As the count of those sickened in the Illinois Subway Restaurant Salmonella outbreak hit 97, a Salmonella lawsuit was filed against Doctor’s Associates, Inc., the restaurant chain’s parent company. The lawsuit was filed on behalf of Will County resident Alicea Bush-Bailey by Drew Falkenstein of food safety law firm Marler Clark and by Gary A. Newland of the Illinois firm Newland, Newland, & Newland.

On May 12, Ms. Bush-Bailey bought a sandwich from the Subway restaurant at 1248 N. Lake Street in Aurora, IL. By that evening, she was experiencing symptoms including nausea, abdominal cramping and diarrhea, all of which worsened quickly and required her to seek medical care at the emergency room. She was treated for dehydration, severe abdominal pain and nausea, and returned home with medication.

I’m not surprised that the number of ill in this outbreak keeps climbing,” Mr. Falkenstein said. “The CDC estimates that for every confirmed Salmonella illness in an outbreak, another 38.6 are never counted. In order for someone to be listed as an outbreak illness, they have to go to the doctor and get tested. Many people stay home and just try to get through their illness on their own, and never know that they have Salmonella or that they are part of an outbreak.”

Mr. Falkenstein and Marler Clark recently represented over 80 victims of the outbreak of Shigella at a Chicago-area Subway restaurant earlier this year.

“It’s unusual to see two outbreaks at the same chain in the same area in so short a time frame,” continued Falkenstein. “Ms. Bush-Bailey and many other customers entrusted their health and safety to these restaurants, and that trust was not honored.”

Consumer Resource: Downloadable Family Food Safety Guide for Salmonella (PDF)

As the investigation continues into the cause of the 80 (and counting) Salmonella Hvittingfoss illnesses associated with Illinois Subway restaurants, the question arises of the possible role each Subway restaurant could have played in furthering the spread of the bacteria. 

With that in mind, a recent article by Nicole Norfleet caught my attention for its insight into the way that outbreaks such as Subway’s can be made exponentially worse by poor food safety practices at the restaurant.

Her report details a study by Ben Chapman, an assistant professor and food safety specialist who used video cameras in eight restaurant kitchens to monitor worker food safety habits.  He found that a typical kitchen worker cross-contaminates food with potentially dangerous pathogens about once per hour.  "Among the risky behaviors cited were workers using aprons and other garments to dry hands, as well as using the same utensils and surfaces to prepare both raw and cooked foods, according to a review by a North Carolina State University researcher."  The article continues:

Joan McGlockton, a food policy representative for the National Restaurant Association, said that while the study is disconcerting, the association doesn’t feel it is representative of the entire restaurant industry.

"We apply strong emphasis on employee training in areas of food safety to ensure that proper practices in hygiene, food handling and sanitation are in place in every food service outlet," she said in an e-mail.

Americans experience about 76 million foodborne illnesses a year. While most of these cases are mild and don’t have long-term symptoms, foodborne illnesses cause about 5,000 deaths annually, according to the Centers for Disease Control and Prevention. From 1998 to 2004, the latest figures available, more than 50 percent of foodborne disease outbreaks reported to the CDC were associated with restaurants or delicatessens.

Cross-contamination happens when pathogens, such as salmonella and E. coli, are transferred from raw food or contaminated source to already prepared food. For example, when a cook uses the same knife to first cut raw chicken and then to slice a sandwich.

Chapman says the risky behaviors were most prevalent during busy periods. For example, some employees didn’t attempt to wash their hands during lunch and breakfast rushes. Multiple workers using the same tools caused many of the cross-contaminations, according to the review published in the June issue of the Journal of Food Protection.

There was also some good news: Chapman found that posting information about food safety in kitchens and break rooms that gives employees examples of the consequences of poor food handling significantly reduced risky behaviors.

The Subway restaurant located on Roosevelt Street in Lombard, Illinois that was the site of a major Shigella outbreak has finally reopened.  Eleni Demertzis, of the Lombard Spectator, who has followed the Shigella outbreak since it was first announced by DuPage County Health Department on March 5, reports as follows:

The Lombard Subway reopened today after being closed for over month with 123 people suffering from a food poisoning outbreak.

