.  Had she eaten E. coli-laden cookies, we may have handled her wrongful death action. 

Only time, and some good epi work, will tell the truth about Nestle cookies and E. coli O157:H7. 

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The Des Moines Register is reporting that Russia has banned the import of pork from two plants. According to the report,   "Russian meat plant oversight group Rossel-khoznadzor said Thursday that E. coli bacteria was found in some meat from the plants."  The implicated plants are located in Waterloo, Iowa, and Columbus Junction, Iowa.

For its part, Tyson is touting the safety of its products, but did not appear to issue a clear denial of the presence of bacteria in the products.   A company spokesperson said. "We have very few details about the Russian plant de-listings.  We're confident about the safety of our pork products."

Tyson then went on to point out that the Tyson plants are federally inspected.   Companies are quick to rely on federal inspections when it comes to giving the impression that their food is safe.  Meanwhile, however, idustry groups are hard at work trying to water down and to avoid paying for increases in those same inspections. 

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Valley Meats LLC recently recalled nearly 96,000 pounds of ground beef due to potential contamination by E. coli O157:H7.  Now, SP Provisions of Portland, Oregon has recalled almost 40,000 pounds of ground beef due to positive sampling of its ground beef during production.   Hamburger E. coli season appears to be getting underway.

John McDonald was a victim of E. coli O157:H7 in hamburger almost two years ago now.  We represented John and his family in a ground beef outbreak that occurred in 2007.  The following summary tells you a bit about John's very sad case.

John was hospitalized at East Tennessee Children's Hospital from October 4 through 12, then was transferred to the University of Tennessee Medical Center where he remained until October 29.  During his hospitalization, John's kidneys failed requiring extensive dialysis to cleanse his blood, and he became badly anemic requiring many blood transfusions.

But these conditions, though in and of themselves potentially lethal, were just the beginning.  What truly separates John's illness from most of the hemolytic uremic syndrome illnesses that we see was the extent of injury to his gastrointestinal tract. 

Jim McDonald, John's father, was present at the moment it became apparent just how severe John's illness was.  It occurred in the early morning hours of Thursday, October 11, 2007.  He recalls: 

As usual, I got up to help as much as possible when the nurses came in and woke us up. When we opened his diaper, I got excited since it looked like he had had dark brown diarrhea, which told me that his digestive system was finally starting to kick in again. Realizing how liquidy the diaper was, we turned on an extra light to help us while changing him.

I will never forget what I saw. To my dismay, the diaper was not full of a bowel movement like I had desperately hoped. It was full of blood. An entire bowel movement of blood. Maybe an entire cup of blood. I got light-headed and almost passed out. I immediately sat down and grasped my head, apologizing to the nurses and telling them that I could no longer help them treat my son. This was the first of five grossly bloody stools that day.

Now bloody diarrhea is typical in the setting of an E. coli O157:H7 illness.  But this was another animal altogether.  John was losing blood from his gastrointestinal tract like he was bleeding from an opened artery.  In fact, over the course of the day on October 11, John was given two transfusions of packed red blood cells to address the significant blood loss he had suffered.  John was transferred to The University of Tennessee Medical Center the next day, where he endured, hopefully, the fight of his life. 

After transfer to UT, it became apparent that John was suffering from an infection somewhere in his body.  Coupled with the fact that he was bleeding heavily from his rectum and was constantly complaining of severe abdominal pain, doctors began to suspect that the infection was in his abdomen.  Heavy duty antibiotics were administered, but with no effect.  John continued for several days to exhibit signs of severe infection. 

The afternoon of October 16, 2007, doctors began to suspect that John had suffered a perforation (e.g. a puncture) somewhere in his gastrointestinal tract.  Besides the immense pain, the concern was that the contents of John's gastrointestinal tract, including the shiga-toxin producing E. coli O157:H7 bacteria, would escape and cause severe, potentially lethal infection elsewhere in his body. 

At around 8:00 PM on October 16, John was rushed to the Operating Room for an emergency exploratory laparotomy—i.e., an incision through the abdominal wall to gain access to the abdominal cavity. What the pediatric surgeon found inside was a mess of fecal material and grossly swollen bowel loops. The surgeon also found a portion of John’s rectum to be necrotic (i.e. diseased and dead) and there he located the perforation through the rectal wall that had allowed the contents of John’s bowel to spill into his abdomen, thus causing the severe infection in his peritoneal cavity.  

Ultimately, the surgeon decided that the necrotic and damaged portions of John’s colon and rectum stood no chance of recovery or survival, and so he removed about five inches of John's colon and rectum. After cutting and removing the damaged tissues, the surgeon washed John’s peritoneum copiously with normal saline. He then took a portion of John's colon outside of the peritoneal cavity and formed a pouch out of John's own tissue.  This pouch was then connected a colostomy bag to drain feces from John's abdominal cavity. 

It goes without saying that John's illness was severe.  After his surgery to remove part of his colon, John had to be sedated and kept on mechanical ventilation for many days.  He was hardly able to walk at discharge on October 29, 2007.  About John's discharge, his father recalls:

October 29, 2007: John got to come home today. He came home to a new house. He still couldn’t walk, but was trying to very hard. It was difficult for him (like Michaela) to rebuild his strength in his atrophied and skinny legs. We carried him when he couldn’t crawl. Nonetheless, everybody, including John, was thrilled that he was home. There were many tears of joy shed by all.
 

John's recovery is still ongoing.  He has done well since discharge, and has proved to be an extremely tough little customer.  We were honored to represent him and his family (by the way, his younger sister Michaela had HUS too), and have truly been inspired by his story.

 

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Grimmway Enterprises, Inc., a carrot producer in Bakersfield, California is suing a neighboring sheep farmer afer the sheep entered Grimmway's property.  The sheep grazed on Grimmway crops, but more importantly, they did what sheep do - they defecated.  Out of resulting concern for possible E. coli O157:H7 contamination, Gimmway destroyed an alleged 75 acres of crops.

In a related story on,  Michele Jay-Russell of UC Davis' Western Institute for Food Safety and Security said the destruction of the crops made sense.  "It's a legitimate c oncern," she said.   Sheep, and other ruminants, such as cattle and goats, are known to harbor E. coli O157:H7.  An investigation of the massive 2006 E. coli O157:H7 outbreak in Dole spinach suggested that wildlife in the crop fields played in role in the outbreak.

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According to an article in Candian Cattlemen,  a Candadian firm, Bioniche Life Sciences,  has developed a vaccine that reduces colonization of cows by E. coli O157 bacteria and reduces the amount of the bacteria shed in cattle manure. One would think that reductions of this nature would in turn lead to less human expsoure to the potentially fatal pathogen.

Surprisingly though, the article states that those in the cattle industry "believe that they receive no immediate or direct benefit for spending money to vaccinate their herds against E. coli O157." 

Really?  No direct benefit from the removal of a fatal pathogen from the food you sell?  Talk about a short-sighted approach to business.  With the cattle industry's reluctance to use [i.e. pay for] such a vaccine on the farm, Bioniche is seeking support [i.e. money] from the Canadian government to implement the use of the vaccine.

If the vaccine really works, lets hope somene sees through to getting it in use, as we continue to see tragic news related to E. coli O157:H7 in hamburger.

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The House Energy and Commerce Committee is out with a discussion draft of “the Food Safety Enhancement Act of 2009.”

Given who’s signed on to this one, it’s probably the one to watch.  Sponsors include Chair Emeritus John D. Dingell, Chairs Henry A. Waxman, Frank Pallone, and Bart Stupak, and Reps. Diana DeGette and Betty Sutton.

The new draft is based on the food reforms contained in H.R. 759, the Food and Drug Administration Globalization Act of 2009, introduced in January by Reps. Dingell, Stupak and Pallone. Favored bills get heard quickly, and this one gets its first hearing next week, on Wednesday, June 3rd.

"As evidenced by the recent widespread contaminations in our food supply, including E.coli in spinach, salmonella in peppers and the most recent outbreak of salmonella in peanut butter, it is clear that we must act now," said Rep. Pallone, Chair of the Health Subcommittee. "This draft builds on legislation introduced earlier this year and will empower the FDA with the resources and authorities it needs to ensure that our food is safe to eat. I look forward to continuing to work with my colleagues and the administration to move this crucial piece of legislation forward

"Our 10 food safety hearings in the Subcommittee on Oversight and Investigations have highlighted the need for an overhaul of our food safety laws," said Rep. Stupak, Chair of the Oversight and Investigations Subcommittee. "The American people deserve a Food and Drug Administration that has both the funding and the regulatory authority needed to protect our food supply and hold the food industry accountable. President Obama and the new FDA leadership have expressed a commitment to food safety reform and I look forward to working with them to return FDA to the gold standard in protecting the public health."

A detailed summary of the draft follows below.

 

• Creates an up-to-date registry of all food facilities serving American consumers: Requires all facilities operating within the U.S. or importing food to the U.S. to register with the FDA annually.
• Generates resources to support FDA oversight of food safety: Requires registered facilities to pay an annual registration fee of $1,000 in order to generate revenue for food safety activities at the FDA; requires registered facilities to pay for FDA’s costs associated with re-inspections and food recalls; allows FDA to charge a fee to domestic firms requesting export certificates for exported food.
• Prevents food safety problems before they occur: Requires all facilities operating within the U.S. or importing food to the U.S. to implement safety plans that identify and protect against food hazards. FDA would have the authority to specify minimum food safety plan requirements and to audit food safety plans.
• Requires safety plans for fresh produce: Directs FDA to issue regulations for ensuring the safe production and harvesting of fruits and vegetables.
• Increases inspections of food facilities: Sets a minimum inspection frequency for all registered facilities. High-risk facilities would be inspected at least once every six to 18 months; low risk facilities would be inspected at least once every 18 months to three years; and warehouses that store food would be inspected at least once every three to four years. Refusing, impeding, or delaying an inspection is prohibited.
• Improves traceability of food: Enhances FDA’s ability to trace the origin of tainted food in the event of an outbreak of foodborne illness. FDA would be required to issue regulations that require food producers, manufacturers, processors, transporters, or holders to maintain the full pedigree of the origin and previous distribution history of the food and to link that history with the subsequent distribution history of the food; and to establish an interoperable record to ensure fast and efficient traceback (current law permits facilities to hold a record in any format — paper or electronic — making efficient tracing of foods difficult for FDA). Prior to issuing such regulations, FDA would be required to conduct a feasibility study, public meetings, and a pilot project.
• Enhances the safety of imported food: As an additional layer of protection, FDA can require food to be certified as meeting all U.S. food safety requirements by the government of the country from which the article originated or by certain qualified third parties. Third party certifying entities must meet strict requirements to protect against conflicts of interest with the firm seeking certification.
• Expands laboratory testing capacity: Requires FDA to establish a program to recognize laboratory accreditation bodies and to accept test results only from duly accredited laboratories. Gives FDA the ability to require laboratories to send test results to FDA.
• Provides strong, flexible enforcement tools: Provides FDA new authority to issue mandatory recalls of tainted foods. Strengthens criminal penalties and establishes civil monetary penalties that FDA may impose on food facilities that fail to comply with safety requirements.
• Creates fast-track import process for food meeting security standards: Permits FDA to develop voluntary security guidelines for imported foods. Importers meeting the guidelines would receive expedited processing.
• Enhances the safety of infant formula: Enhances FDA’s ability to assure the safety of new infant formulas before they go on the market.
• Advances the science of food safety: Directs the Secretary to include food in an active surveillance system to assess more accurately the frequency and sources of human illness. The Secretary is also directed to identify industry and regulatory approaches to minimize hazards in the food supply.
• Enhances FDA’s ability to block unsafe food from entering the food supply: Strengthens FDA’s authority to administratively detain unsafe food products. Grants FDA “quarantine” authority under which the agency may restrict or prohibit the movement of unsafe food products from a particular geographic area.
• Directs FDA to assess the use of carbon monoxide in certain foods: Requires FDA to conduct a safety review of the use of carbon monoxide in meat, poultry, and seafood products.
• Enhances transparency of GRAS program: Requires posting on FDA’s website of documentation submitted to FDA in support of a “generally recognized as safe” (GRAS) notification.
• Requires country-of-origin labeling and disclosure: Requires all processed food labels to indicate the country in which final processing occurred. Requires food manufacturers to identify the country of origin for all ingredients on their websites. Requires country-of-origin labeling for all produce.

The draft also requires all importers of food to register annually and sets up a system of unique identification numbers for all regulated facilities. Further, it protects whistle-blowers and gives FDA the power to subpoena records and locate inspectors overseas.

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The recent recall of nearly 96,000 pounds of ground beef by Valley Meats LLC got me thinking about hamburgers and E. coli O157:H7.  Anytime I hear those words together (which, as an attorney at Marler Clark, is quite often), I think of John McDonald.  John was a 5-year-old boy who we represented in a ground beef outbreak that occurred in 2007.  Unfortunately, John's illness was about as bad as an illness can get without causing a death.  (it is unbelievable how many times I find myself saying that about our clients) 

John was hospitalized at East Tennessee Children's Hospital from October 4 through 12, then was transferred to the University of Tennessee Medical Center where he remained until October 29.  During his hospitalization, John's kidneys failed requiring extensive dialysis to cleanse his blood, and he became badly anemic requiring many blood transfusions.

But these conditions, though in and of themselves potentially lethal, were just the beginning.  What truly separates John's illness from most of the hemolytic uremic syndrome illnesses that we see was the extent of injury to his gastrointestinal tract. 

Jim McDonald, John's father, was present at the moment it became apparent just how severe John's illness was.  It occurred in the early morning hours of Thursday, October 11, 2007.  He recalls: 

As usual, I got up to help as much as possible when the nurses came in and woke us up. When we opened his diaper, I got excited since it looked like he had had dark brown diarrhea, which told me that his digestive system was finally starting to kick in again. Realizing how liquidy the diaper was, we turned on an extra light to help us while changing him.

