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Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Yes, Stewart Parnell and PCA, You Killed People with Salmonella Peanut Butter

Today, the Court in Georgia Federal Court in the criminal case against Stewart Parnell, et al., allowed the defense to question whether PCA and Stewart Parnell was responsible for the death of nine.  Yes, you were and here was one of them.

Screen Shot 2015-07-01 at 8.36.04 PMCLIFFORD TOUSIGNANT’S SALMONELLA ILLNESS

The Early Years

Clifford Frederick Tousignant (Cliff) was born in Duluth, Minnesota, in 1930, to Violet and Clifford Tousignant, Sr. He was an adventurous and fearless young man, known for his introspective nature and generous heart. At the age of 16, Cliff joined the Army in the Civil Air Patrol. He loved the military and serving his country, a duty he maintained for 22 years.

During that time, he fought in the Korean War and earned three purple hearts. The only thing Cliff loved more than his country was his family. He had six children—Paul, Marshall, Susan, Calvin, Jane, and Lou, and eventually became a grandfather to fifteen children, and a great-grandfather to fourteen children. As his family recalls, “He could often be seen with them crawling all over him. He loved every minute of it and loved being in photos with them as well.”

In addition to his loving nature, Cliff was also known for his generosity. One family story that is told often:

The night of his death I sat and spoke with my brother-in-law, Dan Herrick. He shared a story with me. When he and my sister, Jane, were first married, like many Americans times were tight. My dad would make up reasons to come over and fix things that were never even broken. He would give them money as a way to help them get by. He helped out many of us over the years, including his own parents when he joined the army as a teenager. As long as he had a few dollars in his pocket, he was willing to help others as best he could.

After leaving the armed forces, Cliff entered the security field, working for Frasier Shipyards in Superior, Wisconsin until his retirement.

When Cliff was diagnosed with diabetes, he took it seriously, and did his best to care for himself, but despite his best efforts he lost his right leg to the disease when it was amputated in 1985. He also lost four toes on his left foot. But ever the fighter, he did not let the loss of his leg and toes slow him down. After he purchased a motorized wheelchair, Cliff was as mobile as ever.

A Man Loved By Many

For those who knew him best, Cliff could usually be found enjoying a good football game or sharing stories about his past experiences with friends. As his brother, Robert, recalls, he was a “gentle, soft, loving person. That’s not to say that he was a push-over. Although he did not rile easily, when he did he could be very vocal.” Cliff had no qualms about standing up for what he believed to be right.

The memories and stories of those he left behind after his untimely death are the only true way to explain what an extraordinary man, father, grandfather, brother, and friend Clifford Tousignant was to those who knew and loved him. What follows are some of those family memories:

***

My parents divorced when I was 23 years old. My father never dated to much after that so he was pretty much on his own. Of course, that made me want to include him with my family much more at the time. At that time my husband and I had only 1 child our daughter Sarah. We spent one to two days a week with my Dad. Having him over for dinner or him always wanting to take us out to eat. When Sarah was 6, I became pregnant with my 2nd child. We were so excited as was my Dad. Close to my due date, my Dad came down to where I was working to take me to lunch. I had been having a backache all day. I remember him saying ” Maybe you’ll have your baby later today.” I did. My son Brian was born that evening. I called my Dad, he was so happy and showed up at the hospital early the next morning to meet his new Grandson.

As much as he always loved holding the babies and hugging all of his grandkids, he and Brian would just grow closer as Brian got a little older. Being a military man my father just related to guys better. He and Brian became very close, with Brian spending many nights at grandpa’s place. My Dad did so many things for him and with him. He took him on train rides, boat rides, sent Brian flying in a small airplane and just waited on the runway for his return. Brian loved to always go and spend the night at Grandpa’s. It was special, just the two of them. We spent every Thanksgiving with him for years. We always had a birthday party here with our kids on his birthday and on theirs.

