Speech to California Women of Agriculture (1/16/1999)

Laurie Girand, Advisory Board Member
S.T.O.P.
CAWA Annual State Convention
Holtville, CA
January 16, 2025

I want to thank Frances Pabrua and Janell Percy for their efforts to get me here today. May I ask how many of you are parents? Good. And how many of you are daughters?

Like you, I am a daughter, and I am the mother of a 5 year old girl and a 1 year old boy. I want to share with you my family's trip to hell courtesy of an organism

• so elusive that in 50% of severe cases, it is not identified, and
• so powerful that as few as 10 organisms or perhaps as little as a single organism can result in death.

I'd like to clarify a point which is often not clear in the media. You have many beneficial E. coli in your body. E. coli O157:H7 is not one of them. It is distinctly different from the E. coli that cause urinary tract infections. E. coli O157:H7 is an organism that naturally resides in the intestines of healthy ruminants such as cattle, deer, goats and sheep. It usually gets into our food through the animal's feces. It is believed to have evolved in recent decades to its present strength as a result of the overuse of antibiotics in farm animals.

Our story begins while I and my husband were out of town in the fall of 1996 and my only child was 3 years old. Four days before we were scheduled to return home, Anna became very sick. She suffered from frequent, orange diarrhea and cramps that have been likened to labor pains, which would cause her to wake in the night screaming. Though she was toilet trained, she could not make it to the bathroom in time, so she went from panties, to panty shields, to diapers. She ceased eating and drank almost no fluids. Instead of being her usual active self, she would lie listless in my lap, moaning, "My tummy hurts. My tummy hurts."

On the third day of her illness, the doctor thought it was a stomach virus and sent her home. On the 5th day, he began stool culture tests for Shigella, Campylobacter, and Salmonella, the top three foodborne illnesses. He thought he had ordered all related tests as well. He wanted to identify the illness to prescribe the correct antibiotic. He asked us to push fluids. My mother had told us that she had bought apple juice while we were gone and that Anna had really liked it. So we bought Anna more apple juice and encouraged her to drink it. On the 6th day, because she was becoming dehydrated, they gave her IV fluids... they had to stick her three times because her veins had shrunken so. On the 7th day, the stool cultures all came back negative.

As for us, we wondered what we had done wrong. We called her nursery school, and they seemed to think we were strange because no other children had reported sick. We worried about mayonnaise in her lunchbox, and a petting zoo she had visited.

Eight days after it began, the diarrhea stopped, but we took her to the hospital for a second IV treatment, and they admitted her for observation because she didn't look well. After looking over her blood test results, they called me in her hospital room at 2 a.m. to tell me she had "HUS," which is often caused by E. coli O157:H7 in hamburger and water sources. They wanted to transfer her to Stanford Hospital.

My husband, who had gone home, went to the internet and pulled off everything about O157:H7 and HUS. It mentioned apple cider as a possible source. When I read the materials, I couldn't stop crying.

Between 1 and 10 and 1 and 20 children infected with E. coli O157:H7 develop Hemolytic Uremic Syndrome which is a blood disorder, caused by a poison put into the bloodstream by the organism. Red blood cells are shredded, and the number of free platelets falls, as clots form and plug up capillaries. Contrary to what you may have read, the kidneys are merely the first part of the body to fail, clogged with clots and overworked trying to excrete the clots and cell fragments. The victim becomes prone to uncontrolled bleeding in all parts of the body. Every organ suffers damage, including the heart, the pancreas, and the brain. Severe anemia deprives parts of the body of needed oxygen. Victims can suffer strokes, blindness, coma, and death. The autopsies of those who die describe their organs as having been liquefied. There is no cure; all treatment is merely supportive. This organism does not respond at present to any known antibiotics. In fact, antibiotics can hasten the disease.

People who appear to recover from the initial illness are at risk of developing chronic conditions such as complete kidney failure even a decade later. They can also develop gallstones, diabetes, colon and intestinal problems, and heart problems.

At Stanford, we asked if it were possible that

• Anna were part of a larger epidemic,
• if her case should be reported to authorities; or
• if her illness was caused by O157:H7.

The answers we were given were No, No, and Maybe. They told us that the tests for E. coli were negative. The correct answers turned out to be Yes, Yes, and Definitely.

