Marler Blog : Food Poisoning Lawyer & Attorney : Bill Marler : Marler Clark

Two long days after word first surfaced about a multi-state outbreak of E. coli tied to raw cookie dough, the CDC has issued information detailing the illnesses.  The outbreak appears to have begun March 1, 2009 and is still ongoing four months later

The CDC reports:

CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.

As of Thursday, June 18, 2009, 65 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 29 states. Of these, 23 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arkansas (1), Arizona (2), California (2), Colorado (5), Delaware (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (1), Massachusetts (4), Maryland (2), Maine (3), Minnesota (5), Missouri (2), Montana (1), North Carolina (1), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (4), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).

Ill persons range in age from 2 to 57 years; however, more than 70% are less than 19 years old and none are over 60 years old; 75% are female. Twenty-five persons have been hospitalized, 7 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
Investigation of the Outbreak

In an epidemiologic study, ill persons answered questions about foods consumed during the days before becoming ill and investigators compared their responses to those of persons of similar age and gender previously reported to State Health Departments with other illnesses. Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.

E. coli O157:H7 has not been previously associated with eating raw cookie dough. CDC, the state health departments, and federal regulatory partners are working together in this ongoing investigation.
Clinical Features

Most people infected with E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. Most people recover within a week, but some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur in people of any age but is most common in children under 5 years old and the elderly.
Advice to Consumers

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. If consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home they should throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. The recall does not include Nestle Toll House morsels, which are used as an ingredient in many home-made baked goods, or other already baked cookie products.

Individuals who have recently eaten prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local health authorities.

Consumers should be reminded they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.

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Oklahoma State health investigators have confirmed that at least 248 people have become ill as a result of the E. coli O111 outbreak in Northeastern Oklahoma.  Of that number, 202 were adults and 46 were children.  A Pryor man, Chad Ingle, died.  At least 64 people were hospitalized, including 16 who received kidney dialysis treatment.  Of that number, nine were children and seven were adults.  Investigators said the number of reported cases and hospitalizations may change as state investigators continue their investigation into the source of the outbreak.  The common denominator is the Cottage Grove restaurant in Locust Grove, Oklahoma.

To date the water in the well used at the restaurant has tested negative for E. coli O111, as has both the surfaces of the restaurant and left over food - REMEMBER - all were tested at least a week or more after people dined at the restaurant.

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Outbreak of Severe Diarrheal Illness in Northeastern Oklahoma

The Oklahoma State Department of Health (OSDH) reports today that laboratory analysis of water samples taken from a private well on the property of the Country Cottage restaurant in Locust Grove, OK, has found no disease-causing bacteria. The restaurant has been associated with a large E. coli 0111 outbreak in northeastern Oklahoma.

“The well water is not the source of this outbreak,” said State Epidemiologist Dr. Kristy Bradley. “We are continuing our efforts to conduct microbiological testing of food preparation and serving surfaces in the restaurant, and we continue to interview cases, as we try to establish an association with those who became ill and a potential source.”

At least 206 persons are sick as a result of the outbreak including 149 adults, 53 children, and four whose ages have not yet been confirmed. Cases range in age from 2 months to 88 years. One person has died.

“This appears to be the largest E. coli 0111 outbreak ever reported in the U.S.,” Bradley stated. “The complexity of this outbreak and the necessity to be extremely thorough in our investigation means we still have more questions than answers.”

OSDH disease investigators, along with staff from Tulsa Health Department and area local county health departments, have interviewed more than 500 persons in an effort to identify the source of the outbreak.

The restaurant is closed while the investigation continues. Not all persons who ate at the restaurant have become ill. No other restaurant or food service outlet in the area has been linked to the outbreak.

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The Oklahoma State Department of Health (OSDH) reports today that at least 176 persons have become ill as a result of the E. coli O111 outbreak in northeastern Oklahoma. Cases include 128 adults and 48 children. Federal and state health officials say E. coli O111 is a rare type not normally associated with an outbreak this large. OSDH disease investigators, along with staff from Tulsa Health Department and area local county health departments, have interviewed more than 450 persons in an effort to identify the source of the outbreak. Interviews continue this weekend. While the source has not yet been identified, health officials continue to focus on the Country Cottage restaurant in Locust Grove, OK, after interviews with cases indicated most had eaten there during the time period Aug. 15 through Aug. 23.

The restaurant is closed while the investigation continues. Not all persons who ate at the restaurant have become ill. No other restaurant or food service outlet in the area has been linked to the outbreak. OSDH laboratory analysis of water samples taken from a private well on the restaurant property is continuing, however, health officials believe it is unlikely that any well water contamination is the source of the outbreak.

Prior Outbreaks of E. coli O111:

- Community Outbreak of Hemolytic Uremic Syndrome Attributable to Escherichia coli O111:NM -- South Australia, 1995

- Outbreak of diarrhoea due to Escherichia coli O111:B4 in schoolchildren and adults: association of Vi antigen-like reactivity

- Escherichia coli O111:H8 Outbreak Among Teenage Campers - Texas, 1999

- Outbreaks of food poisoning in adults due to Escherichia coli O111 and campylobacter associated with coach trips to northern France

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The food borne illness outbreak in northeastern Oklahoma that has sickened more than 115, hospitalized 50 and taken one life is the latest emergence of the virulent and highly toxic E. coli bacterium. Most E. coli outbreaks in North America are subtypes of E. coli O157:H7, but the CDC has just revealed that this outbreak is a rare serotype: E. coli O111.