It was never a surprise for the kids to come home from school and find their Grandpa here. Brian started to play football at age 12. Now football was my Dads most favorite thing. I’d always go pick my Dad up and off to the game we’d go. Brian’s games were on Saturdays and my husband was always working so my Dad was my loyal companion. He’d sit out there with me in the rain and cold and never complained. He loved that Brian was playing football. My Dad went to every single game with me for 4 years until he moved to Brainerd. My brother Marsh even brought him back here to attend one of Brian’s high school games.

When my brother Marshall retired, he moved my Dad to Brainerd. At that time I was working full time, had one child in college and one in high school. Life was very busy. My Dad spent about 3 years in Brainerd before he passed away. It was nice for my brother and his family to get to spend a lot of time with Dad. It was so different having my Dad not here in Duluth, but I knew my brother and his family were taking good care of him. We’d see him when we could get down there and call. Marshall brought him back to Duluth lots of times so we were still able to see him here in Duluth too.

The last time I saw my Dad was on December 31, 2008. My husband, Sarah, Brian and myself visited him in the hospital in Brainerd. It was hard to see him so sick. He was in the hospital being treated for food poisoning. He looked so happy when we walked into that room. We had a great visit with him that day. I will always be so thankful for that day. I left that day feeling so sad to see him like that but I knew my Dad would get though this because he had always bounced back from everything. I spoke with Marshall, getting updates, just waiting for him to get better. On Sunday January 11, 2009, Marshall called to tell me that he was putting Dad back in the hospital. The next morning Marshall called to tell me that our Dad was gone.

This was devastating to us. This man who had been such a big part of our lives was no longer here. At first I couldn’t get past the shock of it. As more details of how he got the food poisoning came out I just got really angry. My father should not have died from eating peanut butter! How unfair is that? Someone precious to my whole family was taken before his time. We miss him so much.

***

My father raised me on his own from 7th grade on when he and my mother divorced. He and I drove out to Las Vegas together and lived there for a while while I was in Jr High. We then moved back to Duluth and lived there together all through High School. Every time I moved during college (5 times) he was there to help. When I was injured in a severe diving accident he was there. Often times I was asleep in my hospital bed and would wake up; he was there sitting next to me. Not saying a lot but by my side.

My father was a guy that was always helping someone. He did it when he was in the army in Korea, he did it when he came back here after the war and as a person on a very fixed income was helping his brothers and sisters. He wasn’t a man that needed much but was willing to help those that were in need.

He will not only be missed by his children but his siblings, his grand kids and great grand kids. My son will only have fleeting memories of him because he was taken from us at a young age. I purchased season tickets to the new open air Gophers football stadium. He will never be able to go and enjoy an outdoor football game for the team that he loved and that I love now as well. I was recently scrolling through my blackberry and came across his number. I can’t bring myself to delete it. I wouldn’t have to be making a decision like that if he was still with us today.

***

Cliff and I were 20 years apart. He was in the army and when he came home on leave he stayed with his family. His oldest son, Paul, is only one year younger than me so I remember a lot of hectic times. My parents always told me that when Cliff went in the service at 16 years old, he would send his whole check back home to my parents because of the tough times they were going through. Cliff owned a home in Duluth and when the youngest, Louis, was born, Luella (also known as “Toots”), Louis’ mother, had to go back to the hospital with blood clots. I stayed at their house for a month helping out. That’s when I really got to know my brother.

When his wife left him taking all the furniture, but leaving Cliff to raise Louis, I was very supportive of Cliff. I found him a lawyer and went to all court dates with him. Our mother was in a nursing home for 18 months and every weekend I would bring her home and Cliff would come over on Sunday for BLTs with her. When Cliff moved to Brainerd, I talked to him every week. My husband and I went to see him every spring and fall.

I have Rheumatoid Arthritis and ended up disabled. My husband’s company ended after 12 years. Cliff sent $50.00 to us every month for 2 years until my husband could get social security.

Cliff’s Exposure and Salmonella Infection

In late 2000, Clifford moved to Brainerd, Minnesota to live with his son, Marshall. He remained there until November 14, 2008, when he moved into the Good Samaritan Woodland Skilled Nursing Facility, also in Brainerd.

