The Victim Experience with California Food Safety

Laurie Girand
New Outbreak Investigator Training Meeting
California Food and Drug Branch
Ontario, CA
July 20, 2025

Thank you very much.

Good morning, I am a consumer activist and a Board Member of a nonprofit organization called Safe Tables Our Priority. Prior to 1996, I would have to admit that I lived a life of complete and utter blissful ignorance with respect to food safety. I thoroughly trusted that the combination of state and federal agencies ensured that our food supply was as clean as it might have ever been. Though I had had repeated Montezuma's Revenge in another country, I'd only had one really bad case of food poisoning in the U.S. At the time, I was more worried about missing exams than dying.

Today, I want to share with you a few families' experiences with failures in food safety. The first is my own 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.

Our story began while I and my husband were out of the country in the fall of 1996 and our 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 were subsequently 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. When we returned, instead of running into my arms, she lay listless in my lap, moaning, "My tummy hurts. My tummy hurts."

On the third day of her illness, the pediatrician 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 results all came back negative. She had lost at least 10% of her body weight.

As for us, we wondered what we had done wrong. In desperation, I called her nursery school, thinking that if she were this sick, some other children there must have had the same thing; 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 and stomach pains stopped, but because she wasn't peeing frequently and didn't seem to be keeping up with the fluids, we took her to the hospital for a second IV treatment. There, she vomited up all fluids she had consumed in the last six hours, and they admitted her for observation because she didn't look well. They began drawing blood every four hours. At 2 a.m., after looking over her blood test results, the pediatrician on call called me in Anna's hospital room 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. When she hung up the phone, the pediatrician concluded with "I'm so sorry to have to tell you this." I was surprised. They had finally figured out what was wrong with Anna, and we were going to a world class hospital. Everything would be ok, now, I naively believed.

Very early that morning, my husband, who had gone home to sleep, 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 have been found to increase the likelihood of developing 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. Research has been conducted into cognitive issues.

When we reached Stanford, we asked her kidney specialist 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 doctor responded No, No, and Maybe. They told us that the tests performed by her pediatrician were negative for E. coli. 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, in an allergic reaction to her first transfusion, she broke out in hives all over her body, so they stopped the transfusion, 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 that had run our daughter's stool tests had never actually tested Anna's stool for O157:H7 because someone there had decided that her stool was not bloody enough.

A week later, a 17 month old named Anna would die. A Rocky Mountain News article describing Anna Gimmestad's experience said,

"Anna was admitted to Children's on Oct. 26, two days after her parents took her to a Greeley hospital with bloody diarrhea and severe abdominal pains.

'She apparently spoke a lot when she came in, and everybody said she was so cute," Berry said. "Her parents had all of these beautiful pictures of her -- in a swing, sitting on a pumpkin in a pumpkin patch. She was obviously adorable.'

But Berry and others at Children's who fought for Anna's life said they never go tot know that adorable person because she was critically ill by the time they began treating her.

Dr. Kurt Stenmark, chief of pediatric critical care at Children's, said Anna suffered kidney failure, severe brain damage, seizures, lung failure and, finally, the heart failure that ended her life.

The involvement of her heart in the illness, Stenmark said, 'is unusual in our experience as well as in the experience of people around the country.'

He called Anna's illness and death 'the most severe consequences of this disease that we have seen in the past 10 years at this hospital.'

He said doctors used 'extraordinary techniques to try and save this child's life,' including a heart-lung bypass machine, kidney dialysis and a respirator.

Doctors paralyzed Anna with drugs so they could treat her, and gave her strong doses of painkillers and sedatives.

'I don't think that she really suffered,' Stenmark said.

Still, Anna sometimes as aware.

'When we let her wake up, there were signs that she was conscious,' Stenmark said."

Fourteen 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 years old and under. A genetic fingerprint would ultimately show that the organism in our daughter's body was the one found in Odwalla's juice.

When our daughter was discharged after two more transfusions, she was not well. For three months afterward, Anna 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. She still suffers from abdominal pain and sluggish bowels. We hold our breath while awaiting blood test results that are run every year that will tell us her kidney performance is still normal.

Within six months of Anna's discharge, I joined 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 joined because I couldn't just sit back and let this happen to other children when I knew something could be done to protect them.

The second experience I would like to share with you is that of the Bernstein family. 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, three years later, she has recently developed diabetes and is on insulin and an additional medication, has learning disabilities, significant vision impairment, some right side weakness and 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.

Our next experience is that of 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 hepatitis 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. Now, after three years, she appears to have finally recovered.

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.

Here's the last story. 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 tell you about 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.