“This is highly unusual,” said food borne illness attorney William Marler. “We have been involved in every major US outbreak in the last 15 years, and we have only seen this serotype twice before—once traced to apple cider in New York, and once connected to water or salad in Texas.”

Although many strains of E. coli can be present in the body with no ill effects, strains like E. coli O111 and E. coli O157:H7 produce a deadly shiga toxin (stx) which ravages the digestive system and kidneys. By the time symptoms emerge—abdominal cramping, vomiting, and bloody diarrhea—the bacteria is already entrenched. Although there is no cure or antidote, immediate health care is critical to support the systems under attack, keep the patient hydrated, and try to alleviate the intense pain that accompanies the illness as the body works to rid itself of the toxic bacteria.

In those with compromised or immature immune systems, E. coli can progress to Hemolytic Uremic Syndrome, or HUS. Children, whose immune systems are not as developed as adults’, are especially vulnerable. HUS is a cascading complication resulting in kidney failure; at the moment several children in Oklahoma are on dialysis. Even when they are able to recover from the potent E. coli toxin (considered by the CDC to be one of the most toxic substances known to man), victims often have permanent kidney damage. It is not unusual for E coli victims infected as children to need multiple kidney transplants over their lifetime.

“Regardless of the strain of toxic E. coli, it produces a devastating illness.” continued Marler. “Under the best circumstances, it can take months to recover. Some victims are affected for the rest of their lives. We need to support the families going through this nightmare, and do everything we can to help them.”

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According to Kim Archer of the Tulsa World, Oklahoma state health officials have determined that a relatively rare and virulent form of E. coli infected dozens of patrons of Country Cottage, killing one and sickening more than 73 people.  More than 50 of those who fell ill were hospitalized.  Five children remain in the pediatric intensive care unit at Children's Hospital at St. Francis.  Four are on dialysis.  Two other children were sent to OU Children's Hospital.  Ms. Archer quoted State epidemiologist Dr. Kristy Bradley as saying the E. coli strain is not the commonly known E. coli O157:H7.  Non-O157 strains are more common in South America and parts of Europe, according to the Pediatric Infectious Disease Journal.

I could not agree more. Shiga toxin is one of the most potent toxins known to man, so much so that the Centers for Disease Control and Prevention (CDC) lists it as a potential bioterrorist agent (CDC, n.d.). It seems likely that DNA from Shiga toxin-producing Shigella bacteria was transferred by a bacteriophage (a virus that infects bacteria) to otherwise harmless E. coli bacteria, thereby providing them with the genetic material to produce Shiga toxin.

Although E. coli O157:H7 is responsible for the majority of human illnesses attributed to E. coli, there are additional Stx-producing E. coli (e.g., E. coli O121:H19) that can also cause hemorrhagic colitis and post-diarrheal hemolytic uremic syndrome (D+HUS). HUS is a syndrome that is defined by the trilogy of hemolytic anemia (destruction of red blood cells), thrombocytopenia (low platelet count), and acute kidney failure.

Stx-producing E. coli organisms have several characteristics that make them so dangerous. They are hardy organisms that can survive several weeks on surfaces such as counter tops, and up to a year in some materials like compost. They have a very low infectious dose meaning that only a relatively small number of bacteria (< 50) are needed “to set-up housekeeping” in a victim’s intestinal tract and cause infection.

I represented three Hemolytic Uremic Syndrome victims in an outbreak of E. coli O21:H19 linked to a Utah Wendys in 2006. Non-O157:H7 was also likely responsible for some of the illnesses in the Dole Spinach outbreak of 2006.

I also recently gave a speech in front of the USDA/FSIS on making all Shiga-toxin producing E. coli’s adulterants under the US Meat Inspection Act. Here is that text:

Another issue facing, not only the meat industry, but all of us, is the extent to which non-O157 E. coli may be present in food products – FSIS regulated or not. It is clear that Non-O157 Shiga toxin producing E. coli have emerged as a public health issue. Some non-O157 possess the same range of virulence factors as E. coli O157:H7 and are capable of causing serious illnesses, or death. Numerous serotypes, including O26, O103, O111 and O145 have been identified as agents of food borne disease.

I have seen their nasty work in the Dole spinach outbreak and an outbreak in Utah involving Wendy’s. Since 1990, 13 outbreaks of non-O157 E. coli have been reported in the US. While E. coli O157 is the principal strain isolated from implicated food and clinical isolates in the US, non-O157 predominate in other countries, including several of our beef trading partners like Australia, Brazil and Canada.

I will leave this to scientists and public health officials to sort all out. However, perhaps one needs to look no further than the FEDERAL MEAT INSPECTION Act and look at the term ''adulterated" for and answer. A product is adulterated: (1) if it bears or contains any poisonous or deleterious substance which may render it injurious to health." If non-O157 E. coli fits the bill, then to me that answers the question. However, what do we then do about salmonella, listeria, campylobacter, and shigella – especially those with particular virulence or antibiotic resistance?

One thing to remember, whether a product is considered to be an adulterant under the FMI or not, if a food product contains a bacteria or virus that sickens or kills, civil liability can, and often will attach. My vote is to simply get pathogens out of your product.

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As Tim Hay of the San Mateo County Times reported today, a multinational food company and a Salinas vegetable farm have been ordered to pay an undisclosed amount to an elderly woman who was sickened in an outbreak of E. coli in a local retirement home, as well the son of a woman who died after eating the same tainted spinach in October 2003.

Marler Clark sued Sodexho USA and River Ranch Fresh Foods after an outbreak of the food-borne illness sickened at least 16 people and caused the deaths of two others at the Sequoias Portola Valley retirement community.