On Friday, November 14, Cliff arrived at his new home. At the time of his admission, Cliff’s health issues were limited to diabetes mellitus, which had caused nerve damage, pain, and numbness in his hands and feet, gastroesophageal reflux disease (GERD), high cholesterol, and autoimmune thrombocytopenia (low platelet count). Cliff’s thrombocytopenia was being well controlled with twice monthly treatments of platelet infusions. His baseline platelet count was determined to be 20,000—a number achieved immediately following a platelet transfusion. Over the days following the transfusion treatment, the platelet level would slowly drop. Once the number dipped below 15,000, another platelet infusion was given.

With regard to Cliff’s diabetes, Marshall—who lived just a short drive away—continued to see his father on a near-daily basis and took part in monitoring his insulin doses.

The move to Good Samaritan Woodland was a good fit. It allowed Cliff to explore his sociable nature while also be under the attentive care of skilled nurses. As was noted in an early intake:

He does like to visit and talk to people. When he is feeling good he likes to take his scooter outside and ride to the clinic or out to eat. Mr. Tousignant has a friendly and upbeat attitude. [He] appears to cope well with change. Resident has good support from his son who lives in the area and visits often.

Cliff got to know his neighbors well, and was frequently found chatting them up. He also enjoyed the meals at Good Samaritan Woodland, one of his favorites being peanut butter sandwiches, a meal he ate almost daily.

His new life at Good Samaritan Woodland continued without much excitement through December. Early in the month he did have a persistent cellulitis on his right arm that required a brief hospitalization at St. Joseph’s Medical Center, but he was otherwise doing well.

All was well until a marked change occurred on Sunday, December 28. That day, Cliff began to have diarrhea. When staff members at the nursing home were made aware of the development, they obtained a stool sample and sent it to the St. Joseph’s Medical Center lab to be cultured and tested.

Throughout the rest of Sunday and into the next day, the frequency of Cliff’s diarrhea episodes increased steadily. When checked on Monday morning, he had passed a large stool and was in distress over the situation. He demanded to be taken to the hospital for treatment.

Cliff’s son, Marshall, arrived a short time later to visit and calmed him down a bit. But the diarrhea and abdominal cramping continued without relent. He was given Imodium, but it did little to slow the frequency of his loose stools.

Hospitalization One—December 30, 2008 to January 4, 2009

On Tuesday, December 30, he was again noted to have “loose brown stools” and additional amounts of Imodium were provided. Dr. Halverson became concerned, as dehydration can be a serious health risk with profuse diarrhea like that afflicting Cliff. He gave orders for Cliff’s transfer to the St. Joseph’s Medical Center emergency room for further evaluation. Marshall was called and notified of the decision. At approximately 10:40 AM, an ambulance arrived and he was transferred to the hospital without incident.

While in the ambulance, he was given IV fluids and a check of his blood pressure revealed it to be elevated at 149/80, along with a blood sugar level of 217. The ambulance arrived at the ER in about five minutes. He was promptly examined and noted to be suffering from diarrhea—at least three to five episodes per day—over the previous days that was described as “pure water,” with some mucus and very foul smelling. His platelet count had dropped to a low 11,000, and thus a transfusion was ordered to help with blood clotting. Of note, his right conjunctiva was bleeding at the time of the initial exam.

Cliff was moved to a room a short time after his admittance. His decreased short-term memory retention was noted, but it was not a problem. The results from his stool culture sample obtained on December 28 were still pending at the time, but the treating physician believed his diarrheal illness could be a Salmonella infection or possibly from a viral source. A blood transfusion was initiated at 1:00 PM, improving his platelet count.

Overnight Cliff remained calm, despite the intense pains and diarrhea. In the morning he was re-checked and found to be alert and oriented. His blood pressure was checked and had come down to 126/68, a significant improvement from the day prior. Later that afternoon the results of his stool culture were finalized and revealed the reason for his declining health—he was infected with Salmonella. He was discontinued on the antibiotic Rocephin and changed to Bactrim.

