Familiar with strict liability? Schnucks sued over E. coli outbreak

A woman from St. Charles County is seeking damages from Schnucks and three companies in its supply chain after suffering kidney failure and long-term health problems from an E. coli bacterial infection linked to romaine lettuce sold at the Arsenal Street store in St. Louis, according to a lawsuit filed Tuesday in St. Louis circuit court.

lettuce.skull.e.coli.O145The St. Louis Post-Dispatch reports that Romaine lettuce from salad bars at nine Schnucks locations was the most common denominator in an E. coli outbreak in the fall of 2011 that sickened 60 people in 10 states. The contamination probably occurred at a farm before the lettuce reached the stores, according to a federal health investigation.

The plaintiff, Lisa Bryant, spent a week in the hospital and required blood transfusions while being treated for the illness after eating the lettuce in October 2011. She has accrued more than $85,000 in medical bills, according to her attorney, Bill Marler of Seattle.

About a dozen lawsuits related to the outbreak have been filed against Schnucks. Lori Willis, a spokeswoman for Schnucks, said, “It is our position that Schnucks holds no liability on this matter, and we intend to aggressively defend that position in court.”

58 sick; E. coli O157:H7 outbreak – it’s over — linked to romaine lettuce

The Romaine-lettuce-served-at-Schnucks-salad-bars E. coli O157:H7 outbreak that sickened 58 people in the Midwest last fall has received the final-write-up treatment from the U.S. Centers for Disease Control, with many questions unanswered.

In the excerpts below, Chain A is Schnucks, and the farm the lettuce was traced to Farm A, although one Missouri health type at the time said a grower in California was suspected of being connected but records were “insufficient to complete the picture.”

Yes, there are vast limitations when conducting a food safety outbreak investigation, but the public reporting of this outbreak still reeks of the Leafy Greens Cone of Silence – that the most noticeable achievement since the California Leafy Greens Marketing Agreement was created in the wake of the 2006 E. coli O157-in-spinach mess is the containment cone of silence that has descended upon outbreaks involving leafy greens.

Things didn’t sound quite right back on Oct. 28, 2011, when St. Louis County health officials first publicly confirmed that the source of the E. coli O157 strain that had sickened 23 people was foodborne, but that the investigation was ongoing. Though retailers had not been asked to pull any food, Schnucks voluntarily replaced or removed some produce in salad bars and shelves, beginning Oct. 26, 2011.

"Once we heard that the health department had declared an outbreak, we took some proactive steps with our food safety team to switch products out that recent history told us could be potential sources," said Schnucks spokeswoman Lori Willis.

A Schnucks store, Culinaria in downtown St. Louis, put a sign up on empty shelves that read in part, "Due to a voluntary recall on pre-packed lettuce, we will not be able to produce these pre-made salads. Be assured quality is our main concern. All of the lettuce on the salad bar is fresh and not involved with the recall."

A table of leafy green related outbreaks is available at http://bites.ksu.edu/leafy-greens-related-outbreaks.

The U.S. Center for Disease Control reports CDC collaborated with public health and agriculture officials in Missouri, other states, and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Escherichia coli serotype O157:H7 infections linked to romaine lettuce. Public health investigators used DNA "fingerprints" of E. coli O157:H7 bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that may be part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

As of March 21, 2012, 58 persons infected with the outbreak strain of E. coli O157:H7 were reported from 9 states. The number of ill persons identified in each state was as follows: Arizona (1), Arkansas (2), Illinois (9), Indiana (2), Kansas (2), Kentucky (1), Minnesota (2), Missouri (38), and Nebraska (1). Two cases were removed from the case count because advanced molecular testing determined that they were not related to this outbreak strain. Among persons for whom information was available, illnesses began from October 9, 2011 to November 7, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 28 years. Fifty-nine percent were female. Among the 49 ill persons with available information, 33 (67%) were hospitalized, and 3 developed hemolytic uremic syndrome (HUS). No deaths were reported.

This particular outbreak appears to be over.

Collaborative investigative efforts of state, local, and federal public health agencies indicated that romaine lettuce sold primarily at several locations of a single grocery store chain (Chain A) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached grocery store Chain A locations.

During October 10 to November 4, 2011, public health officials in several states and CDC conducted an epidemiologic study by comparing foods eaten by 22 ill and 82 well persons, including 45 well persons who shopped at grocery store Chain A during the week of October 17, 2011. Analysis of this study indicated that eating romaine lettuce was associated with illness. Ill persons (85%) were significantly more likely than well persons (46%) to report eating romaine lettuce in the week before illness. Ill persons (86%) were also significantly more likely than well persons (55%) to report shopping at grocery store Chain A. Among ill and well persons who shopped at grocery store Chain A, ill persons (89%) were significantly more likely than well persons (9%) to report eating a salad from the salad bar at grocery store Chain A. Several different types of lettuce were offered on the salad bar at grocery store Chain A. Of 18 ill persons who reported the type of lettuce eaten, 94% reported eating romaine lettuce. No other type of lettuce or other item offered on the salad bar was reported to be eaten by more than 55% of ill persons.