County health officials said the outbreak was most likely caused by pre-packaged spinach that Sodexho bought from River Ranch and served at the 315-bed home.

Marler Clark represented Keith McWalter, whose 85-year-old mother, Alice McWalter, died when the E. coli caused kidney failure. Mrs. McWalter was hospitalized on Oct. 14, and suffered 12 days of fever and nausea before she died.

The other Marler Clark client was Sequoias resident Sarah Ish. She was hospitalized with severe nausea during the outbreak, but pulled through.

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As the The Salinas Californian reports, legal consequences of two food-borne illness outbreaks that sickened at least 63 people and killed one in 2003 have returned to the Salinas Valley, where state investigators say lettuce and spinach -- contaminated at an unknown point before they were eaten -- were grown.

Beginning with those infected with E. coli 0157:H7 by the tainted produce, lawsuits have blossomed throughout the food-growing and distribution chain. Now River Ranch Fresh Foods and Diamond Produce, the two companies said to have grown the contaminated lettuce and spinach, have taken preliminary steps toward suing Monterey County.

Lawyers for the two Salinas-area companies say the Monterey County Water Resources Agency failed to maintain Santa Rita Creek, resulting in flooding in 2003 that spread waste across a field where produce was grown.

From the article:

Forty of the customers sickened at Pat & Oscar's sued the restaurant chain and settled their claims just before Christmas, said Bill Marler, a Seattle attorney who represented 29 of them.

Marler also represents the family of McWalter and Sarah Ish, another sickened Sequoias resident, in lawsuits against Sodexho USA, he said.

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As the Herald Salinas Bureau reports, Marler Clark clients who were victims of an E. coli outbreak involving contaminated vegetables grown in Salinas Valley are settling their claims against the restaurants serving tainted produce in 2003.

But the legal cases continue while the restaurant owners attempt to pin the blame on Salinas Valley produce companies, and operators of those produce companies blame the Monterey County Water Resources Agency.

Terms of the settlement agreement between the restaurants and the approximately 49 victims of the outbreak are confidential. Not all those claims have been settled, but most have.

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So far eight families have contacted Marler Clark, and one lawsuit has been filed, over the Wendy's ground beef E. coli outbreak in Marion County.

One family was hit twice when the two sons, a 4-year-old and a 23-month-old, became sick from E. coli. The 4-year-old was released last week from Oregon Health Sciences University Hospital, and the 23-month-old remained in fair condition Saturday night. Both had been on dialysis, after which patients can either recover or require transplants, depending on the severity of the condition.

As the Statesman Journal reports, three weeks after the largest E. coli outbreak in Marion County history, the investigation focuses on Wendy's ground beef, said Dr. Paul Cieslak of the Oregon Health Division. The connection was made after a second Wendy's restaurant in Tualatin was linked to the outbreak when an adult female was confirmed Sept. 2 as an E. coli victim. The DNA of the E. coli matched that of the Salem outbreak, confirming a common contamination source.

The lettuce link can be explained by cross contamination, which may have occurred because of improper food handling.

From interviews with Wendy's employees, officials determined that a few workers had washed lettuce in a sink that had not been sanitized and previously contained utensils that had touched raw meat.

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The Washington Supreme Court today declined to review last year's Court of Appeals decision upholding a $4.6 million award to 11 children injured in a 1998 E. coli O157:H7 outbreak that was linked to undercooked taco meat served as part of a school lunch at Finley Elementary School. School District had sought the Supreme Court's review arguing that school districts should not be held legally responsible if ill-prepared food sickens or kills a student. The Supreme Court refused to consider the argument.

Denis Stearns, one of the founding partners at Marler Clark, said:

"Washington State has a long history of holding school accountable when the children in their care are injured or killed. We believe that the Supreme Court's decision today reaffirms the principle that, when it comes to preparing food for their students, a school's foodservice operation should be held to the same high standard as any other restaurant licensed to operate in this State."

"School-aged children are more vulnerable than most when it comes to exposure to contaminated food. Those who argue for lower-standards plainly do not understand what the problem is, or what is truly at stake. If anything, schools should be held to the highest standards. These are our children we are talking about."

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As the Denver Post reports, Tuesday Marler Clark settled with ConAgra Foods the claims of six more victims - three of them in Colorado - who were sickened or died after eating E. coli-tainted beef last summer. That brings to 21 the number of cases ConAgra has agreed to pay without going to court. At least six more victims' claims are pending from the 18.6 million-pound meat recall in July.

The six claims settled Tuesday involved the most seriously affected by the meat, including a 68- year-old Ohio woman who died, the only death among 47 illnesses linked to the recall.

The Colorado cases settled Tuesday involve two girls, 2 and 17, and a 4-year-old boy. The other settlements involve a 2-year-old Nebraska boy and a 7-year-old boy from South Dakota.

The victim who died was Patricia Pfouts of Whitehall, Ohio, who worked as a day-care provider at a grocery store where some of the tainted meat was sold.

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Back in late 2003, Todd Frankel of the Post-Dispatch called dining with me an unusual experience in his article "Seattle attorney is representing 5 of 6 victims in E. coli outbreak," which referred to the Habaneros E. coli outbreak in Missouri.

I told him:

"I haven't eaten a hamburger since Jack in the Box," Marler said, referring to the massive 1993 E. coli outbreak on the West Coast that served as his first experience with his narrow specialty.

"The level of trust we have toward our food supply, in my view, is unwarranted," Marler said, taking another bite of his salad.

In case you were wondering, I'm still not eating hamburgers.

He also wrote:

He doesn't go trolling for business, he said. He's been involved in several high-profile outbreaks: from salmonella in fruit juices to E. coli at an Atlanta water park.