I will never forget what I saw. To my dismay, the diaper was not full of a bowel movement like I had desperately hoped. It was full of blood. An entire bowel movement of blood. Maybe an entire cup of blood. I got light-headed and almost passed out. I immediately sat down and grasped my head, apologizing to the nurses and telling them that I could no longer help them treat my son. This was the first of five grossly bloody stools that day.

Now bloody diarrhea is typical in the setting of an E. coli O157:H7 illness.  But this was another animal altogether.  John was losing blood from his gastrointestinal tract like he was bleeding from an opened artery.  In fact, over the course of the day on October 11, John was given two transfusions of packed red blood cells to address the significant blood loss he had suffered.  John was transferred to The University of Tennessee Medical Center the next day, where he endured, hopefully, the fight of his life. 

After transfer to UT, it became apparent that John was suffering from an infection somewhere in his body.  Coupled with the fact that he was bleeding heavily from his rectum and was constantly complaining of severe abdominal pain, doctors began to suspect that the infection was in his abdomen.  Heavy duty antibiotics were administered, but with no effect.  John continued for several days to exhibit signs of severe infection. 

The afternoon of October 16, 2007, doctors began to suspect that John had suffered a perforation (e.g. a puncture) somewhere in his gastrointestinal tract.  Besides the immense pain, the concern was that the contents of John's gastrointestinal tract, including the shiga-toxin producing E. coli O157:H7 bacteria, would escape and cause severe, potentially lethal infection elsewhere in his body. 

At around 8:00 PM on October 16, John was rushed to the Operating Room for an emergency exploratory laparotomy—i.e., an incision through the abdominal wall to gain access to the abdominal cavity. What the pediatric surgeon found inside was a mess of fecal material and grossly swollen bowel loops. The surgeon also found a portion of John’s rectum to be necrotic (i.e. diseased and dead) and there he located the perforation through the rectal wall that had allowed the contents of John’s bowel to spill into his abdomen, thus causing the severe infection in his peritoneal cavity.  

Ultimately, the surgeon decided that the necrotic and damaged portions of John’s colon and rectum stood no chance of recovery or survival, and so he removed about five inches of John's colon and rectum. After cutting and removing the damaged tissues, the surgeon washed John’s peritoneum copiously with normal saline. He then took a portion of John's colon outside of the peritoneal cavity and formed a pouch out of John's own tissue.  This pouch was then connected a colostomy bag to drain feces from John's abdominal cavity. 

It goes without saying that John's illness was severe.  After his surgery to remove part of his colon, John had to be sedated and kept on mechanical ventilation for many days.  He was hardly able to walk at discharge on October 29, 2007.  About John's discharge, his father recalls:

October 29, 2007: John got to come home today. He came home to a new house. He still couldn’t walk, but was trying to very hard. It was difficult for him (like Michaela) to rebuild his strength in his atrophied and skinny legs. We carried him when he couldn’t crawl. Nonetheless, everybody, including John, was thrilled that he was home. There were many tears of joy shed by all.
 

John's recovery is still ongoing.  He has done well since discharge, and has proved to be an extremely tough little customer.  We were honored to represent him and his family (by the way, his younger sister Michaela had HUS too), and have truly been inspired by his story. 

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It never ceases to amaze me, particularly after the last few years and all the high-profile outbreaks that have occurred, that people still pass off "foodpoisoning" as a couple of days of diarrhea--i.e. that the victim is no worse for the wear.  There is so much that is wrong with this statement that it would be pointless to even begin assailing it with mere facts.  Instead, as I've done recently with Jacob Aggas, Kelly Cobb, and Regan Erickson, I'll tell the story of somebody who, after his Salmonella infection, would disagree wholeheartedly with the notion that "foodpoisoning" is just a couple days of diarrhea.  In fact, don't stop reading this just because you think you've seen, or heard about, every varient of a Salmonella illness.  I assure you that you've never seen one quite like this before. 

At the request of our former client, I have changed the names and locations in this narrative:

Our client, Ron, was infected with Salmonella during a sporting banquet in Indiana. His illness began on July 27, 2004. At first, he suffered from predominantly gastrointestinal symptoms that were, in light of what was to come, relatively mild.

By August 1, Ron was in the emergency room at a nearby hospital The attending physician there noted repetitive diarrhea and, though the vomiting had subsided, that Ron continued to feel “somewhat nauseous and gaggy.” Ron was re-hydrated with a liter of normal saline, and twenty-five milligrams of Phenergan, an anti-nausea medication, were introduced intravenously. He was discharged several hours later with a prescription for Ciprofloxacin, an antibiotic.

Ron’s course over the next two months is one that defies clever adjectival description: He felt generally ill pretty much all of the time. He did manage to return to work after a couple of day’s absence, but he struggled to be as productive as usual, was frequently irritable, and seemed constantly besieged by abdominal discomfort. It was during this time that Ron learned that his stool sample had cultured positive for Salmonella, group D.

The same state of ill health persisted throughout August and September. “Then,” as Ron recalls, “came the first weekend in October,” and “any thoughts I had that the first bout in July was the sickest I’d ever been faded quickly.”
 

Ron’s memory of the onset of symptoms is vivid:

I returned from a short shopping trip and sat in my favorite chair to look at the printer I bought for my digital camera. While I was sitting there I was suddenly taken very ill. I don’t know how to explain it other than it was as sudden as if a bone were broken or a switch was flipped. I had very severe pain in my lower abdomen and started vomiting. I felt just like I did in July, only worse.

The symptoms persisted for the next two days, while Ron tried treating himself with simple, over-the-counter remedies. He had no reason to suspect that his intestines had started to rot. By Tuesday, October 5, the pain turned frighteningly severe, and Ron drove himself, once again, to the hospital emergency room.

The hours that Ron spent waiting to be seen he describes as “the most uncomfortable [] of my life.” He was eventually seen and admitted soon after, the attending physician having become concerned at the intensity of the sub-umbilical pain that “spread across [Ron’s] entire abdomen,” which suggested acute appendicitis. A CT scan revealed some inflammation in the small bowel mesentery, but “no convincing inflammatory changes around the appendix to confirm the diagnosis of acute appendicitis.”

Afterward, Ron was wheeled to his own room, where he slept intermittently throughout the night. By morning, he was running a high fever, had become nauseated, and his stomach was plagued by intense cramps and pains.

Shortly before noon, Ron met a gastroenterologist in consultation. The gastroenterologist’s note presciently draws the first link to Ron’s recent bout with Salmonella, Group D. The doctor stated, “other than the bout of Salmonella noted above, he never had problems with chronic diarrhea or abdominal pain. There is no family history of inflammatory bowel disease or colitis.” The doctor decided to do laparascopic/exploratory surgery to address the worsening fluid collection and inflammation of Ron’s small intestine.

What was found on introduction of the exploratory laparoscope was not what was expected: “upon induction . . . there were multiple socked-in small bowel loops that were adherent to the anterior abdominal wall as well as to each other.” The surgeon was unable to detach and mobilize the small bowel and consequently had to convert to laparotomy.

Upon exploratory laparotomy, the small bowel had a densely fibrotic reaction throughout most of its length. There was one area in particular, it was in the distal ileum, that had the appearance of a chronic perforation that was very diseased. This was not salvageable.

The surgeon stopped the operation at this point, preferring an intraoperative consultation with yet another surgeon, who noted:

The small bowel was also examined in its entirety from the ligament of teitz to the ileocecal valve. The small bowel in general was very inflamed and beefy red. There were areas of dusky serosa. There was one loop of small bowel, however, that appeared near-necrotic. This loop had been involved with the abscess. It was inflamed and stuck to itself. The mesentery of this portion of the small bowel was also thickened and inflamed . . . It was felt that this portion of the small bowel was the primary process and cause of the peritonitis and abscess.

The doctors concurred that removal of the “near-necrotic” portion of Ron’s small intestine—between twelve and sixteen inches—was required. This was done with no complication and, after copious abdominal irrigation, the functional ends of Ron’s resected intestine were stapled and sutured. And as if this alone was not enough, Ron’s appendix was noted to be “inflamed throughout its course.” Accordingly, the surgeon removed the appendix as well. The surgery concluded with the placement of a Penrose drain in the subcutaneous fat.

Afterward, in search of an infectious cause, the surgeon sent the resected intestine and appendix to pathology; he also ordered that tissue samples from Ron’s abdomen be sent to the lab for culture. The pathology report states, in part:

The morphologic findings . . . confirm the clinical impression of intra-abdominal abscess formation. Although acute inflammation is present in the wall of the appendix, it may be secondary to intra-abdominal inflammatory process. The patient has a previous history of Salmonella infection (July 2004) and correlation with the pending culture results is essential.

The culture report from Ron’s abdominal tissue sample would return later in the month with a positive result for Salmonella enteritidis, group D1.

In the days following Ron’s surgery, his wife Mary spent most of every waking hour at the hospital by her husband’s side, leaving only to sleep or get the kids to their various after-school activities. The kids were required, by parental rule, to stay out of the hospital room. Mary thought that they had enough to endure at present without having to see their incapacitated father in a hospital bed with tubes down his throat and sticking out of his abdomen. But dad was not far from everybody’s thoughts. Ron soon had a large mail delivery, which consisted of get-well-soon cards from every boy and girl in his ten-year-old son’s class.

Meanwhile, Ron’s treatment continued with Ciprofloxacin, Zosyn, Zofran, and repeat dosages of morphine, which was available to Ron, in regulated amounts, at the touch of a button.

Until October 11, with a few minor bumps along the way, Ron progressed well. But that day, a Monday, Ron began to suffer greater pains in his abdomen than he had since surgery. Ron was wheeled to radiology that afternoon for another CT scan of his abdomen and pelvis. The exams showed increased fluid collection in Ron’s abdomen, most prominently in the paracolic gutter region in the lower left quadrant.

The next day, a drainage catheter was installed. In detail not meant for the squeamish, Ron recalls the process by which this drain, and others, was inserted. Beginning with the following caveat, “When [doctors] say they are sorry they have to hurt you as part of the treatment—they mean it,” he states:

The process of inserting a drain, at least in my case, was one of technology and brute force. It is done while lying on the movable platform of a CT machine. First, they run a CT scan to determine the best spot to drain the fluid. Then they prepare the area and push a wire through your side into the abdomen. The first time I had this done I think they went in 11cm. I think that’s a little more than 4 inches. With the wire inserted they run you through the CT machine again to make sure it’s properly placed. If it is in place they then push a larger tube over the wire until it is in place, run the CT again, and try to draw off as much fluid as they can. After that’s done they attach a collection bag that is Velcroed to your leg, and tape the tube to your side. I’ve never been stabbed by a knife or run-through with a sword but I think I can imagine the feeling. Unfortunately a couple of days later, while hauling myself out of bed, I snagged the tube and pulled it out.

In addition to the drain difficulties, Ron continued to suffer a variety of complications from his illness. He was confirmed with a Clostridium difficil infection around October 13, for which he was given another antibiotic called Flagyl. He also experienced a dramatic loss of appetite, which would plague him for months afterward. Fluid and gas continued to accumulate in the area of Ron’s bowel resection, requiring the placement of another catheter on October 15—another unwelcome, painful procedure.

Not all was pain and misery, however. The consensus amongst the doctors was that, under the circumstances, their patient had progressed well. Ron had, after all, had nearly twelve inches removed from his small intestine, and had lost one organ entirely, to say nothing of the gastrointestinal discomfort he suffered for two months prior to hospitalization. Also, Ron’s diarrhea had slowed significantly, and he felt far less fevered.

After nearly two weeks hospitalization, Ron was finally discharged on Saturday, October 16, 2004. The principal diagnosis was intra-abdominal abscess, and the principal procedures were noted to be “1. Exploratory laparotomy [] with a partial small bowel resection. 2. Antibiotic therapy. 3. CT-guided intra abdominal drain placement times two.” As for the resected portion of Ron’s small bowel, the pathology report concludes as follows: “Small bowel with subserosal abscess formation with extensive acute inflammation, acute serositis, fat necrosis, foreign body giant cell reaction and serosal adhesions.”
 

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The spinach E. coli outbreak in September 2006 was perhaps the most devastating outbreak of foodborne disease since the Jack in the Box E. coli outbreak in 1993.  Over two hundred people suffered confirmed illnesses in the spinach outbreak, with 102 hospitalizations, and at least four deaths.  We represented over 100 victims, including nearly 30 who suffered kidney failure and hemolytic uremic syndrome  (HUS).  The outbreak caused spinach, and produce companies generally, to lose hundreds of millions of dollars.  But this is all just numbers and words, things that are no closer, or more real, to most of the 300 million Americans than a successful missile launch by North Korea or Iran.  It happens, and its a little scary, but do we do anything different in our daily lives because of it?  

Tiffany and Russ Erickson were just like most Americans until September 2006.  Their four-year-old son Regan (pronounced "Ree-gun") was one of many young kids whose future was unalterably and forever changed by spinach.  What appears below is Regan's story.  It is a little long, but that must be forgiven.  Regan's illness very nearly cost him his life.

ONSET OF ILLNESS:

Regan's mother, Tiffany, and his sister, Emma, were both sickened during the Spinach outbreak as well.  Tiffany actually fell ill first, on August 28. It felt like cruel timing, given that it was only three days before Emma’s birthday and little more than a week since discovering that she was pregnant with her third child, Maggie, but Tiffany took everything in stride. She had no reason to suspect that she was dealing with anything more than a run-of-the-mill flu, and her primary concern was with the health of her unborn child.

After twenty-four hours or so, however, thoughts began to change about the nature of Tiffany’s illness. Her bouts of diarrhea had grown more frequent and severe, and her abdomen was beset by cramps more severe than labor pains. Then, the evening of August 29, after a particularly painful bout of diarrhea, Tiffany noticed that the toilet bowl was streaked with blood. Up until this point, Tiffany had endured everything with resolute confidence, but this symptom suggested something that she had never before reckoned with.

