Michael Booth of the Denver Post published an excellent investigative piece Friday about a 2009 E. coli outbreak that appeared linked to lettuce at restaurants in six states, but was never made public. Excerpts below:

The FDA's decision to let the six-state E. coli probe go dormant, despite clear leads, is part of what some food safety experts call a worrisome "cone of silence" around leafy green produce problems in the United States. These experts say the FDA dropping promising outbreak clues blocks efforts to force better growing and packing methods.

And they say the federal government's tendency to avoid naming names — even when state officials know the producers and suppliers — robs consumers of vital information. In an October 2011 salmonella outbreak that sickened 68, federal agencies told journalists there was no public benefit in being more specific than problems at Mexican "Restaurant Chain A."

It was the Oklahoma health department that disclosed the chain where many victims had eaten was Taco Bell.

"As someone who is out in fields with farmers, it's really hard to get them excited about food safety if they never hear about other outbreaks," said Doug Powell, a Kansas State University food scientist who advocates for wider probes and public disclosure. "We have evidence that telling stories makes a difference."

"I will forever be mad that the FDA didn't pursue" the 2009 E. coli cases that included Colorado, said Kirk Smith, a veterinarian and supervisor of the foodborne disease investigation section of the Minnesota Department of Health.

"It was a smaller outbreak, but still, if you figure out what the food is, even after the fact, you can hopefully get back to where that food was produced and perhaps correct something so there's not a bigger outbreak in the future."

State health officials grow nervous every September with the crowds, heat and open-air food at the Colorado State Fair in Pueblo. When two cases of E. coli O157:H7 matched at the state lab, one from a Jefferson County child and another from a Pueblo County child, health investigators moved fast.

County reporting forms showed both sick kids had attended the state fair. State officials urged the counties to speed up questioning, trying to nail down where the kids ate and what foods they had in common.

As they waited for more answers, cases in Minnesota, Iowa and three other states loaded illness cases into a national network and matched the genetic fingerprint.
Cases in Minnesota and Iowa had eaten at the same Italian-style restaurant in Omaha, Nebraska, in early September. So had a North Carolina case. When Colorado got its deeper case histories back, it found both state victims had eaten at an Italian-style restaurant in Pueblo.

More questions zeroed in on house salads. Even when the victims hadn't ordered salad, they had nibbled from a family member's plate. Eight of 10 cases had eaten lettuce at a restaurant, according to a Colorado outbreak memo obtained through the open records act.

States sought the restaurants' suppliers. Colorado learned that the lettuce used in Pueblo came from a major produce supplier in the Salinas Valley of California, Tanimura & Antle.

The patients, meanwhile, made slow recoveries. Some were in the hospital for days. E. coli is particularly worrisome to food experts because it can cause severe gastroenteritis, pneumonia and kidney failure.

And then the FDA and CDC dropped the case.

Once state public health officials identify an out-of-state supplier, they rely on the federal government's powers to move across boundaries and push outbreak probes forward. But what Colorado and Minnesota officials heard was silence.
By mid-October, officials in those states asked the CDC and FDA for a status on the case. On Oct. 28, according to e-mail records released by Colorado, CDC epidemiologist Colin Schwensohn told the states "with no recent cases, this cluster is less of a priority."

Minnesota's Smith fired back the same afternoon, saying "I think it is a huge mistake for FDA to drop this." Smith's e-mail to the CDC and other investigators, which he acknowledged was a "rant," went on:

"If FDA won't fully engage and work backwards from 2 restaurants on a rock solid lead, then all of their claims about making things better are all so much talk."

Colorado officials took a more measured approach, but still protested. "Colorado and other states challenged this decision, but FDA did not change its position about pursuing the traceback further," according to a state memo.

Colorado epidemiologist Alicia Cronquist said in an interview, "We were extremely frustrated." The states got on a conference call and said a deeper probe would prevent future outbreaks, Cronquist said.

The FDA declined comment, beyond the limited information about the federal agencies' reasoning contained in e-mails at the time, which were released by Colorado in the open records request. Neither the FDA nor the CDC offered responses to specific questions about the 2009 outbreak, or to general questions about how investigations end.

"Consumers of food have a right to know, period. And as taxpayers, consumers have a right to know what public health officials know about those same food producers," said Seattle attorney Bill Marler, a litigator for outbreak victims. Marler's firm was briefly a co-counsel for one of the Colorado victims suing over the 2009 E coli illnesses.

Early e-mails in the 2009 outbreak identified the restaurants that consumers said they had in common. Colorado named the produce grower, Tanimura & Antle, in its wrap-up memo, but said the restaurants did not appear to be at fault. Tanimura & Antle did not return calls seeking comment.

KSU's Powell argues for more disclosure. At the least, he said, CDC policy should make it clear why they name some restaurants and producers, and not others. The CDC stuck with "Restaurant Chain A" for the October 2011 salmonella outbreak even though Oklahoma had disclosed half the victims had eaten at Taco Bell.

"If Taco Bell keeps making people sick with lettuce, I want to know it's Taco Bell," he said. "How bright are they in choosing their lettuce suppliers?"
Taco Bell did not return phone calls seeking comment.

Cronquist said Colorado tries to strike a balance. If the public is still at risk from food, companies are identified. But the state also needs compliance from various facilities while it investigates. Moreover, victim interviews can be skewed by early disclosure; if they have heard "Taco Bell" or "green onions," it can bias their answers.

Telling produce farmers they need to clean up and pay attention to food safety stuff is a hard sell until there’s an outbreak.