I'm still not trolling. Yet those cases still keep finding me.

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A White Water reminder from the past:
E. Coli Victims Sue White Water; Addison and Shook Families File for Damages

Back in July of 1998, we filed lawsuits for the families of Matthew Addison, age 3, from Louisville, Ky., and Jordan Shook, age 4, from Cartersville, Ga., in Cobb County against White Water. This was a situation where both children developed kidney failure and required dialysis as a result of ingesting E.coli 0157:H7 at the White Water park in Marietta.

Both children were hospitalized, and one suffered a stroke as a result of HUS.

Fortunately, the White Water E. coli outbreak helped put in place a number of precautionary safety measures to prevent future outbreaks, but as I said then:

"The children who developed hemolytic uremic syndrome (HUS) from the E. coli poisoning are at risk of developing long-term complications, including kidney failure, learning disabilities and other medical problems."

We can get clients settlements large enough to cover their medical bills and any other financial need they may ever have. But there is no amount of money big enough to compensate for the loss of a child's health, or to compensate parents for the anguish of watching their children nearly die before them. That's why we work so hard here to try to inform and educate about prevention, so I can be put out of a job and gladly find another line of work.

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As the Associated Press reported yesterday, I filed my lawsuit against Crossroads Farm Petting Zoo Friday on behalf of my clients whose young children got HUS from E. coli contamination at the North Carolina State Fair. Some of these families have more than $100,000 in medical bills, so this won't be a cheap lawsuit. Not that HUS cases ever are.

And not that there's any amount of money in the world that could restore what these families have lost. One family had two preschool boys who became severely ill, with one boy hospitalized for 10 days and the other for 17 days. All of the children involved in the lawsuit were 3 or younger.

As the AP reports:

"Twenty-four outbreaks have been linked to fairs and petting zoos since 1995," Marler said after the lawsuit was filed. "At this petting zoo, procedures were woefully inadequate to prevent an outbreak."

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North Carolina health officials announced Thursday that the Crossroads Farm Petting Zoo exhibition at the state fair in October. This was a heartbreaking outbreak -- one that caused 15 young children to get HUS. Four out of the 15 are still on kidney dialysis. Half of the 108 people infected with E. coli were 5 years old or younger, and two-thirds were under 18.

As the Associated Press reported yesterday:

Health inspectors found that those infected at the State Fair were most likely to have fallen down in manure, touched manure, stepped on manure or had animals jump on them.

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To the editor:

Regarding the recent outbreak of E. coli across the state, the blame now apparently rests squarely on the shoulders of departing Commissioner Britt Cobb and the Department of Agriculture under his watch. Mr. Cobb and the state agency he oversaw are charged with "... controlling and eliminating animal diseases and ensuring general animal health." This according to the department's own web site.

The E. coli outbreak at the N.C. State Fair last month which infected over 100 fair goers, half of them children, illustrates the unreserved lack of attention and prioritization by the former commissioner's Veterinary Division and exposes serious flaws in judgment and oversight at the very event which is expected to showcase the Agriculture Department's best side. But alas, Mr. Cobb's apparent lack of experience failed those who have entrusted him with ensuring their health and safety.

Sobering questions come to mind. Why were there not enough hand washing stations? Why were patrons, including parents of children, charged a fee for hand sanitizer? Why was all petting zoo livestock not tested for E. coli if possible?

Mr. Cobb is currently contesting the results of the commissioner of agriculture election, even though he clearly lost. He is maneuvering for another special statewide election to undo the will of the majority who elected his opponent Steve Troxler. Why would voters place their trust and confidence in an appointee such as Mr. Cobb who is clearly more preoccupied with his political career than the welfare of the children who patron the petting zoos at the N.C. State Fair under his administration?

Reagan Sugg
Greensboro

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The Charlotte Observer in an article this week said cases of E. coli infection have tripled since last week to 112 as N.C. health officials narrowed their search for the source of bacteria to last month's State Fair.

State epidemiologist Dr. Jeffrey Engel told the media that they're investigating all areas where people have contact with animals, including the fair's two petting zoos and other livestock exhibits, and that contaminated food is also under investigation.

My client Kevin Closson, whose 3-year-old daughter was hospitalized for 16 days and nearly died of kidney failure after visiting the petting zoo at a county fair in August 2002, was quoted in the article. "This is not new," Closson said, "and people are not learning from the mistakes of other people that run these fair venues." Closson's daughter was one of two dozen families Marler Clark represented in the Lane County Fair E. coli outbreak.

In this case, the Charlotte Observer reports that one of the victims is a 21-month-old girl. Several kids have been hospitalized with HUS.

As I told Karen Garloch of the Observer:

"We the public have not kept up with the virulence of E. coli O157:h7 ... If you talk to every one of the parents from the Oregon case, they had no idea that this could happen," Marler said.

"When I used to take animals to the county fair, when I was a kid, no one ever heard of E. coli."

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As Sarah Avery reported for newsobserver.com, E. coli cases keep increasing in North Carolina. So far, 24 cases have been confirmed and 33 cases are being studied to see whether the cases are related.

The most common link among the people who are sick is a trip to the State Fair last month -- in particular, to a petting zoo exhibit. Of the 33 cases under scrutiny, 15 have State Fair connections, one attended the Cleveland County fair, seven did not attend the fair and the remainder have not completed the investigator's questionnaire.

"If it does turn out to be a petting zoo, there are thousands of people who were exposed, and they are widespread," said Dr. Jeffrey Engel, state epidemiologist. "People came to visit from other states."

