Oregon public health employee faked 56 infection case reports

A former employee in the public health division of the Oregon Health Authority committed misconduct in 56 case reports about Clostridium difficile infections in Klamath County, Oregon, as well as in a manuscript submitted to JAMA Internal Medicine and a published report in the Morbidity and Mortality Weekly Report in March, 2012.

faking.itRyan Asherin, previously a Surveillance Officer and Principal Investigator at the OHA,

falsified and/or fabricated fifty-six (56) case report forms (CRFs) while acquiring data on the incidence of Clostridium difficile infections in Klamath County, Oregon. Specifically, the Respondent (1) fabricated responses to multiple questions on the CRFs for patient demographic data, patient health information, and Clostridium difficile infection data, including the diagnoses of toxic megacolon and ileus and the performance of a colectomy, with no evidence in patient medical records to support the responses; and (2) falsified the CRFs by omitting data on the CRFs that clearly were included in patient medical records.

In addition, Asherin was found guilty of “falsifying and/or fabricating data” that appeared in the research record of the U.S. Centers for Disease Control and Prevention, a manuscript sent to JAMA Internal Medicine in January 2013, and a paper about C. diff that appeared in the CDC’s MMWR journal. The paper — about a potentially deadly infection that’s a common feature of healthcare settings — has been cited 75 times, according to Thomson Scientific’s Web of Knowledge.

Some of these messy data also made their way into 2012 presentations to the CDC and the 11th Biennial Congress of the Anaerobe Society, according to the ORI report.

The OHA told us Asherin no longer works there.

Preventative pasteurization for Hazelnut Growers of Oregon

Hazelnut Growers of Oregon is starting up its large Napasol Pasteurization line this week, effectively bringing in house a state-of-the-art process to eliminate any potential foodborne pathogens. The performance of the Napasol process is validated for a 5-log kill on Salmonella and other pathogens on hazelnuts and other nuts and seeds.

hgobannerOregon is the largest producer of Hazelnuts in the U.S. In business since 1984, the 150 growers that are members of the Hazelnut Growers of Oregon cooperative cultivate 10,000 acres of prime hazelnut orchards in the Willamette Valley. The region’s gentle climate and abundant rainfall grows trees that produce large nuts of exquisite flavor and freshness. Westnut, their industrial ingredients division, is the largest processor and marketer of hazelnuts in North America. Hazelnuts are processed in the Cornelius facility which handles 25 million lbs. of in-shell hazelnuts and 5 million lbs. of hazelnut kernels.

Pathogens such as Salmonella have been involved in foodborne illnesses and product recalls in several kinds of nuts including Hazelnuts. Jeff Fox, President of Hazelnut Growers of Oregon, points out that “the number of samples from the field that test positive warrants this investment to protect the interest of their growers and the commercial development of the cooperative” adding that “whole industry sectors are taking proactive measures to protect their markets, for example mandatory pasteurization of almonds has been in place since 2007.”

Napasol offers an ideal solution, because nuts are treated at relatively low temperatures and the saturated steam is dry, the process preserves the sensory attributes of the raw nuts while delivering the most effective microbial reduction on the market. The process is validated for the pasteurization of a wide range of nuts including hazelnuts, almonds, walnuts, pistachios, cashews, macadamias, and Brazil nuts.

“There is a clear trend in the industry for a demand for pasteurization of nuts, for example for pistachios and walnuts, two other large US crops involved in recalls” says Dieter Kundig CEO of Napasol. He adds “This investment gives a unique advantage to Hazelnut Growers of Oregon and also anticipates regulatory measures that will affect the entire nut industry with the implementation of the Food Safety Modernization Act and with the outcome of FDA’s ongoing tree nut risk assessment.”

Oregon deserves regular, visible grocery inspections

Following up on the series of articles by Tracy Loew about grocery store inspection disclosure in Oregon, her paper, the Statesman Journal, comes out in favor of full disclosure.

image4Good for them.

In Oregon, it is difficult for consumers to learn whether the food at their favorite grocery store is handled safely.

That is the state’s fault.

And that is unconscionable.

The understaffed Oregon Department of Agriculture lags far behind the nationally recommended schedule for store inspections. Even worse, the public cannot easily learn what the inspectors found.

As the Statesman Journal’s Tracy Loew reported last week in stories that should raise legislators’ ire, the Agriculture Department has a huge backlog of grocery store inspections. Some stores have not been inspected for years, even though the federal government recommends inspections every six months.

State agriculture officials say that is because they prioritize inspections based on which activities in the food chain represent the greatest risk to public health and which facilities have a history of problems. That approach sounds defensible from a risk-analysis viewpoint, but it leaves widespread holes in the food-safety system.

The number of serious violations found in grocery store inspections can be astounding. Some — food being sold past the expiration date, food stored at the wrong temperature and food-handling equipment that is unclean — are enough to make the stomach turn.

