Putting
a Price Tag on Food Poisoning Fallout
By Sharon Palmer, RD
Today’s Dietitian
Vol. 7 No. 6 P. 30
A food poisoning incident can be a mighty expensive
problem. Don’t think it can’t happen to you.
Today foodborne illness has gone beyond impersonal
statistics—now it has a name and a face. Like that of Brianne
Kiner, a 9-year-old girl from Washington State, who spent 40 days
in a coma, 188 days on dialysis, and received 80 units of blood
in 1993, just because she ate tainted hamburgers from Jack in the
Box. Brianne earned the title of being the sickest child in the
United States to survive E. coli 0157:H7. Over a three-month period
in 1993, more than 700 children and adults in four states in the
Northwest became ill after eating at various Jack in the Box restaurants.
Fifty-five cases progressed into hemolytic uremic syndrome and four
children died. The price tag for Brianne’s case of foodborne
illness? A mere $15.6 million, with Foodmaker, Inc., the parent
company of Jack in the Box, setting aside a $100 million pool to
cover all lawsuits related to the outbreak.1
Plenty of other high-profile food poisoning outbreaks
have made the evening news, newspapers, and court dockets in the
last decade. In May 1998, Odwalla Juice settled E. coli litigation
for a reported $12 million for the families of children who were
severely injured after consuming Odwalla apple juice. In 2001, the
jury returned a verdict of $4.75 million for an E. coli case involving
a school lunch program in Washington State. In 2003, 650 confirmed
cases were linked to a hepatitis A outbreak from a Chi-Chi’s
restaurant in Pennsylvania, resulting in three deaths, a liver transplant
for one man, and a class action law suit filed against Chi-Chi’s.
The 2004 Las Vegas Flamingo Hotel norovirus outbreak resulted in
more than 1,000 sick patrons and employees, prompting a class action
case to be filed against the hotel owners. Tomatoes produced by
Coronet foods and purchased at the Pennsylvania Sheetz convenience
stores caused a Salmonella outbreak in 485 people in 2004, with
the legal fallout spurring the closure and bankruptcy of the Coronet
plant.1
Very Expensive Bugs
Foodborne illness has become a tangible threat attached with very
real costs. The Centers for Disease Control and Prevention (CDC)
estimates that 76 million cases of foodborne illness occur in the
United States each year, with 325,000 hospitalizations and 5,000
deaths.2 The estimated costs of medical expenses and lost wages
and productivity due to foodborne illness is between $6.5 and $34
billion.3 In 2000, the Economic Research Service of the USDA estimated
the cost from five bacterial foodborne pathogens (Campylobacter,
Salmonella, E.coli O157, E. coli non-O157 STEC, and Listeria monocytogenes)
at $6.9 billion per year.4 A single outbreak of foodborne illness
can cost a foodservice operation as much as $75,000 in legal fees,
medical claims, lost employee wages, cleaning, sanitizing, discarded
food supplies, and lost revenue. This figure rises dramatically
if the incident involves death or serious injury.5
Food Poisoning as Personal Injury
William D. Marler, managing partner in the Seattle law firm Marler
Clark, LLP, PS, represented Brianne Kiner in the Jack in the Box
case, creating a Washington State record for an individual personal
injury action award. Marler also resolved several other Jack in
the Box E. coli cases for more than $2.5 million each. Since those
Jack in the Box days, Marler began focusing his practice exclusively
on foodborne illness cases, turning his law firm into the only one
in the states specializing in foodborne illness litigation. The
Marler Clark firm advises potential clients that if they have lost
wages and incurred medical bills, then they have a right to be compensated
for past and future expenses and pain and suffering.
Marler has taken on foodborne illness with a passion,
now dedicating his time to not only punishing the bad offenders
that make people sick, but teaching food companies the error of
their ways through his nonprofit organization, Outbreak, Inc. Outbreak,
Inc. aims to teach directors, managers, and staff the lessons they
need to learn before they make the next person sick. Bill Marler
is giving back through Outbreak, Inc., providing free education
services, only requesting reimbursement for travel expenses and
donations to food safety organizations.
“It’s not because of litigation that
people should be concerned about food poisoning, they should have
a moral reason to not make people sick,” says Marler, who
relies on video tapes of horribly injured children during his education
and consultation to make an impact on food operations. He often
finds food companies consulting Outbreak, Inc. after he successfully
sues them for a foodborne illness outbreak.