The outbreak is North Carolina's largest E. coli infection since a 2001 incident in Robeson County that stemmed from unpasteurized butter offered to schoolchildren during a demonstration. More than 200 grew sick.

Food contamination, particularly from beef that has come in contact with animal feces during slaughter and processing, is often the source of E. coli infections, but petting zoos are also common sources.

William Marler, a Seattle lawyer who has built a national practice filing lawsuits in E. coli and other contamination cases, said petting zoos are aware of the dangers of the business, and most provide hand-washing stations. But even the best of precautions can still fall short.

He said he represented 25 families in an unsuccessful Oregon case in which people grew ill after visiting the petting zoo. Half of the victims washed their hands; half didn't. Babies in strollers got sick despite never getting out of their strollers or touching the animals.

"The frustrating thing was, there wasn't a common denominator," Marler said. "We were trying to figure out what the fair did or should've done to prevent the outbreak."

He said two of the North Carolina families in the current outbreak have called him, but he does not know whether there is a legal case. Much depends on what state health investigators turn up and whether the outbreak is traced to the State Fair.

"When I was a kid taking my cow to the fair, nobody even heard of E. coli," Marler said. "That was 35 years ago. But since Jack in the Box, and with repeated fair outbreaks, we have to be more vigilant."

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Marler Clark filed a lawsuit Tuesday on behalf of Patricia and Asa Wasden, the parents of Ian Wasden, a two-year-old boy who suffered from Hemolytic Uremic Syndrome (HUS) after contracting E. coli O157:H7 last June at Kid's Korner daycare in Joplin.

"After the first child attending Kid's Korner tested positive for E. coli, the daycare operators should have notified all parents and taken extra precautions to ensure that no other children became ill," said William Marler, managing partner of Marler Clark. "Instead, they continued to operate the daycare as if nothing was wrong, which probably led to dozens of illnesses that could have been prevented."

Through interviews with families, officials from the Joplin Health Department and the Missouri Department of Health learned that Kid's Korner failed to notify 32% of families whose children had attended the daycare and were therefore exposed to E. coli O157:H7. Overall, 26 children attending Kid's Korner experienced diarrhea during the month of May, and four submitted stool samples that cultured positive for E. coli O157:H7.

"When you look at the facts, particularly the Health Department report, it is obvious that Kid's Korner showed a blatant disregard for the safety of Ian Wasden and all other children who attended their daycare," Marler concluded. During their investigation, officials visited the daycare on several occasions, and noted numerous "non-compliances" that were considered "likely to be linked to disease transmission."

Ian Wasden was hospitalized for nearly three weeks, undergoing a full week of kidney dialysis, seven blood transfusions, three surgeries, and a severe case of pancreatitis. He was released from Children's Mercy Hospital on June 20, 2004, but continues to suffer from painful abdominal cramping. His kidneys have not fully recovered from the effects of E. coli and HUS.

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My firm has filed lawsuits in Milwaukee on behalf of four children who were sickened by E. coli after eating at Sizzler restaurants. As the Associated Press reports, more than 60 people got sick and a 3-year-old South Milwaukee girl died after eating at the restaurants in July 2000. Investigators blamed Sizzler's meat handling procedures for the contamination.

Milwaukee County Judge Michael Sullivan ruled in May 2002 that Excel couldn't be sued for supplying the beef to Sizzler restaurants in Milwaukee and Wauwatosa. Excel's attorneys had argued the company wasn't liable because it didn't mishandle the meat and complied with U.S. Department of Agriculture inspections before shipping.

But a state appeals court overturned that ruling a year later, saying even though federal authorities inspected the meat, the processor still had to make sure it was safe. The court reinstated 14 lawsuits against Excel. Excel appealed to the U.S. Supreme Court, but the court refused to hear the appeal, clearing the way for the lawsuits.

"It is time for the company to take responsibility for its actions and compensate victims of its negligence," said William Marler, managing partner of law firm Marler Clark, which is representing the children.

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As Joshua L. Kwan reported in his San Jose Mercury News story Woman's son sues over E. coli death, the son of an 85-year-old woman who died last year during an E. coli outbreak at a Portola Valley nursing home has sued the food service company that supplied contaminated spinach to the home.

''The wrong is that someone got sick,'' said Bill Marler, an attorney for McWalter's family. ''And it came from food that these people served,'' he said about Sodexho. ''In a sense, it's case closed.''

Keith McWalter said his mother complained of abdominal pain when he visited her Oct. 12. She was hospitalized Oct. 10, but residents weren't warned of a possible E. coli outbreak until Oct. 13. Matsumoto said the home did not receive test results indicating an E. coli problem until Oct. 13.

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As Tim Hay of the San Mateo County Times reported in his story Firm sued over E. coli outbreak, my firm has filed a lawsuit on behalf of the son of 85-year-old Alice McWalter, one of at least 16 Sequoias Portola Valley residents and workers sickened with E. coli from eating spinach purchased and served by Sodexho. Alice McWalter was hospitalized for stomach pains on Oct. 14, and suffered through 12 days of fever, nausea and seizures before she died of kidney failure.

"That [they] died after eating contaminated spinach is particularly disturbing," attorney Bill Marler said in a prepared statement. "The whole state of California was, or should have been, paying special attention to food safety -- especially fresh produce safety -- at the time of this outbreak, since an outbreak in the San Diego area had been traced to E. coli-contaminated lettuce just weeks before."

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From a recent article in the San Mateo County Times:

The families of several local E. coli sufferers have contacted a Seattle-based lawyer who has collected tens of millions of dollars in settlements in food-poisoning cases. William Marler, a personal-injury attorney who has represented hundreds of E. coli, salmonella and botulism victims, said Tuesday several County families have called his office to inquire about filing lawsuits.