Tiffany soon underwent a diagnostic procedure called an endoscopy to shed light on what was wrong.  Of his wife’s illness, before his thoughts turned to Regan alone, Russ recalls:

We left the urgent care facility and gave the drugs some time to work, but the pain continued to be unbearable. As my concern shifted from the baby to Tiffany I couldn’t stand seeing her in that much pain, tired from lack of sleep, and not able to get comfortable.

Meanwhile, Regan had begun to develop symptoms, and Emma soon would. “We didn’t realize that the illnesses could be related,” Russ recalls, “since Regan couldn’t express his pain as well as Tiffany. He just knew his ‘tummy’ hurt and he began having diarrhea.” Emma’s symptoms began the very next day, September 1.

Russ recalls:

Everyone in the family was sick, tired, and the children being so young, not knowing how to tell or deal with the symptoms like diarrhea, I was continually cleaning, comforting, and helping where I could, all without Tiffany’s help who is usually the stalwart caregiver. We knew that we had some kind of ‘bug’ but not how severe yet. It presented a lot like flu symptoms, but we began to know it was more serious as the kids, just as Tiffany, began to have blood in their stool, and then blood instead of stool. That is a scary, unnerving experience to see blood when your 3 and 4 year olds are using the bathroom.

Compared to four year-old Regan, the illnesses that Tiffany and Emma Erickson suffered were nothing more than a small current in a raging sea. Nevertheless, to hear Russ describe what his wife and daughter endured is to fully comprehend the aggressive nature of this virulent pathogen. Emma endured many days of an illness more acutely painful than anything her parents had ever seen. But as sick as she was, her older brother was fast-becoming critically ill, and her parents thoughts and attention soon went solely and exclusively to Regan.

REGAN'S ILLNESS:

During an appointment with his pediatrician on September 4, Tiffany reported that Regan had had twenty bouts of bloody diarrhea that day, prompting endless complaints of a sore stomach. Regan been unable to eat or drink for days, and had developed redness and inflammation in the rectal area due to the frequency and severity of the diarrhea. These seemingly benign signs were immediately concerning to the pediatrician, who immediately sent Regan and his parents to Mckay Dee Hospital's emergency department.  Tiffany and Russ rushed to the ER and carried their son in, having no concept of the road that lay ahead.
 

Regan remained hospitalized at Mckay Dee for the next two days.  Gradually, blood tests showed that he was becoming anemic and losing platelets, and he was also not urinating normally.  Soon, stool tests showed exactly why.  Regan had been infected by E. coli O157:H7, and he was developing HUS.  Doctors at Mckay Dee knew that Regan was critically ill, and they transferred him by Ambulance to Primary Children's Medical Center (PCMC) in Salt Lake City on September 6.

Meanwhile, Tiffany and Russ had begun the painful process of contacting friends and relatives. Russ’s mother dropped everything and, leaving at 4:00 AM, drove to Salt Lake City from Las Vegas. She recalls:

I arrived at Primary Children’s just after the ambulance arrived. They had just gotten Regan in his room. It was a flurry of activity, doctors and nurses in and out of the room. I was taken aback by his appearance. The last time I had seen him was on the 4th of July. He was playing with all his cousins, excited with all the fireworks, eating bar-b-que, and being a normal kid. Today he was pretty much unresponsive; he didn’t even know I was there. So pale and vulnerable, it broke my heart to see him in that condition. I was also taken aback by the appearance of Russell and Tiffany. It was obvious that Tiffany was still not well. She looked pale and tired. As if she was just barely making sense of the whole bizarre turn of events. Russell looked like he hadn’t slept in days . . . come to find out he hadn’t. He had been holding his little family together for over a week now. The only one of them not affected, the burden of care had been fully placed upon his shoulders. And they sagged at the weight of it all. He was tired; with worry in his eyes, fear in his voice and faith in his heart he told me that they were in the best hospital, with the best doctors and that Regan would be okay.

Regan had a difficult night his first night at PCMC. He had run a fever consistently; he had been nauseated despite Zofran; and he had vomited and suffered from painful abdominal distention all night long. Perhaps more significantly, he had had little to no urinary output all night, his face was swollen, and there were signs that his pancreas had already been affected, in addition to his kidneys, by the shiga-toxins released by the E. coli O157:H7 bacteria in his gastrointestinal tract.  Regan's nephrologist planned to begin dialysis immediately if the Lasix, a diuretic, did not stimulate more urine production. 

Tiffany placed a call to her mother, Tonya Peterson, the afternoon of September 7. Tonya remembers:

Tiffany told me that his pancreas and kidneys had shut down. I couldn’t believe it. I sat at work at my desk, crying for several hours, unable to concentrate on my work. I thought that Regan might not make it. I called my dad and asked him to take me to see Regan. I knew I wouldn’t be able to drive to the hospital in my condition. I was too distraught at the thought of losing Regan. He was such a sweet, innocent little boy. He called me “Ma-mah,” his version of “grandma.”

Regan continued his descent toward total kidney failure that night. He had stopped producing urine completely, and his nephrologist ordered that Regan be prepped for peritoneal dialysis. Accordingly, Regan was transported to the operating room on Friday morning, September 8, where doctors placed a spiral peritoneal catheter for dialysis. He also placed a PICC (peripherally inserted central catheter) line in Regan’s right arm to facilitate infusion of blood products, medicine, and IV nutrition.  Then dialysis began.

September 9-13

Regan ran a fever all night on September 8 and vomited five times. He produced no urine and continued to suffer bouts of bloody diarrhea, producing 76 ml of mostly blood before 11:00 AM on September 9. Attendants administered morphine to ease the little boy’s immense discomfort. And because he continued to suffer from nausea and vomiting, doctors began Regan on total parenteral nutrition. Dialysis continued with hourly exchanges.

Over the next two days, Regan remained critically ill. He continued to have no renal function, and his hematocrit continued to drop, which indicated progressive anemia. In addition, Regan had consistently elevated blood pressure readings and was overloaded, in fact bloated, from fluid retention because he was unable to urinate. 

Russ recently recalled his sense of devastation and total helplessness during this time:

Together with the surgeries, dialysis, and transfusions was a lot of heartache and a lot of pain. As I watched Regan suffering, I felt helpless. He wasn’t comforted by me and there wasn’t anything I could do to fix the situation. I could just watch, wait, and hope that he would pull through this illness.
***
I also had Emma and Tiffany to worry about. Emma was still having trouble adjusting to what was going on, and she was still regaining strength from her own illness. She couldn’t understand why Regan had to stay at the hospital and have tubes coming out of him all over the place when she had been sick and gotten better without any of that. Tiffany was still recovering, ragged from stress, and she was in a difficult first trimester with all the ailments that come along with that. I was very worried about what I could do to help my family, and it didn’t feel like much.

Regan’s hematocrit continued to drop on September 12, indicating progressing anemia. Doctors ordered that a transfusion of leukocyte filtered packed red blood cells be administered as soon as possible. Regan’s bloody diarrhea continued, but seemed to be improving, and his WBC count dropped as well. Nonetheless, Regan continued to be anuric, leaving his nephrologists little choice but to continue peritoneal dialysis.

September 14-16

By Thursday, September 14, Regan’s medical picture continued to be dire. He continued to be medicated for nausea, hypertension, fevers, to stimulate red blood cell production, and he continued to receive a bronchodilator. He also remained positive, by stool culture, for E. coli O157:H7, and consequently remained under strict quarantine.

Russ’s mother stayed at the hospital, alternating with Tiffany and Russ, at least one of whom was always at Regan’s bedside. She says of Regan’s first week:

The chair made into a bed of sorts and the nurses brought me blankets and pillows. We realized very quickly that the hour drive to PCMC every day was not only costly for the kids but most inconvenient. One of Russell’s cousins lived in the area of the hospital and invited Russell and Tiffany to stay at their house. The Ronald McDonald House had a distance rule that they missed qualification for by just 7 miles. They decided that as long as I could stay with Regan at night, they would go home to sleep in their own bed and then when I had to leave they would go to Russell’s cousin’s house and take turns staying at the hospital at night with their boy.

Throughout the week Regan was so sick that I still wondered if he even knew who I was. He progressed somewhat with the dialysis and his lab tests improved at a snail’s pace. Toward the end of the week they declared him E. coli free and he was allowed to ride in the little red wagon and get out of that tiny room for a minute. Up until that time not only was he confined to the room but his sister, Emma, wasn’t allowed in the play room and his family had strong precautions they were to take to insure that the E. coli would stay contained.

Regan remained very irritable and uncommunicative on Saturday, September 16, prompting an examining physician to describe him as an irritable young lad who had pulled the blanket over his head and his knees up to his abdomen during the examination attempt. Nevertheless, no new symptoms had arisen, and Regan’s hemolytic anemia and thrombocytopenia had begun to improve. Peritoneal dialysis, however, continued just as before.

September 18-23

By September 18, Regan had begun to pass a small amount of urine, and his stools had firmed up. He nevertheless remained extremely irritable and very uncooperative, evidently suffering significant discomfort from his ongoing symptoms. He had begun to moan during the drainage cycle of his ongoing peritoneal dialysis, which had been further reduced to twelve hours per day. But despite the encouraging sign of modest urine production, Regan’s kidney labs had not improved; BUN and creatinine levels remained very high at 62 and 6.1.

Over the next several days, Regan’s kidney lab values continued to fluctuate, so doctors ordered an increase to seventeen hours per day on September 20 due to an unexpected increase in creatinine to 6.7. And on September 22, in fact, Regan again could muster no urine at all. He was anemic and symptomatic with weakness, fatigue, and shortness of breath—all of which convinced his medical team that another transfusion was in order. Dialysis continued as well.

Dr. Sherbotie evaluated Regan the morning of September 23, noting that Regan’s appetite was “clearly” improving with only occasional vomiting. Regan was also able to produce a “substantial amount” of urine that morning. Nevertheless, his lab values indicated ongoing renal dysfunction, and peritoneal dialysis continued with a decrease in the number of hours.

September 25-26

Regan's nephrologist noted significant improvements during his initial assessment on September 26. Generally speaking, Regan appeared well and “was quiet but interactive.” He had lost weight—significant to the clinical picture because it suggested a reduction in fluid retention—and he continued to produce more urine.  Nevertheless, he remained on dialysis.

September 27-28

On Wednesday, Regan’s urinary output continued to increase. He produced 641 ml (3 ml/kg/hr) with 550 ml intake. His appetite also continued to improve and, though still cranky, he was more playful than he had been previously. Additionally, his hematocrit, WBC, platelets, sodium, potassium, and glucose were all within normal range, and his BUN and creatinine were trending down with values of 56 and 5.4. With this positive news, Regan’s nephrology team ordered that peritoneal dialysis be stopped for the first time since September 8.

The order to stop dialysis did not, however, mean that the dialysis catheter could be removed. Labs on September 28 indicated another increase in BUN and creatinine, to 60 and 5.9, which values had remained elevated since dialysis was discontinued the day before. Regan’s blood pressure was stable but high at 118-122 over 70-90. Accordingly, Amlodipine continued for Regan’s hypertension.

September 29

On Friday morning, Regan was doing well overall. He continued to be anxious, but seemed to be less cranky, and he was able to eat and drink more and had further increase in urinary output. His facial edema had also improved, but Regan was considered to be generally mildly edematous. He also continued to have elevated but stable blood pressures.

Later in the day, Regan again went to the operating room—this time, however, to have his dialysis catheter removed. Tiffany recalls:

This was a surgery that wasn’t quite as scary to send him in to. He’s laughing because the anesthesiologist put some type of goofy medicine in his PICC line that just made him into a hoot and a half. I was still quite nervous but it felt better to send a laughing child into surgery than a sickly one.

September 30—Discharge from PCMC

On Saturday, September 30, 2006, after four weeks in the hospital and countless dialysis treatments, Regan Erickson was discharged home.  His discharge diagnoses included HUS; pancreatitis; acute renal failure requiring peritoneal dialysis from September 8 to 26; placement of PICC on September 8 and removal on September 26; placement of peritoneal dialysis catheter on September 8 and removal on September 29; anemia requiring blood transfusions and ongoing Darbopoetin infusion; emesis requiring Prevacid and Erythromycin Ethylsuccinate (anti-infective); hyperphosphatemia requiring calcium carbonate with meals and phosphate restriction; hypocalcemia status post calcium supplements between meals and IV Calcium chloride x 2; and reactive airway disease.

REGAN'S PRESENT CONDITION AND PROGNOSIS:

Sadly, a child's HUS illness doesn't really end when he is discharged from the hospital.  Regan is a perfect example of this.  He remained on blood pressure medications after discharge, and he continued to suffer physical and emotional problems related to his prolapsed rectum and the trauma of going through an illness as severe as his was.  

Tiffany recalls:

A couple of months after Regan's hospitalization, we made a decision, which hindsight tells us was a bad one, to go to Las Vegas with my husband for a conference he had. His parents live there so we thought it would be a nice cheap vacation. We drove down. The morning after we arrived Regan's prolapse came back out but this time we couldn't get it back in the entire day. I had been speaking over the phone to a pediatrician throughout the day. By the time the prolapse had been out for 12 hours we were advised to take him to the ER in Las Vegas. He was hospitalized.

When we got home I took Regan to a local surgeon and then to a pediatric GI doctor. We decided to allow Regan to use a pullup and stay off the toilet for several months. Regan had a hard time with the toilet because it really scared him when the prolapse would appear. We bought a box of rubber gloves and made sure we had plenty packets of lubricating gel.

Regan is one of many people, mostly children, sickened in the Spinach outbreak whose lives have permanently changed as a result of their illnesses.  He is forecast by several of the country's leading pediatric nephrologists to require multiple kidney transplants due to the severity of the kidney injury that he suffered in the Spinach outbreak.  Lifetime medical costs will run into the millions of dollars.

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E. coli O157:H7 outbreaks associated with lettuce or spinach, specifically “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. By way of illustration:

- in October 2003, thirteen residents of a California retirement home were sickened, and two people died, after eating E. coli-contaminated, pre-washed spinach;

- in September 2003, nearly forty patrons of a California restaurant chain fell ill after eating salads prepared with bagged, pre-washed lettuce; and

 - in July 2002, over fifty young women fell ill with E. coli O157:H7 at a dance camp after eating “pre-washed” lettuce, leaving several hospitalized and one with life-long kidney damage.