On the 10th day, they discontinued fluids of all kinds because her kidneys were failing, and she was beginning to swell. They had to cut off her hospital bracelets which became constricting. She would beg us for water but we could only give her one swallow per hour. Her lips became cracked and bloody; her speech slurred. On the same day, she needed a transfusion, but we couldn't donate our blood because we were her best hope as sources for transplanted kidneys, and they didn't want her to develop antibodies to our organs. Her urine turned, what they euphemistically call "tea" colored. Then, she had an allergic reaction to her first transfusion, so they stopped it, and we waited another 15 hours before they started a second.

And then the face of death came to visit my only child, my baby girl. From the anemia, her lips and gums turned gray, her puffy face was ashen. Her bloodwork indicated she should be dialyzed.

That day, through the press, we learned of the Odwalla outbreak in the State of Washington. We learned that the laboratory had never actually tested Anna's stool for O157:H7 because someone there had decided that it was not bloody enough. A week later, a 17 month old named Anna would die a death that included "extraordinary measures": treatment with dialysis, a respirator and a heart-lung bypass machine. 14 children in total would be identified as having developed HUS from unpasteurized apple juice, and 70 total Odwalla cases would be identified--over half would be 5 and under. A genetic fingerprint would ultimately show that the organism in Anna's body was the one found in Odwalla's juice.

When Anna was discharged after two more transfusions, she was not well. For three months afterward, she would resume taking naps she had given up over a year before. For her continuing anemia, she was placed on 9 times a child's daily dosage of iron, which turned her teeth black.

Within six months of Anna's discharge, I joined an organization called S.T.O.P., Safe Tables Our Priority, which consists of victims of foodborne illness, their family and friends who are committed to ensuring that the foodborne tragedies they have experienced are not needlessly repeated. I am on S.T.O.P.'s Advisory Board, and I run its produce programs. I am partly here to explain the human cost of outbreaks that is not typically measured, the experiences that are lost. To reporters, to CDC doctors, and to FDA investigators, we are numbers and percentages. But we have faces, and we want to share some of these experiences with you.

This is 5 year old Haylee. One night in June of 1996, Haylee, who was 3 at the time; Haylee's 7 year old sister, Chelsea; and Haylee's Mom all developed severe cramps and frequent, watery diarrhea which continued day and night. Within the next two days, the Mom improved but the two girls got worse. On Saturday, Haylee developed some blood in her diarrhea so her mother took her and Chelsea in to see the doctor who was not concerned and sent them home. On Sunday, they again went to see their physician and were again sent home. That evening, the parents took the children, who had become quite dehydrated and inconsolable, to the hospital, and they were finally admitted for observation. It was the parents who cautiously and intuitively suggested that perhaps it could be an E. coli infection. Indeed, stool cultures revealed that the children had E. coli O157:H7. Over the next day, Chelsea improved, but the doctors grew concerned that Haylee was developing HUS and wanted to transfer her to another hospital. The parents were told they could not ride with their three year old in the ambulance. Chelsea cried as her parents and sister left on Monday, July 1st, leaving her alone at the first hospital.

Haylee's father left his job to emotionally support his family and wife. Haylee's Mom slept every night at the second hospital. There, Haylee stopped urinating. They tried to do peritoneal dialysis, in which doctors cut a hole in the abdominal cavity, insert a tube and then pour fluid in with the hope that the wastes building up in the blood will leach into the cavity and can be siphoned out. Note that because of severely depleted platelets, surgery is particularly dangerous for these patients because they may just bleed and bleed and bleed. However, in this case, Haylee's diaphragm had holes in it which caused the dialysis fluid to leak into her chest, so instead they had to insert a catheter in her neck and perform hemodialysis for three hours every other day. In this first week at the new hospital, she had been lethargic, and she went into shock. She was put on a ventilator. But then, because she was little and couldn't lie still, the ventilator tube kept hitting her windpipe and caused her windpipe to swell, so they removed the ventilator as soon as they felt she could breathe on her own.

As a result of one procedure, she vomited and inhaled her own vomit. This caused pneumonia which proceeded to respiratory failure. She was put back on the ventilator. They inserted tubes into her chest to drain the fluid around her lungs. As a result of the nutritional supplements, Haylee's blood sugar level skyrocketed, and she was put on insulin. She subsequently became insulin dependent. Sometimes, when the nurses thought the parents couldn't overhear them, even the nurses were crying.

Haylee came off of dialysis in mid-August. On August 27th, she suffered a seizure which led the doctors to discover that she had massive bleeding in her brain which required five hours of brain surgery. She remained in the hospital for another month. When she returned home on October 4th, more than three months after she was admitted, she was blind and had to take 12 medications every day. Gradually, with therapy, she learned to walk again, and her vision improved. Now, two years later, she is on one medication, has significant vision impairment, has some right side weakness and has fine motor problems. Her kidneys are not clearing her body of wastes at normal rates. Her mother describes Haylee as the most wonderful, loving child you will ever meet.

