Investigators have reached an impasse in their efforts to learn why lettuce and spinach grown in the Salinas Valley sickened 114 people, despite exhaustive research.
Second of two parts
Three recent food-illness outbreaks involving Salinas-area produce have raised questions about when, how and with whom California regulators share what they've learned.
A national consumer advocacy group condemns the way state health officials distributed their findings on the E. coli incidents and is calling for more aggressive communication and education.
One key complaint: The state Department of Health Services now has no policy of informing growers or food processors who are in the same business as those being investigated.
"The state officials have an obligation to inform farmers more broadly of these risks," said Caroline Smith de Waal, food safety director for the Center for Science in the Public Interest in Washington, D.C. "I don't think it's good enough to tell one farmer what to do. That would be like trying to tell one consumer how to cook their meat."
A Salinas-based agricultural industry trade group also said there's room for improvement based on how the state handled the outbreaks linked to lettuce and spinach from this area between July 2002 and October 2003.
Jim Bogart, president of the Grower-Shipper Association of Central California, an organization that supports and promotes local agriculture, said members learned about the cases in a trickle-down manner.
"It's very rare that I receive something in writing," Bogart said. "Who do you hear about it from? Whoever gets wind of it first."
"It would make it a lot easier to address these problems and correct these problems if there was a specific policy or protocol in terms of communicating these types of issues."
The three outbreaks, all involving the most dangerous form of the bacteria E. coli, killed one elderly woman and sickened 113 others. At east 16 victims were hospitalized with such symptoms as severe cramping and bloody diarrhea, according to official reports.
Despite extensive analysis, investigators have been unable to pinpoint what caused the contamination somewhere between planting and consumption.
E. coli type 0157:H7, which can lead to kidney failure in the worst cases, is more often transmitted in food handling than during cultivation or processing. But in two of the incidents, evidence suggests trouble occurred before produce reached food preparers.
State and county officials, as well as ag company representatives, say consumers should continue to trust Salinas Valley produce because of wide-ranging efforts to ensure food safety.
Although efforts are under way to benefit from the advice of Health Services, critics say the cases revealed shortcomings in how safety recommendations get out.
The first outbreak of E. coli 157 occurred in July 2002 at a drill-dance camp in eastern Washington state. The subsequent outbreaks were in September-October 2003 at a restaurant chain in Southern California and in October 2003 at a Bay Area retirement community.
County found out late
Health Services has a policy of contacting health officials in the county where contaminated food originated, as part of its efforts to trace the source of contamination, said Dr. Jeff Farrar, California's food safety chief.
The department's policy is to also alert companies whose operations were investigated, Farrar said, most of whom have already had direct contact with agents in the field.
But those companies still have to directly ask for a copy of the final report rather than automatically receiving one, he said.
"Our usual procedure following an investigation is that we just get our findings and we put them in a file," Farrar said. "It's not always a perfect system."
In one communication breakdown that neither state nor county officials can explain, Monterey County officials failed to learn about even the first outbreak, in Washington state, until this April.
Health Services says it mailed its findings to the county in November 2002.
"I don't know if it (Washington state report) got lost in the mail or never was sent to us or if something happened on our end," said Allan Stroh, Monterey County director of environmental health.
A colleague of Stroh, county health officer Dr. Hugh Stallworth, declined to speculate whether an earlier heads-up might have given Salinas-area growers and processors critical safety information.
"Would that have prevented the second and third outbreak? I would have no way of knowing," Stallworth said.
Instead, county health officials and local ag industry leaders learned of the E. coli findings -- for all three cases -- at a meeting in Salinas. The state has yet to release its report on the case involving various locations of Pat & Oscar's restaurant in San Diego, Riverside and Orange counties.
Both Stroh and Stallworth said the county has a good working relationship with Health Services.
Chain of communication
Stroh said he wasn't surprised the county didn't learn of the E. coli cases earlier.
"They don't typically involve the locals unless the locals got sick," Stroh said, explaining that the county health department is in charge of retail food sales, not wholesale food such as produce.
