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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Information as Currency in Public Health

Are we seeing an emerging trend favoring secrecy?

The 2006 E. coli O157:H7 outbreak linked to DOLE baby spinach was the known high-water mark for critical safety failures by Salinas, California’s leafy green growers and processors (1). Well over two hundred confirmed illnesses nationally, five deaths, and dozens of cases of kidney failure were the coup-de-grace for a ten-year period that saw a litany of E. coli and Salmonella outbreaks linked to Salinas’s leafy greens. But the outbreak, and more specifically the painstaking investigation and analysis that followed, also marked the beginning of the end of full disclosure, and the beginning of, in some cases, complete silence by some state and federal public health officials about the details and even existence of foodborne illness outbreaks.

The 2006 Spinach E. coli outbreak was, of course, a highly public event, no doubt requiring an open and frank discussion of the actions and failures that contributed to so many illnesses and deaths. Together with the Food and Drug Administration (FDA), California’s Food Emergency Response Team (CalFERT), which was a collection of epidemiologists and other scientists formed in 2005 to investigate outbreaks originating in California, produced a lengthy report discussing the trail of evidence that lead to the conclusion that DOLE’s baby spinach caused the outbreak, as well as the microbiological and environmental findings that gave some insight into the outbreak’s cause and likely source (2).

After the 2006 Spinach outbreak—in fact, within three months of it—two more E. coli outbreaks, which sickened at least 152 people in six states, were linked to lettuce produced by California growers (3, 4).  Again, CalFERT investigated the outbreaks and issued final reports, thereby providing both the industry and the public generally with information about the state of the industry in America’s salad bowl, and most importantly, the likely causes of the outbreaks.

But there the paper trail slowed. Since the devastating fall of 2006—three outbreaks; 404 illnesses; five deaths; dozens of cases of kidney failure—CalFERT has not issued a single report of its investigative activities, despite a leafy-green link to many more outbreaks. And, these are only the outbreaks that are known to have occurred. Moreover, what can be pieced together based on limited responses to Freedom of Information requests, shows that the trend is not only limited to a lack of documented investigative conclusions about an outbreak, but also incomplete investigation of outbreaks, and increasing failures to notify the public at all that an outbreak has occurred. A few of the more known examples:

• September 2008—at least 45 residents of Michigan, Illinois, and Ontario, Canada were infected by E. coli contaminated iceberg lettuce that was grown in California and processed at Aunt Mid’s Produce Company, a Detroit-area wholesale distributor. Again, neither the FDA nor CalFERT issued any kind of a summary report documenting their conclusions about the source or cause of the outbreak (5).

• April 2010 – at least 33 residents of Michigan, Ohio, Tennessee, Pennsylvania, and New York were sickened by a relatively rare strain of E. coli called E. coli O145. Perhaps the most publicly known outbreak since the devastating fall of 2006, FDA refused to name the company that had grown the lettuce, instead choosing to identify only the state where the farm was located: Arizona. CalFERT was not involved in this investigation (6A, 6B).

• October 2011 – at least 60 people from 10 states were sickened by E. coli contaminated romaine lettuce. Most of the ill were customers of Schnuck’s grocery stores in Missouri. Traceback investigation revealed both the processor of the contaminated lettuce and the grower, but again the FDA has declined to name either company (7).

A few of the lesser known, or not publicized, examples:

• May 2008—at least 10 residents of Washington State were infected by E. coli contaminated romaine lettuce grown and processed in Salinas, California. Despite being involved in the investigation and product traceback to the lettuce processor, neither the FDA nor CalFERT documented their findings about the outbreak’s source or cause (8).

• October 2008 – at least 55 people in Canada, California, North Dakota, Illinois, Florida, New Jersey and Ohio were sickened by E. coli-contaminated romaine lettuce that had been grown in California. California and FDA investigation revealed that the implicated lettuce had been supplied to retail locations where people became ill by a Salinas, California company. Again, neither CalFERT nor the FDA issued a summary report about the outbreak (9).

• July/August 2009 – dozens of Oregon, Washington, Idaho, Colorado, and Montana residents, and multiple Canadians, were sickened by Salmonella Typhimurium in an outbreak dubiously investigated by officials at the California Department of Public Health’s Food and Drug Branch. The contaminated lettuce was grown and processed in Salinas, California, and despite clear epidemiological evidence implicating the lettuce, California officials declined to state a relationship between the implicated lettuce and the outbreak. Neither California nor the FDA issued a comprehensive report on the outbreak, nor was the implicated product ever recalled (10).

