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

   Yesterday, the USDA Food Safety and Inspection Service issued a largely useless, but still widely published, news release entitled “Independence Day: Drills for the Grill.” See News Release, www.fsis.usda.gov/News_&_Events/NR_062909_01/index.asp While notable for a cheery and reassuring tone, the information provided is, at best, unhelpful, and, at worst, is dangerously misleading. In addition to providing little in the way of substantive food safety information about how to “safely” grill a burger, the FSIS news release deceitfully soft-pedals the real risks posed by ground beef, generally, and outdoor grilling in particular. For example, the new release clumps together hamburgers, steak, chicken, hot dogs, and ribs as if all can be treated in the same way, and pose the same relative risk—which is blatantly false. And also, how can anyone at FSIS expect to educate the public about safely grilling ground beef (the real risk here) without once mentioning E. coli O157:H7, the primary risk?

  Take, for example, the introductory quote from FSIS Administrator, Alfred V. Almanza, who states: “Safe food handling is always important, but during the warm summer months — peak grilling season — there is an increased need for awareness of safe food handling practices.” Well, Mr. Almanza, why is that? Could it be because numerous research studies have shown that the incidence of E. coli O157:H7 in cattle rises significantly during the spring, and peaks during the summer months? See, e.g., Edrington, et al, 2006. Seasonal shedding of Escherichia coli O157:H7 in ruminants: a new hypothesis. Foodborne Pathog Dis 3:413-21; Hancock, et al., 1994. The prevalence of Escherichia coli O157.H7 in dairy and beef cattle in Washington State. Epidemiol Infect 113:199-207; Hancock, et al., 1997. A longitudinal study of Escherichia coli O157 in fourteen cattle herds. Epidemiol Infect 118:193-5; and Hussein, et al., 2005. Prevalence of Shiga toxin-producing Escherichia coli in beef cattle. J Food Prot 68:2224-41.  Why not level with the public and tell them that ground beef simply tends to be more dangerous in the summer, and that is when a higher than average percentage of E. coli O157:H7 infections occur?  Of course, that might make the USDA look bad, and could further depress the sales of ground beef.

(Please click on Continue Reading to view the rest of this article.)

Another reason the safe grilling practices are particularly important is because grilling burgers on a barbecue grill is an exceedingly risky practice that is almost certain to result in burgers not consistently reaching an internal temperature of 160 degrees Fahrenheit? Snyder, O. P. 2005. Cooking hamburgers on a Weber outdoor grill. HITM. St. Paul, MN.: http://www.hi-tm.com/Documents2005/hamb-cook-webgrill-6-4-05.pdf  And the USDA spent years and years telling people to rely on color as an indication of doneness when cooking hamburger patties, but then switched in June 1997 and started recommending the use of thermometers to determine doneness. See FSIS Technical Publication, Color of Cooked Ground Beef as it Relates to Doneness, available www.fsis.usda.gov/oa/pubs/colortech.htm (citing the studies that prompted the changed recommendation). Or because once the USDA started to recommend the use of a thermometer use, it was inappropriate and inaccurate bi-metallic coil thermometer (the one that appears on the USDA safe-handling instructions on all meat) that was consistently suggested. See, e.g. O. Peter Snyder, Ph.D., The Dangerous Bi-Metallic Thermometer, available at www.hi-tm.com/Documents2001/hamburger-temp.pdf (“USDA-recommended bimetallic coil thermometer is an inaccurate, awkward, and complicated device for measuring the temperature of highly contaminated, government-inspected and improved raw foods that cooks must pasteurize”).

Notably, yesterday’s press-release recommends the “use of an instant-read thermometer,” which is an excellent recommendation. But few consumers even own this kind of thermometer, let alone use one. McCurdy, et al., 2004. Availability, accuracy and response time of instant-read food thermometers for consumer use. Food Prot. Trends. 24(12):961-968. A 2006 food safety survey conducted by—you guessed it—the USDA (and FDA) found that only 13% of consumers always or often use a thermometer, of any kind, when cooking hamburgers. Lando and Verril, 2008. 2006 USDA/FDA Food Safety Survey, www.cfsan.fda.gov/~comm/crnu-tri7.html And there is also the significant risk that the temperature measured in one place on the hamburger will be different than the temperature elsewhere. Berry, B. W., and Bigner-George, M.E. 2001. Postcooking temperature changes in beef patties. J. Food Prot. 64(9):1405-1411.