The Agriculture Department inspection staff is stretched too thin. And some legislators say the situation is not unique to that department.

deli.counterThe 2015 Legislature should undertake a thorough review of inspections conducted by the state’s licensing and regulatory agencies, including:

•Do the inspections serve the purposes for which they were intended?

•Should the inspection process be streamlined? Intensified? Eliminated?

•How are inspections financed, and is staffing appropriate for the workload?

•Are inspection reports promptly posted online, where they are easily available for public view?

For grocery stores, another question desperately needs answering: Should county health departments be given the duty — and the state funding — to inspect grocery stores.

Counties already inspect restaurants. Grocery stores have added delis and other restaurant-style options to meet Americans’ changing lifestyles. For many people, a quick stop at the grocery store has replaced either eating at home or dining out.

In contrast to the backlog in grocery store inspections, about 95 percent of Oregon restaurant inspections are completed on time. The Oregon Health Authority is responsible for those restaurant, cafe and food-cart inspections but delegates that work to counties.

Because grocery stores operate on slim profit margins and face intense competition, it’s in their best interests to have the cleanest, healthiest food handling, display and storage. Some stores have increased their own inspections to compensate for the infrequency of state inspections. That is to their credit.

Still, inspections throughout the food chain are among government’s most important roles. A government inspection report, especially one that the public easily can see, adds clout to the importance of food safety.

It is baffling that the Agriculture Department this year created a database to track inspections and findings but planned the database only for internal management use instead of posting the results online. That suggests misplaced priorities and misunderstanding of the importance of transparency. In contrast, Marion County has an easy-to-use public database of restaurant inspections.

Gov. John Kitzhaber and legislators have a duty to bring Oregon from one of the least progressive states on food-to-table inspections to one of the best. This is an issue of public health, accountability and transparency.

Oregonians should not have to file a public records request and pay a fee for a copy of a grocery store’s inspection report.

Oregonians should not be left in the dark about their neighborhood grocery stores.

Oregonians should expect that their state government ensures their food safety — regularly and publicly.

How safe is a grocery store in Portlandia? It’s not easy to find out

In Cincinnati, Chicago or Washington, D.C., grocery store customers can go online to check out their favorite stores’ latest inspection report.

portlandia-we-can-pickle-thatAt least eight states and many counties and cities across the country post full copies of retail food inspections online. Many other states and municipalities offer online access to, at a minimum, an establishment’s last inspection date and score.

Tracy Loew of the Statesman Journal writes that in Oregon, customers are left in the dark.

Oregon adopted the FDA Food Code, which recommends inspection reports be public documents. But there is no requirement that they be publicly posted or made easily available.

Earlier this year, the Oregon Department of Agriculture created a new database to track food inspections and results. But the system was designed for internal use only, said Mark Stuller, an ODA information systems specialist.

Downloading the data, stored in a program called Filemaker Pro, would take a $30-an-hour analyst at least four hours, Stuller said, as would downloading any updates.

Oregon officials haven’t discussed putting the database online or otherwise making it accessible to consumers, said Frank Barcellos, an ODA food safety program manager.

To get a paper copy of an inspection report, customers must file a formal request under Oregon’s public records law and pay a minimum $15 search fee plus copying costs.

The system is in stark contrast to restaurant inspections, which are available online in Marion and the state’s other most-populous counties.

The Statesman Journal paid $109.50 for copies of inspection reports for the largest stores in Salem and Keizer.

In a follow-up story, leading food safety experts say Oregon officials have a responsibility to make grocery and food processing inspections publicly available.

“The more information you give them, the more consumers are able to make really good decisions to keep themselves safe,” said Bill Marler, a Seattle food-safety lawyer and founder of Food Safety News. “If a grocery store has a bad track record of safety, the public has a right to know that.”

Portlandia_veganOn Sunday, the Statesman Journal reported that while the Oregon Department of Agriculture aims to inspect grocery stores, bakeries, food storage warehouses, dairies and other food establishments once a year, it misses that target by a third.

Grocery stores, in particular, are being neglected. More than half have not had an inspection in the past year, and five percent haven’t had an inspection for more than three years.

Oregon doesn’t give retail food and food processors scores or letter grades. And, consumers who want a copy of their store’s last inspection must file a formal public records request and pay a minimum $15 search fee.

It’s a stark contrast to Oregon’s restaurant inspections, which are conducted by county health departments and overseen by the Oregon Health Authority. OHA reported 95 percent of restaurant inspections were completed on time, and it complies a yearly report with results. Most large counties also make restaurant inspection results easily available.

“There are two issues here – the inspections and the disclosures. Oregon is lacking in both,” said food safety expert Doug Powell, creator of barfblog.com. “What you’re talking about is things that make people sick.”

Powell, a former Kansas State University food safety professor who has published a number of peer-reviewed papers on the subject, said restaurants are the focus of the public attention because it’s easier to pinpoint outbreaks when everyone reporting illness has eaten the same meal.