Here are a few more examples:

• Aug. 1993--E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State
• July 1995 Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana
• Sept. 1995 Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho
• Sept. 1995 Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine
• Oct. 1995 Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio
• May-June 1996 Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York
• May 1998 Salad E. coli O157:H7; two reported cases in California
• Feb.-Mar. 1999 Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska
• July-Aug. 2002 Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho
• Oct. 2003-May 2004 Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California
• Apr. 2004 Spinach E. coli O157:H7; 16 reported cases in California
• Sep. 2005 Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

But we all know that the list does not end there.  E. coli O21:H19 nearly killed two women at a Wendy's in Utah.  Who can forget the September 2006 outbreak associated with Dole Baby Spinach?  Click here to see how the Spinach outbreak unfolded, and what all the epidemiological and other scientific evidence revealed.  Also Taco Bell and Taco John's in late 2006.  2008 saw E. coli outbreaks linked to lettuce in Michigan and the State of Washington - Spinach too in Oregon.  And, there have been may others sickened in produce-related outbreaks of E. coli O157:H7, Salmonella, and other dangerous bugs.

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Approximately 96,000 pounds of ground beef products are being recalled by Valley Meats, a company operating out of Coal Valley, Ill., for E. coli O157:H7 contamination.

It appears this recall did not come soon enough for one unfortunate person.  The Department of Health in Cleveland, Ohio has announced that a 6 or 7 year old girl has died, apparently from consuming some of the recalled ground beef.

For a complete list of the products currently being recalled, see below:

3S Brand Products:

• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN 3/S 100% GROUND BEEF PATTY." Each package bears the identifying case code "95554."
• 10-pound cases containing a total of 60 (6-1) "KEEP FROZEN 3/S 100% GROUND BEEF PATTY." Each package bears the identifying case code "95556."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN 3/S CHOPPED BEEF SIRLOIN STEAK BURGER." Each package bears the identifying case code "95573."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN 3/S CHOPPED BEEF SIRLOIN STEAK BURGER." Each package bears the identifying case code "95574."

Grillmaster Brand Products:

• 10-pound cases containing a total of 100 (10-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." Each case can be identified by the case code "95588."
• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." Each case can be identified by the case code "95500."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." Each case can be identified by the case code "95502."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." The cases can be identified by the case codes "95504" and "95505."
• 10-pound cases containing a total of 50 (5-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." Each case can be identified by the case code "95508."
• 10-pound cases containing a total of 60 (6-1) "KEEP FROZEN GRILL MASTER 100% GROUND BEEF PATTY." Each case can be identified by the case code "95509."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN GRILL MASTER BEEF PATTIE." Each case can be identified by the case code "95512."

J & B Brand Products:

• 10.5 pound cases containing a total of 28, 6-ounce "KEEP FROZEN BEEF HOAGIE PATTIE." Each package bears the identifying case code "51706."
• 10.5 pound cases containing a total of 14, 12-ounce "KEEP FROZEN BEEF DINNER PATTIE." Each package bears the identifying case code "51312."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN TENDERKNIT BEEF STEAK CHOPPED AND FORMED." Each package bears the identifying case code "11028."
• 10-pound cases containing a total of 40 (4-1) "TENDERKNIT BEEF STEAK CHOPPED AND FORMED." Each package bears the identifying case code "11024."
• 10-pound cases containing a total of 10 (4-1) "KEEP FROZEN TENDERKNIT VEAL LUNCHEON CHOPPED AND FORMED." Each package bears the identifying case code "13014."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN SEASONED GROUND BEEF PATTIE." Each package bears the identifying case code "11384BR."
• 10-pound cases containing a total of 40 packages (4-1) "KEEP FROZEN BEEF STEAK BURGER." Each package bears the identifying case code "J1004."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN FLAVOR BURST BEEF PATTIE." Each package bears the identifying case code "51803."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN FLAVOR BURST BEEF PATTIE." Each package bears the identifying case code "51804."

Klub Brand Products:

• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN KLUB GROUND BEEF STEAK." Each case can be identified by the case code "95565."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN KLUB GROUND BEEF STEAK." Each case can be identified by the case code "95567."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN KLUB GROUND BEEF STEAK." Each case can be identified by the case code "95568."
• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN KLUB HOMESTYLE GROUND BEEF STEAK." Each case can be identified by the case code "95583."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN KLUB HOMESTYLE GROUND BEEF STEAK." Each case can be identified by the case code "95584."

Thick 'N Savory Brand Products:

• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN THICK 'N SAVORY SEASONED BEEF PATTY." Each case can be identified by the case code "95579."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN THICK 'N SAVORY SEASONED BEEF PATTY." Each case can be identified by the case code "95580."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN THICK 'N SAVORY SEASONED BEEF PATTY." Each case can be identified by the case code "95581."

Ultimate Brand Products:

• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case can be identified by the case code "1012CL."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case can be identified by the case code "1013CL."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case can be identified by the case code "1014CL."

Products with No Specified Name Brand:

• 10-pound cases containing a total of 20 (2-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case bears the case code "50123."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case bears the case code "50125."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN ULTIMATE BURGER CHOPPED BEEF STEAK." Each case bears the case code "50127."
• 10-pound cases containing a total of 30 (3-1) "KEEP FROZEN PURE BEEF PATTIE HEARTY HOMESTYLE." Each case bears the case code "3253."
• 10-pound cases containing a total of 40 (4-1) "KEEP FROZEN PURE BEEF PATTIE HEARTY HOMESTYLE." Each case bears the case code "3254."
• 10-pound cases containing a total of 50 (5-1) "KEEP FROZEN PURE BEEF PATTIE HEARTY HOMESTYLE." Each case bears the case code "3255."
• 24.75-pound cases containing a total of 144 "KEEP RERIGERATED GROUND BEEF PATTY." Each case can be identified by the case code "8218."
• 20-pound cases containing a total of 4 (4 X 5) "KEEP REFRIGERATED GROUND BEEF." Each package bears the identifying case code "8020EC."
• 40-pound cases containing a total of 8 (8 X 5) "KEEP REFRIGERATED GROUND BEEF." Each package bears the identifying case code "8020VP."
• 20-pound cases containing a total of 4 (4 X 5) "KEEP REFRIGERATED GROUND BEEF." Each package bears the identifying case code "8515."
• 20-pound cases containing a total of 4 (4 X 5) "KEEP FROZEN GROUND BEEF." Each package bears the identifying case code "8020ECF."
• 20-pound cases containing a total of 4 (4 X 5) "KEEP FROZEN GROUND BEEF." Each package bears the identifying case code "10201."
• 20-pound cases containing a total of 4 (4 X 5) "KEEP FROZEN GROUND MEAT." Each package bears the identifying case code "10301."

Additionally, each product bears the establishment number "EST. 5712" inside the USDA mark of inspection. The (2-1), (3-1), (4-1), (5-1) and (6-1) markings refer to the number of portions per one-pound.

These ground beef products were produced on March 10, 2009, and were distributed to various consignees nationwide.

The problem was discovered through an epidemiological investigation of illnesses. On May 13, 2009, FSIS was informed by the Ohio Department of Health of a cluster of E. coli O157:H7 infections. Illnesses have been reported in Ohio, Pennsylvania, and Illinois. Individuals concerned about an illness should contact a physician.

E. coli O157:H7 is a potentially deadly bacterium that can cause bloody diarrhea, dehydration, and in the most severe cases, kidney failure. The very young, seniors and persons with weak immune systems are the most susceptible to foodborne illness.

Media and consumers questions regarding the recall should be directed to the company spokesperson at (309) 799-7341.

Consumers with food safety questions can "Ask Karen," the FSIS virtual representative available 24 hours a day at AskKaren.gov. The toll-free USDA Meat and Poultry Hotline 1-888-MPHotline (1-888-674-6854) is available in English and Spanish and can be reached from l0 a.m. to 4 p.m. (Eastern Time) Monday through Friday. Recorded food safety messages are available 24 hours a day.

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Lindsey Jennings (middle), our client, was a "perfectly healthy" twenty-one year old girl.  Actually, better than that, Lindsey was an avid athlete, in training for a marathon, running over 40 miles a week, all while completing her pre-med courses during her senior year at the University of Michigan in Ann Arbor, when she was unfortunate enough to eat contaminated lettuce. 

In fall 2008, Lindsey suffered an E. coli O157:H7 infection and illness the likes of which we don't often see . . . at least not in somebody so undeniably healthy and vibrant.  Lindsey was hospitalized for 12 days with a gastrointestinal illness so severe that she required replacement nutrition (total parenteral nutrition) because her gastrointestinal tract was too injured to process food or fluid.  She did not eat solid food for over a month, and actually had to continue to receive this nutrition through a tube (peripherally inserted central catheter--PICC) even after she was discharged from the hospital. 

Lindsey has continued to recover from her illness in 2009, but she has chosen not to forget about the experience of being so ill.  Along with several other Marler Clark clients, Lindsey recently spoke to members of Congress about food safety issues and the need for more vigorous legislation and regulation of the food supply.  Afterward, in an interview with Elizabeth Rackover of The Oakland Press, Lindsey stated, “It’s made me much more interested in the political side of things.”  “No one should have to go through what we’ve gone through. There are approximately 5,000 people who die every year from foodborne illnesses and almost all of it is preventable.”

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Andrew Martin of the New York Times wrote a nice article this morning on the safety of our food supply.  We represent all three individuals profiled in his article:  Heather Whybrew, Carl Ours, and Mary Tardiff.  All suffered devastating illnesses in separate outbreaks and from different pathogens.  All have unbelievable stories of suffering. 

Heather's story is unique, perhaps because she had lived through so much pain in her life even before her severe E. coli O157:H7 illness.  In November 2004, after two years of headaches, she was diagnosed with a brain tumor. Treatment for her relatively rare condition—giant cell glioblastoma—included a full craniotomy to remove the tumor from the left frontal lobe of Heather’s brain. The procedure left her partially paralyzed. She remained hospitalized at Seattle Children’s Hospital and in intensive rehabilitation from November 16 until December 24, 2004.

During her rehabilitation, Heather had to relearn many basic motor functions, including how to walk.  Relearn these skills she did, and despite her brain tumor, Heather eventually went on to college at Pacific Lutheran University.

Heather was infected by E. coli O157:H7 in the midst of finals her freshman year from contaminated lettuce served in a University Cafeteria. She would ultimately be hospitalized at St. Francis Hospital and Seattle Children's Hospital for three weeks.  During her hospitalization, Heather battled endless nausea, vomiting, and diarrhea, a bad pneumonia illness, and severe blood clots in the superficial veins of her arms.  The combined medical treatment would cost almost $114,000.  She would have to make up her final exams during the next school year.

By the time Heather had recovered to the point that she could return to school at Pacific Lutheran University, class was already well into the first semester.  Thus, as a result of her E. coli O157H7 illness, not only did Heather miss final exams her freshman year, but also she had to drop certain courses from her schedule during fall semester of her sophomore year.  She will be forced to take another year of class at Pacific Lutheran University as a result of the delays caused by her E. coli O157:H7 illness.  The cost of this additional year will be at least $36,000. 

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Towns in Oklahoma, Texas, and Wisconsin are taking steps to prevent illness in residents using public water after positive tests for  E. coli.  Officials in Hollis, Oklahoma were distributing bottled water after positive tests in the public water system.

In Baytown, Texas, officials announced a boil order after positive E. coli tests. 

And finally, residents in Janesville, Wisconsin were also under a boil order, again after positive tests for E. coli.

The term E.coli referst to family of baceria that includes the dangerous E. coli O157:H7 bacteria.  A positive, general,  test for E. coli does not necessarily indicate the presence of E. coli O157:H7.  Likewise, it does not rule out its presence.

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Brandy Baltzell is a freshman at Millersville University.  She is going to major in biochemistry, and will soon, I think, be doing great work with E. coli O157:H7 and other nasty little foodborne pathogens.  I was happy to play what role I could in the recent research paper that she wrote, discussing the characteristics of E. coli O157:H7, including how it spreads and what it does to the body.  See Brandy's paper here.

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This week's food safety infosheet (pdf) from the International Food Safety Network focuses on what we learned this week - that ground beef is once again the source of a multi-state E. coli outbreak.  At least five people in Wisconsin and one California resident became ill with E. coli infections after consuming meat produced by Rochester Meats of Michigan.  According to the Food Safety and Inspection Service's recall announcement from last weekend:

The problem was discovered through an investigation initiated by the Wisconsin Department of Health and Family Services and the California Department of Public Health into five illnesses in Wisconsin and one illness in California. Anyone concerned about an illness should contact a physician.

The ground beef products subject to recall were produced on Oct. 30, 2007, and Nov. 6, 2007. The products subject to recall were shipped to distributors nationwide for further distribution to restaurants and food service institutions. These products were not available for purchase by consumers in retail establishments.

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On January 5, Mark's Quality Meats, Inc. of Detroit, Michigan, recalled over 13,000 pounds of ground beef and steak products that were produced in late December after E. coli contamination was identified through lab testing.  In announcing the recall, the Food Safety and Inspection Service stated that no illnesses have been reported in connection with the recall.  According to the Detroit Free Press: 

Michael Layne, a spokesman for Mark’s Quality Meats, said some of the meat has been consumed, but the products that weren’t have been removed from the restaurants, brought back to the company’s facility and destroyed. About 200 restaurants had received meat from the company, he said.

Meanwhile, public health officials are investigating to determine the source of Salmonella outbreaks in Pennsylvania and Montana.  The Pennsylvania outbreak has been traced to foods prepared by a restaurant, and the Montana outbreak is still under investigation, although the strain of Salmonella isolated from Montana patients is likely linked to the strain causing illness in Texas and Pennsylvania. 

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The US Department of Agriculture's Food Safety and Inspection Service announced yesterday that Texas American Food Service Corporation of Fort Worth, Texas, was recalling 14,800 pounds of ground beef products for possible E. coli contamination. The products were sold under American Fresh Foods labels (right).