And then there is the low infectious dose of E. coli O157:H7, and its virulence. Patricia M. Griffin, et al., Large Outbreak of Escherichia coli O157:H7 Infections in the Western United States: The Big Picture, in RECENT ADVANCES IN VEROCYTOTOXIN-PRODUCING ESCHERICHIA COLI INFECTIONS, at 7 (M.A. Karmali & A. G. Goglio eds. 1994) (“The most probable number of E. coli O157:H7 was less than 20 organisms per gram.”) Patricia M. Griffin & Robert V. Tauxe, The Epidemiology of Infections Caused by Escherichia coli O157:H7, Other Enterohemorrhagic E. coli, and the Associated Hemolytic Uremic Syndrome, 13 Epidemiologic Reviews 60, 73 (1991) (“an organism that can be transmitted by exposure to extremely few organisms.”) Indeed, the USDA has repeatedly noted that a primary reason behind the decision to treat E. coli O157:H7 as an adulterant per se is “the low infectious dose of E. coli O157:H7 associated with foodborne disease outbreaks and the very severe consequences of an E. coli O157:H7 infection.” See  Beef Products Contaminated with Escherichia coli O157:H7, 64 Fed. Reg. 2803, at 2804 (Jan. 19, 1999).

Finally, there is the issue of the cooking instructions that appear on the packages of frozen ground beef patties, one of the most popular products purchased for purposes of outdoor grilling. By law, the USDA is supposed to approves the labels of meat and poultry products, which includes any cooking instructions. But a recently published study compared the cooking instructions on 37 retail packages and found a huge variation in suggested cook times (from 1.5 to 8 minutes per side), and inconsistent advice on whether to use a thermometer or rely on the color of the patty to determine doneness. S. McCurdy, et al., Label Instructions and Cooking Times for Retail Frozen Ground Beef Patties, Food Prot. Trends, 29 (6, 335-41 (June 2009). The study found many cooking instructions “are inadequate to produce a safely cooked patty.” And these are instructions supposedly approved by the USDA.

So if consumers cannot even rely on the USDA-approved cooking instructions printed on the box of frozen ground beef patties, how can they be expected to take seriously a new release about the “food safety ‘drills of the grill’”? I certainly wouldn’t.

(Oh, and by the way, if you do want to grill burgers, I would suggest that you cook all hamburger patties on a cooking rack in your oven set at 350 degrees. After cooking for 15-20 minutes, check the temperature of each patty in multiple locations with a digital read thermometer. If all readings are above 150 degrees, remove the patties from the cooking rack to a warm platter. Now take those patties out to the barbecue grill so you can put grill marks on them. Happy cooking!)

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Minnesota Senator Amy Klobuchar held a press conference today to announce new proposed leglisation to "promote a more rapid and effective national response to outbreaks of foodborne sickness." 

According to Klobuchar, the new act would, among other things:

• Enhance the  Centers for Disease Control's  (CDC)  foodborne disease surveillance system.
• Direct CDC to provide more support to state health agencies, including promoting "best practices" in food safety investigations.
• Establish a “Food Safety Centers of Excellence.”

This last prong of the legislation owes its origins to Minnesota's own "Team D" [D for diarrhea].  Team D is a group of foodborne illness investigators from Minnesota agencies that have been previously praised here and elsewhere for being the first, and sometimes only, health officials to recognize foodborne illness outbreaks.    Among the outbreaks where Team D took the lead were the Salmonella Saintpaul outbreak in 2008, and the PCA Salmonella outbreak announced this February.

As for the content of the legislation, its good to see an emphasis on increased surveilance.   Of course, preventing illnesses in the first place is always the first choice.  Still, the overwhelming majority of foodborne illness in the U.S. goes unreported, and therefore un-investigated.  There are lessons to learn and improvements to make with every investigated outbreak.   Until we stop foodborne illness outbreaks altogether, we are best served to rezognize those that do occur, so that we can stop making the same mistakes over and over again.

