This document summarizes the key factors that Marler Clark considers when evaluating potential foodborne illness cases and the challenges involved in proving them. It discusses the types of cases they typically take on and turn away, the importance of incubation periods and health department investigations. Specific examples are provided of cases that were proven using evidence like prior health inspections, improper food handling procedures identified, and lab tests confirming the pathogen and source. The document concludes with a detailed example of a real case involving an E. coli outbreak among elementary school students traced back to undercooked taco meat served in the cafeteria.

1. Separating the
Wheat from the Chaff
The Reality
of Proving
a Foodborne
Illness Case
William D. Marler, Esq.

2. The Chaff – Cases We Turn Away Every Day
• Since 1993 • Only a fraction of the victims
Marler Clark has who contact our office end
represented up being represented.
thousands of • Who do we turn away?
legitimate food
illness victims
in over 30 States.
Settlements and
Verdicts – total over
$600,000,000.

3. Incubation Period
• The time between
ingestion of a
foodborne pathogen
and the onset of
symptoms, are only
ranges – and wide
ones at that – they
can still be used to
identify a suspect
food-poisoning
claim.

4. Incubation Periods of
Common Foodborne Pathogens
PATHOGEN INCUBATION PERIOD
Staphylococcus aureus 1 to 8 hours, typically 2 to 4 hours.
Campylobacter 2 to 7 days, typically 3 to 5 days.
E. coli O157:H7 1 to 10 days, typically 2 to 5 days.
Salmonella 6 to 72 hours, typically 18-36 hours.
Shigella 12 hours to 7 days, typically 1-3 days.
Hepatitis A 15 to 50 days, typically 25-30 days.
Listeria 3 to 70 days, typically 21 days
Norovirus 24 to 72 hours, typically 36 hours.

5. Within Hours of Eating
• After getting out of
church yesterday
morning, I stopped
at a restaurant to
grab a sandwich….
Within two hours of
eating that sandwich
I became very ill.

6. The Food Looked/Smelled/Tasted Funny
“My husband recently
opened a bottle of salsa
and smelled an unusual
odor but chose to eat it
regardless, thinking that it
was just his nose. He found
what appeared to be a
rather large piece of animal
or human flesh. He became
very nauseated and I feel
the manufacturer should be
held responsible.”

7. “Gross-Out” Claims
“I opened a box of Tyson
Buffalo wings and saw an
unusually shaped piece of
chicken and I picked it
up. When I saw that the
‘piece’ had a beak, I got
sick to my stomach. My
lunch and diet coke came
up and I managed to
christen my carpet, bedding
and clothing. I want them
to at least pay for cleaning
my carpet etc.”

8. In Between the Quickly Dismissed
and the Clearly Compelling
• Health department
investigation of an
outbreak or
incident
• Prior health
department
inspections
• Medical records
• Lab results

9. Health Department
Investigation of an Outbreak
• All states have agencies tasked with monitoring
bacterial and viral illnesses associated with food
consumption
• The scope of the investigation varies from case
to case
• It is very difficult to dispute a health department-
confirmed outbreak or even an isolated case.
• Health departments do not point the finger
prematurely. Most epidemiologist will not confirm
an outbreak without 95% confidence in a
particular conclusion.

10. Can the Plaintiff Make a Case Without
Health Department Support?
• In cases in which the health department cannot
rule out a source but also cannot identify it with
95% certainty, it is possible for a plaintiff to make
a claim for damages even without a health
department’s confirmation of an outbreak.
• In these cases, reliable expert opinion or
examination of the health department
investigators themselves can establish the source
of a plaintiff’s illness with sufficient certainty to
meet the legal burden of proof.

11. Proving a Case Using Prior Health
Inspections/Violations
• Document the food
service establishment’s
sordid past.
• Documents can be
acquired through the discovery process
or through the Freedom of Information Act.
• A list of improper techniques and code
violations can serve as a tool for limiting
a defendant’s trial options.

12. Identifying the Improper Procedure
That Led to the Contamination of the Food
• It is rare that contaminated leftovers can be
located by the time investigative agencies or
lawyers are on the scene.

13. Improper Cooking Procedures
• A young girl suffered HUS after eating
a hamburger from a midsized southern
California fast-food chain.
• Her illness was not culture-confirmed.
• No food on site tested positive for
E. coli O157:H7.
• Review of health inspections
revealed flaws in cooking methods.
Hamburger buns are toasted on the grill immediately adjacent to the
cooking patties, and it is conceivable that, early in the cooking process,
prior to pasteurization, meat juices and blood containing active
pathogens might possibly splash onto a nearby bun.