Subway, at 1009 E. Roosevelt Road, was shut down on March1 by the DuPage County Health Department as people began reporting shigellosis infections. These infections are spread from person to person, and also can be acquired from contaminated food.

Dupage County Health Department officials say the store has been cleaned multiple times, and all food products have been removed from the premises. The owner and employees were tested twice before returning to work, and environmental surface testing results have come back negative.

The final report has not been completed as the cause of the outbreak has yet to be identified.

A total of 13 people were hospitalized due to the infection and discharged.

Law firm Marler Clark now represents close to 70 people affected by the outbreak.

The Shigella outbreak at the Lombard, Illinois Subway restaurant has sickened well over one hundred people, and has left the restaurant shuttered for weeks pending the Dupage County Health Department’s investigation.  Reports widely suggest that one of the problems leading to the outbreak was sick foodhandlers (i.e. employees) at the restaurant.  We have been contacted by over 70 of the outbreak victims and have filed lawsuits on behalf of Ron and Sarah Bowers, Barbara Romero, and Michael Carpino.  See Subway Lawsuits and Foodpoisoning Claims.

The illnesses that our clients have suffered are proof, once again, that foodpoisoning is far from just a few days of diarrhea.  Certainly, some of the people sickened in the outbreak have suffered "run-of-the-mill" food borne illnesses, but most continue to struggle with ongoing gastrointestinal symptoms, reactive arthritis, post-infectious irritable bowel syndrome, and other ongoing, possibly permanent, conditions related to their illnesses. 

It is also proof of the wide-ranging impact of infectious disease, and how virulent and dangerous these little bugs can be, leading ultimatly to a cost of $152 billion every single year in the United States.  In addition to many people who consumed sandwiches from the Lombard Subway, we represent the family-members of several outbreak victims who also became ill (known as secondary infections). 

The Shigella outbreak linked to Subway sandwiches in Lombard, Illinois has sickened well over one hundred people.  We represent close to 70 individuals now in the outbreak, and are continuing to receive calls from people daily who missed substantial work or required medical attention, many times both, as a result of their illnesses.  And claims will only continue to pile up in this major outbreak. 

The silver lining, if there is one, is that nobody died in the outbreak.  Shigella is always devastating, and can be fatal. 

So now that the victims are recovering, for the most part, thoughts will turn to identifying exactly what failures caused this outbreak.  It is probably beyond debate at this point whether the Subway in question had sick employees.  It certainly did, which is likely a primary reason why so many people became ill in this outbreak.  But what else went wrong?  A restaurant with a sick employee problem, and likely even no sick leave policy whatsoever, probably had addtional failures.  Were gloves being worn?  Or was there bare handed contact by ill employees with ready to eat foods–e.g. most everything in a Subway store? 

Here are a few other areas of inquiry for depositions and at trial in these cases (NOTE: the following are requirements for retail food establishments set forth in the Illinois Administrative Code):

§ 760.410 General–Personal Cleanliness.

Employees shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work as often as is necessary to keep them clean, and after smoking, eating, drinking, or using the toilet. Employees shall keep their fingernails clean and trimmed.

§ 760.430 General–Employee Practices.

c) Employees shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in the retail food store.

§ 760.500 General–Materials.

Multi-use equipment and utensils shall be constructed and repaired with safe materials, including finishing materials; shall be corrosion resistant and shall be nonabsorbent; and shall be smooth, easily cleanable, and durable under conditions of normal use. Single-service articles shall be made from clean, sanitary, safe materials. Equipment, utensils, and single-service articles shall not impart odors, color, taste, nor contribute to the contamination of food.

§ 760.700 Cleaning Frequency.

a) Utensils and foodcontact surfaces of equipment shall be cleaned and sanitized:

1) Each time there is a change in processing between raw beef, raw pork, raw poultry or raw seafood, or a change in processing from raw to readytoeat foods;

2) After any interruption of operations during which time contamination may have occurred; and

3) After final use each working day.

b) Where equipment and utensils are used for the preparation of potentially hazardous foods on a continuous or productionline basis, utensils and the food-contact surfaces of equipment shall be cleaned and sanitized at intervals throughout the day on a schedule based on food temperature, type of food, and amount of food particle accumulation.

c) The foodcontact surfaces of cooking devices and the cavities and door seals of microwave ovens shall be cleaned at least once each day of use, except that this shall not apply to hot oil cooking equipment and hot oil filtering systems. The foodcontact surfaces of all baking equipment and pans shall be kept free of encrusted grease deposits and other accumulated soil.

d) Nonfoodcontact surfaces of equipment, including transport vehicles, shall be cleaned as often as is necessary to keep the equipment free of accumulation of dust, dirt, food particles, and other debris.