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In a bit of news that is less surprising than it should be, the AP today reports that the FDA has for the last several years failed to perform a large percentage of required audits for inspections being conducted (under contract) by the States.  According to today's report (based on documents recently released to Congress:

The Food and Drug Administration conducted only about half the state food safety audits it promised in the two years before the recent peanut salmonella outbreak, according to new documents the agency sent to Congress.

The documents show the agency did not do any of the required audits of state-run food inspections in five states during those states' budget years spanning 2007 and 2008. And the FDA was unable to say whether audits were conducted at all in 11 additional states during that time, including Georgia and Texas, where salmonella was found in two peanut plants during a wide-ranging peanut recall earlier this year.

Only 14 states saw 100 percent of the audits completed.

As you will recall, the failure of state-performed inspections was a key contribution the recent nationwide Salmonella outbreak linked to contaminated peanuts processed by the Peanut Corporation of America.  Ditto the Conagra pot pie Salmonella outbreak, and the Peter Pan peanut butter Salmonella outbreak.  Double ditto the Veggie Booty Salmonella outrbeak. 

But at least the FDA seems to starting its long overdue recovery process, taking the first step by admitting it has a problem.  As the AP story reports:

Stephen R. Mason, acting assistant commissioner for legislation at the agency, said the recent salmonella outbreak "has highlighted limitations in our current approach and has prompted internal discussions on potential enhancements to the audit program." 

An agency spokesperson, trying hard to put the best spin on things, goes on to offer the following lame rationalization:

FDA spokeswoman Susan Cruzan says the agency is "evaluating approaches" for improving the audits.

"Although FDA has not been able to fulfill the goal of conducting 100 percent of the audits expected under FDA's internal auditing policy, FDA has audited each state at least once, has good knowledge of the state programs and state inspection personnel, and works to improve the programs as needed," she said.

Having admitted the problem, one can now only hope that the FDA will move on to the crucial next step: Stop Being in Denial.

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A tip of the meat-thermometer to Herb Weisbaum for an excellent column on how stores could to a better job of notifying customers about recalled products.    Mr. Weisbaum points out that stores are the last line of defense in our food safety system.  He also points out that they often fail. 

California State Senator Dean Florez said his staffers found numerous recalled products on grovery store shelves when doing a spot check.  Senator Florez is introducing legislation to force stores to adopt systems to block the sales of recalled products.   Corporate food safety leader Costco already does just that.   This is especially important in light of a recent study that consumers are not generally in the habit of scanning their household for implicated products when recalls are announced. 

One place consumers can keep track of recalls is at www.recalls.gov. 

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Yesterday, the New York Times published an interesting, as well as disturbing, article on the continuing dangers of ConAgra frozen pot pies.  Specifically, despite the 2007 outbreak and all the serious illnesses it caused, the safety of the pot pies still depend on the customer cooking them correctly.  Apparently, the challenge of making the pot pies safe to eat, even if cooked to a temperature below what would constitute a "kill step," was simply too difficult.  Here is how the NY Times described the decision:

The frozen pot pies that sickened an estimated 15,000 people with salmonella in 2007 left federal inspectors mystified. At first they suspected the turkey. Then they considered the peas, carrots and potatoes.

The pie maker, ConAgra Foods, began spot-checking the vegetables for pathogens, but could not find the culprit. It also tried cooking the vegetables at high temperatures, a strategy the industry calls a “kill step,” to wipe out any lingering microbes. But the vegetables turned to mush in the process.

So ConAgra — which sold more than 100 million pot pies last year under its popular Banquet label — decided to make the consumer responsible for the kill step. The “food safety” instructions and four-step diagram on the 69-cent pies offer this guidance: “Internal temperature needs to reach 165° F as measured by a food thermometer in several spots.”

For the full article, see www.nytimes.com/2009/05/15/business/15ingredients.html

But getting a frozen-hard pot-pie to reach a uniform temperature of 165 degrees is by no means an easy thing to accomplish, as the Times article amply demonstrates. 