Consumer products being recalled include:

• 2-pound approximate weight packages of "73/27 GROUND BEEF" bearing a sell-by date of "12.30.07"
• 2-pound approximate weight packages of "80/20 GROUND BEEF CHUCK" bearing a sell-by date of "12.31.07"
• 1-pound approximate weight packages of "85/15 GROUND BEEF ROUND" bearing a sell-by date of "12.31.07"
• 1-pound approximate weight packages of "90/10 GROUND BEEF SIRLOIN" bearing a sell-by date of "12.31.07"
• 1-pound approximate weight packages of "96/04 EXTRA LEAN GROUND BEEF, 4% FAT" bearing a sell-by date of "12.31.07"

Bulk ground beef being recalled includes:

• 40-pound "net wt." box of "73/27 100% GROUND BEEF; REWORK MAP"
• 260-pound "net wt." combo bin of " CHUCK 100% GROUND BEEF; REWORK MAP"
• 370-pound "net wt." combo bin of "SIRLOIN 100% GROUND BEEF; REWORK"
• ervice announced yesterday that

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Ediets.com provided some good tips on safer eating this morning in an article titled, "13 Foods That Could Kill".  The thirteen foods the column focuses on are:

Lettuce: because lettuce has been identified as the source of several E. coli and other foodborne illness outbreaks.  In 2006, Dole spinach was the source of a large E. coli outbreak, and lettuce was the source of outbreaks at Taco Bell and Taco John's restaurants.  Ediets.com states, "All raw fruits and vegetables can harbor disease-causing bacteria. Thoroughly wash any raw produce under cold running water before eating it. If appropriate, use a small scrub brush to remove any visible dirt. This is true even for organic fruits and vegetables."

Water: because contaminated water can harbor bacteria, viruses, and parasites, it is important to ensure your drinking water, as well as water in pools or at sprayparks, has been properly treated to eliminate the possibility of contamination.  According to Ediets.com, "The Environmental Protection Agency (EPA) recommends that private water supplies be tested at least once a year for: nitrates, total dissolved solids and coliform bacteria, the presence of which (although it is generally harmless) may indicate other contamination. You may need to test more frequently and for more potential contaminants if a problem is suspected."

Raw sprouts: Because sprout seeds can be contaminated with foodborne pathogens that cause food poisoning, raw sprouts should be avoided.  Raw sprouts have been associated with E. coli and Salmonella outbreaks.  Ediets encourages consumers to cook sprouts thoroughly to kill bacteria.

Unpasteurized juice, milk or cheese: Because unpasteurized juices and "raw" dairy products do not go through a "kill step" before they are served, bacteria, viruses, or parasites could be present in the products.  Several E. coli outbreaks have been traced to raw juices, including a 1996 E. coli outbreak traced to apple juice and subsequent Salmonella outbreaks traced to orange juice.  outbreaks have been traced back to raw milk, including E. coli outbreaks that resulted in children being hospitalized for kidney failure.  Edites.com states, "Make sure you always purchase the pasteurized versions of your favorite products. Pasteurization kills bacteria. When you go to a juice bar, make sure the juices being served are pasteurized. Unpasteurized products have been linked to salmonella, E. coli and Listeria -- all of which can lead to death."

Moldy peanuts:  Because moldy peanuts, wheat chereals, and corn can produce aflatoxins.  Ediets.com encourages people to check these products for any signs of discoloration or mold, as, "Alfatoxins have been found to cause liver cancer in animal species."

Raw or undercooked shellfish: Because shellfish, such as clams and oysters, can be contaminated with micro-organisms such as vibrio or viruses such as norovirus.  Raw oysters should be avoided.  Ediets.com states:  "Any animal protein consumed raw or undercooked has an increased potential for causing illness."

Swordfish, shark, king mackerel and tilefish: Because these fish have been associated with high levels of methyl mercury, which can cause brain damage in unborn and young children.  According to Ediets.com, "The Food and Drug Administration (FDA) and the EPA advise young children, women who are planning to become pregnant and pregnant or nursing women not to eat these fish."

Caesar salad: Because many recipes for Caesar salad dressing call for raw eggs, and eggs can carry Salmonella, Campylobacter jejuni, and other foodborne pathogens. Ediets.com encourages you to ask your server or host if Caesar salad dressing contains raw eggs because, "Many restaurant or homemade recipes call for raw eggs in Caesar salad."

Wild mushrooms: Because several species of mushrooms contain deadly poisons.  According to Ediets.com, "Portabella and shiitake lovers have no reason to worry. Just don’t go scavenging in your backyard. Only eat mushrooms you’ve purchased in the grocery store."

Raw, homemade cookie dough. Because, again, raw eggs can contain potentially deadly foodborne pathogens.  Ediets.com says, "We're not talking about the prepackaged kind that many of us prefer to nibble on straight from the tube or tub. We're talking about homemade batter that's made with eggs."

Rare hamburger. Because ground beef can be contaminated with E. coli, Salmonella, and other bacterial pathogens that cause food poisoning.  All ground beef products and hamburgers should be cooked to 160 degrees fahrenheit.  Ediets.com provides the advice to, "Always use a food thermometer to ensure you've cooked the beef to a safe temperature. Avoid any restaurant entrée labeled "tartare" – it's raw."

Turkey and stuffing. Because stuffing cooked inside a turkey or chicken has a reduced likelihood of reaching a hot enough temperature to kill Salmonella, Campylobacter, or other "bugs".  Ediets explains, "The bird cooks both from the outside and the inside. When you stuff the bird, it reduces the heat penetration. Your best bet is to cook the turkey and stuffing separately. If you do choose to cook them together, make sure the temperature reaches at least 180 degrees Fahrenheit in the innermost part of the thigh while the center of the stuffing inside the turkey reaches 165 degrees."

Shakes and eggs. Because, as pointed out earlier, raw eggs can carry Salmonella or Campylobacter jejuni.  Protein shakes can be made with p asteurized eggs, but unless they're pasteurized, avoid raw eggs.  Ediets warns, "Once again, you're putting yourself at risk for salmonella when you consume raw eggs. Also, beware of sunny side up or runny eggs. The rule of thumb is to cook the egg until both the yolk and the white are firm."

More about food poisoning can be learned at www.foodborneillness.com. 

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E. coli, Salmonella, and botulism were all featured in the news today:

In Hutchinson, Kansas, the Hutchinson News reported that a five-year-old girl from Sterling, Kansas, has been put on dialysis.  She became ill with an E. coli infection and hemolytic uremic syndrome.  She is in critical condition after 18 days in the hospital.  As reported by the Hutchinson News:

Aubrey Anderson, 5, continued to undergo daily dialysis treatments lasting three to five hours each at Wesley Medical Center, said her father, Bill Anderson, who is principal of Sterling High School.

"Aubrey's hemoglobin was down a little today, which is not good," Anderson said in an e-mail. "Her platelets, however, have reached a 'normal' level and the doctor feels that they will not decrease again, and that is encouraging. Her toxicity level is down from yesterday, but they would like to see it come down farther."

In Omaha, Nebraska, the Omaha World Herald reported that ConAgra has resumed the production of Banquet and private label pot pies - one of two ConAgra products identified earlier this year as the source of a nationwide Salmonella outbreak.  According to the World Herald:

ConAgra Foods Inc. said Wednesday that it had enhanced its food safety procedures and resumed making frozen Banquet and private-label pot pies, which the company recalled last month after they were linked to salmonella illnesses.

The company said it would ship the pot pies to stores beginning in December, and they should be back on store shelves as soon as January.

And in Roanoke, Virginia, a relative of a doctor who passed away this week - allegedly of botulism poisoning - spoke with the Roanoke Times.  While testing has not been completed, the relative stated that health authorities are investigating the possibility that the doctor's death was caused by botulism.

Kwang Kim, the doctor’s younger brother, said the family is still awaiting laboratory results to confirm the death was caused by botulism. They expect those results Thursday, he said.

Kwang Kim said the state health department approached the family last week about the doctor’s illness. Dr. Kim’s husband, George Makarie, is also ill and was still hospitalized Wednesday morning, Kwang Kim said. He said he doesn’t know if Makarie’s illness is also related to botulism.

The Centers for Disease Control and Prevention (CDC) estimates that 76 million foodborne illness cases occur in the United States every year. This amounts to one in four Americans becoming ill after eating foods contaminated with such pathogens as E. coli O157:H7, Salmonella, Hepatitis A, Campylobacter, Shigella, Norovirus, and Listeria.

On an annual basis, approximately 325,000 people are hospitalized with a diagnosis of food poisoning, and 5,000 die. The annual dollar costs of foodborne illnesses—in terms of medical expenses and lost wages and productivity—range from $6.5 to $34.9 billion.

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According to Cargill and FSIS press releases: Cargill Meat Solutions said it is voluntarily recalling approximately 1,084,384 pounds of ground beef produced at its Wyalusing, Pa., Cargill Regional Beef facility because of the possible presence of E. coli O157:H7. The ground beef products subject to recall were produced at the Wyalusing plant between Oct. 8 and 11, 2007, and were distributed to retailers nationwide.  In addition to the below listed products, there are various weights and varieties of ground beef, ground chuck, and ground sirloin product that were distributed for further processing and repackaging and will not bear the same establishment number on the package.  Products subject to recall are:
* 1.3-pound packages of “Century Farm 80/20 Ground Beef.” Use by/freeze by 11/03/2007
* 3.0-pound packages of “Century Farm 80/20 Ground Beef.” Use by/freeze by 11/03/2007
* 1- pound packages of “Century Farm 80/20 Ground Beef Patty.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Century Farm 85/15 Ground Beef.” Use by/freeze by 11/03/2007
* 3-pound packages of “Century Farm 90/10 Ground Beef.” Use by/freeze by 10/19/2007
* 1.3-pound packages of “Century Farm 90/10 Ground Beef Patties.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Century Farm 90/10 Ground Beef.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Century Farm 93/7 Ground Beef.” Use by/freeze by 11/03/2007
* 1-pound packages of “Century Farm 96/4 Extra Lean Ground Beef.” Use by/freeze by 10/19/2007 & 10/31/2007
* 1-pound packages of “Century Farm 85/15 Ground Beef Patties.” Use by/freeze by 10/19/2007
* 1.3-pound packages of “Century Farm 93/7 Ground Beef Patties.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Century Farm 80/20 Chuck Ground Beef Patties.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Century Farm 80/20 Chuck Ground Beef for Chili.” Use by/freeze by 10/31/2007 & 11/03/2007
* 1.3-pound packages of “Century Farm Meatloaf Mix, Beef, Pork and Veal with Natural Flavors.” Use by/freeze by 10/19/2007, 10/22/2007, 10/31/2007 & 11/03/2007
* 1.25- pound packages of “Giant 75/25 Ground Beef, All Natural.” Use by/freeze by 11/03/2007
* 3.0- pound packages of “Giant 75/25 Ground Beef.” Use by/freeze by 10/31/2007
* 1.25-pound packages of “Giant 80/20 Ground Beef, All Natural.” Use by/freeze by 11/03/2007
* 3.0-pound packages of “Giant 80/20 Ground Beef.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Giant Eagle Ground Chuck Beef Patties 80/20.” Use by/freeze by 10/19/2007 & 10/22/2007
* 1.3-pound packages of “Giant Eagle Ground Beef Patties 92/8.” Use by/freeze by 10/22/2007
* 1.3-pound packages of “Giant Eagle Ground Beef Patties 85/15 – Certified Angus Beef Brand.” Use by/freeze by 10/19/2007 & 10/22/2007
* 1.3-pound packages of “Giant Eagle Ground Round Beef Patties 85/15.” Use by/freeze by 10/19/2007 & 10/22/2007
* 3.0-pound packages of “Shop Rite, 80% Lean 20% Fat, Ground Beef.” Use by/freeze by 10/31/2007 & 11/03/2007
* 3.0-pound packages of “Shop Rite, 85% Lean 15% Fat, Ground Beef.” Use by/freeze by 10/31/2007 & 11/03/2007
* 1.3-pound packages of “Shop Rite, 93% Lean 7% Fat, Ground Beef Patties.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Shop Rite, 93% Lean 7% Fat, Ground Beef.” Use by/freeze by 11/03/2007
* 1-pound packages of “Shop Rite, 96% Lean 4% Fat, Ground Beef.” Use by/freeze by 10/31/2007
* 1.25- pound packages of “Stop & Shop 75/25 Ground Beef, All Natural.” Use by/freeze by 10/31/2007 & 11/03/2007
* 5.0- pound packages of “Stop & Shop 75/25 Ground Beef, All Natural.” Use by/freeze by 11/03/2007
* 1.25-pound packages of “Stop & Shop 80/20 Ground Beef, All Natural.” Use by/freeze by 10/31/2007 & 11/03/2007
* 1.25-pound packages of “Stop & Shop 85/15 Ground Beef, All Natural.” Use by/freeze by 10/31/2007
* 1.2-pound packages of “Stop & Shop 87/13 Ground Beef Sirloin, All Natural.” Use by/freeze by 10/31/2007
* 1- pound packages of “Stop & Shop 90/10 Ground Beef, All Natural.” Use by/freeze by 10/31/2007
* 1.0-pound packages of “Stop & Shop 80/20 Ground Beef Patties, All Natural.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Stop & Shop 80/20 Ground Beef Patties, All Natural.” Use by/freeze by 11/03/2007
* 2.6-pound packages of “Stop & Shop 80/20 Ground Beef Patties, All Natural.” Use by/freeze by 11/03/2007
* 1.3-pound packages of “Stop & Shop 90/10 Ground Beef Patties, All Natural.” Use by/freeze by 10/31/2007 & 11/03/2007
* 2.5-pound packages of “Stop & Shop 90/10 Ground Beef, All Natural.” Use by/freeze by 10/19/2007
* 2.5-pound packages of “Stop & Shop 93/7 Ground Beef, All Natural.” Use by/freeze by 10/31/2007
* 1-pound packages of “Wegmans 80/20 Ground Beef Patties.” Use by/freeze by 10/19/2007
* 1.3-pound packages of “Wegmans 90/10 Ground Beef Patties.” Use by/freeze by 10/19/2007 & 10/22/2007
* 3.0- pound packages of “Weis Premium Meats, 73/27 Ground Beef.” Use by/freeze by 11/03/2007
* 1- pound packages of “Weis Premium Meats, 80/20 Ground Beef.” Use by/freeze by 10/31/2007
* 3- pound packages of “Weis Premium Meats, 80/20 Ground Beef.” Use by/freeze by 10/31/2007 & 11/03/2007
* 1-pound packages of “Weis Premium Meats 85/15 Ground Beef.” Use by/freeze by 10/31/2007
* 2.0 and 3.0 -pound packages of “Weis Premium Meats 85/15 Ground Beef.” Use by/freeze by 11/03/2007
* 2-pound packages of “Weis Premium Meats 93/7 Ground Beef.” Use by/freeze by 11/03/2007
* 1-pound packages of “Weis Premium Meats 93/7 Ground Beef.” Use by/freeze by 10/31/2007
* 1-pound packages of “Weis Premium Meats 96/4 Ground Beef Extra Lean.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Weis Premium Meats 90/10 Ground Beef Sirloin Patties.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Weis Premium Meats Meatloaf Mix, Beef, Pork and Veal with Natural Flavors.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Weis Premium Meats 80/20 Ground Beef for Chili.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Meat Loaf Mix, Made with Beef, Pork, Veal, with Natural Flavors.” Use by/freeze by 10/19/2007 & 10/22/2007
* 1.25-pound packages of “Meatloaf Mix, A Blend of Fresh Ground Beef, Pork & Veal, All Natural.” Use by/freeze by 10/31/2007
* Various weight packages of “85/15 Coarse Ground Beef for Chili Meat, All Natural.” Use by/freeze by 10/31/2007
* 1.3-pound packages of “Ground Beef Chuck for Chili 80/20.” Use by/freeze by 10/19/2007 & 10/22/2007
* 1.3 pound packages of “Price Rite 85% Lean, 15% Fat Ground Beef.” Use by/freeze by 11/03/2007
* 1.3 pound packages of “Price Rite 80% Lean, 20% Fat Ground Beef.” Use by/freeze by 11/03/2007
* 1.3 pound packages of “Price Rite Meat loaf mix.” Use by/freeze by 10/31/207 & 11/03/2007

