Gary White of The Ledger reports that Barbara Whitman’s 63rd birthday was unforgettable — and not in a good way. Whitman’s two sisters took her out to one of her favorite Lakeland restaurants the night before her birthday last August. She indulged in a crabmeat appetizer and her usual entree, mahi mahi, both of which she found delectable.
Later that night, though, Whitman awoke to a sensation of extreme nausea. The misery carried though her birthday, ruining a home-cooked dinner her sister, Angela Akins, planned for Whitman and their mother, whose birthday was three days later.

Whitman is convinced the 24hour gastric distress resulted from something she ate at the restaurant, probably the crabmeat appetizer.
“It’s made me think twice when I go out (to eat),” said Whitman, a Lakeland resident. “I really don’t have much interest to go back there, which is a shame, because I enjoyed it.”
Americans are dining outside the home more than ever, consuming some 77 billion meals and snacks a year, according to the National Restaurant Association. Though state regulations are intended to ensure food safety, some diners inevitably get sick from food they eat in restaurants.
The Centers for Disease Control estimates 76 million cases of food-borne disease occur each year in the United States. Most cases are relatively mild, causing nausea and/or diarrhea for a day or two, but the CDC says food-related sickness sends 325,000 Americans to the hospital each year and kills 5,000. The CDC does not say what percentage of those episodes are caused by food eaten in restaurants.
The Florida Department of Health tracks food-borne disease outbreaks, defined as those affecting two or more people and single incidents of certain particularly serious illnesses. Florida had 175 such outbreaks in 2004.
Those incidents sickened 1,954 people, according to Dr. Roberta Hammond, the department’s food and waterborne disease coordinator. Hammond said 134 of the outbreaks, involving 1,163 people, were traced to restaurants and food vendors.
The most common sources of food-related infection are bacteria, including Salmonella and a strain of E. coli, and viruses, according to the CDC. Other diseases, such as hepatitis A and those associated with the bacteria Shigella and the parasite Cryptosporidia, can be foodborne, though they are normally transmitted in other ways.
A hepatitis A outbreak in 2002 affected four Polk County restaurants, and one patron died.
Barb Kowalcyk of Cincinnati learned about the risks of food-borne illness in 2001, when her 21/2-year-old son, Kevin, died of hemolytic uremic syndrome, an illness related to E. coli. Kowalcyk says Kevin contracted the disease after eating a hamburger at a restaurant in Wisconsin.
“Most Americans don’t understand food-borne illness can be more than just a bad tummy ache that may or may not send you to the bathroom for 24 hours,” said Kowalcyk, president of an advocacy group called Safe Tables Our Priority (S.T.O.P.). “This is a very serious public-health problem.”
Kowalcyk, a published biostatistician, thinks cases of food poisoning are significantly underreported because people often mistake a food-related illness for a “stomach flu.” She notes a true case of the flu involves symptoms other than just nausea and diarrhea.
The only certain way to avoid possible food poisoning at a restaurant, of course, is to stay home (although food-safety experts say home kitchens probably cause more food-borne illnesses than restaurants). But those who dine out often can take precautions to lessen their vulnerability.
Floridians can consult an archive of restaurant inspection reports on the Department of Business and Professional Regulation’s Web site.
Kowalcyk also advises diners to conduct inspections of their own. A dirty restroom is an obvious warning sign, and Kowalcyk said a lack of hot water in the restrooms’ sinks means employees probably aren’t washing their hands properly.
In Florida, restaurants are licensed and inspected by the Department of Business and Professional Regulation through its Division of Hotels and Restaurants.
That division oversees about 42,000 food retailers and conducts unannounced inspections twice a year.
The division’s methods are based on the Food and Drug Administration’s Food Code, a set of guidelines updated every few years. Geoff Luebkemann, director of the Florida agency, said many of the nation’s 3,000 foodsafety programs do not use such stringent standards.
The inspections follow a 60point checklist covering food handling, cooking methods and cleanliness, as well as fire-prevention practices. Violations are classed as either critical — for example, those involving improper cooking or poor temperature control — or noncritical. Luebkemann said the statewide average is one to two critical and two to three noncritical infractions per inspection.
Restaurants are typically given 30 days to make changes before a repeat inspection. If violations recur, the agency can take disciplinary action, usually fines ranging up to $1,000 per infraction.
Luebkemann said his division has a reputation as a national leader, but the Florida system has its critics. A recent legislative audit faulted the division for reducing the roster of inspectors from 180 to 159 — an average of one per 264 regulated businesses.
Roger Bergere of Babson Park says the frequency and quality of restaurant inspections have declined since the early 1990s, when Florida shifted oversight from county health departments to the state.
Bergere, a retired inspector with health departments in South Florida and Polk County, notes the counties conducted inspections four times a year and had several laboratories for analyzing food samples, whereas the state division has no labs of its own.
County health departments are called in only after the state agency reports a suspected outbreak of food poisoning — an incident involving more than one person or one of the most serious varieties of illness.
Cynthia Goldstein-Hart, epidemiology program manager for the Polk County Health Department, said suspected outbreaks are not common. She said the department investigated four in 2004 and three last year.
Even when epidemiologists get involved, it’s not easy to determine the source of a food-borne illness. Confirmation requires obtaining a stool or vomit sample from a victim while the person is still sick and finding food from the same batch the person ate for laboratory analysis.
Lacking those scientific clues, health officials rely on circumstantial evidence — several unrelated diners becoming ill after eating at the same restaurant.
But many people, like Whitman, never see a doctor for a short-lived case of food poisoning. Whitman didn’t call the restaurant she suspected of making her sick and doesn’t know if any other diners also became ill after eating the crabmeat dish.
Luebkemann, director of the Florida regulatory agency, said there’s no correlation between location or cuisine and food-safety problems, but he said the more a proprietor has invested in a restaurant, the safer it is likely to be for diners.
Then again, the eatery Whitman suspects of serving her tainted food is established and relatively upscale.
“We’ve eaten at some places a lot of people might consider dives and never gotten sick,” noted Whitman’s sister, Angela Akins.
Akins, 60, had her own episode of suspected food poisoning after eating a chicken dish at the same restaurant about a month before her sister’s illness. Akins noticed a lengthy inspection report in the newspaper shortly afterward, and she hopes the bad publicity prompted the restaurant to improve its safety practices.
“We used to be very frequent diners there,” Akins said. “We’ve probably been back after that once or twice, maybe.”