14. Improper Refrigeration
• A Chinese buffet-restaurant in
Ohio was the suspected source
of an E. coli O157:H7 outbreak.
• No contaminated leftover food
was found.
• A number of ill patrons were
children. Jell-O was suspected as
the vehicle of transmission.
• Health Department report noted
“raw meat stored above the
Jell-O in the refrigerator.”
The likely source of E. coli O157:H7 in the Jell-O was from raw meat
juices dripping on the Jell-O while it was solidifying in the refrigerator.

15. Improper Storage and Cooking Procedures
• Banquet-goers in
southeastern
Washington tested
positive for Salmonella.
• Leftover food items
had been discarded
or tested negative.
• Restaurant had “pooled” dozens, if not hundreds,
of raw eggs in a single bucket for storage
overnight, then used them as a “wash” on a
specialty dessert that was not cooked thoroughly.

16. Patterns of Poor Food-Handling Practices
• In a situation where
defending the case
from a liability
standpoint is a
less-than-certain
undertaking, defense
counsel may be wary
of admission of
evidence that will make
the defendant look bad
in the eyes of the jury.

17. Improper Sanitation
• In 2000, large Shigella
outbreak on the West Coast –
producer and distributor of
high-end fresh food items.
– A major purchaser of the producer
had conducted its own inspection
and refused to purchase any more
of the firm’s products.
• In 2002, Seattle-area
restaurant had outbreak
of food poisoning. Unable to
pinpoint pathogen, but prior
inspection reports revealed a
consistent pattern of poor
food-handling practices.

19. Punitive Damages

20. Proving a Case Using Medical Records
• Evidence of a possible
foodborne illness
source can sometimes
be found in the
person’s medical-
treatment records,
such as an emergency
room notation of a
suspected food or drink
item, or a lab test
result.

21. What Type of Medical Evidence
Can Help Make a Case?
• Lab tests aren’t
always available
• Each foodborne
pathogen carries an
expected incubation
period
• Most common bacterial
and viral pathogens
found in food share
similar symptoms

22. Proving a Case Using Lab Tests
• Many states require reporting
of tests for a number of
pathogens, including;
– E. coli O157:H7
– Salmonella
– Shigella
– Listeria
– Hepatitis A
– Campylobacter
• The process of obtaining the
DNA fingerprint is called
Pulse Field Gel
Electrophoresis (PFGE).

23. Proving a Case Using PFGE
• The PFGE pattern of
bacteria isolated from
contaminated food can
be compared and
matched to the PFGE
pattern of the strain
isolated from the stool
of infected persons.
• When paired, PFGE and
epidemiological evidence
are extremely potent in
supporting causation.

24. Proving a Case with PulseNet
• PulsetNet is an early-
warning system for
outbreaks of foodborne
disease.
• Using this system
scientists at labs
throughout the country
can rapidly compare the
PFGE patterns of
bacteria from ill persons
to help determine where
the outbreak occurred.

25. The Impact of the Absence
of a Positive Test
• A negative test result or
the lack of any lab test at
all, can sometimes be
explained by other factors.
– Antibiotics
– Untimely Testing
– No test given
– Looking at the
circumstances as a whole
– Testing the food

26. Legitimate Cases:
What Do They Look Like?
• The Case of the
Ammonia Chicken
Tenders
• The Case of the
Restaurant with
No Hot Water
• The Case(s)
of E. coli-Contaminated
Leafy Greens

27. The Case(s) of E.Coli-Contaminated Leafy Greens
Date Vehicle Etiology Reported States
Cases
Aug. 1993 Salad bar E. Coli O157:H7 53 1: WA
July 1995 Lettuce (leafy green, E. Coli O157:H7 70 1: MT
red, romaine)
Sept. 1995 Lettuce (romaine) E. Coli O157:H7 20 1: ID
Sept. 1995 Lettuce (iceberg) E. Coli O157:H7 30 1: ME
Oct. 1995 Lettuce (iceberg; E. Coli O157:H7 11 1: OH
unconfirmed)
May-June 1996 Lettuce E. Coli O157:H7 61 3: CT, IL, NY
(mesclun, red leaf)
May 1998 Salad E. Coli O157:H7 2 1: CA
Feb-Mar 1999 Lettuce (iceberg) E. Coli O157:H7 72 1: NE
July-Aug 2002 Lettuce (romaine) E. Coli O157:H7 29 2: WA, ID
Oct 2003-May 2004 Lettuce (mixed salad) E. Coli O157:H7 57 1: CA
Apr. 2004 Spinach E. Coli O157:H7 16 1: CA
Sept. 2005 Lettuce (romaine) E. Coli O157:H7 32 3: MN, WI, OR

28. Here We Go Again:
Another Dole E.coli O157:H7 Outbreak
• The FDA and CDC found that
spinach sold under several brand
names had all come from the
Natural Selection Foods processing
center in San Juan Bautista, CA.
• Further data narrowed the possible
sources of outbreak down to Dole.
• The FDA found that a bag of Dole
baby spinach sold in
Albuquerque, NM, contaminated
with E. coli O157:H7, bore the same
genetic marker as the outbreak
strain.
• Lab evidence traced the source of
the contaminated spinach to one
field. Pigs, water and cattle feces
all tested positive to the same
strain.