In this modern age of litigation, it’s easy
to wonder whether foodborne illness litigation is treading into
the frivolous lawsuit territory. But Marler says it isn’t
so. “We turn away about 90% of people who call about litigation
for foodborne illness. The reality is, if you poison someone, the
chances are you are not going to get caught. The CDC reports 76
million people with foodborne illness per year, while we only have
10,000 to 15,000 active files in our firm at any given time.”
The Good News and the Bad News
About Foodborne Illness
Fortunately, it appears that all of our preaching about food safety
might finally be paying off. The CDC reported in April that when
comparing 1996-1998 with 2004, the incidence of several foodborne
infections declined significantly. The estimated incidence of infection
with Campylobacter decreased 31%, Cryptosporidium decreased 40%,
E. coli O157 decreased 42%, Listeria decreased 40%, Yersinia decreased
45%, and overall Salmonella infections decreased 8%.6
“There is an enormous decrease in E. coli
O157 related to hamburger meat cases. I think that the restaurant
and beef industry are being more responsible. The meat industry
got tired of being sued. On average, I have not seen egregious conduct
[recently] that I have seen over the past years,” says Marler,
who points out that in the last decade high-profile outbreaks have
effected change in the industry, from testing the temperatures of
hamburger meat to pasteurizing juice.
Of new concern is the trend toward outbreaks due
to fresh produce that require little processing before eating and
serving. “With an increase in imports, we bring in products
from countries that don’t have HACCP [Hazard Analysis and
Critical Control Point] and bacteria and viruses are coming in that
we don’t have experience with,” says Marler.
Questions are being raised about the impact of recommendations
for consuming more fresh fruits and vegetables, even though many
may pose greater foodborne illness risks, such as sprouts, lettuce,
and cider. And although organic farming is good for the environment,
some public health experts are concerned about pathogens from animal
manure in foods that are eaten fresh or minimally processed. The
CDC reports that new pathogens continue to emerge and that the proportion
of outbreaks caused by fruits and vegetables has increased.7
“Sometimes a person’s natural instinct
turns to raw meat, poultry, and fish when they think about food
safety, hence ignoring safe handling with produce,” says Dana
Fillmore, RD, CFSP, corporate dietitian for Gordon Food Service,
a broad-line foodservice distributor in Grand Rapids, Mich. “However,
produce is certainly not exempt from food safety risk, as evidenced
by many foodborne illness outbreaks that have been traced back to
produce sources. We must train the foodservice industry to focus
food safety policies and procedures on all potentially hazardous
foods.”
A Place for Dietitians in Food
Safety
And what are we doing about the high cost of foodborne illness?
Apparently, not enough. “I start from the premise that food
has to be safe in order for it to be nutritious. Food safety is
one of the fundamentals that dietitians must integrate into their
practice,” says Cathie Woteki, PhD, RD, dean of the College
of Agriculture at Iowa State University. Woteki believes dietitians
should routinely spend a few moments with their clients to instruct
them on food safety basics. Not a bad idea when even the 2005 Dietary
Guidelines for Americans include a plug on food safety.
“I have incredible respect for food safety.
More nutritionists must be aware of what is going on. The field
is enormous, it goes way beyond the one-on-one,” says Arlene
Spark, EdD, RD, CSP, FADA, FACN, associate professor and coordinator
of nutrition and food science at Hunter College of the City University
of New York. Spark has served as a committee member for the New
York City Department of Health and developed a 2004 meeting on globalization
and food safety.
“The laws that the FDA enforces for food safety
place the burden of responsibility of food safety on producers,
processors, and preparers. That makes it an issue that dietitians
need to know more about,” says Woteki. “I think that
particularly for dietitians in foodservice management, these liability
issues and public health reasons for food safety should be a major
part of their concerns.” Of particular interest are dietitians
managing the care of patients or consumers who are at risk due to
compromised immune function.
“Dietitians can have input with the board
of health,” suggests Spark. Dietitians may also play a role
in influencing food policy, not only raising their voices on public
nutrition issues, but speaking up on food safety as well. By getting
involved with state agricultural and health departments, dietitians
can lend their support for food safety efforts.