But attempts by The New York Times to follow the directions on several brands of frozen meals, including ConAgra’s Banquet pot pies, failed to achieve the required 165-degree temperature. Some spots in the pies heated to only 140 degrees even as parts of the crust were burnt.

A ConAgra consumer hotline operator said the claims by microwave-oven manufacturers about their wattage power could not be trusted, and that any pies not heated enough should not be eaten. “We definitely want it to reach that 165-degree temperature,” she said. “It’s a safety issue.”

A safety issue indeed.  Because if that pot pie is contaminated with a deadly pathogen, and the cooking process does not essentially pasteurize the pot pie, then eating will could be the real "kill-step" here. 

For additional discussion, please click Continue Reading.

One of the issues really missed in the Times article--although it is one missed a lot, is the question of whether the real problem here is that ConAgra wants to be able to sell the pot pies, and do so profitably, for a price of 69 cents per pie. According to the article:

The company says the outbreak and management changes prompted it to undertake a broad range of safety initiatives, including testing for microbes in all of the pie ingredients. ConAgra said it was also trying to apply the kill step to as many ingredients as possible, but had not yet found a way to accomplish it without making the pies “unpalatable.”

Its Banquet pies now have some of the most graphic food safety instructions, complete with a depiction of a thermometer piercing the crust.

Pressed to say whether the meals are safe to eat if consumers disregard the instructions or make an error, Stephanie Childs, a company spokeswoman, said, “Our goal is to provide the consumer with as safe a product as possible, and we are doing everything within our ability to provide a safe product to them.”

Yes, they are going to do "everthing within [their] ability to provide a safe product" EXCEPT, that is, to raise the price to a point that would allow them to manufacture a product that did not require that consumers pasteurize the pot pie before eating it. So, yest the problem might be with the cooking instructions.  And the problem might be with consumers not microwaving something along enough to constitute a "kill step" for the pot pie.  But the REAL problem, that no one wants to talk about is this: You get what you pay for, including safety.

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State legislators around the US, fed up with the perceived slow response of the federal government to enact stronger food safety laws, have begun sending a clear message to Washington:  if you won't protect our citizens from increasing foodborne illness outbreaks, then we will.

in a Wall Street Journal article by Jane Zhang, she highlights the numerous changes some states are making to strengthen their food safety laws and better protect their own citizens, including:

• Georgia recently enacted legislation that gives food processors 24 hours to report internal tests that find tainted products. The state's peanut industry was hit hard after a widespread salmonella outbreak was traced to a processing plant in rural Blakely, GA.

• Idaho enacted a law last month that authorizes the state to charge food services, retailers and processors a licensing fee to help pay for food-safety inspections.

• The Oregon Senate, with the support of the food industry, passed legislation in February that would let the state impose civil fines of as much as $10,000 for food-safety violations. Under current law, a food company must be convicted of a criminal violation and the fine is limited to $200.

• California lawmakers have introduced a bill aimed at strengthening food safety after a massive recall this year of pistachios from Setton Pistachio of Terra Bella Inc. that could be tainted with salmonella. Like the new Georgia law, it would require food processors to report positive tests for pathogens or harmful contaminants within 24 hours. It also would require food processors to keep detailed safety plans to prevent contamination and stepped-up testing of foods from California facilities.

Of course, these state-led efforts are leading to another potential issue: lack of uniformity for food manufacturers and distributors.  Food-industry groups say anything other than a uniform federal food-safety system will add to their costs. "It's a good thing states are trying to raise the bar and improve food safety, but it needs to be looked at carefully," said Robert Brackett, chief science officer of the Grocery Manufacturers Association, a trade group in Washington. "It should really lead to a national system."

What are your thoughts on this issue?