By June of 1996, Ann was 40 and had a fifth child who was three years old. She was still trying to get her kids to eat healthy foods. They had gone to the swimming pool, and she took orders for sandwiches which she planned 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 took her up on the suggestion. That night, after fixing a dinner the whole family eats, she felt a little under the weather when getting the kids put to bed. At 2:00 a.m., she awakened with diarrhea and terrible stomach cramps that she likened to labor pains. She was deathly ill and had a fever of 102. By 5:00 a.m., she had had so much diarrhea that she was hemorrhaging. Her doctor recommended that she go to the Emergency Room, but she couldn't finish talking to him because she had to go back to the bathroom. She and her husband scrambled to find someone who could watch the kids. In the Emergency Room, they gave her two bags of IV fluids even though ten hours before she was perfectly hydrated. They asked 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 sent her home. It never occured to her that it might be Salmonella because the experience was so different from that of the previous illness.

That afternoon, they called to confirm that Ann had gotten Salmonella again and to prescribe an antibiotic. The next night, the evening news confirmed what the county would soon determine by matching the Salmonella in Ann's stool to that of others. Ann iss a victim of Salmonella food poisoning from alfalfa sprouts. Sprout growers in California were briefly shut down, and the grocery store where she bought the sandwiches pulled them off of the shelves. To this day, though the combined federal and state governments have mounted significant education campaigns toward sprout growers, sprouts cannot really be grown with any guarantee of safety. Outbreaks are ongoing, and yet there is no warning on this hazardous food product.

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's infection changed the activities in which she participated. Haylee will always live with brain damage. We watch our own daughter 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.

You will note that the common theme in all of these stories is that victims of foodborne illness caused by California food companies. Not only as an investigator, 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 never 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 chosen to do nothing. Someone just looked the other way and let people be injured, left maimed or die... in many cases these people were children. 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.

Third, despite significant education efforts on the part of state and federal government, outbreaks of known-to-be-hazardous foods continue to recur. In the last year, more than four years after the Odwalla outbreak, two recalls of unpasteurized juice have affected California. Since the sprout outbreak that affected Ann in 1995, there have been regular outbreaks and recalls for sprouts. Cantaloupe outbreaks have finally reached a level that government has put out a press release to consumers with warnings that often fail to reach consumer's eyes or ears.

As far as I can tell, over the last month, you have received an exhausting education on food safety hazards and regulations. In the little time I have left today, I want to remind you that you are also consumers and that the most important part of your job may be the part where you think "outside-the-box." You not only have the power to enforce regulations, you have the power to change them, if you look for the right opportunities.

S.T.O.P. believes that you need tougher regulations. Rules should enable you to shut down dirty producers, not just repeatedly cite them. We often say that we are less interested in raising the average safety quality of food; what we want is to raise the lowest common denominator. All the great new regulations in the world are useless if the bottom ten percent continues to operate in an unsanitary or hazardous manner. They are also useless if the most basic common-sense restrictions, such as prohibiting the use of drop apples in unpasteurized cider, are not codified. We would like to see licenses put in place for food producers that would require they pass basic tests that show they understand food safety hazards.

S.T.O.P. believes that all growers need to be held accountable for the quality of their product. We want producers to stop mixing their batches of food such that their eggs, or berries or apples cannot be distinguished from those of other producers. We want to see your investigation results published, not buried in a file somewhere. When growers in California are held accountable, and when consumers understand the the judgment you have passed on a grower's processes and the relative safety of the products they are buying, we believe that everyone benefits.

S.T.O.P. also believes that having additional, highly educated investigators such as yourselves is absolutely essential for maintaining the safety of our food supply. As one apple grower told me, and you've heard already, I'm sure, "You get what you inspect, not what you expect."

These three areas: solid regulations, industry accountability, and ample inspection resources are the three legs holding up food safety in our country. There are industries that would tell you that consumers need to be held accountable. When consumers are told the truth about what these biohazards really do to the human body, when consumers are adequately alerted about recalls and outbreaks, when consumers are openly given the same data about hazards that government and industry already have, when California spends as much on food safety advertising to consumers as it does on anti-smoking campaigns, then I might agree. Until then, I'm afraid that consumers are not equal partners with industry and government in food safety. Instead, we are all unsuspecting guinea pigs... sampling raw oysters at farmer's markets, ordering alfalfa sprouts on our deli sandwiches, buying unpasteurized juices for children at juice bars, eating hotdogs at the community picnic, creating demand where none would be if we were truly making informed purchases.

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. This year, when asked to write about what she wanted to do when she grew up wrote, my daughter wrote: "I want to save people from apple juice." If government and industry do a good job with food safety over the next ten years, my daughter won't grow up to be a food safety activist because the job won't exist. In the world I envision, our children won't have to worry about the safety of our grandchildren's food, the way our parents didn't worry about the safety of our food, because together we will have ensured that all Californian food is safe enough from deadly pathogens.