October 2006

Woman died in E. coli outbreak

Marler Clark has filed a lawsuit in Sarpy County District Court on behalf of a Bellevue woman who died from complications of E. coli.

Attorney Bill Marler says 81-year-old Ruby Trautz died of acute kidney failure in late August. Trautz’s death has since been linked to the national E. coli outbreak related to tainted spinach.

Marler’s firm has filed seven other lawsuits across the country on behalf of victims of the outbreak. The Sarpy County suit names “John Doe Farms,” the Dole Food Company, Natural Selections Foods and No Frills Supermarkets as defendants.

“FDA owes it to the American public, and to the victims of this outbreak in particular, to release information as to the identity of the spinach farm,” Marler said in a press release. “This far into the outbreak investigation, FDA should already have named the farm where the spinach came from. We included John Doe Farms as a defendant to try to get more answers for our clients.”

The Trautz lawsuit is the first of all Marler’s cases to go after both the farm where the spinach was grown and the retail outlet where it was sold.

“It is time that the fresh produce industry, from farm to grocery store, takes responsibility for what happened,” he said.

Salmonella bacteria can grow on tomato skin surfaces and infiltrate core tissues during tomato harvest, packing, and transportation. Dicing and pooling of contaminated tomatoes may play a role in further amplifying the amount of contaminated product. Contamination of internal tissue from the outer skin and stem scar can also occur during cutting and slicing. Finally, many Salmonella strains grow rapidly in cut tomatoes held at room temperature, enhancing the risk if tomatoes are maintained at room temperature for extended periods.

Salmonella outbreaks have previously been associated with raw tomatoes, which accordingly should have been recognized as a potential source of contamination. In 1990, a reported 174 Salmonella javiana illnesses, as part of a four state outbreak, were linked to raw tomatoes. In 1993, 84 reported cases of Salmonella Montevideo were part of a three state outbreak that was linked to raw tomatoes.

 

Continue Reading Prior Salmonella Outbreaks Associated with Tomatoes

In what may become the tag-line for last month’s E. coli/spinach outbreak and this month’s Salmonella/Tomato outbreak, Dr. Doug Powell of Kansas said it best – DON’T EAT

Dr. Powell was interviewed by Elizabeth Weise, USA TODAY for this morning’s article:

Food-borne bacteria evolving, becoming more dangerous

The first rule of public health is one most of us learn in kindergarten: Don’t eat poop.  But that’s what the people were eating who were struck down with E. coli in the late summer outbreak tied to bagged spinach, California health officials now say. 

Frankly, although it seems clear that we as consumers should not eat poop, the industry seems to have little problem serving it to us – well, at least until they get caught – with their pants down – so to speak.

Interesting that produce buyers have finally asked produce manufacturers to finally stop sending them produce-laden poop to serve to customers.  According to the USA TODAY:

A newly assembled group of produce buyers is calling on three of the major produce industry associations to come up with new, enforceable food safety standards.  The buyers represent some of the biggest food retailers, including Safeway, Costco and Denny’s restaurants. They sent a letter to the Produce Marketing Association, United Fresh Produce Association and Western Growers Association last Thursday.  “We believe the power to change the industry is in the hands of the buyers,” says Tim York, president of Markon Cooperative and leader of the ad hoc group.

When big buyers finally got together and forced the meat industry to clean up poop(E. coli)-laden hamburger, we finally saw the drop in illnesses that consumers deserved – it was the “tipping point.”  Now it is good to see that this same pressure is finally forcing the lettuce and spinach industry from ignoring consumer deaths and illnesses as it has for over ten years.  AP writer, Lisa Leff, covered the Western Growers Association press conference yesterday:

Growers respond to E. coli outbreak with mandatory guidelines

Western Growers is proposing mandatory food safety guidelines for California lettuce and spinach producers, in hopes that such a system will help restore public confidence following a deadly E. coli outbreak this summer.  Under the new proposal, the California Department of Food and Agriculture would enforce the guidelines and give compliant growers a clean bill of health. The state also would have the authority to sanction growers who don’t follow food safety procedures by enjoining them from shipping or selling their crops, assessing fines or seeking criminal penalties.

Kudos to the big buyers and Western Growers for getting together in an effort to stop serving poop to customers.  Although I hate to say it – but what took you so long?  Why did the industry wait until it put the industry at risk?  Why did it not respond when consumers became sick or died years ago?  The great thing about a lawsuit is I get to ask DOLE, Natural Selection Foods, Western Growers and all the big buyers those questions – I look forward to it.

The Atlanta Associated Press reports that the salmonella outbreak potentially linked to produce  has sickened at least 172 people in 18 states, health officials said Monday.  Marler Clark represented over 150 people sickened in a salmonella outbreak linked to tainted tomatoes in 2003.  Perhaps this outbreak will take the heat off of the California Lettuce and Spinach Industry.

In this outbreak Health officials think the bacteria may have spread through some form of produce — the list of suspects includes tomatoes.