• September 2009 – at least 19 residents of Colorado, Utah, New York, South Dakota, Wisconsin, and North Carolina were infected by E. coli contaminated lettuce grown in Salinas, California. Again, neither CalFERT nor the FDA generated a report on outbreak findings (11).

• September 2009 – 10 individuals in 6 different states, Colorado, Connecticut, Iowa, Minnesota, Missouri, and North Carolina suffered E. coli infections, sharing an indistinguishable PFGE pattern. The outbreak was identified by the CDC as cluster 0910MLEXH-1. Epidemiological investigations by multiple states strongly suggested lettuce as the source of the outbreak. The lettuce served at a restaurant in Colorado where both Colorado members in the outbreak consumed lettuce was traced to a specific grower in California’s Salinas Valley. Colorado state health officials pushed for further Federal agency effort but were rebuffed:

By mid-October, Colorado had not received any further communication from the CDC and FDA about the traceback, so Colorado made several inquiries about the status of the investigation. Investigators from the CDC reported that FDA had decided not to pursue further traceback activities because of limited resources and the length of time that had elapsed since the original exposures with no new cases. Colorado challenged this decision, but FDA did not change its position about pursuing traceback further (12).

Since the fall of 2006, and the media vortex that the three large E. coli outbreaks that occurred then created, the FDA and CalFERT have repeatedly failed to provide conclusions, and in some cases much information at all, about multiple major public health crises that have occurred in this country. This is a threat to the public’s health, which has as its only currency the free and rapid exchange of information.

Questions raised by FDA’s and CalFERT’S approach, or lack thereof, to providing information to the public about post-2006 leafy green outbreaks are many. Is funding for public health programs lacking? Across the board, possibly, but CalFERT has not experienced any cuts to its operating budget; in fact, during this period, CalFERT has received a large grant from FDA. If not a problem of funding, will CalFERT and FDA respond that they lack manpower? Unlikely, given the underlying reasons for the existence of CalFERT in the first place, which was a specific devotion of resources and highly competent public health officials to the problems emanating from Salinas Valley, and California generally. There is no clear conclusion available from the known data as to why there is a lack of complete disclosure. Of course, there has been no explanation from these public health bodies regarding their reasons for the trend of non-disclosure.

Whatever the explanation, the lack of information about these outbreaks is far from simple instances of non-disclosure. Indeed, the path that CalFERT and FDA have chosen to take since the fall of 2006 threatens a general withdrawal from the obligations of open disclosure. And, this is only about the outbreaks that are known. There are likely many more that have occurred that have never seen the light of any disclosure at all.

References:

1. See 2006 Dole-NSF investigation documents as Attachment No. 1 and No. 2.

2. For additional information on CalFERT, see the CalFERT poster as Attachment No. 3.

3. See 2006 Taco Bell investigation documents as Attachment No. 4.

4. See 2006 Taco John’s investigation documents as Attachment No. 5, No. 6A, No. 6B and No. 7.

5. See 2008 Aunt Mid’s trace back diagram as Attachment No. 8.

6. See 2010 Freshway Foods investigation documents as Attachment No. 9 and No. 10.

7. See 2011 Investigation Announcement: Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce as Attachment No. 11.

8. See 2008 WA DOH investigation document as Attachment No. 12.

9. See 2008 CDPH and CDC documents as Attachment No. 13.

10. See 2009 Salmonella Typhimurium investigation summary as Attachment No. 14.

11. See 2009 Church Brothers investigation documents as Attachment No. 15 and No. 16.

12. See April 30, 2010 Memorandum, Colorado Department of Public Health and Environment, Communicable Disease Epidemiology Program as Attachment No. 17.

  • doc raymond

    Could it be that the detailed investigation of the spinach and the Taco Bell lettuce E coli outbreaks revealed farming practices that contributed to the contamination, thus pointing fingers at other than large processing plants? And that identifying farming practices that need to be changed enters the US Government into an arenal they have not ventured into before?
    All you have to do is take a look at the CDC’s pictures of the farms (dairy and lettuce) and you know how this happened

  • Chuck

    The Doc usually speaks inconvenient truths. And I know industry fights hard to keep company names out of the press, usually pleading protection of trade secrets. or maybe protection from bad publicity?