Through epidemiology, it was later learned that Haylee and her family were poisoned by lettuce contaminated with E. coli O157:H7. The lettuce was rinsed with unpotable water in an open air storage shed about 100 feet from a cattle pen. Forty-seven cases were identified. The lettuce was certified organic and shipped to Connecticut and Illinois from Hollister, California.

This is Lindsay. Lindsay was 10 years old in March of 1997 when she spent three days unable to eat or drink because of severe abdominal cramps, vomiting, fever, and splitting headaches. Lindsay didn't want to go to the hospital because it hurt to move. When her family rushed her to the emergency room, she was screaming in pain, vomiting continuously and was so dehydrated that emergency room personnel had trouble finding a vein to start an IV. As they stuck her, she screamed for her mother.

Once there, she continued to vomit and her stomach pain increased. She was on continuous IV fluid, pain medication, and anti-nausea drugs. The doctors concluded that she was suffering from hepatatis A, a viral infection of the liver in which the liver becomes enlarged and painful and which results in jaundice.

On the second day of her hospitalization, Lindsay stopped talking and could barely open her eyes. Her small eyebrows would furrow from the pain and tears would silently run down her face. She whispered through dehydrated, cracked lips, "Mommy, it hurts everywhere." She hadn't eaten or taken a drink in over a week, yet she continued to try to vomit, endlessly heaving, trying to rid her body of the poison that had overtaken it. With each convulsion, she would continue to cry because she couldn't breathe and her liver was so inflamed that the movement was excruciating for her. At one point during her hospitalization, Lindsay stopped communicating and curled up in the bed in a fetal position; her mother thought that she would die.

Lindsay was hospitalized for six days and lost 10% of her body weight. Approximately 4 months after she contracted hepatitis A, Lindsay suffered from shingles. In the past year, she has been diagnosed with asthma and now uses an inhaler. She continues to complain of unexplained back and joint pain; she has experienced hair loss and returned to the doctor on several occasions with unexplained skin rashes. When she returned to school she went 1/2 days frequently as she was unable to complete a full day of school due to fatigue. She was forced to quit the dance classes she has taken since she was 4 years old as she was physically unable to keep up. She also had to quit soccer.

Lindsay lives in Michigan and had eaten strawberry shortcake as part of her school lunch. Strawberries were imported by a distributor and passed off as American as part of the U.S.D.A. school lunch program. The company responsible was based out of San Diego. Ironically, though thousands of children were affected, the only law broken was that of defrauding the government.

Just when you thought I didn't have another story, here's the last one for today. There's a lot of talk in foodborne illness circles about who is at greatest risk from foodborne illness. The next victim I want to describe is someone who was not typically considered at-risk.

This is Ann. In 1988, Ann was a 32 year old, active mother of four, whose youngest child was 1.5 years old. She was the healthy eater in her family, always eating fresh fruit and vegetables and trying to convince her kids to do the same, though they were much pickier eaters. During this year, she had diarrhea off and on for three months and was losing weight. Though she could still function, she never wanted to be far away from home. When she was finally diagnosed with Salmonella, the doctors had to be careful about which antibiotic they prescribed because she is severely allergic to penicillin. Indeed, for this illness, she had to have two courses of antibiotics, because she was still testing positive for Salmonella after the first course was completed. After the treatments she developed a constant ache in her right side below the rib cage. Though she had no other signs of gall bladder disease, the physicians treating her were convinced it was caused by Salmonella, which given how long she had carried it, would have established itself in the intricate network of blood vessels in the gall bladder. Despite her fears of surgery, her gall bladder was removed The gall bladder is responsible for producing bile and enzymes that aid in digestion. To this day, Ann cannot digest meals the way you and I do. For the rest of her life, if she eats a large meal one night, such as a Thanksgiving dinner, she will still feel full the next day because her digestive tract does not move food along the way ours does. After the surgery, she was hospitalized for a week with severe pain, lost significant weight, and came home, according to her, "looking like a cadaver". Thus, ended, what for her was a year of chronic illness. The pain was gone. Everyone was telling her "it must have been chicken." This was common in the late 1980's when produce had not yet been associated with fecal contamination.