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General Mills Operations, a Wellston, Ohio, establishment, is voluntarily recalling an undetermined amount of frozen meat pizza products because they may be contaminated with E. coli O157:H7 and may be linked to an outbreak of E. coli O157:H7 illnesses, the U.S. Department of Agriculture’s Food Safety and Inspection Service announced today.

The following products are subject to recall:

• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza Pepperoni.”
• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Classic Pepperoni.”
• 10.2-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Pepperoni Trio.”
• 10.7-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Combination Sausage & Pepperoni Pizza.”
• 10.5-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Three Meat Sausage, Canadian Style Bacon & Pepperoni Pizza.”
• 10.9-ounce packages of “Totino’s The Original Crisp Crust Party Pizza, Supreme Sausage & Pepperoni Pizza with Green Peppers & Onions.”
• 6.8-ounce packages of “JENO’S CRISP `N TASTY PIZZA, PEPPERONI.”
• 7.0-ounce packages of “JENO’S CRISP `N TASTY PIZZA, COMBINATION SAUSAGE AND PEPPERONI PIZZA.”
• 7.2-ounce packages of “JENO’S CRISP `N TASTY PIZZA, SUPREME SAUSAGE AND PEPPERONI WITH GREEN PEPPERS AND ONION PIZZA.”

Each package also bears the establishment number “EST. 7750” inside the USDA mark of inspection as well as a “best if used by” date on or before “02 APR 08 WS.” The company applies the “best if used by date” on the package based on a 155-day shelf life, however consumers are urged to look in their freezers for similar frozen pizza products and discard them if found. The frozen meat pizza products subject to recall were produced on or before Oct. 30 and were distributed to retail establishments nationwide. The recall affects approximately 414,000 cases of pizza products currently in stores and all similar pizza products in consumers’ freezers. It includes eight SKUs (stock keeping units or UPC codes) of Totino’s brand frozen pizza and three SKUs of Jeno’s brand frozen pizza with pepperoni topping, or incorporating pepperoni in combination with other toppings.

The problem was uncovered by state and federal authorities investigating 21 occurrences of E. coli-related illnesses in 10 states. Approximately half of the individuals who became ill were hospitalized as a result. The earliest case reported to state authorities occurred on July 20, and the latest case reported occurred on Oct. 10. Nine of the 21 people reported having eaten Totino’s or Jeno’s pizza with pepperoni topping at some point prior to becoming ill. Since July 1 of this year, Totino’s and Jeno’s have distributed more than 120 million pizzas nationwide.

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The USDA's Food Safety and Inspection Service announced that Blue Ribbon Meats, a Florida company, is recalling 8,200 pounds of frozen ground beef products for possible E. coli O157:H7 contamination.  The ground beef was produced between September 14 and September 27, and was shipped to two distributors.  The ultimate destinations the meat was designated for include a correctional institution in Florida and a distributor in St. Thomas, U.S. Virgin Islands.

According to the FSIS press release, "The problem was discovered by Creekstone Farm (Est. 27), an Arkansas City, Kan., establishment that supplies the recalling company and inadvertently shipped product that they had on hold." 

The products subject to recall include:

• 10-pound boxes of "WESPAK B.R.'S BRAND SEASONED BEEF PATTIES FOR SALISBURY, 80/20."
• 10-pound boxes and 20-pound cases of "JNS FOODS, LLC, B.R.'S BRAND SEASONED BEEF PATTIES FOR SALISBURY, 80/20."
• 10-pound boxes and 20-pound cases of "JNS FOODS, LLC, BEEF PATTIE MIX, 80/20."
• 10-pound boxes and 20-pound cases of "JNS FOODS, LLC, BEEF PATTIES, 80/20."
• 10-pound boxes and 20-pound cases of "JNS FOODS, LLC, MEATLOAF SEASONED BEEF PATTIES, 80/20."

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Amy Bowen of the St. Cloud Times has written about Stephanie Smith, 20, (Just for Kix instructor) who is struggling for her life after contracting what appears to be a critical case of E. coli poisoning. She was on life support Friday in the intensive care unit at St. Marys Hospital, Rochester. Doctors are treating her for a severe case of E. coli poisoning that they believe came from ground beef she ate, said Smith's mother, Sharon Smith of Cold Spring. Doctors have yet to confirm the strain of infection through lab tests. Doctors diagnosed Stephanie Smith with hemolytic uremic syndrome. The condition is caused when E. coli toxins enter the bloodstream. It causes kidney failure and low blood-cell counts, Dr. Kirk Smith said.

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The Centers for Disease Control and Prevention updated its reporting on the E. coli outbreak linked to Topps Meats yesterday. 28 cases of E. coli have been identified as part of the outbreak. According to CDC:

Health officials in several states who were investigating reports of E. coli O157 illnesses found that many ill persons had consumed the same brand of frozen ground beef patties. Ground beef patties recovered from patients' home were tested by state public health department and federal laboratories. Tests conducted by the New York State Wadsworth Center Laboratory and by a USDA-FSIS laboratory on opened and unopened packages of Topp's brand frozen ground beef patties yielded E. coli O157 isolates with several different “DNA fingerprint” patterns.

Investigators compared the “DNA fingerprints” patterns of E. coli O157 strains found in ground beef with “DNA fingerprints” patterns of E. coli O157 strains isolated from ill persons. As of 12 PM (ET) October 2, 2007, 28 cases of E. coli O157:H7 infection have been identified with PFGE patterns that match at least one of the patterns of E. coli strains found in Topp's brand frozen ground beef patties. Ill persons reside in 8 states [Connecticut (2), Florida (1), Indiana (1), Maine (1), New Jersey (6), New York (8), Ohio (1), and Pennsylvania (8)]. Seventeen (94%) of 18 patients with a detailed food history consumed ground beef. Three illnesses have confirmed associations with recalled products because the strain isolated from the person was also isolated from the meat in their home. The first reported illness began on July 5, 2007, and the last began on September11, 2007. Among fifteen ill persons for whom hospitalization status is known, ten (67%) patients were hospitalized. One patient developed a type of kidney failure called hemolytic-uremic syndrome (HUS). No deaths have been reported. Twelve (43%) patients are female. The ages of patients range from 3 to 77 years; 33% are between 15 and 24 years old (only 14% of the US population is in this age group).

DNA "fingerprints" or Pulsed Field Gel Electrophoresis patterns, are explained as follows:

When a sample is taken from either a piece of meat or poultry that is contaminated with a dangerous form of bacteria, such as E. coli O157:H7, listeria, or campylobacter, it can be cultured to obtain and identify the bacterial isolate. If a person consumes some of the contaminated meat or poultry, and becomes infected as a result, a stool sample can then be cultured to obtain and identify the bacterial isolate. These bacterial isolates are then broken down into their various component parts creating a DNA "fingerprint".

The process of obtaining the DNA fingerprint is called Pulse Field Gel Electrophoresis, or PFGE. This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of listeria and campylobacter, and other pathogenic bacteria.

The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product. When PFGE patterns match, they, along with solid epidemiological work, are proof that the contaminated product was the source of a person's illness.

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Proof that ‘Lightning does strike the same spot twice,’ says Marler Clark attorney

The USDA’s Food Safety and Inspection Service yesterday announced that Topps Meat Company of Elizabeth, New Jersey, was recalling 331,582 pounds of frozen ground beef products that may be contaminated with E. coli O157:H7. The recall was prompted by a combined New York Department of Health and Centers for Disease Control and Prevention investigation into an E. coli O157:H7 outbreak that was determined to have been caused by consumption of Topps ground beef products.

New York is not the only state impacted by the beef recall and E. coli outbreak. The Associated Press reported today that residents of Connecticut, Indiana, New Jersey, Ohio, and Pennsylvania were part of the outbreak.

“We have a lawsuit pending in Albany County Superior Court that is the result of a 2005 E. coli case traced back to ground beef produced by Topps and sold at Price Chopper,” said William Marler, the nation’s foremost attorney representing victims of foodborne illness. “What we’re seeing here is that lightning does strike the same spot twice.”

Marler noted that for the first time since 2002, the number of meat recalls and E. coli outbreaks connected to ground beef has been increasing. “The CDC and USDA’s numbers have shown significant declines in E. coli outbreaks traced back to contaminated ground beef since 2002, and our client-base was backing those numbers up,” Marler continued. “Most of our E. coli cases in the last five years have been the result of contaminated produce, but not this year – we’ve filed lawsuits against California [UFG and the Fresno Meat Market], Minnesota, and Oregon beef producers in the last six months.

“To quote Buffalo Springfield, ‘Something’s happening here.’”

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A New York Times editorial from today begins:

President Bush took a potentially useful step last week, appointing a cabinet-level committee to find ways to ensure the safety of imported food and other products. But his actions would be a lot more credible if the administration had not been cutting the staff and budget of food safety programs at the Food and Drug Administration while also planning to eliminate half of the agency’s laboratories.

Hearings before a House oversight subcommittee raised serious questions about the F.D.A.’s ability to protect the public against contaminated or adulterated foods. William Hubbard, a former top agency official who consults for a coalition of industry and consumer groups, told the committee that the F.D.A. has lost some 200 food scientists and 700 field inspectors over five years, exactly the wrong direction when food imports are skyrocketing. He also noted that the small budget increase the White House has proposed for food safety next year would be a decrease after accounting for inflation.

Details behind the potential closure of food testing laboratories and inspections of imported foods are further discussed in the editorial, which is titled:  Is It Safe to Eat?
Increasing fears over foods imported from China and other countries, and the FDA's assertions that only one percent of food imports are inspected every year are major concerns surrounding the safety of the American food supply.  And it's not just the federal government and food safety advocates who are speaking up about their issues with the safety of the American food supply.  Bill Marler posted the following email he received from a client who became ill after eating E. coli-contaminated spinach on his blog recently:

Please pass this on: I am 55 years old and having been married for 37 years, so I have been grocery shopping for at least that long. I got sick from spinach; last month I opened a can of Geisha brand peaches (from China but distributed from New York) only to find a dead fly in the can; and this past week I purchased 2 cans of Castleberry's hot dog chili sauce distributed from Augusta, GA that have been recalled. Am I being paranoid or is someone out there trying to kill Americans with the food chain, or just me in particular? What's going on here and how can we protect ourselves other than reverting back to growing our own food. I know growing up if we didn't shoot it, reel it in or grow it, we didn't eat it (ie; deer meat, fish (lots & lots of fish) and fresh vegetables & fruits grown by family members.) What's going on here with the food chain is scaring the h_ _ _ out of me. Too many things happening in a very short time frame to me.

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Washington Beef, a Toppenish, Washington firm, recalled over 82,000 pounds of beef products on Friday.  The recall was initiated after the Washington State Department of Health determined that the products were likely produced using non-potable water.  According to a recall release by the United States Department of Agriculture's Food Safety and Inspection Service:

The beef products subject to recall were shipped in bulk for further processing and may have been sold under different retail brand names in the affected states. Consumers should check with their local retailer to determine whether they may have purchased any of the products subject to recall.

The list of recalled products can be accessed on the FSIS Web site here:  http://www.fsis.usda.gov/News_&_Events/Recall_028_2007_Release/index.asp

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According to Los Angeles AP, for the third time in a week, a meat supplier has expanded a ground beef recall to include about 5.7 million pounds of fresh and frozen meat because they may be contaminated with E. coli.  David Goldman, acting administrator of the USDA Food Safety and Inspection Service, announced on Saturday that the recall would be expanded to include products with sell-by dates from April 6-April 20. The beef was distributed by California-based United Food Group LLC. Goldman said that none of the latest batch of suspect beef is in stores now because the product would be well past its expiration date, but consumers may still have some of the meat at home.``

It is important for consumers to look in their freezers,'' Goldman said.