  • Public health authorities are service organizations. They have at least two customers: the tax-paying public (consumers) and the food industry. One could hypothesize, without market research in hand, that the tax-paying public is a consumer of information that they can use to manage their risk of illness, and that they demand highly sensitive surveillance, timely information, and accurate information. Is providing this information a stated goal in the official mission statement of CalFERT? It’s only fair to evaluate a program in the context of its mission and objectives.
    All of these outbreaks involve fresh leafy greens. Could it be that by the time the source is identified, there is “no risk” to the public because of the short shelf-life of leafy greens? In that case, there would not be a failure to communicate risk information. If public health customers demand the public communication of information about outbreaks that are no longer a threat to public health, then you’ve got to identify that need through market research, commit to providing that information in the mission statement, and implement processes that meet customer needs.
    The question is, what happens if two public health customers (the public and the food industry) have mutually exclusive quality needs for the same information service (publicity vs. confidentiality?)

  • Interesting point – Evan, if consumers are never told that a company just poisoned a bunch of people, how can consumers vote with their pocketbook and choose not to buy that product or to choose to buy a product that has not been linked to an outbreak? Public health should stop outbreaks AND tell us what products have problems, so we can make informed choices.

  • Bill, I agree, and as a food safety geek and academic customer of public health information, I’d love more data that we could use to inform the prevention of future food safety failures and to reduce the burden of foodborne disease.

  • Paul F Schwarz

    Sounds like Public health is now protecting the private health of private industry!

  • My (limited) experience is that the public health profession is nearly impervious to what the outside world thinks or wants. I can’t think of any efforts public health professionals make to engage or inform the public. Makes you wonder what the word “public” is doing as a descriptor. Maybe it should be “private health profession,” since key decisions are made privately, with no input from the public.

  • John Munsell

    Reminds me of Lee iacoca’s book “Where Have All The Leaders Gone?” Frankly, we need bold leaders heading up our state public health organizations, FDA, FSIS & CDC, who will fearlessly implement unrestricted epidemiological investigations whenever confronted with either (a) outbreaks and (b) adverse lab reports. Uncomfortable implications accompany such investigations, such as lawsuits from producers which do not want to be identified, and public perception that perhaps the gov authorities are asleep at the wheel.
    Taxpaying consumers are footing the bill for these public health officials, whose primary goal should be to protect public health, not protect corporate bottom lines or bureaucratic comfort.
    We’re not looking for Dirty Harry to shoot his way to the truth. But we direly need some Brave Daves and Valiant Valeries who fearlessly seek out the truth, and REVEAL it to the public, with no fear of consequences. Folks who will rock the boat. And when public health authorities attempt to “Shoot The Messenger” who has uncovered uncomfortable truths, not only should messengers be provided whistleblower protection, but the authorities who attempted to coverup the truth must be terminated. Tall order, I admit, but it’s gotta be done.
    Otherwise, we are guaranteed ongoing outbreaks and recurring recalls. Sound familiar?
    John Munsell

  • Sam

    Evan brings up a couple excellent points. I’ve spent a lot of time in California agriculture, and the power wielded by large food companies in that state is immeasurable. As with almost everything in this country, follow the money and you will get to the source of the problem. I would bet that for every Bill Marler, the food giants have 100 lawyers working to minimize cooperation with public agencies.

  • doc raymond

    David, your broad sweep damning public health officials is more than just a little narrow minded. There are hundreds of individuals who go to work every day to protect us and our neighbors, from promoting tobacco free environments to vaccinating our children. Most could make more money in a life outside of public health, but they have commited themselves to this often silent work. And I will provide you with just one example of how public health has worked to inform the public and resisted the pressure from industry not to do so. FSIS now, since 2008, lists the retail stores where recalled meat and poultry were sold, just to inform the public. There are hundreds of other examples, but I hope Bill’s readers are now better informed as to the great work of public health professionals.

  • Disclosure: If you do not like lawyers, and according to most polls lawyers are less liked than Congress, your first thought might be that this Op-ed’s purpose is to get public health to announce more outbreaks, so I can get more work. Although, that certainly might be a result of more robust disclosure, believe me with $100,000,000 worth of recent Listeria cantaloupe work, I will be just fine. However, I ask you for just a moment to put that bias aside and ask a few critical questions. 1) Does the public have a right to know if a particular food product and manufacturer has produced food that has made people ill? I would say yes. Whether someone hires me may or may not happen, but most would “vote with his or her pocketbook” and not buy that product from that manufacturer, or change his or her habits in other ways. 2) Is Public Health served when problems are traced to where they arose? I would say yes to that as well. Finding out how an outbreak happened gives us all the opportunity to learn how to lessen the chance of the same thing happening again.

