Lessons Learned From Foodborne Illness Outbreaks
Listeria Outbreak in Cantaloupes
“They probably look at themselves as victims too, but as between the person who bought the cantaloupe in the grocery store, who is more of the victim? And does a grocery store have an obligation to its consumer to not sell them products that are contaminated and from entities that have limited assets and insurance. That’s why it is 100% likely that this cantaloupe outbreak is going to bring in everybody in this outbreak, including the retailers and the auditor and Frontera and Jensen Farms because that’s the only way that the victims - whom we all would agree have far less culpability than the other side of the equation - that’s the only way that these people are going to be fairly treated. But it’s going to be a battle”. Bill Marler.
The Listeria outbreak in cantaloupe is still producing cases. Much has been written about the responsibilities of all involved and what needs to happen to correct deficiencies in our approach to food safety in produce, along with much sadness and much controversy.
As attorney Bill Marler has said in this exceptional interview in the Packer, the legal associations of the packinghouse, retailer, distributor, auditor and consumer are clear, and it is sobering.
Reflecting on Mr. Marler’s perspective, we will look at the chain of legal liability and see how it intersects with the chain of causation to see if we can learn something from these monumental, tragic and frightening events.
One must look at the disease pathway to see the intersections clearly, and it is a complex scenario with Listeria monocytogenes due to this pathogens ubiquitous presence in the environment, its likely ability to create bio-films on the surfaces of plants and inanimate objects and its propensity to cause serious illness in the immune deficient.
In terms of the infection pathway, we do not know whether the causative agent spread to the packinghouse and colonized the equipment, or the equipment was already contaminated by another farming operation due to previous use and spread to the packinghouse as pointed out by FoodSafetyNews.
What we have learned is that conditions at the packinghouse allowed propagation of Listeria monocytogenes at this site, and subsequent conditions eventually affected the entire supply chain. Additionally, contaminated products continued to be sold for an extended period, revealing our failed traceability systems .
On the packinghouse level, once the environment is contaminated, Listeria monocytogenes can spread throughout production and create niches for growth. That conditions were ripe for this at Jensen Farns is now clear, but unfortunately in hindsight.
On the product level, we know from FDA that cantaloupe is potentially hazardous, but this hazard was believed to occur only after cutting the melon.We did not understand the clear probability of the pathogen to not just colonize a melon surface, but also proliferate on it. I believe this chain of causation probably involves growth conditions for the pathogen on the surface of the melon, probably post washing. This phenomena should have been realized, but it was not.
The temperature controls at Jensen would not have been sufficient to control LM after colonization of the melon. Growth would begin at the packinghouse cooler and continue through to the cold-supply chain. Any increase in temperatures in the supply chain would result in accelerated growth, thus amplifying the problem for the next user.
At the level of the buyer, the buyer is obliged to ensure conditions at its supplier do not render a product adulterated. The buyer should maintain controls over the supplier. These can include test of water, tests of products, independent audits, self-audits and second party audits along with letters of indemnity and guarantees. Given that the buyer receives products that may be contaminated, controls should be in place in further distribution to reduce the likelihood of any dangerous product reaching the consumer, pointing to the need for more testing nearest to the consumer level and traceability. It’s interesting that industry has vigorously opposed the random testing of products and has effectively killed some of these programs.
That all involved in this distribution chain now bear responsibility is clear. This is not the first outbreak of a pathogen in cantaloupes. That our standards for handling cantaloupes were too low is painfully clear.
At the level of supplier control, the retail industry must start getting smarter about how to qualify its suppliers, currently the industry-required tests of finished products may be driven by a poorly defined risk assessment, or simply rely on industry practices, The bar is now raised extremely high for quality assurance in the produce industry and we should see a move to integrate technology into the food safety effort at a very high level, especially traceability and end products testing. We should see a major emphasis on water quality, in in-process tests and final tests for products, whether they be directly from a farm, from a packinghouse or from a processor. If there is a gaping hole in the producer-buyer-retailer food safety net, it’s the failure to adopt the best microbial standards and best quality assurance standards and traceability for producers.
At the level of the consumer, an acute problem arises with controlling Listeria. Refrigerator temperatures would not be able to prevent the slow the growth of LM; there have been no consumer advisories on how long or at what temperature to keep whole cantaloupes, making this a unique challenge for the consumer.
This melon’s netted surface hinders removal of LM (especially in a bio film) making washing by the consumer of little effect. Before, during and after preparation, it is common for consumers to leave food before serving without temperature controls and to put the leftover items away at some latter time, potentially allowing proliferation in the cantaloupe meat.
Unfortunately, we have not properly educated the consumer about the intricacies of food safety and they simply do not know in every case of contaminated product hitting them, what to do.
But as food safety professionals, we should know what to do.
Events like this can trigger a bit of fear. In a twist of fate and circumstances, I was auditing a firm less than 100 miles away from the site of the Jensen Farms outbreak about a week before the fateful Jensen Farms audit. I met with farmers just like Mr. Jensen.
I have to ask myself, if I was the auditor, would I have spotted the inconsistencies in production?
Would I have understood the critical environmental factors I was seeing and understood the entire process and its role in the growth of LM?
Would I have appreciated the relationship of the factors I was looking at and reacted to the risk of the survival and growth of Listeria monocytogenes on the surface of Jensen Farms' melons?
The answer could be frightening. No, I may not have realized the conditions were ripe for a Listeria outbreak the has killed 28 people to date.
This is a gut wrenching realization and one that has been with me since the day this outbreak began; if we are going to truly perform a valid risk assessment, we need to be carrying a very big bag of tools.
The audit instrument is best used like a surgeon’s scalpel. The scalpel is best for delicately separating the good, from the excellent, from the superior. Sometimes we need a hatchet for the ones that need it, and all we have in our tool kit is a small knife.
We should ask about FDA's prevention role, and the role a strong FDA might have played in preventing this outbreak; and ask about the regulatory scenarios moving forward. Certainly, these events point to the urgent need for FDA to come in and level the food safety playing field. But unfortunately, no one wants to pay for the FDA to do its best work, so now the auditor, the consumer, the packinghouse, the farm the processor, the retailer and the consumer must pay.
Thanks to the strength of our legal process and the skill of our legal firms, that there will be justice in the end. This would bring closure for me, except for the fact that our public health structure is letting us down and my efforts without that crucial element will be forever flawed.
I predict we are going to see more sad stories, failures and more finger pointing, and maybe rightly so.
If there are more hazardous facilities out there, they need to be identified, repaired, or closed.
All produce facilities should be reviewed to make sure they have the correct infrastructure, ideally, before they are allowed to operate.
Buyers must insist on the application of the best quality assurance methods and traceability systems.
Food safety efforts from farm to table need proper financial support.
There needs to be less politics played with food safety and a cooperative effort byindustry and government to protect the consumer.
The education of the American consumer about food safety is woefully lacking.