Ill persons reported purchasing salads from salad bars at grocery store Chain A between October 5 and October 24, 2011. A total of 9 locations of grocery store Chain A were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Chain A fully cooperated with the investigation and voluntarily removed suspected food items from the salad bar on October 26, 2011, out of an abundance of caution. Romaine lettuce served on salad bars at all locations of grocery store Chain A had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached grocery store Chain A locations.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. Farm A was no longer in production during the time of the investigation.
 

60 sick with E. coli O157 in 10 states: it was Romaine lettuce (grown in California?) served at Schnucks salad bars by Mr. Green

A day after Missouri health types announced the source of the Schnucks-salad-bar-related E. coli O157 outbreak may never be found, the feds announced they found a source.

The U.S. Centers for Disease Control (CDC) reported today that as of Dec. 4, 2011, 60 persons infected with the outbreak strain of E. coli serotype O157:H7 had been reported from 10 states.

Collaborative investigative efforts of state, local, and federal public health and regulatory agencies indicate that romaine lettuce is the likely source of illnesses in this outbreak, and contamination likely occurred before the product reached retail stores.

CDC called Schnucks Chain A, and the farm the lettuce was traced to Farm A, without saying in what state the lettuce originated. But one of the Missouri health types did, saying a grower in California was suspected of being connected but records were “insufficient to complete the picture.”

The public reporting of this outbreak reeks of the Leafy Greens Cone of Silence – that the most noticeable achievement since the California Leafy Greens Marketing Agreement was created in the wake of the 2006 E. coli O157-in-spinach mess is the containment cone of silence that has descended upon outbreaks involving leafy greens.

Things didn’t sound quite right back on Oct. 28, 2011, when St. Louis County health officials first publicly confirmed that the source of the E. coli O157 strain that had sickened 23 people was foodborne, but that the investigation was ongoing. Though retailers have not been asked to pull any food, Schnucks voluntarily replaced or removed some produce in salad bars and shelves, beginning Oct. 26, 2011.

"Once we heard that the health department had declared an outbreak, we took some proactive steps with our food safety team to switch products out that recent history told us could be potential sources," said Schnucks spokeswoman Lori Willis.

A Schnucks store, Culinaria in downtown St. Louis, put a sign up on empty shelves that read in part, "Due to a voluntary recall on pre-packed lettuce, we will not be able to produce these pre-made salads. Be assured quality is our main concern. All of the lettuce on the salad bar is fresh and not involved with the recall."

As a retailer, Schnucks drew my attention earlier this year when it announced it was expanding its so-called Peace of Mind initiative from pricing to quality assurance with a new website, www.peaceofmindquality.com, that emphasizes the chain’s dedication to quality and food safety. Unfortunately, quality and safety are seemingly used interchangeably on the website when they are actually two different concepts.

A table of leafy green related outbreaks is available at http://bites.ksu.edu/leafy-greens-related-outbreaks.

I’m not feeling peace of mind.

More from the CDC report:

As of December 4, 2011, 60 persons infected with the outbreak strain of E. coli O157:H7 have been reported from10 states. The number of ill persons identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1).

Among persons for whom information is available, illnesses began from October 10, 2011 to November 4, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 29 years old. Sixty-three percent were female. Among the 45 ill persons with available information, 30 (67%) were hospitalized, and 2 developed hemolytic uremic syndrome (HUS). No deaths have been reported.

Collaborative investigative efforts of state, local, and federal public health agencies indicate that romaine lettuce sold primarily at several locations of a single grocery store chain (Chain A) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached grocery store Chain A locations.

Ill persons reported purchasing salads from salad bars at grocery store Chain A between October 5 and October 24, 2011. A total of 9 locations of grocery store Chain A were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Chain A fully cooperated with the investigation and voluntarily removed suspected food items from the salad bar on October 26, 2011, out of an abundance of caution. Romaine lettuce served on salad bars at all locations of grocery store Chain A had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached grocery store Chain A locations.

The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of grocery store Chain A and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply the grocery store Chain A locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. Farm A was no longer in production during the time of the investigation.

Unsolved mysteries: source of E. coli illnesses not found

Yesterday I gave a talk to fresh produce farmers and told them that outbreaks happen all the time and only in special cases, when all the right data is available, are health officials able to pinpoint a cause. I think it made some of the audience mad, but that’s the reality. Outbreak investigations are at the mercy of individual recall and product movement and condition attributes. All of which are often incomplete. It’s like my kids trying to put together a puzzle without the corner or border pieces. Health officials in Missouri announced yesterday that their investigation into an outbreak of pathogenic E. coli has ended. With no real answers. While preliminary epidemiology pointed to an association with eating food purchased from Schnuck’s salad bars, that was as far as things got.

According to Missouri Net, the data just wasn’t there.

Director Margaret Donnelly says the inspections and food trace-back investigation by federal agencies were extensive, but did not reveal a definitive source. She says a grower in California was suspected of being connected but records were “insufficient to complete the picture.” She told the House Appropriations Committee on Health, Mental Health and Social Services it is not unusual for a source to go unidentified. “The food which caused the outbreak is identified in less than 50 percent of food bourne (sic) outbreaks, and the reason for that is because of the amount of time that passes from when the person is exposed to the pathogen until the public health receives a report. This incubation period can be up to ten days. In addition, after that period of time, food products are often no longer available for analysis.”