But what if there’s no outbreak?

That was the situation 15 years ago when I started working with Ontario growers; outbreaks related to fresh produce were starting to become reported regularly in the U.S., the Food and Drug Administration was making rumblings about pathogen sampling (which can shut down cross-border trade) and produce exporters, like Ontario greenhouse veggie growers, were cautiously eyeing the situation.

But there hadn’t been any outbreak involving Ontario greenhouse product. Still hasn’t been (that anyone knows of).

Scare stories from other jurisdictions work to a point, pressure from retailers and others in the supply chain works better, but ultimately, when chatting with individual growers, it would usually come down to: I’ve been doing it this way all along and haven’t made anyone sick. So why should I change?

Public health types have adopted their own version of why change? It’s the increasingly heard, there-was-an-outbreak-but-the-product-was-gone-by-the-time-we-figured-it-out-so-there-was-no-ongoing-threat-to-public-health scenario; therefore, we didn’t have to tell anyone, publicly.

It happened with Fresh Express, the salad folks, that had some salmonella issues in 2010 in which people got sick.

It happened in several outbreaks involving Taco Bell, usually referred to as Mystery Restaurant A long after the fact.

According to long-standing policy at the Centers for Disease Control and the Food and Drug Administration, as long as it does not pose an ongoing public health risk, companies that may be the source of dangerous outbreaks are kept out of the headlines.

"Companies voluntarily share information with CDC and FDA, so when we publish company or brand names and there is not a public health need to do, it could have the effect of discouraging such cooperation between our agencies and the food industry," an FDA spokesperson told ABC News.

And now it’s happened in Kansas.

In Jan. 2012, 18 people were sickened by campylobacter in raw goats milk from a dairy in south central Kansas. The sick people attended the same community function so the outbreak was identified and isolated quickly, so no public warning was ever issued – until Friday, in what was supposed to be a statement from state health-types about the dangers of raw milk.

Instead, it’s another example of outbreaks not being publicly disclosed. And if they aren’t disclosed, how is the public, or farmers or others to know there are problems? How can people become informed without access to information?

People are instead doing it themselves.

The Internet, social media, smartphones, and a host of other tools are providing increasing access to public information, and the private experiences of individuals. Because who doesn’t want to share stories of barfing or bad hookups on the Internet. The information will, increasingly, get out.

In California, there are recurring reports of at least nine children being sickened by campylobacter, in raw milk, from Claravale Farm. No word from public health.

Public health types have a tough job, separating the wheat from the chaff, the meaningful noise from background chatter; resources are diminishing. But establishing some ground rules – and publicizing those rules – would help quell conspiracy theories and perhaps rebuild some public trust.

If people get sick, let it be known, sooner rather than later. Those stories are essential to support statistics. Otherwise I’m just another propeller-head who don’t know nothing about farming and food.

As Americans grapple with the public health implications about going public either too early or too late, the Italians have added an unique variation: a company issued a public warning, then prohibited people from speaking or writing about it.

A food safety friend based in Italy who has followed the machinations of Taco-Restaurant-A-Bell and a recent salmonella outbreak, noted that going public with a food safety recall is an exception in Italy. Companies have plans for disseminating information to the public in their recall procedures, but are reluctant to put them into practice. National authorities don't insist on much. A recall for foreign bodies is also exceptional as officials don't mind foreign bodies much. What is typically Italian is the threatening message at the end: we tell the public because we have to, but we will sue you if you talk about it to anyone, or you link to our page.

The press release, translated from Italian, says, “Leaf Italia informs its consumers of the possible presence of foreign bodies inside some boxes of chocolate pralines "Sperlari Granperle plain chocolate with crushed nougat" gr. 160 which belong only to production lots L11284 - L11285 - L11287 - L11294 - L11296 - L11300 as indicated on the package.

“As a precautionary measure, it is therefore recommended not to consume the product in the image and to call the toll free number 800829008 for more information.

“This information is owned by LEAF. The information is intended for exclusive use for the purposes covered by this statement and any different use must be authorized in writing by LEAF: in the absence of such authorization, any dissemination and reproduction is forbidden."

After the belated public notification about a salmonella outbreak linked to Rizzo's Pizza in Ballarat, Australia, the Herald-Sun uncovered a bunch of other incidents of people barfing in the state of Victoria that were never or belatedly made public.

A poisoning outbreak at a sushi bar that left 84 people sick and 19 in hospital is among serious food safety incidents kept quiet by authorities.

Other cases uncovered include 17 diners who fell acutely ill after eating Vietnamese chicken and pork rolls; 10 people struck down after eating eggs Benedict at a cafe; and 13 people who fell crook from chicken parmigiana at a hotel.

Health department figures show a significant rise in salmonella cases in the past two years, many of them linked to eggs (a table of raw-egg related outbreaks in Australia is available at http://bites.ksu.edu/raw-egg-related-outbreaks-australia).

Brooke Dellavedova, a principal at Maurice Blackburn, said she often heard about food poisoning outbreaks, but new laws meant class actions were difficult to mount on behalf of victims.

"So the proprietors get a slap on the wrist, if that, and that's the end of the story," she said.

Department of Health spokesman Graeme Walker said the department did not routinely reveal the names of businesses because its role was to identify and remove the source and investigate the cause.

Acting chief health officer Dr Rosemary Lester said the information was not being kept secret and salmonella was common adding, "We do know that many cases of salmonella arise in the home and other outlets.”

This isn’t about where salmonella happens: this is about accountability by publicly-funded health types.