29. The Final Report on Dole:
Blame Enough for Everyone
• Everyone involved in the growing, harvesting,
processing, distribution and sale of the
implicated spinach products was at fault.

30. A Real Life Example
Benton Franklin
Health District
October 1998
• Call from Kennewick
General Hospital
infection
control nurse
• Call from elementary
school principal

31. Preliminary Interviews
• Kennewick General
Hospital
• Kennewick Family
Medicine
• Interview tool
– Knowledge of
community
– Asked questions
from answers

32. Case Finding
• Established communication with area
laboratories, hospitals and physicians
• Notified the Washington State Department
of Health Epidemiology office
• Established case definition early
and narrowed later

33. Finley Schools
• Finley
School District
– K-5
– Middle School
– High School
• Rural area
– Water supply
– Irrigation water
– Septic system
– Buses

34. Epidemiologic Investigation
• Classroom schedules
• Bus schedules
• Lunch schedules
• Recess schedules
• Case-Control Study
• Cohort Study of
Staff
• Cohort Study of
Meals Purchased

35. Environmental Investigation
• Playground
Equipment
– Puddles
– Topography
– Animals
• Water system
• Sewage system

36. Environmental Investigation
• Hand Rails
• Dirty Can Opener
• Army Worms
• Stray dogs

37. Environmental Investigation
• Kitchen inspection
• Food prep review
• Food sample
collection
• Product trace back
– Central store
– USDA

38. Results
9801447
• 8 confirmed cases 9801446
of E. coli O157:H7 9801443
9801462
• 3 probable cases 9801480
9801482
• 1 secondary case 9801513
9801455
• 8 PFGE matches 9801481

39. Results
• Ill students in
grades K-5
• All but one ill child
at a taco meal
• No other common
exposures detected
• No ill staff members

40. Results
• Food handling
errors were noted
in the kitchen
• There was
evidence of
undercooked taco
meat
• No pathogen found
in food samples

41. Conclusions
• Point source outbreak
related to exposure
at Finley Elementary
School
• A source of infection
could not be
determined
• The most probable
cause was consuming
the ground beef taco

42. The Lawsuit
• Eleven minor plaintiffs:
10 primary cases, 1 secondary case
• Parents also party to the lawsuit,
individually and as guardians ad litem
• Two defendants: Finley School District
and Northern States Beef

43. The Basic Allegations
• Students at Finley Elementary
School were infected with E.
coli O157:H7 as a result of
eating contaminated taco meat
• The E. coli O157:H7 was
present in the taco meat
because it was undercooked
• The resulting outbreak
seriously injured the plaintiffs,
almost killing one of them

44. At Trial: The Plaintiff’s Case
• The State and the BFHD
conducted a fair and thorough
investigation
• Final report issued by the
WDOH concluded the taco
meat was the most likely
cause of the outbreak
• The conclusion reached as a
result of the investigation was
the correct one

45. More of The Plaintiff’s Case
• There were serious deficiencies in the
District’s foodservice operation
• There were reasons to doubt the District’s
explanation of how the taco meat was
prepared
• The law only requires a 51% probability
to prove the outbreak’s cause-in-fact

46. The School District’s Defense
• The taco meat was
safe to eat because:
– We love children
– We are always
careful to cook
it a lot

47. The Taco Meal Recipe Card
It’s not our fault, someone sold us
contaminated beef

48. More of the School District’s Defense
• We’ve never poisoned
anyone before
• The health departments
botched the investigation
and jumped to a hasty
conclusion
• Something else caused
the outbreak

49. What Will a Jury Think?

50. What Did This Jury Think?
• The investigation was
fair and thorough
• More probably than not,
undercooked taco meat
caused the children to
become ill
• The School District was
ultimately responsible
for ensuring the safety
of the food it sold to its
students

51. In The End
• After a six week trial,
plaintiffs were awarded
$4,750,000
• The District appealed
the verdict on grounds
that product liability
law did not apply
• September 2003 the
WA State Supreme
Court dismissed the
District’s case
• Final award -
$6,068,612.85

52. Conclusion
• Decision makers in the food industry must
be prepared to quickly and accurately
assess potential foodborne illness claims.
• They must have an understanding of the
epidemiological, microbiological, and
environmental health issues at play.
• Rash action to disregard or deny a claim
could be damaging to the company and to
the public.

53. Questions