But according to the CDC, the illnesses have not been tied to any specific product, chain, restaurants or supermarkets.  No one has died in the outbreak, which stems from a common form of salmonella bacteria. Eleven people have been hospitalized, health officials said.  “We’re very early in the investigation,” said Dave Daigle, a spokesman for the U.S. Centers for Disease Control and Prevention.

The CDC first detected the outbreak two weeks ago through a national computer lab system that looks for patterns and matches in reports of food-borne illness. The U.S. Food and Drug Administration has joined the investigation and will try to help trace the outbreak to its origin.  Most of the cases are in adults, and more than 60 percent are women, said Dr. Chris Braden, a CDC epidemiologist investigating the outbreak.

The states involved are Arkansas, Connecticut, Georgia, Indiana, Kentucky, Maine, Massachusetts, Michigan, Minnesota, North Carolina, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Virginia, Vermont and Wisconsin.

See my recent post at www.salmonellablog.com too.

I get asked frequently about how we decide which cases to go forward with.  Frankly, how we evaluate cases is quite similair to how Health Departments decide which cases to investigate or not – please see my publication – Separating the Chaff from the Wheat : How to determine the strength of a foodborne illness claim. (PDF).

If you have any questions, please shoot me an email at bmarler@marlerclark.com

As reported last Friday by Larry Parsons – Monterey Herald Staff Writer – in “Taking on the spinach stigma – Officials gather to discuss how to restore vegetable’s image after deadly E. coli outbreak,” a  group of 60 people lunched Friday on fresh spinach, Congressman Sam Farr said with pride, which according to the FDA “is as safe as it was before the outbreak.”

Then the Salinas assemblage of public officials, scientists and farm industry representatives returned to the table to talk about how to restore spinach’s battered image after the September E. colioutbreak that killed three people and sickened 204 across the country.

You would think that one way the industry could get back on its feet is to reach out to the victims in a meaningful way – but hey, they do not vote in Farr’s district do they?

 

Over the last several weeks I have been asked dozens of times about the origin of E. coli O157:H7 and the impacts upon people.  I remembered an article written on January 6, 1998 By Gina Kolata of the New York Times entitled: Detective Work and Science Reveal a New Lethal Bacteria

I have taken the liberty to excerpt some answers to the questions:

So, what the heck is E. coli O157:H7?

Normally, Escherichia coli bacteria live innocuously in the intestines of people and animals. But E. coli O157:H7 can cause diseases from standard diarrhea to kidney failure and death. The bacteria still befuddle medical doctors, who have misdiagnosed their infections as everything from appendicitis to blocked blood vessels of the colon. Once someone is infected, there is no effective medical treatment to combat the disease, and all doctors can do is prevent dehydration, wait for the disease to run its course, and hope for the best.

What illness does it cause?

However the toxin does its work — and scientists still do not know for sure — the result is that it can injure cells that line blood vessels, plugging them with blood clots. When this happens, the first symptom is bloody diarrhea. But a small proportion of people, especially young children and the elderly, develop hemolytic uremic syndrome, the actual destruction of the kidneys that occurs when blood vessels in these organs are destroyed. The syndrome can lead to kidney failure or can be fatal. Infections with E. coli O157:H7 are now the leading cause of kidney failure in children, the disease control centers says, with at least 1,000 children a year developing kidney failure from these infections, and 3 percent to 5 percent of them dying.

Older people also tend to develop another complication, thrombotic thrombocytopenic purpura, a sort of leakage of the blood vessels that feed nerve cells. The result is an encephalitis-like disease, with psychosis, comas or seizures.

The bacteria are surprisingly tough and virulent. For example, said Dr. Marguerite Neill, chief of the division of infectious diseases at Brown University School of Medicine, most bacteria do not produce disease unless a person is exposed to millions of them. But as few as 10 or so E. coli O157:H7 can produce illness — far too few to see or smell.

Where did it come from?

In the 1980’s Dr. Alison O’Brien, a microbiologist at the Uniformed Services University of the Health Sciences in Bethesda, Md., examined the rogue E. coli, and sure enough, discovered that it had somehow taken on the Shigella toxin gene. Moreover, in many of the E. coli, that gene was slightly altered in a way that made the bacterium produce toxin even deadlier than the original toxin made by Shigella.

No one knows exactly how the Shigella toxin genes jumped to E. coli, but Dr. O’Brien has an educated guess. Viruses that infect bacteria can sometimes pick up a gene from one bacterium and carry it to another.

But if that was the seminal event, Dr. O’Brien said, it probably did not occur in the United States, where Shigella bacteria do not have the dangerous toxin gene. Shigella in Central America do have that gene, however, and in the 1970’s, that area was hit with a pandemic of Shigella dysentery. As the Shigella mixed with harmless E. coli in people’s intestines, or as it mixed with harmless E. coli that inhabited animal manure, a virus may have carried Shigella toxin genes to E. coli. The result would have been a strain that had never been seen before: the toxin-armed E. coli O157:H7.