You really must feel good when your governent's response to 5,000,000 pounds of meat being recalled, and over a dozen illnesses, is for us to "look in their freezers."  Seven recalls and seven outbreaks in seven weeks.  I am looking forward to asking these meat executives (under oath) why this is happening again.

5.7 Million Pounds Of Ground Beef Recalled Due To E. coli

Fourteen illnesses reported to the U.S. Centers for Disease Control were referred to the USDA, which confirmed they might be linked to the ground beef in question. There are three cases in California, six in Arizona, two in Colorado, one in Utah, one in Idaho and one in Wyoming.

The recalled products were distributed in 11 states: Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming.

The ground beef subject to this expanded recall was produced at United Food Group’s facility in Vernon, California, from April 6th through April 20th, and was distributed under the brand names Moran’s All Natural, Miller Meat Company, Stater Brothers, Inter-American Products and Basha’s.

The affected grocery stores included Albertson’s, Basha’s, Grocery Outlet, Fry’s, “R” Ranch Markets, Save-A-Lot, Save-Mart, Scolari’s Wholesale Markets, Smart and Final, Smith’s, Stater Bros. and Superior Warehouse.

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Newsinferno.com added a post titled, "CDC, FDA, ConAgra or Peter Pan himself, Who’s to Blame for the Underreporting of Sickening and Potentially Deadly Salmonella & E-Coli Food Poisoning Cases?" which offers an interesting discussion on foodborne illness outbreaks.  

The federal agency responsible for insuring food safety was also been taken to task for its role in the incident. In April 2007, the Washington Post published documents proving that the FDA, as well as ConAgra, knew of contamination problems at the plant as far back as 2004. The agency took few corrective measures, assuming that ConAgra would address the situation itself. ConAgra apparently did little to nothing to fix the problem.

And this was not the first time the FDA knew about food safety problems but did little to correct them. The Post article also cited evidence that the agency had been aware of problems with contaminated spinach and other California greens as far back as 1995. In the fall of 2006, hundreds of people were sickened and three were killed after contracting e-coli from contaminated California Spinach.

Critics say that under-funding and a lack of trained inspectors at the FDA have left the nation’s food supply in a perilous condition. A congressional fact sheet published by Henry Waxman (D-Calif) in 2006 said funding for the FDA fell short by $135 million. The number of scientists employed by the FDA’s food division dropped from 1,000 to 800 in the past three years. This decrease in personnel and the ongoing budget cuts have overwhelmed the agency, greatly impacting its ability to watch over the food supply. The results of this shortfall are apparent — according to the CDC, contaminated foods cause 325,000 hospitalizations and 5,000 deaths each year.

Maybe Newsinferno.com will post about the recent E. coli outbreaks traced to ground beef and include USDA in its next analysis.

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In the last six weeks there have been six recalls of meat and nearly 50 people sickened.

Tyson Fresh Meats voluntarily recalled 40,440 pounds of ground beef products due to possible contamination with E. coli O157:H7. The ground beef products were produced on June 2, 2007 and were distributed to retail establishments in Alabama, Arkansas, Colorado, Kansas, Kentucky, Louisiana, Missouri, Mississippi, New Mexico, Oklahoma, Tennessee and Texas.

Seven Minnesotans who were confirmed as part of the E. coli outbreak that prompted PM Beef Holdings to recall 117,500 pounds of beef trim products that was ground and sold at Lunds and Byerly’s stores.

Thirteen people have been confirmed ill with E. coli O157:H7 infections after eating ground beef produced by United Food Group sold in Arizona, California, Colorado, Idaho, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming and Montana. 445,000 pounds of meat has been recalled.

Over twenty people have been confirmed ill with E. coli O157:H7 infections in Fresno County. The Fresno County Department of Community Health inspected the “Meat Market” in Northwest Fresno, a potential source of the outbreak. The outbreak investigation is ongoing.

Two people were confirmed ill with E. coli O157:H7 infections in Michigan after eating ground beef produced by Davis Creek Meats and Seafood of Kalamazoo, Michigan. The E. coli outbreak prompted Davis Creek Meats and Seafood to recall approximately 129,000 pounds of beef products that were distributed in Arkansas, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Missouri, Ohio, Pennsylvania, Tennessee, Virginia, West Virginia, and Wisconsin.

Several people were confirmed ill with E. coli O157:H7 infections in Pennsylvania after eating E. coli-contaminated meat products at Hoss’s Family Steak and Sea Restaurants, a Pennsylvania-based restaurant chain that purchased its meat from HFX, Inc., of South Claysburg, Pennsylvania. As a result of the outbreak, HFX recalled approximately 4,900 pounds of meat products.

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E. coli outbreaks and the discovery of E. coli contamination in ground beef and other meat products have resulted in a number of recalls in recent months (see E. coli Attorney:  Recent outbreaks traced to meat products 'cause for concern').  In particular, United Food Group has recalled hundreds of thousands of pounds of ground beef products for E. coli contamination.  At least 14 people have been confirmed ill with E. coli O157:H7 infections after eating UFG ground beef. 

And while much of the nation, from California to Washington to Minnesota and Michigan, is focused on E. coli in ground beef, North Carolina health officials are trying to determine the source of an E. coli outbreak at a restaurant.

After last year's E. coli outbreak traced to spinach and Salmonella outbreak traced to peanut butter, we are reminded that E. coli contamination in ground beef is still a threat to public health.

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SEATTLE, WA (May 17, 2007) – Food safety is a hot topic these days. The New York Times and Wall Street Journal ran stories on the subject on Wednesday, May 16th, and CNN is airing a special on food safety both Saturday and Sunday, May 19th and 20th.

Most media attention geared toward food safety in recent months has focused on foodborne illness outbreaks traced to contaminated spinach, lettuce, and peanut butter. But Bill Marler, a Seattle attorney who exclusively represents victims of foodborne illness, says that dangers presented by contaminated meat products should not be forgotten or overlooked.

In the last two weeks, Minnesota, Wisconsin, and Michigan residents have been stricken with E. coli after eating contaminated ground beef. “It’s almost official grilling season, and although the meat industry has done a tremendous job of cleaning up and reducing the number of E. coli outbreaks traced to ground beef, E. coli contamination in meat products is a real danger,” Marler said.

Marler, who was recently retained by a Minnesota woman who became ill after eating E. coli-contaminated ground beef produced by Minnesota company PM Beef Holdings, has represented victims of E. coli outbreaks traced to ground beef, steaks, apple and orange juice, lettuce, spinach, sprouts, cantaloupe, and other foods. Marler’s firm, Marler Clark, currently represents over 100 victims of last year’s E. coli outbreaks traced to spinach and lettuce, nearly 5,000 victims of the recent Salmonella outbreak traced to contaminated peanut butter, and several victims of an E. coli outbreak traced to ground beef served at a church picnic in Longville, Minnesota, last summer, including the family of a woman who died.

“I think people will be shocked with what they learn from watching the CNN special,” Marler added. “Americans like the people featured in the special shouldn’t have to learn the hard way that the food supply isn’t as safe as they think it is. We should be able to trust that we’re putting on our tables and feeding our families is pathogen-free before it ever reaches our homes.”

Marler, a food safety advocate, recently joined clients on a trip to Washington, DC, where they participated in a hearing titled, “Diminished Capacity: Can the FDA Assure the Safety and Security of the Nation's Food Supply?” He spends several days per month traveling around the country speaking on topics related to food safety and foodborne illness litigation through a non-profit consulting firm, OutBreak.

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An article on HOI.com titled, "E. coli and Friends," gives a good description of several foodborne pathogens featured at www.foodborneillness.com.  Reporter Jen Christensen profiles E. coli, Salmonella, Campylobacter, and Listeria, and describes how health officials determine which pathogen is responsible for illness:

Tracking Down the Culprits

When stomach symptoms occur, people tend to attribute the cause to a “bug” rather than food. Clues suggesting a possible foodborne pathogen include severe symptoms and having more than one person is affected – especially if the symptoms occur in several families. A physician may contact the local health department to determine if other cases have been reported. In addition, stool samples may be sent to a lab for testing.

It can take quite a bit of detective work to track down a source of foodborne illness. Not everyone who eats a contaminated food product gets sick (typically the very young, very old, patients with chronic medical conditions and those with weak immune systems are most susceptible). The severity of symptoms may also vary.

Health officials gather data on patient characteristics, how long they have been sick and places they may have visited days before the onset of illness. Hopefully, common traits will begin to emerge, such as “everyone ate at the same restaurant” or “ate the same food.” Suspect food items may be tested for the presence of bacteria or toxins. As more clues emerge, experts may be able to narrow down or pinpoint the source of the problem. In some cases (as with the peanut butter/salmonella link recently), an investigation may lead to an extensive recall of a particular food item.

The E. coli Reference Center at Penn State University is the nation’s largest repository for E. coli strains, holding more than 70,000 strains collected over the last 40 years. The bacteria are frozen to enable researchers to study and track changes or genetic mutations that may make the illness more difficult to treat. Older samples are stored at room temperature in “slants,” or test tubes containing a solid growth medium to preserve the culture. The lab can also test a current sample for the bacteria and look for genes associated with those causing the most serious illness.

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The USDA is expected to announce today whether 20 million chickens who were fed melamine-contaminated feed are to be released into the US food supply.  Bloomberg News reported on USDA's investigation and decision-making process:

The U.S. Department of Agriculture said it is keeping as many as 20 million chickens from slaughter this weekend as officials investigate whether the birds were given tainted feed.

The chickens are in several states on farms contracted to ``large commercial operators,'' USDA spokesman Keith Williams said today in a phone interview. The chickens are being voluntarily held until at least May 7 while the USDA, the Food and Drug Administration and the Environmental Protection Agency decide whether they are safe for eating.

The chickens received feed believed to be tainted with melamine, an industrial chemical that has been found in wheat gluten imported from China, Williams said. The contaminated feed has been connected to the deaths of at least 14 pets and caused the quarantine of hog farms in six U.S. states this year.

Pet food contaminatin and the FDA's creation of a new position - assistant commissioner for food protection, or what has been dubbed "Food Safety Czar," have both been widely discussed in food safety circles, as well as on editorial pages of newspapers like the New York Times and the Seattle Times.
 
In today's New York Times, the editorial board focuses on pet food contamination and the need for government action to ensure the safety of imported food:

As the global trade in foodstuffs expands, the Food and Drug Administration must be given more legal authority, money and inspectors to ensure the safety of imported foods. It would be even more tragic if the next episode were to kill thousands of people before being detected and contained.

It now looks as if two Chinese companies sold wheat gluten and rice protein spiked with an industrial chemical, melamine. Their apparent goal was to cut costs. Last week the F.D.A. rushed to upgrade its food safety programs, creating a new position — assistant commissioner for food protection — and naming a respected scientist to fill it. That should focus needed attention on a subject that often seems secondary in an agency straining to regulate drugs and medical devices. But not much will change until Congress provides money and legal authority to police foreign producers.

The Seattle Times editorial board focused more on the Food Safety Czar and on upcoming legislation:

This week, the FDA established a new position — assistant commissioner for food protection. The first task for David Acheson, a physician who has researched food-borne pathogens extensively, is crafting a strategy to ensure food safety and defend the food system from people who would deliberately try to compromise it.

The U.S. Senate also this week approved a provision by Sen. Dick Durbin, D-Ill., to strengthen the food-safety system. The amendment to a Food and Drug Administration reauthorization bill would establish an early-notification system for food problems, increase inspections of foreign imports and create a database to help spot patterns needing investigation.

Imports aren't the only challenge. During the past year, hundreds of people were sickened by salmonella in peanut butter and by E. coli in organic spinach. At least five people died between the two cases. A surveillance system might have noticed earlier the pattern of problems in the Central California area where the spinach was produced.

Senator Durbin has also introduced the Safe Food Act of 2007, which is the focus of a blog post at The Ethicurean, where it is stated that: 

The Safe Food Act calls for the creation of a single cabinet-level Food Safety Administration with a singular mission: safe food. The bill aims to increase the frequency of inspections of food processing plants, create a method to trace food ingredients to their points of origin, and to step up monitoring of food imports. Unlike the current FDA, the administration will have the power to order mandatory recalls of unsafe foods.

More food safety discussions are occuring across the country.  The Atlanta Journal-Constitution asked its readers whether they wash fruits and vegetables before eating them.  Answers to the question have been posted on the AJC Web site.  The LA Times reported on Los Angeles County's attempt at requiring food handlers to be vaccinated against hepatitis A, pointing out that, "The county cannot legally require food workers to be vaccinated against hepatitis A," but noting that the state of California has the legal authority to put such a requirement in place.  And the Bioblog posted recently about the debate over whether grass-fed beef produce E. coli.

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A Maine meat processor is recalling products due to potential E. coli contamination.  According to a Maine Department of Agriculture press release:

The Maine Department of Agriculture, Division of Quality Assurance & Regulations, announced today that Bubier Meats, located in Greene, Maine, is voluntarily recalling approximately 1,936 pounds of beef products because they may be contaminated with fecal material and other contaminants.

The problem was discovered through HACCP verification tasks and visual observations performed on April 30 and May 1. An audit was then conducted on the HACCP records correlating with theses dates and it was discovered that approximately 1,936 pounds had been released into commerce in Maine.

Fecal contamination is a direct source of possible E. coli 0157:H7, a potentially deadly bacterium that can cause bloody diarrhea and dehydration. The very young, seniors, and persons with compromised immune systems are the most susceptible to food-borne illness.

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In an article titled, "The Feds are Still Looking for the E. coli," Salon.com writer Michael Scherer discusses two recent E. coli outbreaks - one in Pennsylvania and one in California.  In Scherer's article, he focuses on USDA's attempts to find the source of an E. coli outbreak, and its inability, or unwillingness, search beyond a final meat processor to a supplier or slaughterhouse "upstream".