  • doc raymond

    Bill, I am with you all the way on this one. I have changed my purchasing AND eating habits from what I learned at USDA. One can maybe say ignorance is bliss, but it is also potentially deadly.
    We started listing Salmonella testing results for poultry on the internet while I was there, and we hoped it might change some purchasing habits, even if only with international trading, and look at the dramatic drop in the number of positives. This stuff you are exposing here just amazes me and I find it unbelievable.

  • Mrs. Mudder

    Bill.
    How do those that have the power to investigate or not, then to
    continue knowing the public is at RISK and then nothing gets settled
    for the health of our food?? Help me understand this situation in
    the power they hold and hide!!
    Thank-you,
    Mrs. Mudder

  • Paul

    Bill, once again kept up the great work !!!
    John, I am a Brave Dave and willing to help you out at any stage !!
    I am from a country with similiar eating habits to that of your country but with less food safety outbreaks and less severity to that of your country.
    The first thing that I must say it we have the same narrow minded government structures in place which vary from state to state and terriority.
    The second thing is when we do have problems, no one seems interested in getting to the ‘root cause’ of the problem !! Correct me if I am wrong but we need to identify the root cause to be able to correct the problem with confidence. Supplier, manufactures and growers all look for the easier avenue as this is the cheaper avenue.

  • As an environmental health professional I have devoted my career to hands on food protection at food production levels from the farm to the table by applying environmental health principles. Nowhere in food safety today is there a more needed discipline than down on the farm where the environmental health risks are well known. As a practitioner, there are some key areas of environmental health that keep coming up in my work, contamination of water sources, animal intrusion and less than great worker hygiene. We as auditors have started calling these the Three W’s.
    Downstream effects of the environmental health problem on produce farms as we have seen in this wide ranging discussion are huge, and reverberate back through all of the programs we have in place. We now need surveillance, traceability and product recall, testing; and of course, redress for victims. These unfortunates hold the bag at the end of the system without much control. How many lawsuits now Bill, can you throw out a number? All of this because of a relatively few, simple environmental health protections not established
    Thinking optimistically, if we could fix the contamination problems at the source of produce, we can ease the pressure on the supply chain, and minimize the downstream effects on consumers and society at large.
    Agriculture has been side by side with animal husbandry and wild animal populations for millennia, we will not remove the reservoirs completely, if we remain with open farm environments. I am still unsure why vaccination is not an option against infection, since we have one with efficacy, but this protection has had poor discussion. One would start there by reducing the incidence in the cattle population (the reservoir), and then the intrusion if possible of the wild populations.
    It is likely that adequate fences, adequate setbacks (still don’t know what this means in every case), water treatment (when needed), and strict adherence to personal hygiene will solve much of the problem.
    Then I have to ask, why cannot simple things like this be done? And the answer is that everything has a cost, and somebody must pay, then somebody must make sure it gets done, and nobody wants to.
    The farms I see would need about $10,000 to $50,000 (could be higher for some) initial investment and probably at least 10% of that for yearly maintenance, to implement animal exclusion and effective water treatment (of course when needed). This is in addition to the other programs in place now.
    But not all farms need such. There are places I go where the water coming out of the pipe is as clean as your tap water, and the crops see no foliar applications. I see other situations where the foliar application of water is sourced from the surface and must be treated. As far as animals, there are some farms in the SE US where I see only dogs or cats, or bird exposure with occasional rodent or ground animals. While on some fewer occasions; I see extensive deer, pig and wildlife intrusion and extensive droppings where harvesting must be halted and or production stopped.
    Out west, I see the cattle operations butted right up to produce production. As an aside, during our private investigation of the 2006 spinach E coli matter I sampled one cow patty from a Salinas area hillside pasture and isolated an E coli: O157:H7 serotype (not the outbreak strain). What does that tell you, one random sample? Or is this bug seriously rampant?
    There are areas with water diversion and flooding problems (due to drought conditions we have not seen much of this factor). But all of this is environmental health stuff is manageable, way more manageable for society than putting into place all of the elaborate stuff we now need including an army of investigators running around trying to connect the dots, and thousands of attorneys battling it out in court.
    What I am saying is that problems are in your face, we can solve it, and let’s do it kind of things that are in some cases already being done. We already have an environmental health workforce, let’s mobilize them.
    Fix the environmental health problem down on the farm, simple as that. If you got the money, I got the time.
    In the meantime, let’s be honest about everything we find that affects the health and safety of you and me, and be truthful to the public.