Although he remained connected to IV fluids, Cliff’s urine output began to decrease. He was therefore encouraged to sip juice and other fluids frequently. After nearly a week of profuse diarrhea, his rectum and scrotum were unsurprisingly red with irritation and bloody drainage. His treating physicians were worried about infection of that area, making frequent cleanings of the perianal area necessary, but no less pleasant for Cliff. He was noted to frequently “yell out” in pain during the cleanings, and would then become upset and frustrated with his caregiver.

The next day, January 1, 2009, marked the beginning of a new year, and also a slight turnaround for Cliff. He was in better spirits than he had been for the past few days, although he was still having “loose mushy green stools,” albeit a little less frequently. The pain medication was also providing relief from the stabbing abdominal cramps.

The seemingly unending blood draws and cleanings began to wear on Cliff, a man who was normally very sweet and gentle, but who valued his independence and privacy. He particularly dreaded the perianal cleanings, but due to the never-ending diarrhea it was necessary. The skin in that area was significantly compromised, causing constant pain and itching. To Cliff, it was pure misery.

Over the next three days, Cliff’s diarrhea continued to be a problem, as was the related skin breakdown in the perianal area. It eventually became ulcerated, with “bloody abrasions throughout peri area.”

Cliff’s body also ached all over and grew increasingly weak. By Saturday, January 3, he required almost complete assistance just to get in and out of the bed, a marked turnaround for a man previously mobile and independent despite his reliance on a wheelchair. That night, after yet another nurse woke him up and the accumulated frustration got the better of him, Cliff had an angry outburst. It was just too much. Between the blood draws, perianal cleanings, diarrhea, body aches, and required assistance just to get out of the bed, he could not contain himself.

Thankfully the next day, Sunday, January 4, brought some good news. The frequency of Cliff’s bouts of diarrhea had significantly slowed and he was feeling better. Other than keep him hydrated and provide assistance as needed, there was little else the hospital could do at that time to treat his Salmonella infection. He was thus discharged that afternoon to the care of the Good Samaritan Woodland Skilled Nursing Facility and transported by medivan.

Cliff was relieved to be back at the familiar surroundings of Good Samaritan Woodland. But over the next week, he continued to struggle with loose stools that simply would not abate.

Hospitalization Two—Sunday, January 11, 2009

In the afternoon on Sunday, January 11, Marshall stopped by to check on Cliff and visit for a little while. He noticed a shift in his dad’s demeanor, who turned lethargic and agitated before becoming completely unresponsive. Marshall had no idea what was going on, and in a panic went to the nursing station to request an immediate blood sugar check and an ambulance to take Cliff to the ER.

The ambulance arrived at 4:40 PM. Marshall and the nurses relayed the events leading up to their arrival, including that Cliff’s blood sugar had tested 99, then 106. While he was awake, he would not respond to anyone. The emergency medical technicians moved Cliff to the ambulance and sped off to St. Joseph’s Medical Center with Marshall not far behind in his own vehicle.

At the hospital, Cliff was assessed for his unresponsive spell. Marshall had arrived by then and explained that his father was in the hospital just last week for a severe Salmonella infection, and that his diarrhea persisted. The decision was made to admit him again for further tests and motoring, including blood glucose monitoring, IV fluids, and another stool culture.

He was noted to be weak, lethargic, and “in such a state that he cannot carry on any useful conversation.” He also passed two loose, brown, liquid stools shortly after being admitted. A gastrointestinal consultation was requested. It was noted that Cliff was previously treated with Cipro after being diagnosed with a culture-confirmed Salmonella infection, but that he continued to decline. It was further noted that “there has been an outbreak of Salmonella at the nursing home.”

That night, he passed a bloody liquid stool, and began vomiting. The vomiting episodes came frequently, and lasted all through the night. A blood sample collected at the time of admission was cultured and confirmed to be positive for Salmonella—the bacteria had made its way from his gastrointestinal tract into his blood stream. The prognosis was dire.