The two separate E. coli outbreaks subsequently demonstrated both the strengths and ongoing weaknesses of the troubled federal food safety system, which has been under recent scrutiny because rising rates of E. coli sickness. Within weeks, nationwide recalls were announced for nearly 400,000 pounds of meat, and two local meat-processing facilities were temporarily shuttered. But federal food safety inspectors have not yet been able to track down the original slaughterhouses that probably caused the outbreak, leaving open the possibility that more contaminated food is still in the food system. Meanwhile, smaller meat-processing firms that are probably blameless bear the financial brunt of the recalls.

Scherer interviewed Bill Marler and John Munsell, both key players in the ConAgra E. coli outbreak in 2002, about USDA's traceback abilities. 

The current problems can be traced to USDA regulations first put into place in 1994. Under those rules, small meat processors who mechanically tenderize or grind USDA-approved beef from outside slaughterhouses became legally responsible for any "adulterants" like E. coli in the final product. "Whoever grinds it gets stuck with the problem," explains Bill Marler, a Seattle trial lawyer who specializes in food poisoning cases. "If the product has E. coli on it, they are on the hook. It is an unfair situation."

The rules have resulted in inspectors who have historically shown little interest in finding the source of the contamination, with sometimes disastrous results. In 2002, E. coli-contaminated beef from a ConAgra slaughterhouse in Greeley, Colo., sickened 46 people in 16 states and killed a woman in Ohio. But months before most of the illnesses became apparent, two small meat processors, including a plant run by Munsell, received positive tests for E. coli from boxed beef that had been sent from the Greeley plant. Federal meat inspectors blamed the processing plants and initially refused to trace the contamination back to its source. "Existing policy stated that the grinders should be held accountable for ensuring the product that they purchased was wholesome," explained the USDA's inspector general in a damning report about the incident. "FSIS was slow to react."

Marler has commented on USDA's recall abilities and its partnership with the meat industry several times, including his essay titled, "E. coli and the Church Picnic," which is posted at his blog, and an Associated Press article titled, "USDA withheld information from state in E. coli investigation," an excerpt of which is also poted at marler's blog.

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Bill Marler is traveling to Washington, DC today to support victims of three recent foodborne illness outbreaks as they give testimony before the House Committee on Energy and Commerce's Subcommittee on Oversight and Investigations.  Marler provided written testimony for the subcommittee, highlighting eight steps he feels could greatly improve food safety. 

They are:

1. There exist two “best practices” in meat that should be extended to produce. Following the Jack in the Box crisis, the head of the USDA’s Food and Safety Inspection Service took a regulatory and systems approach to food safety. That “hero” was Michael Taylor. Taylor declared that raw ground beef that is contaminated with E. coli would be classified and treated as “adulterated” within the meaning of the Federal Meat Inspection Act. Taylor also introduced a mandatory Risk Management System. The required meat processors to adopt comprehensive precautions. Those included carcass washes, citric acid sprays, steam pasteurization and air-exchange systems. Following Taylor’s example, we must serve notice to produce and other food processors that E. coli, salmonella, etc. will be classified and treated as adulterants. In addition, the same kind of comprehensive Risk Management System must be established and implemented. Penalties must be criminal and civil. When these best practices are adopted, firms will have to certify that not only they, but that every aspect of their supply chain, also are in compliance. Branding can and should reflect this certification of both the firms and their suppliers. This would be a new kind of “Seal of Approval.” This “Seal of Approval” can also apply to such issues as the location of produce fields near animal farms, what kinds of procedures are used, and the method of irrigation as well as the type of water used.
2. We need the same kind of food safety champion that Taylor was. This person would be a highly visible symbol of our commitment. Along these lines, it is useful to consider consolidating responsibility in one federal-level agency. That would be the central point for communication about best practices and the point of contact for state and local regulators and health departments.
3. The track record of business for issuing warnings and recalls rapidly isn’t good. The federal and state governments should have authority to recall food products. That means increased funding, particularly at the state level. Most outbreaks are regional, not national.
4. Produce an E. coli vaccine for cows. I would say that the lion’s share of produce problems result from this contaminant passed on through cow feces.
5. The nation requires education about the benefits of irradiation of all mass-produced food including produce. Resistance to this practice seems to be rooted in public perception, not science.
6. Attention has to be paid to the vulnerability of our food supply system to acts of terrorism. Denial and lack of common sense seem to dominate thinking at all levels – business and federal and state government.
7. Why haven’t we applied our economic and political muscle to imposing more stringent regulations on food imports? This is a central trade issue that has been neglected.
8. There’s an urgent need to improve the resources available to foodborne disease victims. At the top of the list are the out-of-pocket medical costs. Those are usually not immediately or even eventually reimbursed by medical insurance if victims have coverage. By time compensation comes from litigation, individuals are sometimes heavily in debt. Next on the list is the expense of missing work. Marler Clark has been encouraging food processors and retailers to provide this help as a gesture of goodwill.

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Health officials confirm a 12th case of E. coli and learn an employee also tested positive

Mary Ann Milbourn of the Orange County Register reported this morning that the restaurant in Foothill Ranch has been closed after a 12th case of E. coli was confirmed among customers and one employee tested positive for the bacteria, county health officials announced Saturday.

If earlier outbreaks are a guide, there is usually about 15 - 20 times the actual number of ill people that are ever officially counted.  If this outbreaks holds steady at 13, we would expect somewhere between 150 to 250 actually ill people.

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On March 23, 2007, The California Department of Health Services and the United States Food and Drug Administration released its report, "Investigation of an Escherichia coli O157:H7 Outbreak Associated with Dole Pre-Packaged Spinach (redacted)." (PDF) and, "Recommendations in follow up to the Investigation of an Escherichia coli O157:H7 Outbreak Associated with Dole PrePackaged Spinach." (PDF) The report and recommendations follow the 2006 E. coli outbreak that was traced to pre-packated Dole spinach that was produced in California's Salinas Valley and sold nationwide.

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Today Show food reporter and MSNBC columnist Phil Lempert recently published an article about preventing E. coli and Salmonella infections. 

Top tips to prevent salmonella and E. coli:

• Always wash hands, dishes, utensils and counter surfaces often while preparing and cooking all foods
• When preparing or cooking raw meats, poultry or other foods, clean surfaces and hands with hot soapy water and use paper towels and discard immediately
• Never use the same plate, tray or utensils for the cooked meat that you use for the raw meat
• Separate raw meat, poultry, and seafood from other foods in your refrigerator
• Always cook all foods thoroughly. Meats, poultry, pork and especially ground meats, should be cooked until the juices run absolutely clear.

To read the full article, click here.

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A recent article in the Salt Lake Tribune highlighted common myths about food safety, including myths about irradiation and E. coli:

Myth: It's unsafe to eat meat or other foods that have been irradiated.

Reality: Federal health officials say irradiation kills E. coli, salmonella, campylobacter and other organisms that make consumers sick without posing health risks or significantly reducing nutritional quality or taste.

What to do: If you're concerned, check the label. The Food and Drug Administration requires warnings on all irradiated foods.


Myth: E. coli is commonly found in red meat.

Reality: It's true that undercooked, contaminated ground beef has caused more E. coli-related illnesses than any other food. The bacteria, the leading cause of foodborne illness, also have been found in bean sprouts and fresh leafy greens, possibly from contaminated water or contact with cattle waste.

What to do: Cook hamburgers until they're brown and have an internal temperature of 160 degrees.

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Salinas-based Fresh Express is investing up to $2 million to research the potentially fatal bacterium that has brought the leafy-green industry under scrutiny since last year's E. coli scare.

The company, whose products have never been shown to cause a foodborne illness outbreak, will share the results of the research with the public.

"We are hopeful that this research will yield new knowledge, practices and technologies that the entire fresh-cut produce industry can use to provide consumers with ready-to-eat produce that is consistently safe and healthy," Tanios Viviani, president of Fresh Express, said in a statement released Wednesday.

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CBS 3 News reports that health officials have confirmed a case of E. coli in the city of Philadelphia. The announcement comes after a nationwide alert concerning tainted spinach.

CBS 3's Medical Reporter Stephanie Stahl spoke with an official from the Pennsylvania State Health Department who reports there is a positive case of E. coli. While it has not been officially linked, there is a possibility the latest incent may be connected to the recent E. coli outbreak involving fresh bagged spinach.

Officials said a Philadelphia resident was diagnosed with E. coli, but has since been treated and is recovering.

Nationwide, health officials are warning advising consumers to avoid bagged spinach and to dispose of any suspected produce that may be in their homes. Symptoms of e-coli infection include; abdominal cramps, diarrhea - often with bloody stools, mild fever, nausea, and vomiting.

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Barb Smith for ABC 4 reports that "The kids were playing and they came running down and they started saying poop, poop in the Playland." Tania Wymore was alarmed by the very obvious form of E-Coli that her toddler found at a birthday party.

Other Utah moms say they have seen similar problems in the play areas at restaurants. Pamela Davis says it's the things she cant see that she worries about most.

"From experience children do go to the bathroom in there. They do throw up in there, and they do all of that sort of stuff and its just not possible to know if its clean," says Davis.

ABC 4 wanted to know if the negative perception of restaurant areas was warranted, so we put five restaurants, selected at random, to the test.

We collected laboratory samples for the most common and noxious of bacteria: Staphylococcus Aureus, Pseudomonas, Salmonella, and E-Coli. All of those could make a child sick, but only if ingested.

"Getting bugs on the hands won't make anyone sick," says Dr. Sean Biggs from the Jordan Valley Clinic. "But touching your mouth and then touching your food, putting it in your mouth, that is what gets you in trouble."

In areas where food is side-by-side with playground equipment the temptation is not to wash. Nelson Laboratories took our test tube samples, plated out the bacteria on the swabs, and a few days later came back with the results.

Microbiologist Jason Smith says he was pleasantly surprised, and so were we.

"I was expecting a lot worse," Smith said.

All of our tests came up negative for the really bad bacteria we were testing for, but Smith says there were other organisms present.

"It's not filthy but then again, it is not exactly clean either," Dr. Biggs says.

Bacteria is not the only problem in play areas, viruses are also present. Viruses are difficult to test for, and most are airborne.

Dr. Biggs says the best way to stay healthy and still let your children enjoy themselves is to wash their hands for fifteen to thirty seconds with soap and water before they put food in their mouths.

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In a recent CanWest News story, Joe Schwarcz asks "what are you more worried about eating, beef from a hamburger joint or a sandwich made with alfalfa sprouts at your local health food emporium?"

Scientifically, this is a "no contest." I know what you're thinking. Eat beef and risk mad cow disease. Or, eat beef and risk E. coli 0157:H7. After all, didn't 120 or so people die in England from mad cow disease? And what about the four children who died from eating tainted hamburgers in the famous "Jack In The Box" episode in 1993? Yes, both of these are awful numbers. But the chance of any individual being affected is extremely low. In England, two million infected cows ended up in the food stream and that resulted in about 10 deaths a year. In Canada we are talking about one cow that never ended up in the food system. As far as the Jack In The Box episode goes, the meat wasn't properly cooked. That's it. Cooking hamburger to an internal temperature of about 70 degrees Celsius eliminates the risk of bacterial contamination.

Now let's turn to those sprouts that adorn many a salad and sandwich in places that feature so-called health foods. The largest recorded case of E. coli 0157:H7 infection in history had nothing to do with meat. It had to do with radish sprouts. In 1996 in Japan 6,000 people became sick and 17 died from eating raw radish sprouts. Can you imagine the publicity this would have garnered if meat had been involved? And it doesn't only happen in Japan. In the US since 1995, 15 outbreaks of Salmonella infection and two of E. coli 0157:H7 have been associated with sprouts.

Why does this happen? Because conditions favourable for seed sprouting are ideal for increasing bacterial counts on seeds. Bacteria just love the moist, warm, nutrient-filled sprouts. How do bacteria contaminate the seeds in the first place? On the farm untreated agricultural water may be used, manure used as fertilizer may be improperly composted and there may be runoff from animal production facilities. That's why federal guidelines stipulate that potable water should be used, that synthetic fertilizers are preferable for sprout seed growth and that seeds should be disinfected by dipping them into a calcium hypochlorite solution for 15 minutes. It is also recommended that people at high risk for infections, such as young children or the elderly not consume raw sprouts.

As for the rest of us, there is no worry if recommended procedures are followed. Indeed certain sprouts, especially broccoli sprouts are highly recommended. These contain sulphoraphane, a substance that may help reduce the risk of macular degeneration, hypertension and prostate cancer. No worry about contamination here because the company that produces these takes extreme care to follow government guidelines and tests every batch for salmonella and E. coli before shipping to stores. But as far as the run of the mill raw sprouts that burst out of those vegetarian sandwiches E well who knows their history? Statistically there is a greater chance they will make you sick than the hamburger everyone worries about.

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Starr Shuppert of the Rushville Republican reports that there have been two recent reports in the county of efforts to sell meat that that has been recalled due to testing positive for E. coli bacteria.

On almost any given day a local resident might get a knock on their door and find an individual saying they have some meat left over from a delivery and they are willing to "let it go at a reduced price."

Reno Gosser, the Rush County Sanitarian and Environmentalist, recently issued a warning to county residents about such practices and the meat they are trying to sell.

The individual selling the meat has no permit to do so and generally offers seven or eight different cuts or types of steaks at a reduced price to unsuspecting individuals. You should not purchase the meat, Gosser said.

Because of the severity of the problems associated E. coli the local health department is concerned about the tainted meat found locally and the possibility that other unsuspecting county residents may or may have purchase some of it.

"We have a lead on the individual that has been selling the meat in the county and law enforcement personnel is looking for him at this time. We are confident that he is from Ohio, but that is all of the information we can give out presently. We may have more information in a couple of days," Gosser told the local media.

He was quick to add that if you are approached by anyone attempting to sell meat out of the back of a car or truck you are asked to contact the Rush County Sheriff's Department at (765) 932-2931 or the RPD at (765) 932-3907 or the Rush County Health Department at (765) 932-2216.

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