California should have a law requiring restaurants to report foodborne illness

Last month in mid-December 2011, 20 employees of a capital investment firm in San Francisco all began experiencing stomach cramps and vomiting within a day or two of attending a private company party. It didn't take any degrees in epidemiology for the group to trace their illnesses back to restaurant.

Refer to the article, "Restaurant Outbreak Went Unreported in San Francisco," for the name of the restaurant that hosted the event and the one place where each individual had eaten at the same time. Who oversees illness outbreaks for San Francisco? It's the San Francisco Department of Public Health.

How would someone know whether the food was contaminated or whether any given employee didn't wash his or her hands or whether the employee was around people at home who are or recently were ill with stomach flu or whether the food from the supplier in any given restaurant is or was contaminated, not washed thoroughly, or had other issues?

Locally here, it's the Sacramento  Department of Public Health. Usually, there's a physician specializing in environmental and occupational health who looks at food outbreaks from restaurants or public kitchens, and the physician or physicians examine information and reports for any given state's Department of Public Health when illness outbreaks occur in a specific city.

If you check out the article, "Restaurant Outbreak Went Unreported in San Francisco, you can read how the investment firm informed the restaurant that its food had sickened 20 out of 50 guests. Guess what happened?

According to the article, neither the restaurant, the firm, nor any of the individuals notified the health department. Finally the Health Dept. found out about the illness outbreak by December 29, when journalist Scott James called the health department asking about the incident.

The question now, is if your group gets sick eating in any given restaurant in any city, do you first call a journalist and ask the media to do a public story on the illness outbreak? Or do you first go to the Department of Public Health?

Do you call your lawyer or your doctor? Of course, you go to your doctor to find out what's making you sick. The main point of the article focuses on why there aren't laws requiring restaurants to report illness outbreaks from customers who ate food.

On the other hand, how does the restaurant really know whether it was the food eaten there or somewhere else for the group? How would a restaurant know whether the group was exposed to an illness that's common in December.

For example, if the group was exposed to someone who had contact with someone who had the norovirus, very common in December that for example, in Sacramento was sweeping through nursing homes. And often the norovirus, especially in December and in June is found on cruise ships, at various hotel buffets, or numerous catered events. But did the people get sick that way? Or was it the food from a specific restaurant?

When the journalist was alerted, he broke the story for the Bay Citizen and the New York Times, writing that the incident "highlights the absence of laws requiring restaurants to report illnesses." The issue in question is the huge size of the illness outbreak due to foodborne microbes.

Why was it unreported? And did doctors confirm the illness was from the food rather than from a virus such as the norovirus?

Why didn't the victims report the illness outbreak? Why didn't the restaurant report the outbreak? And why didn't any doctors report the outbreak?

According to the article, the health department did not yet know whether any of the victims sought medical attention. When most people get a foodborne illness that lasts a few days, few call a doctor or want to sit in an emergency room (waiting room) when vomiting and having diarrhea at the same time. Most people want to be near a bathroom and in bed for a few days.

The restaurant posted a statement to its website concerning the incident, calling it an isolated case and reassuring customers that the restaurant is working with the health department. What caused the outbreak? Was it reportable?

Did anyone analyze whether a bacteria or a virus caused the illness? Bacteria known to cause those symptoms from food might be Salmonella, Shigella, Listeria, E. coli O157:H7 and Hepatitis. But a lab has to confirm whether the outbreak is caused by those bacteria. If someone has a confirmed case of those species of bacteria, then the results are reportable. Doctors have to report their findings to state health departments, which in turn report to the federal Centers for Disease Control and Prevention.

If you look at the CDC's suggestions, the Centers for Disease Control and Prevention wants suspected outbreaks of foodborne illness to be reported to the Department of  Health. So how far does one go to let the professionals know what is happening? Does the public know how to report foodborne illness that's confirmed if the professionals are not reporting it?

California law requires restaurants to report employee illnesses but not customers when they get sick from the food. The reporting goes to the state health department. You're supposed to detail what you ate. The professionals are supposed to eliminate the places you ate at or the food you ate one by one until the foodborne bacteria is narrowed down to specific foods.

In the restaurant issue, the elimination process narrowed down the foods to three leafy green vegetables. The restaurant contacted its suppliers of those vegetables. The newspaper reporter wanted to know why the restaurant didn't inform the health department. Is it because restaurants are not obligated to report when customers get ill only when employees of the restaurant are ill?

If an employee comes down with an illness, the restaurant is supposed to report it. But when a customer comes down with an illness, there's no law making a restaurant report the illness to the health department.

After all, when you look at the restaurant's side, how does the restaurant really know what the customer ate and where before coming to the restaurant or whether the food is the culprit or a virus such as stomach flu (norovirus) caused by someone handling food who has the norovirus or by visiting a nursing home where the norovirus in the winter frequently sweeps through, or from a hotel buffet or a cruise or any other exposure outside the restaurant?

Food safety is a big issue. If an entire group of people come down with foodborne illness after eating in any given restaurant, the cause should be found out. Is it the food from the supplier causing the problem? Illness needs to be reported by restaurants, even though the law doesn't require it.

How does one know whether some emotionally disturbed person didn't sprinkle the food of a buffet with bacteria, for example? How would anyone know unless the food was examined and the problem reported if a whole group of customers become ill after eating a specific type of food in any restaurant?

Is it a problem of money, staff, and resources? At the time the article was written, the investigation is ongoing. No one has found a source or pathogen. A formal investigation requires interviewing each of the 20 patients who suffered the foodborne illness.

All this takes time. California doesn't require restaurants to report to health officials when customers become ill after eating the food in any given local restaurant. Some states do require it, such as Washington. You don't have to be an epidemiologist to have the common sense that if a group of people call a restaurant and complain that their entire group is sick after eating there, that it should be reported and investigated.

You don't know whether someone contaminated the food or not. You don't know whether there's a pathogen coming from a supplier or not. What do you look for when no pathogen has been found yet? San Francisco Dept. of Health gets up to 500 foodborne illness reports each year and most of the complaints come from restaurant customers.

The issue is staff, money, resources, and time and whether the complaints focus on any one restaurant more than another. But how many more patients don't report it when they feel ill because perhaps they're too sick to say anything and when they get well, they just don't want to get involved and perhaps just avoid the food?

The moral of this story is if you serve food, report any illnesses if a customer complains. But most restaurants will not report illness simply because they usually fall back on the idea that there's no proof the person became sick due to anything eaten in the restaurant. Usually, the restaurant first talks to its suppliers to see whether there's contamination.

California should have a law requiring reporting not only eateries but also schools that serves food if students become ill after eating the food. How many universities have had foodborne outbreaks of norovirus or bacteria contamination of foods where students in dormitories all rushed into the bathroom down the hall at the same time?

It has happened in the past. And few incidents like these may be reported because the food services have no way of knowing if a virus is going around or whether there's something about the food.