Fast forward to June of 1996, Ann is now 40 and has a fifth child who is three years old. She's still trying to get her kids to eat healthy foods. They've gone to the swimming pool, and she's taking orders for sandwiches which she plans to get from a local grocery store deli. She remembers telling her kids, "Hey guys, don't you want something green on your sandwiches? Don't you want a little lettuce or sprouts?" No one takes her up on the suggestion. That night, after fixing a dinner the whole family eats, she feels a little under the weather when getting the kids put to bed. At 2:00 a.m., she awakens with diarrhea and terrible stomach cramps that she likens to labor pains. She is deathly ill and has a fever of 102. By 5:00 a.m., she has had so much diarrhea that she is hemorrhaging. Her doctor recommends that she go to the Emergency Room, but she can't finish talking to him because she has to go back to the bathroom. She and her husband scramble to find someone who can watch the kids. In the Emergency Room, they give her two bags of IV fluids even though ten hours before she was perfectly hydrated. They ask for a stool sample, and she remembers handing it to them and saying "Oh, this won't work, all there is is blood." Then, they send her home. It never occurs to her that it might be Salmonella because the experience is so different from that of the previous illness.

That afternoon, they call to confirm that Ann has gotten Salmonella again and to prescribe an antibiotic. The next night, the evening news confirms what the county will soon determine by matching the Salmonella in Ann's stool to that of others. Ann is a victim of Salmonella food poisoning from alfalfa sprouts. Sprout growers in California are briefly shut down, and the grocery store where she bought the sandwiches pulls them off of the shelves.

Let me ask if you are familiar with the disease Listeria? There have been many Listeria-related recalls in the last year, recalls for cheese, alfalfa sprouts, hot dogs and sandwich meats. Listeria can create asymptomatic infections in pregnant women. A woman can have a perfect pregnancy, have an amnio with results indicating the baby is fine, appear to be perfectly healthy, and then find, half way through her pregnancy or even close to delivery, that her baby has died. She then has a choice of whether to use a dilation and extraction procedure to remove the baby's body by sucking it out through a tube or she can experience the pain of chemically induced labor to give birth to a body that is already dead. When autopsies are performed, pathologists may not even test for Listeria, specifically because it is considered less common. As a result, epidemiologists largely do not investigate undiagnosed stillbirths, and outbreaks of Listeria largely go undetected. Babies born with a Listeria infection can develop meningitis, a dangerous infection of the lining of the brain. The latest Michigan outbreak of Listeria in hotdogs or maybe deli meats is reported to have killed eight people, including two spontaneous stillbirths.

When you read about foodborne illness victims in the newspaper, you may hear reports that they have recovered. They may live, but many suffer for years or even decades after the initial illness. As you've seen, a year passed before Ann finally had her gall bladder removed. Lindsay is still suffering. Haylee will always live with brain damage. We watch Anna closely for signs of failing health. These are the nightmares parents of victims wake to every morning: previously healthy children with long term, chronic illnesses that can render them medically uninsurable. The possibility of hospitalization and transplants in years to come.

These are all stories of victims of foodborne illness caused by California food companies. Yet, because foodborne outbreaks are not widely reported, you may not be aware of how many outbreaks are reported for some foods all across the country. It actually takes an appallingly long list of outbreaks to bring the government to action. What everyone is now discovering is that some foods and food products are grown, handled and processed in ways that make them more hazardous. I've included a couple of slides on these. I have deliberately excluded foreign outbreaks in the same food categories.

This is a list of outbreaks caused by unpasteurized apple juice. Unpasteurized apple juice has hospitalized children in Canada as recently as November, 1998. The most common single factor across most unpasteurized apple juice outbreaks is the use of drop apples, a practice that to date, no one has outlawed in the United States. In fact, in the state of Massachusetts, SSOPs give assurance that drop apples can be used in unpasteurized cider. Ironically the first outbreak of cider identified in the U.S. was found in Massachusetts. And on this slide, I've added to the apple juice list, outbreaks caused by unpasteurized orange juice.

Here's a list of lettuce related outbreaks.

Here's a list of alfalfa sprout-related outbreaks. When California Health and Human Services investigators went to alfalfa sprout locations, they found someone growing alfalfa sprouts in a broken-down bus. In one facility, rust from overhead beams was dripping into the growing alfalfa. It is now believed that the seed itself is contaminated with organisms, putting all growers at risk. The alfalfa sprout growers have recently gotten permission to use high concentrations of chlorine to soak the seeds; yet, this technology is proven only to reduce hazards, not render the seed pathogen-free. Due to the present risk, the FDA has advised that children, the elderly and the immune impaired should not eat alfalfa sprouts.