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As reported by the Wall Street Journal's Jane Zhang,  states frustrated by the slow pace of national food safety reform have begun to take matters into their own hands.  Georgia was hit hard by the recent outbreak of Salmonella in peanut butter and peanut products;  as the leading producer of peanuts in the US, the 25% drop in demand has hurt farmers and businesses all the way up the production chain.  Even though the outbreak was traced to a single processor in Blakely, GA (the now-bankrupt Peanut Corporation of America), it affected consumers in 46 states, sickened hundreds, and cost nine people their lives.  Analysts estimate that beyond the human toll of the outbreak, the recall and lost revenues might add up to as much as 1.5 billion dollars.

Georgia has taken a "get tough" attitude, enacting legislation that requires food processing companies to report any contamination within 24 hours of a positive test.  Although a step in the right direction, this quick-to-the-books law may create as many problems as it hopes to solve.  A few bumps in the road:

1) The law does not mandate testing, just the reporting of positive tests.  Some consumer groups worry that this will actually cause companies to test less often.

2) If a food processor is considering where to locate, the law might tip the balance away from Georgia, which could negatively impact future economic growth.

3) As other states enact their own laws, the result could be a nationwide patchwork with a dizzying array of regulations which differ from state to state.  According to Zhang's article, no fewer than 600 different laws relating to food safety have been initiated at the state level. 

Meanwhile, several forms of national legislation are crawling forward at glacial speed.  Ostensibly everyone wants safe food.  How  - and if - we get there is another thing altogether.

Edward Abbey said "The idea of wilderness needs no defense, only more defenders."  Perhaps it's the same for food safety.

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There has for a long time been valid criticism of food recalls, both with regard to how agencies like the FDA implement them, and whether recalls really work to prevent foodborne illness.  In my view, most recalls are best described as closing the barn-doors after the horses have escaped.  But that said, when a food product is determined to be contaminated, there is no avoiding the need to try to remove the product from the market.  That means recalls are necessary.  It also means that recalls need to be effective as possible at limiting the spread of foodborne disease. According to a great and interesting new study out of Rutgers' Food Policy Institute, it appears that recalls are anything but effective in prompting necessary public action.  For example, in a survey of over 1,100, the study found that only about 60 percent of the studied sample reported ever having looked for recalled food in their homes, and only 10 percent said they had ever found a recalled food product.

This is a disturbing finding, because, unless we can reliably count on the public to take the actions necessary to prevent the spread of foodborne disease, we may be assuming that recalls work when, in fact, they do not.  This study thus deserves to be read carefully by public health officials, and additional research definitely seems to be needed.

The full study can be found here: www.foodpolicyinstitute.org/docs/news/RR-0109-018.pdf

To read the full press release announcing the study, please hit the Continued Reading link.

