May 2009

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.”
 Continue Reading Foodborne Illness is Just a Few Days of Diarrhea Right?

The International Food Information Council is reporting that Americans’ food safety habits are getting worse, not better, despite a slew of recent high-profile illness outbreaks.

The deterioration in food safety habits appears to be across the board.  According tot he IFIC study, fewer Americans are washing hands with soap and water; washing cutting boards with soap

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.Continue Reading Spinach E. coli Outbreak Revisited: The Story of Regan Erickson

Bill Marler and the other attorneys at Marler Clark have been litigating E. coli O157:H7 cases for sixteen years.  I have done it now for six.  Collectively, we have seen E. coli illnesses ranging from a few days of diarrhea to some of the most agonizing deaths imaginable . . . and everything in between.  It doesn’t matter how it happens–at least not to the parents of the kids getting sick.  Whether its lettuce, hamburgers, stagnant pond water, or contaminated venison, the results can be tragic.

Many of the saddest cases we have been involved came from California produce.  Ruby Trautz is a perfect example.  She was a beloved mother and grandmother who lived in Bellevue, Nebraska.  Ruby died a death more befitting of a capital murderer . . . and only because she ate contaminated spinach.  Read more about Ruby’s E. coli O157:H7 illness here.

Kelly Cobb is yet another example.  Kelly was also infected by California produce, though her illness arose from a different outbreak than Ruby Trautz.  Kelly was more fortunate than Ruby, but only because her younger body was more capable of fighting the severe infection than Ruby’s was. 

Nonetheless, Kelly’s E. coli O157:H7 infection also resulted in hemolytic uremic syndrome.  See www.about-hus.com.  Here is the story of Kelly’s illness:

In the early morning hours of May 16, 2008, Kelly was roused from sleep, at first by a strange bloated feeling and then a bad bout of diarrhea. It seemed as if there was a rock under her rib cage causing an overwhelming feeling of nausea, yet she did not vomit. This was followed by crampy pain in the upper part of her stomach, with sharper spasms of pain coursing through her torso every ten minutes or so. With the pain came diarrhea, which by 5:00 AM had turned to blood.

Kelly was seen in the emergency room of Good Samaritan Hospital in Tacoma, Washington from 6:00 AM until 11:00 AM. She described to the doctors the surprisingly severe, sudden onset of the nausea, abdominal cramping and bloody diarrhea. The history taken by the triage nurse revealed nothing out of the ordinary: Kelly had been in good health, she was not pregnant, her children had not been sick.

But blood tests showed an elevated number of white blood cells, the sign of a bacterial infection. The presence of gallstones was picked up by an abdominal ultrasound, yet there was no evidence that Kelly had cholecystitis, an active gallbladder attack. A watery stool was guaiac positive—in other words, there was blood in it. This was sent to be cultured and also for Clostridium difficile toxin-testing. Kelly was initially given intravenous fluids and pain medication, then sent home with prescriptions for the antibiotic Ciproflaxin, as well as oral pain and anti-nausea medications. She was told to see her primary care physician in a day or two, or return to the emergency room if other problems arose.

Other problems did crop up, almost immediately. Kelly could not drink or eat anything, including her prescribed medications, without vomiting. The diarrhea was unrelenting, and the watery rectal discharge was mostly bright red with blood. She was also suffering from intense pain. Kelly returned to the Good Samaritan Hospital emergency room on May 17, and this time she was admitted to the hospital for treatment. She was severely dehydrated, with depressed levels of serum electrolytes, blood urea nitrogen and creatinine. She was started on IV fluids and given something for the pain.

A colonoscopy performed on May 18 showed pancolitis, a form of severe, ulcerative colitis that is manifested by an irritation throughout the length of the colon and that typically is the result of an infection. The pathologist suspected that the source was likely E. coli O157:H7, but could not rule out the possibility of ulcerative colitis. Bowel tissue biopsies showed inflammatory pseudomembranes. These findings were nonspecific, so still did not explain the cause of the problem.

On May 19, the doctor noted that Kelly’s abdominal pain was relatively better, and that she no longer felt nauseated and was not vomiting. Her pancolitis was improving and there was no blood in her stool. The plan was to take her off intravenous medications, switch her to oral treatments and then let her go home.

On the morning of May 20, the mystery of Kelly’s symptoms was solved. A stool sample collected on May 16 had grown out E. coli O157:H7 bacteria. The Ciproflaxin was discontinued. Kelly still rated her abdominal pain as a seven on a scale of one to ten, and she was nauseated again. But doctors were encouraged that she could finally keep down food and water and that there had been no bouts of bloody diarrhea overnight, so they discharged her to go home around midday.

The following day, May 21, Kelly’s symptoms returned worse than ever. She had awakened overnight feeling quite ill and began to vomit again repeatedly. She was absolutely unable to keep any fluids down. Her family took her back to the hospital on May 22 after she had been up the whole night with awful nausea and vomiting.

Laboratory tests now indicated that she was anemic. Since her discharge May 20, her hematocrit and platelet counts had decreased significantly, while her BUN and creatinine levels had increased since her recent discharge. These were ominous signs that Kelly’s kidneys were beginning to lose filter function and that she appeared to be developing hemolytic uremic syndrome (HUS), the dire complication of an E. coli O157:H7 infection. Kelly was told her kidney function was at 50 percent of normal.

Kelly was once again admitted to the hospital, where a catheter was inserted so she could receive intravenous fluids and for blood draws. She was tired and miserable. Whenever she opened her eyes she felt dizzy and sick to her stomach.

By May 23, the doctors agreed that plasmapheresis, or plasma exchange, would be necessary as soon as possible to remove waste products from the blood that were accumulating as Kelly’s kidney function diminished. Plasmapheresis involves withdrawing whole blood from the patient, removing the plasma from the blood cells through a cell separator, and then returning the blood cells to the patient while replacing the plasma with donor plasma.Continue Reading E. coli in Lettuce or Hamburgers: Sadly, the Results are Often the Same

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

In a 483 Inspection Report released today, FDA inspectors identified multiple food-safety shortcomings at the Setton Pistachio of Terra Bella California that was linked to a Salmonella outbreak earlier this year:

1. The company detected the bacteria in roasted pistachios in October but did not change its processing procedures until March

2. In one instance

Please don’t let the title mislead you.  I am certainly not implying there is a lighter side to any individual’s foodborne illness–as anyone who has ever experienced an E. coli infection or the like can tell you–but it is much less common for someone’s illness to be brought about by a nefarious act.  Unless, of