As the outbreak of E. coli in the Sequoias-Portola Valley retirement community went into its 19th day Tuesday, one of two sufferers who had remained hospitalized at Stanford Medical Center was released.

And the family of Alice McWalter -- the 85-year-old resident who died from kidney failure related to E. coli on Sunday -- began preparing for a memorial service at her beloved Valley Presbyterian Church in Portola Valley.

As the San Mateo County Times reported, health officials are still tracking the source of the outbreak, which sickened dozens of residents and staff members at the retirement center since it was reported Oct. 9. County Health Officer Scott Morrow said Monday that "food and food handlers" were being closely scrutinized, and said a report on the cause of the outbreak should be completed within a week.

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Todd Frankel of the Post-Dispatch called dining with me an unusual experience in his recent article "Seattle attorney is representing 5 of 6 victims in E. coli outbreak," which refers to the recent Habaneros E. coli Outbreak in Missouri. As Frankel reported:

"I haven't eaten a hamburger since Jack in the Box," Marler said, referring to the massive 1993 E. coli outbreak on the West Coast that served as his first experience with his narrow specialty.

"The level of trust we have toward our food supply, in my view, is unwarranted," Marler said, taking another bite of his salad.

As well as food, Frankel and I discussed the recent Missouri E. coli outbreak. As I told Frankel, I was in St. Louis two weeks after the Habaneros outbreak was first publicized. I've been contacted by two of the victims' families.

"He doesn't go trolling for business, he said. He's been involved in several high-profile outbreaks: from salmonella in fruit juices to E. coli at an Atlanta water park.

Marler said he hopes to avoid filing suit in the Habaneros case. He has been talking with the restaurant's insurance carrier to work out payment for the victims' medical bills. He estimated that the most seriously injured, Patty Timko, would have bills in excess of $250,000.

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In his recent article "E. coli Strikes Like Lightning," Todd C. Frankel of the Post-Dispatch recently reported on several of the e. coli victims who ate at Habaneros at the St. Clair Square mall.

Frankel reported on Stan Pawlow (age 7) who spent six days in the hospital and still asks if his food is tainted, Kate Reed (age 24) who was hospitalized with what she referred to as the worst pain in her life, Brett Hellinga (age 29) and Jamie Eastwood (age 25) whose severe symptoms forced them both to go to the emergency room, and Patty Timko (age 20) who suffered kidney failure and severe seizures when the e. coli poisoning traveled to her bloodstream.

From Frankel's Post-Dispatch article:

Her back arched off the hospital bed. Her jaw slammed shut. Her face, covered with light freckles around the nose, turned deathly blue.

A seizure gripped Patty Timko.

This seizure was unlike the others in recent days, when she went rigid, as if holding herself back from flying out of bed. This one was worse, her family said later. And it wasn't letting go.

Her father struggled to hold on to Timko's right leg. Her mother grabbed her daughter's left hand. She wanted to sing to her, to calm her. Phyllis Timko is a music teacher, and the earlier seizures were made somehow easier by songs like "All Night, All Day, Angels Watching Over Me" and "Somewhere Over the Rainbow." But all she could do now was urge her daughter to breathe.

E. coli 0157:H7 is a sickness with no cure.

"I'd rather roll the dice with salmonella or campylobacter than E. coli 0157:H7," said Bill Marler, a Seattle lawyer who specializes in litigation tied to food-borne illness.

Each year, the E. coli strain leads to 73,000 cases, 2,100 hospitalizations and about 60 deaths. It causes severe bloody diarrhea and intense abdominal cramping; some female victims compare the pain to childbirth. In the worst cases, the toxins spill from the intestines into the bloodstream, causing hemolytic uremic syndrome. That was what hit Patty Timko so hard.

It is a sickness with no cure. Antibiotics are useless. Doctors are left only to wait for the pathogen to run its course.

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The families of 11 children sickened by E. coli bacteria in a school lunch nearly five years ago will likely get the $4.6 million awarded by a jury.

A Benton County Superior jury awarded $4.6 million in early 2001 after finding the district at fault for serving undercooked meat in tacos to Finley Elementary School students in October 1998.

The district's insurers had asked the state's highest court to consider the case, but the justices refused on Thursday for the second time.

Marler Clark's Denis Stearns said:

"The only option remaining is to ask the high court to reconsider, but succeeding in that bid would be highly unlikely in a case the justices have twice refused."

The affected families are glad the court battle is over. Five years have passed since the kids ate the tainted taco lunch, and these families still have medical bills to pay.

2-year-old Faith Maxwell was awarded $3.6 million, plus past medical expenses, even though she didn't eat the contaminated taco meal. She was infected by a child who ate the lunch and suffered serious kidney problems that are expected to cause her kidneys to fail.

The other 10 children's awards started at $1,200 plus medical expenses. Children besides Faith who had kidney problems and were taken to Children's Hospital in Seattle were awarded about $275,000, plus past medical expenses.

Most of the money not spent on medical expenses so far will be held in trust for the children's education and medical expenses.

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The Washington Supreme Court today declined to review last year's Court of Appeals decision upholding a $4.6 million award to 11 children injured in a 1998 E. coli O157:H7 outbreak that was linked to undercooked taco meat served as part of a school lunch at Finley Elementary School. School District had sought the Supreme Court's review arguing that school districts should not be held legally responsible if ill-prepared food sickens or kills a student. The Supreme Court refused to consider the argument.