When a food-borne illness outbreak is contained within a county, that county's health department will typically do the investigations, he said. But when an outbreak happens in multiple counties or states, the state and federal agencies including the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration and the U.S. Department of Agriculture, perform the investigation.
Likewise, state and federal agencies have the authority to investigate where the suspect food came from -- a process called a "traceback" -- and how it was contaminated.
County health officials are involved in wholesale food tracebacks only if the state requests their assistance. The agricultural commissioner, likewise, is not involved in tracebacks or really in dealing with pathogen contamination of produce in general.
"I don't have a direct regulatory responsibility," said Eric Lauritzen, Monterey County Agricultural commissioner, calling his office a liaison between regulatory agencies and the agricultural community. "So notification (of outbreak reports) wouldn't be standard."
On the other hand, Stroh said that if his office had received the report earlier, they would have contacted the agricultural commissioner and local growers and shippers to discuss its ramifications -- operational and economic.
'We would make contact ... '
"We would make contact with the ag industry and say, 'Hey, this is a serious issue and the state is pointing towards Monterey County as the supplier of all this produce that was involved in all this outbreak so it's something that we need to take a serious look at," he said. "That would be our knee-jerk reaction."
Both Bob Jenkins, chief operating officer for River Ranch Fresh Foods LLC, and Matt Conley, harvesting manager of Dobler and Sons -- among 10 Salinas-area companies named in state reports -- said they knew the findings were available to them through Health Services.
"We had been advised that the reports would be forthcoming," Jenkins said. "It is incumbent upon us to find the report."
Farrar said other growers, processors or suppliers in the same industry sector are not automatically informed about investigations because the findings aren't always valuable and relevant.
"Determination of the precise source of the contamination is often difficult," he said by e-mail, "so reports ... generally reflect only those observations and findings that the grower is already aware of on their farm."
De Waal, whose consumer advocacy group has been operating for 33 years, said California regulators should be required to inform other companies in the same business.
"The state is relying on motivated farmers to get the report and actually read it," she said. "The real irony in it is that the farmers that are most motivated to read the report are probably not the ones that are causing most of the problem."
De Waal said federal communication about food safety is also inadequate.
"When there is an outbreak going on, the CDC can't say which agency is involved until the food (causing the outbreak) is identified," she said. "This is a real problem."
Food regulation decentralized
A total of 10 federal agencies have responsibility over some aspect of food-borne illness outbreaks, according to a report by the Center for Science in the Public Interest.
The organization has urged U.S. Secretary of Health and Human Services Tommy Thompson to assign one federal agency to be in charge of food safety problems, de Waal said, much as the new Department of Homeland Security has centralized terrorism prevention efforts.
No single federal agency database now tracks all food-borne illness outbreaks reported nationwide. Since 1996, the CDC has run a surveillance system called "FoodNet" that looks at nine sites across the nation and analyzes the incidence of nine food-borne illnesses, including E. coli 157:H7.
Between 1996 and 2003, FoodNet's surveillance area increased from 14.2 million people to 41.5 million people, or 14 percent of the U.S. population, according to data published in the April 30 edition of the CDC's Morbidity and Mortality Weekly Report.
FoodNet reports also do not indicate the source of the food-borne illness, the origin of that source or where along the line of production and consumption the contamination occurred.
In addition to calling for regulators to directly inform all local companies in the same industry as those associated with in a contamination case, de Waal said consumers also should be told about results.
"I think consumers have a right to know ... the source of food that is being linked to outbreaks," she said.
"I think consumers have an absolute right," adding that she believes the lack of consumer awareness -- and a subsequent lack of consumer pressure on the agricultural industry -- is one reason outbreaks continue to happen.
But Alex Avery, director of research and education for the Hudson Institute's Center for Global Food Issues in Washington, D.C., questions whether consumers should be informed about every, single outbreak.
"Should the community know? Maybe, maybe not. Yeah, there are often times a weak link and sometimes a weak link in the system. You can do everything right and still have these things hit."