Hepatitis still hurts


On that fateful Sunday, it was a coupon that took Richard and Linda Miller to the Beaver Valley Mall Chi-Chi's -- a coupon that turned out to be invalid for the lunch they planned on sharing.

Not a regular at the restaurant, Linda Miller raised the possibility of going elsewhere to eat on Oct. 12, 2003, but Richard thought they might as well stay.

The Millers went on to become two of the 660 people sickened with hepatitis A in the largest outbreak of its kind in U.S. history. Four Chi-Chi's patrons died from the disease and, short of those cases, Richard Miller's sickness might have been the worst. Hepatitis A forced him to undergo a liver transplant, and the Beaver County man continues to struggle with a host of health problems to this day.

"They say that time heals all wounds, but it will be a long time before this is healed," Miller, 58, said last week. "I'll never really recover."

Tomorrow marks the single day on which the greatest number of outbreak patients -- more than 50 -- started feeling sick last year. Most of those people have recovered, but from Richard Miller's home on a quiet street in the town of Beaver to the farms of northwest Mexico, the outbreak's impact still lingers.

$10 million to victims

A state Department of Health investigation linked the hepatitis A illnesses with consumption of green onions, and officials concluded that the scallions were contaminated before they arrived at Chi-Chi's. About six weeks before the Chi-Chi's outbreak was discovered, hepatitis A outbreaks involving green onions occurred at restaurants in Tennessee, Georgia and North Carolina.

Four Mexican farms had shipped green onions to the restaurants, and the Food and Drug Administration began stopping green onions sent from those farms at the border last November.

Two of those firms have spent much of the past year trying to get back into the U.S. market. And one of them has been successful, gaining FDA clearance three weeks ago to resume shipping scallions here, after a lengthy application and inspection process. The company's scallions won't be back in the United States for some time, however.

The business aftershocks felt south of the border have reverberated in the United States too.

The Beaver Valley Mall Chi-Chi's is now closed. Chi-Chi's had filed for bankruptcy about one month before the outbreak was discovered, and in August the designation rights to the chain's remaining 76 restaurants were sold in a bankruptcy court proceeding.

Chi-Chi's is in the process of paying out about $10 million to roughly 350 of those sickened in the outbreak. That includes payments of more than $35,000 to each of about 50 victims -- larger claims that are subject to bankruptcy court approval, said David A. Ernst, a lawyer representing Chi-Chi's.

Ernst said fewer than 100 claims from hepatitis A victims have yet to be resolved through a special mediation process. But Bill Marler, an attorney for several people sickened in the outbreak, said several of the remaining cases -- including that of Richard Miller -- involve some of the most serious illnesses. Chi-Chi's has $51 million in liability insurance.

For its part, Chi-Chi's this summer sued two companies that supplied the restaurant with green onions, saying the presence of hepatitis A virus on the scallions rendered the product adulterated, unsafe and unfit for human consumption.

"That's a violation of the contract," said Fred Gordon, another attorney representing Chi-Chi's. "While at this point in time it is Chi-Chi's that is responding to the victims' claims ... [the company also is] seeking reimbursement not only for those costs but also the damage done to the Chi-Chi's brand."

Quick response

For state health officials, the outbreak has lingered as a teaching tool about responding to public health emergencies.

Officials have been credited with a quick response to the outbreak, thanks initially to a doctor and nurse at The Medical Center, Beaver who quickly made the connection between hepatitis illnesses and Chi-Chi's. That enabled the state Department of Health to administer about 10,000 immune globulin shots to Chi-Chi's patrons who might have been exposed to the virus.

The shots can prevent people from developing hepatitis A illness, and the health department held a week's worth of clinics at the Beaver County Community College to get the treatments to patrons. But public health agencies don't maintain a stockpile of the shots, and that fact created some financial and logistical problems, said Joel Hersh, the director of epidemiology, during a recent symposium about the outbreak at the University of Pittsburgh's Graduate School of Public Health.

The department had to order new supplies every afternoon, and the immune globulin was shipped overnight. The supplies arrived at the state health department's office in Beaver, but one shipment was inadvertently delivered to a nearby hot dog shop.

Workers tracked it down in about 30 minutes, Hersh said.

The health department also had to find about $145,000 to buy the immune globulin, and wound up taking money intended for education programs about hepatitis C. Noting that the immune globulin purchases might not have conformed with state regulations, Hersh said at the symposium: "This was one of those times when it was better to ask for forgiveness than permission."

The state filed a lawsuit in July seeking reimbursement, and Chi-Chi's agreed to pay $95,297 just last week.

The outbreak has lingered in an emotional way for George A. Daniels, a state Department of Agriculture worker who regularly performed food safety inspections at Chi-Chi's and spoke at the Pitt symposium.

Daniels lives two miles from the restaurant. Twenty people in his church ate at Chi-Chi's at a time when they could have been exposed to the virus.

Four wound up sick, including two who were hospitalized, but all spent agonizing days wondering when symptoms might hit them. Hepatitis A virus typically incubates for 28 days in an infected person, but some won't get sick for as long as 50 days after exposure.

Restaurant workers didn't cause the contamination, Daniels noted, and there was nothing that he could have done during his inspections to prevent the illnesses. Still, the outbreak hit so close that it has given Daniels a renewed sense of purpose in his work.

"Even after about a year, to think about what happened -- it's difficult," Daniels said, pausing to compose himself. "It almost hurts inside your heart."

Lifelong effects

Richard Miller still feels the pain, too.

In the kitchen of his Beaver home, a plastic tub filled with 11 pill tubes sits on the counter, a constant reminder of the many medicines he must take. Miller received a liver donated by a 24-year-old, and the organ is functioning very well. But the transplant requires him to take anti-rejection drugs, likely for the rest of his life, and cope with their side effects.

During the transplant surgery, Miller suffered a cardiac arrest, which cut the supply of oxygen to the brain. As a result, he has brain damage that sporadically affects his short-term memory.

Miller is quick to note, however, that he has nothing but praise for doctors and surgeons who cared for him at the University of Pittsburgh Medical Center.

Miller is sometimes afflicted by nightmares that take him back to the days he spent in the intensive care unit following the transplant. He takes medication to treat depression and anxiety. It's been a struggle to trade hopes of a complete recovery for accepting limitations, Miller said.

A variety of nerve problems leave him feeling different sorts of pain on both his left and right sides. His speech is largely back to normal, but Miller's vocal cords were injured while he was on a ventilator in the hospital.

That hospitalization lasted 27 days, and doctors tell him that health problems will likely require him to spend more time in hospitals through the years. Miller still lacks muscle mass and has trouble walking.

Hobbies such as golf, hunting and fishing are impossible, and Miller says he can't even mow his lawn. But what really hurts is not being able to work, he said.

Miller was general superintendent of railroads and civil construction for a railroad construction company. He was responsible for making bids on jobs and then managing the operation of those jobs once the company won bids.

"Work gives you purpose in life," Miller said. "Somewhere along the line, I have to find a way to find that again. But right now, I only have about two hours worth of work in me each day."