Rutgers Study Finds Many Consumers Ignore Food Product Recalls
April 14, 2009

NEW BRUNSWICK, N.J. – Rutgers’ Food Policy Institute (FPI) released a study today showing that many Americans fail to check their homes for recalled food products. Only about 60 percent of the studied sample reported ever having looked for recalled food in their homes, and only 10 percent said they had ever found a recalled food product.
The study was based on a survey of 1,101 Americans interviewed by telephone from Aug. 4 to Sept. 24, 2008. The study can be downloaded at www.foodpolicy.rutgers.edu.
Most respondents said they pay a great deal of attention to food recalls and, when they learn about them, tell many other people. But 40 percent of these consumers think that the foods they purchase are less likely to be recalled than those purchased by others, appearing to believe that food recalls just don’t apply to them.
Despite widespread awareness of recent foodborne illness outbreaks and a sense that the number of food recalls is increasing, about half of Americans say that food recalls have had no impact on their lives, said psychologist William K. Hallman, a professor of human ecology at Rutgers, The State University of New Jersey, School of Environmental and Biological Sciences. “Getting consumers to pay attention to news about recalls isn’t the hard part," he said. “It’s getting them to take the step of actually looking for recalled food products in their homes.” Hallman is also the director of FPI and lead author of the study report.
The Rutgers researchers also offered suggestions about how to improve communications about food recalls. Nearly 75 percent of those surveyed said they would like to receive personalized information about recalls on their receipt at the grocery store, and more than 60 percent said they also would also like to receive such information through a letter or an e-mail.
Hallman said that personalizing communications about food recalls may be the way to overcome the sense that the messages are meant for someone else. Providing consumers with recall information about specific products they have purchased makes it harder for them to ignore the advice to look for the recalled items.
But even when people find recalled food, not all do what they are told. Approximately 12 percent reported eating a food they thought had been recalled. At the other extreme, some consumers take a “better safe than sorry” attitude. More than 25 percent reported that they had simply discarded food products after hearing about a recall, potentially wasting safe, nutritious food. Many consumers also avoid purchasing products not included in the recall but which are similar, or are from the same manufacturer.pistachios
“Our research also points out that instructions to consumers must be clear and comprehensible if you want them to act appropriately after a food recall,” Hallman said. He cites the Food and Drug Administration’s recent advice to consumers not to eat pistachios, but to hold onto them and not throw them away as confusing to consumers.
“We found that clear, direct messages such as ‘throw the food in the garbage’ or ‘return the food to the store for a refund,’ should motivate action. Keeping people in a holding pattern is more likely to result in inaction, and it certainly increases the likelihood that someone might eat the food by accident.”
The authors of the study are William K. Hallman and Cara L. Cuite, researchers at FPI, and Neal H. Hooker, a researcher at the Ohio State University. The study was funded by the United States Department of Agriculture and the Grocery Manufacturers Association.
An earlier report based on data from the same survey provided insight into consumer awareness of the Salmonella Saintpaul advisory in the summer of 2008. The report is also available at www.foodpolicy.rutgers.edu.
FPI is a research unit of Rutgers’ New Jersey Agricultural Experiment Station. The institute addresses important emerging food policy issues and supports public and private decision makers who shape aspects of the food system within which government, agriculture, industry and the consumer interact.
 

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Last June, Brian Grubbs, of Colorado, suffered a Salmonella Saintpaul infection after consuming contaminated jalapeno peppers.  His illness was one of more than 1,200 in a nationwide outbreak.    The Grubbs purchased the peppers at their local WalMart.   Marler Clark subsequently filed suit against WalMart on Mr. Grubbs behalf.   WalMart tried unsuccessfully to have the suit thrown out, and has now identified Frontera Produce Ltd, of Texas, as the supplier of the jalapenos in question.

Brian Grubbs, and his wife Cheryl, were in Washington D.C. on April 29 to call for increased food safety in the U.S.  About 25 former foodpoisoning victims met with federal legislators to discuss the problem, and the various pieces of pending food safety legislation. 

As reported in the Cortez Journal, Ms. Grubss stated, "'The food we die for shouldn't be killing you, we don't want everyone to find out about foodborne illness like we did. We're trying to educate our community and get (legislation) passed."

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Last fall I got the opportunity to give a guest lecture at the University of Wisconsin Law School, which is where I went to law school.  It was for an innovative class called Transnational Regulation: Increasing the Safety of Globally-Sourced Products.  The University of Wisconsin has long been the home of the Food Research Institute, which has done groundbreaking research over the years on E. coli O157:H7, among other things.  So I was especially happy to receive news of what sounds like a great conference being held this month at the University:  Food Import Safety: Systems, Infrastructure & Governance.  This one-and-a-half -day conference will be held on May 26 and 27.  For more information about the program, and how to register, click on the Continue Reading link.

Dates: May 26 & 27, 2009 (One and one-half day conference)
Location: Tong Auditorium in Engineering Centers Building, University of Wisconsin – Madison
Registration is free-of-charge but space is limited
To register: http://wage.wisc.edu/events/Index.aspx?ID=527  
For more information: go to website above and click on click on “event agenda and speaker list” or send an email to: chpra@engr.wisc.edu
Sponsors: Center for World Affairs and the Global Economy (WAGE), Center for Freight and Infrastructure Research and Education (CFIRE), Engineering Professional Development (EPD), European Union Center of Excellence (EUCE), ISyE (Department of Industrial & Systems Engineering), and FRI (Food Research Institute), CIBER (Center for International Business Education and Research, The China Initiative.

