Four children remained in intensive care Tuesday as officials confirmed that a suspected E. coli outbreak has affected more victims than previously reported.
A total of 13 children and 23 adults who might have the bacteria are at St. Francis Hospital, a spokeswoman said. An additional four adults are at St. Francis Hospital South.
Of the four children in the Pediatric ICU, three have kidney failure and are on dialysis, said Dr. William Banner, pediatric intensivist at the Children's Hospital at St. Francis.
"We are concerned about the fourth child needing dialysis at some point," he said.
Two more children were sent to an Oklahoma City pediatric intensive care unit, he added.
Four of the children are suffering from a syndrome that is — in 90 percent of cases — caused by E. coli O157, Banner said. However, other related bacteria can produce
it, he said.
The state Health Department has not confirmed an E. coli outbreak. Test results from specimens taken from patients could take up to a week, depending on when samples were taken, officials said.
In its latest public advisory, the state Health Department confirmed that a majority of the patients ate at the Country Cottage, a Locust Grove restaurant. They include 26-year-old Chad Ingle of Pryor, who died Sunday at St. Francis. His family confirmed that he ate at the restaurant on Aug. 17.
The restaurant passed a surprise health inspection last Saturday — a day after St. Francis reported the suspected outbreak to the state Health Department. But if the restaurant had been held to Tulsa County Health Department standards, it would have come close to failing the inspection.
The restaurant was flagged for nine violations, two of which were deemed "more serious" and directly related to the causes of foodborne illness.
In one instance, inspectors noted that a pan of chicken in the buffet warmer was tested at 115 degrees Fahrenheit, below the 135 degrees required by the food safety code. The chicken was discarded on the spot.
In another violation, corn muffin mix, bologna and cheese in a red cooler registered 50 degrees Fahrenheit, above the 41-degree requirement for cold storage, the report says.
Violations considered "more serious" are those that can cause foodborne illness and stem from risk factors set by the U.S. Centers for Disease Control and Prevention, said Debbie Watts, supervisor in the Consumer Protection Division at the Tulsa City-County Health Department.
In Tulsa, one additional "more serious" violation would have earned the restaurant a return trip from inspectors two weeks later, Watts said.
However, in Mayes County, once a violation is corrected, "it's still a violation, but it's no longer an issue," said Larry Bergner, a Mayes County public health specialist supervisor who was present for Saturday's inspection.
"We would not have taken action because we corrected it," he said.
Bergner said the report was nothing out of the ordinary and that the violations were easily correctable.
According to state Health Department inspection records, the Country Cottage has received a total of 88 violations since August 2004, with only six of them considered "more serious."
Given that information, "I would tend to say they seem to do a sufficient job at maintaining their facility and protecting customers," said Watts, the Tulsa City-County supervisor.
She noted that every restaurant inspection is simply "a snapshot in time. We all have bad days, and we all have blips. We tend to look at the big picture and at trends over time. Then if it's consistently good, but there's a blip, what has changed?"
Amanda Clinton, a relative of the Country Cottage's owners, said state health officials have said they are pursuing many leads and that the restaurant's owners continue to cooperate with the state investigation.
"Our deepest sympathies go out to Mr. Ingle's family. Additionally, we remain concerned about our neighbors who have become ill from what appears to be the same illness," Clinton said.
The town of Locust Grove voluntarily tested its water supply on its own Monday, and the Oklahoma Department of Environmental Quality also conducted extensive testing of the town's water, but the test results are not back yet, said Locust Grove Mayor Shawn Bates.
"It's almost like crisis-control here," he said. "We're just trying to keep everyone from panicking."
State health officials early Tuesday would only confirm 17 people being hospitalized with the illness and more than 40 cases under investigation. The cause for the discrepancy with St. Francis' numbers is unclear.
When asked for a breakdown of how many patients are adults and how many are children, state Health Department spokesman Larry Weatherford declined to answer, citing privacy laws.
He also would not reveal how many of the hospitalized patients or those whose cases are under investigation actually ate at the Country Cottage.
"We're not releasing that because it could be matched to individual cases," Weatherford said, indicating that the data could jeopardize patients' privacy.
As to why state Health Department officials didn't release information about the outbreak when they learned about it Friday, Weatherford said officials must investigate and verify information before releasing it to the public.
"As soon as we get a confirmable situation, we release it to the public," he said.