So, why do Cows, Pigs, Sheep and Goats carry this nasty bug?

The NYT article did not answer the question on how Shiga-toxin E. coli jumped from humans to animals, but a 2003 study on the prevalence of E. coli O157:H7 in livestock at 29 county and 3 large state agricultural fairs in the United States found that E. coli O157:H7 could be isolated from 13.8% of beef cattle, 5.9% of dairy cattle, 3.6% of pigs, 5.2% of sheep, and 2.8% of goats.  A single cow produces about 30 kilograms (66 pounds) of manure per day. Each gram of manure can contain ten million (10,000,000) fecal coliform organisms, which could include E. coli O157:H7. A cow can put out about three hundred billion (300,000,000,000) fecal coliforms per day.

Fecal testing of dairy cattle worldwide showed wide ranges of prevalence rates for E. coli O157:H7 (0.2 to 48.8%) and non-O157 STEC (0.4 to 74.0%). The prevalence of E. coli O157H7 in beef cattle in Canada at the three different sites in the horizontal study varied from 2.5 to 45%. The point prevalence of E. coli O157 among Saskatchewan cattle from 20 different feedlots ranged from 0% to a high of 57%.

And cows are next to spinach fields because?

Interesting article that I hope has no applicability of the source of E. coli O157:H7

4NI Northern Ireland News reports that defense scientists secretly tested E. coli bacteria as a possible biological weapon in the 1960s, according to a Ministry of Defense report. According to the 1966 MoD report on the Porton Down laboratory in Wiltshire, the trials were conducted near Swindon and Southampton between 1965 and 1967.

The trials involved the release of “microthreads” covered in the bacteria. The report discusses the “production of micro-organisms for weapons systems”, and said that the “excellent quality and reproducibility” of E. coli suggested that “highly satisfactory results” could be achieved.

There did not appear to be any mention of whether anybody was affected by the bacteria during the course of the trials. The report has been released for public viewing for the first time at the National Archives in Kew, south west London.

The FDA has found nine positive E. coli O157:H7 samples from one of the four ranches implicated previously – several hundred environmental samples have been taken.  The samples have been found in cattle feces, a water sample and in the intestinal lining of a feral pig (YES, they killed the pig).  The positive samples from this ranch have been linked to the spinach outbreak – both from ill people and samples from left over DOLE spinach bags.

Although the FDA refuses to name the ranch (Why is that?), it has confirmed that the implicated spinach field (consisting of 50 acres) is within 1/2 mile from the ranch cattle pasture and a water source.  The FDA and CDHS also confirmed that feral pigs do enter the spinach field from the cattle pasture and water source.  Broken fences, as well as feral pig tracks, were found in the spinach field.  The spinach field and the cattle ranch appear to be owned jointly.

So, when will the FDA and CDHS let the public know what cattle/spinach ranch is the likely source of the E. coli contamination?  See this morning’s LA TIMES Article by Ron Lin.  And, see “Wild pigs eyed in tainted spinach probe.”

When I was in Milwaukee Monday I had the chance to talk to the Rotary and to WTMJ News – here is part of the report on the station’s Spinach test for E. coli O157:H7 in bags of spinach off store shelves:

E. coli killed three people and made 200 others sick. The culprit: bagged spinach. It’s back on Wisconsin grocery store shelves.  Is it safe? We bought bagged spinach at grocery stores all over the Milwaukee area. We took it all to a lab to answer the question on everybody’s mind, is it really safe for me to feed this stuff to my family?  We took the spinach to a microbiologist, Gil Kelley at SF Analytical in West Allis. He tested bags from the Jewel, Pick’n Save, Sendik’s and Whole Foods.

We also talked to Bill Marler, a lawyer who’s representing 97 people who got sick after eating E. coli-tainted spinach from California.  “Are we now able to trust what’s on grocery store shelves?” we asked. His response: “No. I mean the bottom line is no. We know that the Salinas Valley is like big bowl and they grow the spinach and the lettuce at the bottom of the bowl, and there’s cows all around the perimeter of the valley and the perimeter of the bowl.”  The old “you know what” rolls down hill theory, a problem federal investigators are looking into….

Any fruit or vegetable grown in contaminated soil. Which takes us back to the lab and our highly scrutinized bags of spinach. Any E. coli? All clean. No E. coli. Our microbiologist says they are absolutely safe to eat. But a few clean bags may not be enough to convince some to start serving up spinach, attorney Bill Marler warns:

“It’s good that you got negative test results, but the reality is there’s no assurance yet that this product is safe in my view.”

Despite the negative test results in a few bags of spinach, please recall the quote by an FDA official in the recent article by Herb Weisbaum – E. coli aftermath: Where is the accountability?

Dr. David Acheson, chief medical officer in the FDA’s Center for Food Safety and Applied Nutrition, responds by saying scientists must figure out what went wrong before the agency can decide what to do to prevent future outbreaks. In the meantime, he says, “fresh produce in the United States is as safe now as it was before the outbreak.”