This conference will address food import safety from a variety of perspectives including systems analysis, infrastructure resilience, governance and policy analysis. Two morning plenary talks will set the stage by covering the origins of adulteration and contamination in rapidly developing economies, and by examining import violations found at both port and land-borders. An industry panel will address several aspects of supplier management and self governance, including supplier agreements. Another panel will discuss cost-effective sampling schemes, testing and detection technology advancements, and testing limitations. European speakers will discuss approaches from the European Food Safety Authority and European Commission used to regulate safety in imported foods, including the rapid alert system. A second day panel will be chaired by a well-known industry spokesman for food safety, who will be speaking to the way forward. This will include discussions of global approaches to food protection, as well as different forms of governance, including third party oversight.
 

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The Orange Bulletin reports that once again, consumers are suffering from an outbreak of foodborne illness. As of Dec. 8, 63 individuals from six -states have developed E. coli 0157:H7 infections from a presumed exposure at the fast food chain, Taco Bell.

There are a number of suspected cases being evaluated in numerous other states, as well. According to William Gerrish, a spokesman for the Connecticut Department of Health, several Connecticut residents, having fallen ill after eating at Taco Bell, are being investigated.

The investigation of the E. coli outbreak is being handled by the Centers for Disease Control, or CDC, and the Food and Drug Administration, in cooperation with Taco Bell. Based on the probe, Taco Bell seems to be the link in this outbreak. 

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David Smith of Journal and Courier reports that food-borne illness comes from consuming food or beverages that have been contaminated with a pathogen, such as a virus, a bacterium or a parasite.

Careful food preparation at the correct temperatures can kill microorganisms or prevent those that survive from multiplying and making the consumer ill.

Richard Linton, a Purdue University professor of food safety who has written two textbooks on the subject, said two crucial temperatures are 41 degrees and 135 degrees Fahrenheit.

"Within that range, dangerous bacteria can grow," he said.

Health inspectors, when they visit a restaurant, grocery store or other food establishment, check to make sure foods are either hotter than 135 degrees or cooler than 41 degrees.

When cooked food is cooled, the less time it takes to pass through that temperature range, the better. This can be done by dividing it into portions, placing the food in shallow pans and by using ice to speed the process.

The Tippecanoe County Health Department recommends that potentially hazardous cooked foods be cooled from 135 degrees to 70 degrees within two hours and from 70 degrees to 41 degrees within the next four hours.

"If that can be done, then it will prevent the growth of bacteria that will survive the cooking," Linton said.

While restaurants in Tippecanoe County amass thousands of critical health code violations a year, relatively few cases of food-borne illnesses are confirmed.

Linton said that's due to several reasons. The symptoms of food-borne illness -- diarrhea, nausea, vomiting and cramps -- can be mistaken for some other ailment.

And people who suspect they have a food-related illness rarely go to the doctor for the necessary blood or stool tests. Fewer still are cases where a pathogen is positively identified and traced back to the food source.

For every confirmed case, the Centers for Disease Control estimates as many as 100,000 cases go unconfirmed.

The CDC reports that the most commonly recognized food-borne infections are those caused by the bacteria Campylobacter, Salmonella and E. coli, and by a group of viruses known as Norwalk viruses.

The CDC estimates that each year in the United States, an estimated 76 million people suffer from food-borne illnesses, resulting in an estimated 5,000 deaths.

When a restaurant is cited for a "critical" violation of a food safety standard, it means the violation has the potential to have a direct impact on public health, Linton said.

The most common critical vio lations relate to time and temperature abuse, such as improper cooking, improper cooling and improper storage.

Jaime Romo, general manager of La Bamba Mexican Restaurants in Indiana and Kentucky, said proper hand washing and proper use of gloves are also very important.

"You go to places, and they work at the cash register, then they go to the glove box. You should wash your hands before you put on your gloves," he said.

All food establishments are required to have someone on staff who has passed an exam certifying that he or she is knowledgeable about food safety regulations.

"When I read the newspapers and I see critical violations, it makes me think twice of going there to eat," Linton said.