Denis Stearns, one of the founding partners at Marler Clark, said:

"Washington State has a long history of holding school accountable when the children in their care are injured or killed. We believe that the Supreme Court's decision today reaffirms the principle that, when it comes to preparing food for their students, a school's foodservice operation should be held to the same high standard as any other restaurant licensed to operate in this State."

"School-aged children are more vulnerable than most when it comes to exposure to contaminated food. Those who argue for lower-standards plainly do not understand what the problem is, or what is truly at stake. If anything, schools should be held to the highest standards. These are our children we are talking about."

In its investigation of the outbreak, the Washington State Department of Health found that the Finley School under-cooked the taco meat. The Department further found the "differences in the preparation, handling, and transport of meat may have allowed for uneven cooking, uneven cooling, and uneven re-heating at the elementary school. This outbreak and the resulting investigation highlight the importance of regular inspections of institutional kitchens and the need for training of food service workers."

In declining to accept review of the Court of Appeals decision, the Supreme Court foreclosed any further legal options for the school district and its insurers. Stearns said:

"While this day has been long in coming, it is a day that our clients are grateful for. They will get the compensation that the jury found them so deserving of, and can now get on with their lives."

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Two dozen families plan to file a lawsuit today against Lane County and the Lane County Fair Board, seeking damages for illnesses caused by the biggest outbreak of E. coli bacteria in state history at last year's county fair. All these folks became ill with a very deadly pathogen through no fault of their own. The fair board and the county could have done more to prevent these people from getting sick in the first place.

The families -- all but two from Lane County -- face a major hurdle even if they win a verdict from a local jury. Oregon law caps the liability of government agencies. Under the law, the most any single family could recover from the Fair Board and the county is $200,000. I will challenge the cap, and I put the county on notice last January that I planned to bring the action.

The suit lists 13 E. coli outbreaks at fairs, petting zoos and farms across the country since 1994, including three at county fairs in the Midwest in summer 2001. County fair officials were negligent if they knew about the earlier outbreaks and didn't take more aggressive steps to protect the public. If fair officials didn't know of the earlier outbreaks, they should have known.

The bottom line is the fair board created a place where people were bound to get ill regardless of what they did. Kids who never got out of their strollers, who never touched a cow, never touched a railing -- all they did was get wheeled through a shed, and they got sick.

Warren Wong, the fair's managing director, said the fair followed appropriate sanitary practices. "I believe what we did and have done are traditional and customary practices that represent the state of the industry," he said.

The fair plans to spend up to $25,000 to reduce the risk of E. coli infection at this year's exhibition by installing hand-washing stations outside animal barns, putting up signs and distributing brochures warning people of the risk.

The county should require that every animal be tested for E. coli. Some animals may slip through such a test, but it would go a long way to reduce risk.

E. coli is most commonly spread through contaminated ground beef and water. But public health investigators traced the fair outbreak to the sheep and goat exposition hall on the south side of the fairgrounds. Investigators never determined exactly how people got infected, but said the bacteria could have spread through straw contaminated with animal feces. Bacteria also were found in the building's rafters, indicating that it became airborne and could have fallen on food, floors, railings or people's skin.

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Marler Clark filed a lawsuit today against the Lane County Fair Board on behalf of 29 individuals and families of individuals who were infected with E. coli O157:H7 during an outbreak at the Lane County Fair last summer.

A number of fairs and petting zoos have been implicated in E. coli outbreaks in recent years. The Lane County Fair Board should have been aware of risks to patrons, and taken the necessary precautions to prevent this outbreak. These kids were severely injured, and many may suffer from complications of their E. coli infections later in life. Someone needs to be held responsible for what they went through.

I recommended taking the following steps to prevent outbreaks at future fairs:

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Two dozen people sickened by the biggest E. coli outbreak in state history filed a lawsuit Wednesday against the Lane County Fair Board, claiming the board didn't do enough to protect fairgoers given similar outbreaks in other states.

Eighty-two people became sick at the fair -- nearly two-thirds of them younger than age 6. Twelve children were treated at Portland hospitals for hemolytic uremic syndrome, or HUS, a potentially fatal complication of E. coli infection that causes kidney failure.

Tim Outman and Kimberly Kessel took their boys, Makyah and Kyler, to the fair on Aug. 17. The parents pushed the boys through the animal barns in a double stroller. At one point, Makyah got out to inspect a mother pig nursing her piglets and put his hands on the railing of the pen, Kessel said. She wiped off his hands afterward. Kyler, now 2, never got sick. But within days, Makyah, now 4, became violently ill with cramps, abdominal pain, bloody diarrhea, vomiting and fever.

They took Makyah to Doernbecher Children's Hospital in Portland for three days to treat his HUS. The boy avoided dialysis and blood transfusions and today seems to be doing fine, with no sign of permanent damage, Outman said. Outman and Kessel are both artists. They live in Eugene and have a studio in McKenzie Bridge. They don't have health insurance and incurred about $15,000 in medical expenses during their son's illness.

Outman called the fair board after the outbreak and asked it to cover their medical bills. He said he was told to send a copy of the bills to the fair board for coverage. But when he called back after sending in the bills, he was told the county wouldn't cover their expenses. That's why they decided to join the suit.

"The fair board didn't seem to use a reasonable amount of care to prevent this," Outman said. "If someone comes on our property and gets injured, the standard we're held to is warn people or make it safe, and the fairgrounds did neither of those."

While Outman and Kessel hope their son won't have long-term health problems, many children who get HUS develop serious complications later in life and require lifelong medical care.

Carson Walter, the 2-year-old daughter of William and Shelly Walter of Eugene, spent 31 days at Doernbecher and underwent 17 rounds of dialysis, a process that filtered toxins and excess water from her blood.