Illnesses in the Shigella outbreak linked to the Subway restaurant on Roosevelt Road in Lombard, Illinois continue to be counted.  There are likely well over one hundred victims in the outbreak.  Several lawsuits have been filed on behalf of outbreak victims.  Unfiled claims continue to increase as well.  Marler Clark represents 65 people in the outbreak, including many who required hospitalization as a result of their illnesses.  The Subway restaurant at the center of it all remains closed as the Dupage County Health Department’s investigation continues. 

At Marler Clark, we represent foodpoisoning victims from across the country.  Many of our foodpoisoning clients are people sickened with bacteria and viruses like E. coli, Salmonella, campylobacter, Hepatitis A, norovirus, and of course Shigella.  As has been widely publicized, a major outbreak has occurred at the Subway restaurant on Roosevelt Road in Lombard, Illinois.  The outbreak has likely left hundreds of people ill, including over 40 people who have contacted our firm for representation in claims against the restaurant. 

The Lombard Subway shigella outbreak prompts a basic question:  why is this outbreak so large?  Why have so many people fallen ill?  Answers will come, as the Dupage County Health Department continues its investigation into the circumstances and causes of the outbreak.  But there are certain, readily apparent circumstances that have likely contributed to the large scale of the outbreak. 

The nature of the product, and how the finished sandwiches are ultimately produced, with hand-to-food contact with virtually every individual sandwich component, means that there are multiple opportunities for insidious bacteria from an infected worker to contaminate the food. And without a kill step, there is virtually no way to rid the food of bacteria once it becomes contaminated.

See complete article.

We will have to wait for the results of Dupage County Health Department’s investigation before knowing for sure what failures occurred at Subway restaurant to cause such a large outbreak.  Notably, however, the restaurant has been closed for some time now, which is not something that always happens in restaurant outbreak situations.  Generally, the closure of a restaurant is an extreme step taken when the investigating health department believes that there is the potential for environmental contamination–i.e. contamination of surfaces and equipment, likely from ill employees and poor sanitation practices–at the restaurant. 

As lawsuits commence, the Dupage County Health Department continues to receive reports of illness linked to the Lombard, Illinois Subway restaurant that is at the epicenter of a major shigella outbreak.  Spokesperson David Hass recently stated that lab tests have confirmed 21 illnesses in the outbreak.  At least seven people have been hospitalized. 

We have been contacted by 12 families now seeking representation due to illness amongst family members.  Of those, several have been confirmed by stool tests as outbreak cases, but many have not.  The reality of any foodpoisoning outbreak, no matter the bacteria and no matter the food vehicle, is that many more people than simply the confirmed cases were sickened. 

In fact, some estimates indicate that the number of people sickened in foodpoisoning outbreaks is actually 20 or even 30 times the number of "confirmed cases."  These additional "cases" of illness may not have had a stool sample tested; they may not have had medical attention at all; or they may have received antibiotics prior to submitting the stool test.  Whatever the case, they are no less outbreak cases than the "confirmed cases." 

How many people are actually ill in the Lombard, Subway outbreak?  The math is a little scary.  21 X 30 equals . . . a lot of sick people.

The DuPage County Illinois Health Department has reported that four more cases of shigellosis were confirmed Friday, bringing the total number of confirmed cases caused by the outbreak at the Subway restaurant in Lombard to 12. Of those 12 cases, seven have required hospitalization. Six of those who were hospitalized have been released. The restaurant at 1009 E. Roosevelt Road in Lombard remains closed as investigators try to determine the cause of the outbreak.