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John Seewer of PennLive.com reports that big retailers such as Wal-Mart are encouraging growers to embrace new technology that allows them to more closely track produce with bar codes and scanners. Growers are using bilingual videos and posters to train seasonal workers on proper hygiene. Some small farms are treating the water they use to scrub veggies.

Throughout the food chain there's more attention to food safety within the last five years because there's more worry about how an outbreak of illness could cost growers and wholesale buyers millions of dollars.

Two years ago a hepatitis outbreak traced to Mexican-grown green onions sickened 600 people and killed four who ate at a Chi-Chi's near Pittsburgh. The restaurant chain settled hundreds of lawsuits for more than $21 million. A few more are pending.

For most growers, a renewed emphasis on food safety means little change in the ways they pick, wash, pack and ship produce.

"You're inspected by your customers. That probably keeps you on your toes as much as anything," said John Wargowsky, executive director of Mid American Ag and Hort Services, whose organization works with Indiana and Ohio growers on food safety.

"We should take it as seriously as any restaurant does," he said.

The good news is that food safety awareness has increased at a time when people are eating more fresh fruits and vegetables. Consumption is up about 25 percent since 1970. An increasing percentage of foodborne illnesses, however, has been linked to fresh produce, according to federal statistics.

About 12 percent of foodborne illnesses in the 1990s were blamed on fresh produce, up from 4 percent in the 1980s, the Centers for Disease Control and Prevention estimated.

Eating produce contaminated by Salmonella, E. coli or other bacteria can lead to stomach cramps, hospital stays and, in extreme cases, death.

Food safety experts say the reasons for the rise may include increased consumption and handling of produce, better testing and an aging population with weaker immune systems. The micro-organisms that cause illnesses also are becoming more resistant to chemicals designed to kill them.

Some retailers require independent auditors to check over growers and their safety habits.

Others are looking into using bar codes and radio frequency scanners to track where and when their produce was harvested all the way to store shelves.

The technology has the potential to allow retailers to quickly pull a bad shipment of fruit from stores soon after a problem is detected, said Matt Darr, a researcher at Ohio State University's Department of Food, Agricultural and Biological Engineering.

"They can find out where the product was shipped and pull it out before others can buy it," he said.

Researchers and those who work in food safety say most growers have properly handled produce for years but that there's always room for improvement, especially with more farmers selling directly to restaurants and consumers. The number of farmers' markets nationwide has more than doubled from 1994 through 2004, according to the U.S. Department of Agriculture.

"Any time you're handling food it's always an issue," said Tony Bratsch, a fruit and vegetable specialist with Virginia Tech University's agriculture extension service. "It goes all the way from field to fork."

Bratsch also works with the Good Agricultural Practices, a six-year-old federally funded program that educates growers and packers how to handle food. He and food safety experts from North Carolina are developing a training program for growers who sell directly to shoppers.

David Schacht, who grows a variety of fruits and vegetables on his family's farm on the edge of Columbus and sells them at his market, said running a clean business is always on his mind because he's the last link between the food and his customers.

"The vast majority of it is common sense -- keep things cleaned and sanitized," he said. "It's a raw product that's grown in the dirt. It's not like a hospital environment."

Steps growers should take to reduce the risk of food-related illnesses include making sure employees are washing their hands and cleaning areas where the produce is packaged. Testing irrigation water for bacteria and making sure manure has had time to decompose before it's spread on fields also can prevent contamination.

No longer can farmers take the risk of hauling manure in the same trailer where they carry vegetables.

Luke LaBorde, an associate professor of food science at Penn State University, said he's more concerned about educating farmers who turn their grapes into jam and their milk into ice cream.

"People are doing more preparation and that means more handling and that increases the risk," he said "I would hope they're doing that properly and not using grandma's old recipe."

Roger and Markell Vogt, who run a potato farm in Palisade, Minn., sanitize the water they use to spray their potatoes. And there's always a broom or hose nearby in the shed where they clean and sort the potatoes, they say.

"It's not one of those things where you shut down and walk away at night," said Roger Vogt. "It has to be cleaned every night."

They sell most of their potatoes at local groceries. "We want to keep our reputation," said Markell Vogt. "We have a lot of local customers, and they trust us."

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