It is widely recognized that the numbers of victims identified and the breadth and scope of these illnesses is grossly underreported for the following reasons. Clearly some foods have national track records that cause them to be singled out for special scrutiny.

However, not only as a producer, but as a consumer of California grown foods you should find the following frightening.

First, some of the California growers that have caused the outbreaks described here are still in business. The apple grower that supplied Odwalla with tainted apples has not been publicly acknowledged. The owner of the lettuce processor in Hollister is believed to have reorganized under a different name and is practicing elsewhere in the state.

Second, not only do some businesses act fraudulently or willfully flout existing, inadequate laws, but in many cases of foodborne outbreaks, individuals have known that something was not right and chose to do nothing. Someone just looked the other way and let people be injured, left maimed or die. Odwalla threw more cullers onto its juicing line rather than declare a batch of apples not worthy of processing. Fancy Cutt, the lettuce processor, had organic inspectors onsite who didn't call attention to unsanitary conditions.

Well, S.T.O.P. doesn't look the other way. And we think you're here with your eyes wide open.

What can YOU do to make this situation better?

First, make your product as safe as possible. Don't take unnecessary risks with your business and other people's lives. Don't stop at government and Western Growers Association guidelines. Exceed them by looking for hazards and critical control points in the field and in your process for two reasons. One, the currently published guidelines are insufficient to ensure safety. Because they don't go far enough, implementing them alone will not protect your product from contamination. Two, they will be passed up in the next decade by regulations that will be better. You don't want to keep reaching the bar just to find it has been raised.

Here's an example. The single greatest cause of foodborne illness involves animal feces coming into contact with food, either directly or indirectly through water. Studies show pathogens are able to survive in soil for months and even years and they survive better in colder climates. Because it takes so few organisms to kill someone and because chlorine and other chemicals are imperfect sanitizers, it can be impossible to rid produce of pathogens after contamination through any means other than heat. Yet, in current guidelines there is no requirement for the control of manure application. The best recommendation we have in this country is to not apply raw manure within 60 days of harvest.

If you are a produce grower, you can choose to use only pathogen-free fertilizers.

Second, label your product with pride. If you have done more to make your product safe, let the consumer know. Clear differentiation of your product may cost you a little bit more, but safer food that is clearly labeled should also get you more in the market. But don't just put labels on your food to help inform the customers, do it to protect your business. If an outbreak occurs in your industry, you want consumers to quickly be able to identify that it didn't come from your products.

Lastly, it's not enough to stop once you've addressed food safety at your business. You have to think about the other guy. One bad producer can create a serious economic problem for an entire industry. A lot of people like to tell me "No one wants something bad like this to happen to consumers." Yet, in every industry, not just foods, we all know by reputation of people who deliberately cut corners and get away with flouting the most basic laws.

We are not referring to the people who because of ignorance just need some education to understand the issues. We are talking about the people who can't grow safe food because it would put them out of business, who deliberately take advantage of the system, take advantage of YOU, and take advantage of consumers. If you have been looking the other way, focus on reality. How long can you wait until someone you've heard of, or even know, causes an outbreak that results in illnesses like ours or deaths? Within your industry, you need to decide how you can force these people to tow the line or to get out of business.

Here's an example. I cannot understand why apple and citrus fruit growers who are NOT using drop fruit in unpasteurized juice can sit back and let Massachusetts endorse the use of drop apples when they know it can lead to children dying. All the education in the world doesn't matter if we codify unsafe practices. Somewhere--this year in Canada--parents are feeding drop-apple cider to children. How many children have to die or be injured before the safer members of industry take a public stand against unsafe producers to protect consumers? Food safety issues are not just theoretical questions in an ethics class somewhere.

I'd like to thank you for opening your hearts and minds to the plight of these victims. Before I go, I'd like to add a little more food for thought. In our home, what our children eat is very restricted. Our children eat no lettuce, no apples, no alfalfa sprouts, and, though this may seem obvious, no oysters. They drink no unpasteurized juice. They eat no dry cured salamis or dry-cured ground meats. They eat no ground meat or hot dogs cooked outside our home. We avoid buying produce from third world countries. We boil the exterior of most fruits and peel them before giving them to our kids. We scrub melons in bleach and water. We pray over berries and grapes. For my family's sake, I'm searching for food producers I can trust to do everything they can to make food safer. I want those producers to be you.

Thank you very much.