Today, Carson "seems to be fairly stable," though she's still taking blood pressure medicine, her mother said. The long-term damage to her kidneys won't be known until she's 10 or 12.

Madeleine Closson, 3, is doing well 10 months after she spent 15 days and underwent three surgeries at Doernbecher after she developed HUS, said her father, Kevin Closson of Portland. "That's a hell of a lot to put a kid through," he said. But she often wakes up in the middle of the night, gets headaches and routinely suffers painful stomachaches, he said, though he's not sure whether those are complications of her E. coli-induced illness.

Lane County Commissioner Bill Dwyer said he doesn't think the county or the fair board can be held liable for the outbreak.

"Whenever you're around animals, there's a risk you have to take," he said. "The question is, was it reasonable what the county had done? I'd say it was probably the cleanest fair we ever had. You take some risks when you allow your children to peruse among animals," Dwyer said.

Even with the cap on damages, the Lane County Fair pays about $61,000 a year for a $5 million general liability insurance policy to guard against federal lawsuits, out-of-state claims or contractual liability claims.

I will challenge the constitutionality of the state's "tort caps," as they're known. If I win, I'll ask the jury to award damages that would compensate at least some victims for a lifetime of medical care -- sums that would likely run into millions of dollars and exceed the state cap.

The trial judge would then decide whether the cap applied. Whichever side lost that argument would appeal to the state Court of Appeals and ultimately to the state Supreme Court -- a process that could take years.

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The family of one of the teens that contracted E. coli poisoning at a Washington camp last summer has sued Spokane Produce Inc. County health officials implicated the firm's romaine lettuce as the possible source of infection. But Spokane Produce says the lawsuit hinges on a flawed investigation by local health officials and that the scientific evidence falls short of implicating the company's product.

Last July, health officials investigated an E. coli O157:H7 outbreak at a summer dance camp after some 50 campers complained of nausea, vomiting and other gastrointestinal symptoms. Investigators with the Spokane Regional Health District conducted several inspections of the camp, tested water samples, interviewed food service staff, and polled campers on diet choices in search of the cause of the outbreak. By July 31, 33 cases of E. coli O157:H7 were confirmed by culture in Spokane County. The food surveys showed a strong association between a salad offered at the camp and a culture-confirmed gastroenteritis, said a report issued by the Spokane Regional Health District.

At the same time, reports of E. coli infection sprung up in other locations; some samples matched the campers' stool samples, while others didn't. Those patients whose infection matched the campers remembered eating a salad containing romaine lettuce at Walla Walla and Spokane restaurants, both of which were later traced to Spokane Produce, said the local health department's report.

With data from the dance camp and the Walla Walla case, FDA moved quickly to implicate Spokane Produce's romaine lettuce as the culprit and issued a nationwide alert advising the public to throw out the company's bagged, prewashed, precut romaine lettuce. Sources say documents unearthed in preparation for the legal battle show Washington health officials were concerned that FDA moved too fast to issue the product withdrawal announcement.

Company says the investigation was mishandled.

FDA investigated the Spokane Produce plant, took hundreds of samples and found no evidence of E. coli O157:H7 at the company facility, nor has any E. coli O157 been found on any of the company's lettuce, said Gregory Arpin, an attorney who represents Spokane Produce.

The company says the investigation was mishandled, because health investigators sent out an incomplete survey to campers and employees who were asked whether they ate a Caesar salad with romaine lettuce at a July 11 dinner. Investigators failed to mention in the first survey that a tossed salad, with lettuce supplied from another company, was also offered that night. To clarify the survey, investigators sent another survey out on July 31-Aug. 1, just after FDA had sent out its July 29 nationwide warning about romaine lettuce. The risk ratio of people who got sick after eating the Caesar salad dropped when results of the second survey were analyzed, Arpin said.

Concerning the Walla Walla incident, documents show lettuce from Spokane Produce was either already consumed or thrown out by the time that person could have been served the salad, the company will argue. The surveys, which are critical in outbreak investigations, could raise questions about the scientific evidence supporting the government's charge that only romaine lettuce could have caused all the illnesses. The produce firm also suggests that other leads, such as whether the water supplied in the camp or whether at least one camper who showed up already sick at the Washington camp, weren't followed up on.

I say not enough was done.

Spokane Produce washed and cleaned the lettuce, but it was not enough. Kids still got sick. My client, Angela Hadley, developed hemolytic uremic syndrome, a life-threatening condition, and may have long-term kidney problems as a result of exposure to E. coli O157:H7. The likelihood that another source caused the outbreak is slim, since health investigators found other people whose illness matched the campers' fingerprint and who ate the lettuce.

The lawsuit is based largely on the county health department's report on the outbreak and the government's conclusion that the produce company should be held responsible for her illness. Even if FDA moved too quickly to issue the warning, it doesn't mean they got it wrong. An investigation of the Eastern Washington University Dining Service, which administered the meals at the camp, didn't identify any food handling practices that might have been a probable source of contamination of the salad.

The lesson for the industry is that produce companies need to learn as much as they can about their suppliers, make clear in contracts where the responsibility lies in the event of a mishap, and have sophisticated traceback systems in place. Some of the California farms that supplied the company's romaine lettuce followed better sanitation procedures than other suppliers.

For now, both sides of the case are waiting on a missing piece in the puzzle: the state health department's report on the outbreak. That report, which has been delayed due to internal personnel changes and competing public health priorities, is close to being completed and may be available in the next few weeks. It will include an analysis of the epidemiological evidence gathered in the case. FDA is not expected to issue a similar report.

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