By morning on January 12, he was completely unresponsive. A plan was made for the insertion of a central line catheter and for the transfusion of platelets to combat his plummeting platelet count, but unfortunately those plans did not amount to anything. At 11:08 AM, Cliff took his last breath and quietly passed away. The final diagnosis—Salmonella Gastroenteritis.

At the time of his death, Cliff left behind six children, fifteen grandchildren, and fourteen great-grandchildren.

CAUSATION

It is clear that Cliff’s Salmonella infection and death are directly linked to his consumption of contaminated peanut butter manufactured by King Nut using peanut butter product manufactured by Peanut Corporation of America (PCA).

Specifically, Cliff consumed peanut butter sandwiches on a near-daily basis in the days leading up to the onset of his illness in late December 2008. He began to suffer from symptoms consistent with a Salmonella infection around December 28, 2008, and a stool sample submitted on that date confirmed his Salmonella infection. Also, a blood sample collected on January 11, 2009 cultured positive for Salmonella, confirming the bacteria was in his blood stream.

Further testing revealed that he had been infected with Salmonella serotype typhimurium. Pulsed Field Gel Electrophoresis (PFGE) fingerprinting of the bacterial isolate revealed a genetic match to the pattern linked to the nationwide outbreak strain of Salmonella associated with contaminated PCA peanut product used by King Nut in the manufacture of its peanut butter.

Dean Norman, MD, a geriatric medicine specialist, reviewed Cliff’s records and provides the following opinion on the relationship between his confirmed Salmonella typhimurium infection and his death:

Mr. Tousignant was 78 years old when he was admitted to Woodland Care Center in November of 2008. His major medical problems included diabetes and diabetic neuropathy resulting in numbness in his extremities, right below the knee amputation and multiple amputations of toes of left foot presumably as complication of diabetes, polycystic kidney disease with high levels of protein in his urine, autoimmune thrombocytopenia (low platelet count and platelets are necessary for adequate coagulation), dementia and hyperlipidemia. He had undergone splenectomy in the past in an attempt to improve his autoimmune thrombocytopenia. Of note, he was on multiple medications including the immunosuppressant medications prednisone and mycophenolate mofetil. Despite these problems, Mr. Tousignant was usually alert, able to carry on a conversation. He required assistance for transferring from bed to wheelchair but was able to self propel himself in wheelchair. He enjoyed watching John Wayne movies and listening to music.

Mr. Tousignant developed mild cellulitis (infection of the skin) of his right upper extremity in early December of 2008 and was briefly admitted to St. Joseph’s Medical Center for intravenous antibiotics and discharged back to the nursing home on oral antibiotic therapy after he showed substantial improvement. However, he was readmitted to St. Joseph’s Medical Center on December 28, 2008 after experiencing several days of diarrhea. In the hospital it was noted that he had bloody drainage from his rectum and he suffered from perianal (around the rectum) discomfort. Subsequent stool specimens were culture positive for Salmonella species but negative for other gastrointestinal pathogens.

His symptoms improved on antibiotics and he was discharged back to Woodland Care Center on January 4, 2009. However, the following week, on January 11, 2009 he was transferred back to St. Joseph’s after his son found him to be unresponsive and he was subsequently found to have hypoglycemia (low blood sugar). A blood culture on admission was positive for Salmonella species with similar antibiotic sensitivities to the original pathogen found on his last admission stool cultures. Despite antibiotic therapy Mr. Tousignant’s condition deteriorated and he passed away the next day on January 12, 2009.

It is my opinion that, to a reasonable degree of medical probability, Mr. Tousignant’s illness resulting in admission to St. Joseph’s Medical Center on December 28, 2008 was due to salmonella enteritis (inflammation of the gastrointestinal tract). Usually this infection is due to consuming contaminated food and is usually self-limited. However, in the elderly and patients whom are immunocompromised as was the case with Mr. Tousignant the infection can result in bacteremia (bacteria in the blood) and overwhelming infection. His final admission to St. Joseph’s was clearly due to worsening salmonella infection as evidenced by salmonella bacteremia and this infection directly led to his demise.