Stumbling Blocks on the Path
to Food Safety
Any dietitian who’s had to pull on a hair net and grab a sanitation
checklist is fully aware of the many challenges that exist in developing
an effective food safety program. And even if you’ve written
the best food safety policies and procedures under the sun, they
may not actually happen during the daily grinding, chopping, and
dishing in a foodservice operation. “Many foodservice workers
are migrants and may be illiterate in both languages, so communication
is a challenge,” says Spark, who is working on a point-and-click
computer program to teach food safety to individuals who can’t
read. Developing a food safety training program that measures the
employee’s comprehension, willingness, and ability to perform
specific food safety practices is essential to the success of a
safe foodservice operation.
“When it comes to the safety of food, I feel
that the two most important things for a dietitian to have in place
are a comprehensive food safety and sanitation detailed policy and
procedures program, including a step-by-step action plan in case
of a possible foodborne illness outbreak within their foodservice
operation, and a comprehensive employee training program,”
says Fillmore, who helps identify HACCP policies and procedures
to be followed at Gordon Food Service. “HACCP is a great start
to protecting against foodborne illness outbreaks. Used correctly,
this approach will hopefully prevent a foodborne illness outbreak.
In the case of an outbreak, HACCP programs will provide important
documentation that could help identify the cause of the outbreak
and hopefully exonerate your staff from blame.”
“Food safety has to be constantly reinforced.
The HACCP approach in food preparation has been very beneficial
in standardizing approaches and helping to maintain better quality
control,” says Woteki, who says new data supports that HACCP
in meat and poultry processing has continued to lead to decreases
in pathogens in meat and poultry.
Justifying the Price of Food
Safety
In a recent survey of dietitians and dietary managers on food safety
practices, findings indicated that the greatest barriers to the
implementation of HACCP related to insufficient time and the need
for written policies for food safety.8 It is difficult to achieve
an effective food safety program without the allocated labor resources
to set it up.
“You go where the money is,” says Spark,
who finds that often management may not support a cause until there
is a value associated with it. With today’s high price for
foodborne illness litigation, maybe dietitians can finally attach
a cost savings for a high-quality food safety program.
And when it comes to the future of foodborne illness
in an age of global imports, dietitians should be braced for the
unexpected. “We need to be prepared for surprises. When E.
coli O157:H7 was first identified, that was a surprise. There could
be the emergence of another new food pathogen,” says Woteki.
“The margin of error is huge, more now than ever. We can’t
be complacent,” comments Spark.
Marler puts it all into perspective. “No one
ever thinks it’s going to happen to them.”
— Sharon Palmer, RD, is a freelance food
and nutrition journalist in Southern California.
References
1. Marler Clark, LLP, PS Web site. Available at: http://www.marlerclark.com.
2. Centers for Disease Control and Prevention Web
site. Division of Bacterial and Mycotics Diseases, Disease Information.
Available at: http://www.cdc.gov
3. Buzby JC, Roberts T. Economic costs and trade
impacts of microbial food borne illness. World Health Stat
Q. 1997;50(1-2):57-66.
4. Economic Research Service, USDA Briefing Room.
Economics of Foodborne Disease: Overview. Available at: http://www.ers.usda.gov/Briefing/FoodborneDisease/overview.htm
5. Lynn J. Better safe than sorry: Training food
handlers protects everyone. Restaurants USA. 1996:16(8):13-17.
6. Centers for Disease Control and Prevention. Preliminary
FoodNet Data on the Incidence of Infection with Pathogens Transmitted
Commonly Through Food – 10 Sites. United States. 2004, MMWR.
April 15, 2005/54(14);352-356. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5414a2.htm
7. Centers for Disease Control and Prevention. Foodborne
Infections – Technical Information. December 2003. Available
at: http://www.cdc.gov
Resource
Strohbehn CH, Gilmore SA, Sneed J. Food safety practices and HACCP
implementation: Perceptions of registered dietitians and dietary
managers. J Am Diet Assoc. 2004;104(11):1692-1699.
Food Safety Resources at Your Fingertips
FDA Center for Food Safety and Applied Nutrition
www.cfsan.fda.gov/list.html
Food Safety Training and Education Alliance
www.fstea.org
International Food Safety Council
www.foodsafetycouncil.org
National Food Safety Education Month
www.nraef.org/nfsem
Foodborne Illness Educational Information Center
www.nal.usda.gov/foodborne
Integrated Food Safety Information Delivery System
www.profoodsafety.org
Outbreak, Inc.
www.outbreakinc.com
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