San Francisco Chronicle writer Janet Fletcher reports that confirming the cause of a food-borne illness is devilishly difficult, public health officials say, especially without a cluster of cases.
Consequently, many sickened patrons don’t even bother to report incidents, and many chefs struggle with how to respond when they do.
Armed with more knowledge about food-borne illness — its causes and its usual course — stricken diners may find they’re more reluctant to assign blame and more realistic about what restaurants can and should do.
The federal Centers for Disease Control estimates that Americans experience 76 million food-borne illnesses a year, with very few of those incidents reported, and even fewer confirmed by laboratory tests. The symptoms are typically similar to those that accompany the
flu: diarrhea, vomiting, stomach cramps.
Most people never go to a doctor with their complaint because their symptoms quickly subside. Those who do see a physician are rarely tested for food-borne illness because the lab tests are expensive, and the patient probably will have recovered by the time the results come back.

Incubation period
Although many people want to associate their discomfort with the last meal they ate because that’s the meal that came back up, “you can’t make that assumption,” says Harris.
Incubation periods for the bacteria and viruses that cause food-borne illnesses range from several hours to several weeks. For many types of food-borne illness, says Harris, the time elapsed between ingestion and symptoms will be 24 to 72 hours.
“Here’s a typical scenario,” says Lawrence Pong, principal inspector and manager of training for San Francisco’s Department of Public Health. “A person calls up and says, ‘I ate at Pong’s Deli last night, and I was sicker than a dog at 9 p.m. I had diarrhea, vomiting and stomach cramps, and my temperature was 101 degrees.’ Now, I know in my mind, he did not get ill from Pong’s Deli.”
How does he know? Because a fever indicates infection, and the pathogens that cause infection take, on average, 24 to 48 hours to reproduce sufficiently to bring on a fever. In cases of food-borne illnesses, Pong and his fellow public health investigators operate like detectives, using what they know about the typical behavior of pathogens to track them to their source.
Common culprits
According to Harris, the most common food-borne bacterial offenders are salmonella, shigella, campylobacter and E. coli 0157:H7. A virus known as Norwalk-like virus is also among the most frequent causes of intestinal upset. These troublemakers spread and multiply as a result of poor food-handling practices, such as failure to keep hot foods hot and cold foods cold, or inadequate hand washing by food preparers and servers.
Some food-borne pathogens haven’t even been identified yet, scientists say, and consequently, there is no test for them. As recently as 20 years ago, scientists did not know that E. coli
0157:H7 and Listeria monocytogenes — two of today’s most feared miscreants — cause food-borne illness.
Despite the challenges of pinpointing the cause of your distress, public-health authorities still suggest that you report an illness you attribute to a restaurant meal. In San Francisco, a Department of Public Health employee will ask for a detailed account, not just of your last meal, but of several prior meals, too.
Immediate inspection
If the incident involves fewer than four victims, an inspector will visit the restaurant immediately to look for conditions that might have caused your problem. Rarely in such cases do inspectors take a food sample for testing; the evidence — suspect fish, for example — has probably been tossed or consumed. And with so few complainants, the fish is an unlikely cause. Fillets cut from a single salmon might serve 20 diners, so a contaminated fish would presumably produce more than one victim.
If the department learns that four or more people got sick after dining at the same establishment, responsibility shifts to the department’s disease control unit, a team of epidemiologists and investigators, and the Centers for Disease Control will be notified.
The restaurant will be swiftly inspected, and the victims’ recent food histories recorded.
“We treat it seriously but confidentially,” says Pong. “We want the
(restaurant) operator to know we’re working together.”
In the fiscal year ending June 30, San Francisco’s health department logged 79 complaints, only seven of them involving four or more people. When investigators succeed in tracing food-borne illness to its cause, the perpetrator is rarely a restaurant, Pong says. San Francisco’s dining establishments “have a good track record,” says the inspector.
Since 2000, California law has required at least one employee in every restaurant to be certified as a safe food handler. Many restaurants send more than one employee for training and certification. In the eyes of public health officials, the training appears to be working. “(A restaurant) may still look like a funky place,” says Sheldon Lew, a senior health inspector in San Francisco, “but they know how to handle their food.”
Still, slipups happen, and people who attribute stomach upset to a restaurant meal should definitely call the establishment, advises Lew. Bay Area chefs say they want to know — not because they believe they caused your illness (they probably don’t, especially if yours is the only call they get), but because they want a chance to erase the bad impression.
Call the restaurant
“We take it very seriously,” says Michael Wild of Bay Wolf in Oakland. “They got sick, and they associate it with you. That’s why we go to great pains to make sure we give them a different experience as soon as possible.” The customer will probably be offered a gift certificate. “We don’t assume they’re trying to scam us,” Wild says, “even though it has happened.”
Be prepared to tell the restaurant exactly what you ate and drank, what time you dined, and whether anyone who ate with you also experienced symptoms. It’s best not to be demanding or accusatory — you have no proof, after all — or expect the restaurant to confess wrongdoing. But you should receive a sympathetic hearing, an assurance that the restaurant will review its procedures, and a genuine thank-you for taking the trouble to call.
“We talk about what they had to eat, and I can frequently draw some conclusions,” says Chris Durie, general manager of Farallon in San Francisco. “More frequently than not, it’s that they don’t normally eat butter sauces and lick the plate clean and have dessert and a bottle of wine. They ate too much rich food, and they blame us for food poisoning.”
Nevertheless, says Durie, he never contradicts a customer’s claim, and as long as he can find documentation that the caller actually dined in the restaurant — through a credit card transaction, for example — he will probably send a gift certificate.
Making amends
“When somebody’s not scamming us, it’s constructive,” says one prominent San Francisco restaurateur, who insisted on anonymity.
“They’ll say, ‘I just want you to know in case it’s part of a pattern.’ It helps me revisit everything. But sometimes you find out that they didn’t even eat here. Or when you look at what they ate, maybe they had 36 oysters and three margaritas.”
Despite impressions to the contrary, some national chains may be safer places to eat than many fine-dining establishments. Because their exposure to lawsuits is huge, these volume feeders may take extra precautions. At Chipotle, the burrito chain owned by McDonalds, with 460 locations nationwide, employees keep detailed records of relevant temperatures, says spokesperson Chris Arnold, and monitor the temperature of cooking and refrigeration equipment and food on the service line several times a day.
An independent restaurateur is unlikely to be so conscientious and more likely to come in contact with ingredients — actually chopping fresh garlic, for example, instead of spooning it out of a jar.
“I’m doing a dangerous thing,” says the San Francisco restaurant owner who declined to be named. “I’m feeding people fresh food touched by a lot of people. At our restaurant, everything is handmade.”
Some restaurateurs are reluctant to talk about their experiences with food-borne illness claims for fear of casting doubt on their operation or encouraging scam artists.
“It’s a no-win situation,” says Nancy Oakes, chef-partner at Boulevard in San Francisco. “People work the system, for sure, but you can’t blow them off.” Oakes says a diner once claimed to have cracked a tooth on Boulevard’s bread, presenting as proof a tooth that was “from the Neolithic age,” says the chef.
Middione recalls the diner who insisted that he had gotten sick on Vivande’s mussels. “He said, ‘What are you going to do about it?’ recounts the chef. “He wanted a dinner for four, including wine. And I said, ‘I’ll make you a deal. If you’ll bring me a lab report specifically saying it was mussels from where I get them, I’ll personally cook the dinner for you.’ ”
Nevertheless, says Middione, echoing the comments of many of his colleagues, “I think people should be treated carefully and respectfully and with concern, because you just never know.”