In mid-October of 1999, an unusually high number of hepatitis A cases were reported among individuals residing in Northeast Seattle and Snohomish County, Washington. Public health officials conducted an epidemiologic survey that included questions about whether case-patients had eaten at fast food restaurants and grocery stores prevalent in the North Seattle area. By November 5, 1999, 18 of 21 persons confirmed positive with hepatitis A in King County after October 15, 1999 were found to have eaten at one of two Subway Sandwich outlets during the two to six week period prior to the onset of symptoms. During this same time period, the SHD determined that at least six persons with hepatitis A had eaten at one of the two implicated Subway outlets.

An environmental investigation resulted in the finding that neither of the implicated Subway outlets had a written hand washing policy, and that employees were not required to document their knowledge of proper hand washing technique. Having confirmed that the Subway outlets were, in fact, the outbreak’s common source, health department officials issued a press release that stated, in part, that: “An ongoing investigation by Public Health suggests that many [hepatitis A] infections are associated with consuming food from one of two Subway Salads and Sandwiches outlets during the month of September. . . .”

It is estimated that over 40 persons became ill as a result of eating contaminated food sold at the two Subway outlets implicated in the September 1999 hepatitis A outbreak. One child developed acute liver failure and required a transplant; many others were hospitalized with severe symptoms.

Foodpoisoning is a major national health concern, with associated costs topping $152 billion annually.  Currently, several major national outbreaks and recalls are occurring, resulting in likely many hundreds, if not thousands of cases of foodborne illness.  Since July, over 245 confirmed cases of foodpoisoning (specifically salmonella) are linked to salami coated with black pepper; and Basic Food Flavors, Inc., a Las Vegas company is at the epicenter of a massive recall of hydrolyzed vegetable protein (HVP) used in many foods distributed nationally. 

Another outbreak that is thankfully, hopefully over is from infection by Shigella sonnei at a Chicago-area Subway restaurant.  The restaurant was closed by health authorities.  Actually, the restaurant in question is located in Lombard, Dupage County, Illinois, but for any national readers, calling it Chicagoland probably gives you a better idea of where the restaurant is.  So far, there are reports of at least 8 confirmed cases in the outbreak with four hospitalizations. 

But the current Shigella sonnei outbreak linked to the Illinois Subway restaurant is only one of several major outbreaks to hit the general Chicago area in recent years.  In July 2007, over 700 people became ill in an outbreak linked to food sold by Pars Cove restaurant at the Taste of Chicago Festival. 

And In June 2003, a large Salmonella outbreak occurred in Vernon Hills, Illinois, a Chicago suburb.  The outbreak occurred at a Chili’s restaurant, and the conditions found at the restaurant were memorably appalling.  Here is a short summary of the outbreak:

The Lake County Health Department concluded its investigation into the outbreak on July 18 2003, by which time over 300 individuals had been sickened as a result of consuming contaminated food. Of those, 141 customers and 28 employees had tested positive for the Salmonella bacteria, while 105 other infected individuals met the LCHD’s definition of a probable case. LCHD issued a preliminary report that concluded the outbreak was caused by infected employees who contaminated food with Salmonella as a result of poor sanitary practices and improper food-handling. It was by this time also determined that the Salmonella associated with the outbreak was Salmonella serotype javiana, a relatively rare and virulent strain often associated with foodborne transmission.

Once the LCHD believed the outbreak was controlled, the department sent a letter by certified mail informing the restaurant’s management of a hearing scheduled for July 31 to discuss their failure to cease operations during periods where no hot water, or no water at all, was available, failure to adequately monitor their employees’ health, and the steps management had implemented to prevent future outbreaks.

Following the hearing, Executive Director Dale Galassie stated that Chili’s had violated local ordinances by remaining open and serving customers while without available water. Although LCHD decided not to pursue punitive measures against Chili’s and its management, the department sent a letter to Chili’s corporate parent requesting reimbursement of outbreak-related investigation costs, including testing and training of staff, in the total amount of $32,500. A health department official stated, “[t]hese were extraordinary circumstances. There were excessive costs in dealing with [the outbreak] and therefore we are requesting reimbursement. The good news is that it prevented a secondary outbreak as a result of cooperation of the Chili’s corporation, local media, and ourselves, but it doesn’t excuse poor local management decisions made that caused it.” After a relatively lengthy, silent delay, it was announced on December 2, 2003, that Chili’s agreed to reimburse the LCHD for the costs associated with the outbreak.