“It’s a farm-to-fork problem,” he said. “There are vulnerabilities all along the system. Everyone has a responsibility all along the system to provide safe food. (Oregon regulators) should have a responsibility to make that data publicly available.”

The newspaper has reached out to legislative leaders on the issue.

In an email response Sunday, Senate Republican Leader Ted Ferrioli didn’t address funding or transparency.

qr.code.rest.inspection.gradeBut, he said, “Any system so complex and with so many players inevitably fails on occasion. That’s where the educated consumer comes in. The person in the family who prepares and serves meals is ultimately responsible for making sure that all foods, even pre-packaged foods are washed before storing, kept under proper refrigeration, cooked hot enough to kill.

Such terrible advice. But he’s a politician, not a food safety type.

Filion, K. and Powell, D.A. 2009.

The use of restaurant inspection disclosure systems as a means of communicating food safety information.

Journal of Foodservice 20: 287-297.

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Filion, K. and Powell, D.A. 2011. Designing a national restaurant inspection disclosure system for New Zealand. Journal of Food Protection 74(11): 1869-1874

The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.

Investigation of E. coli outbreak at Oregon Montessori school closed and remains a mystery

The E. coli outbreak at a West Linn Montessori school that sickened three children will remain a mystery, with health officials announcing Monday they have wrapped up the investigation without evidence pointing to the cause.

West-Linn-MontessoriInvestigators combed Heart Centered Montessori School, taking environmental samples that were tested for E. coli. All students and staff were tested as well. Those tests yielded nothing, according a news release.

3 confirmed E. coli O157 cases at Oregon Montessori school

Three cases of E. coli infection since September have prompted the Clackamas County Health Department to begin testing all children and staff at a West Linn Montessori program for the potentially deadly bacteria.

West Linn MontessoriIn a Thursday letter to parents with children at Heart Centered Montessori, 2152 S.W. Ek Rd., the department said it continues to investigate the source of the infections. Meanwhile, health officials recommended students and employees be tested for E. coli and to avoid returning to school, swimming and participating in group activities until test results are back.

The Montessori school serves children up to age 6 and was established in 2007, according to its website. 

At least two of the three infections are of the most virulent type of E. coli, O157.H7, the letter to families said. A 4-year old girl in Lincoln County died of the same bacterial strain in September.

Too many tragedies from foodborne pathogens

Stories in food safety matter. Folks aren’t compelled by the fancy facts and figures that all of us nerds have access to. It’s too easy to forget that food safety is about people that get sick. When I get bogged down by the churn of the academic system and all the rhetoric around policy, stories like that of Serena Faith Profitt clarify things for me.1410363185283_wps_18_Serena_Faith_Proffit_7_pn

Serena, a 4-year-old Oregonian died from pathogenic E. coli last week; according to News Times, her family is preparing for her memorial.

A week after the nearly unbearable death of her granddaughter, Laurie Whitaker wiped at an eye and laughed while recalling the tow-headed 4-year-old who called her “Nana.”

“She was very, very smart,” reflected Whitaker, swept into an unsolved mystery that resulted in the death of Serena Faith Profitt from E. coli poisoning. “She knew her alphabet at two-and-a-half, and could count to 50 by the time she was four. She had an ear for music — not kids’ nursery rhymes, but real music. And she loved twirly dresses and sparkly shoes, which is all she ever wore.”

On Monday, Whitaker buried her own grief and hit the bricks to organize a funeral service for Serena that is likely to stretch the resources of the tight-knit clan over which she dotes

Stuff like this makes me feel like I’ve been punched in the stomach. It makes me think about my kids; the kids in my family; and, all the folks I know with youngsters.

And reminds me of why I do what I do.

E. coli connection in Oregon? 3-year-old girl also gets sick

After seeing reports on KATU TV, the family of a 3-year-old girl who got sick from E. coli is convinced that the case is connected to another case of E. coli that killed 4-year-old Serena Profitt on Monday. Both children were in the same general area just before they got sick.

serena1Serena swam in a section of the South Santiam River in Linn County. Then Aubrie Utter had her birthday at Waterloo Park about 20 minutes away and a few feet from a section of that river. They used a water fountain to fill up water balloons.

Aubrie’s birthday party was Saturday, Aug. 23, and her mother, Katie Hendricks, said her daughter was sick that very night.
“During the middle of the night, she woke up crying (that) her stomach hurt. She had diarrhea,” Katie said.

She brought her daughter to a clinic in Albany and just like with Serena she said they thought it was a minor virus and sent her home. But she just kept getting worse, and her mother brought her back in and demanded they do a blood test.

Two hours later they confirmed Aubrie had E. coli, and she was rushed to Doernbecher Children’s Hospital in Portland, just two doors down from Serena. Aubrie was hospitalized for a full week and underwent five blood transfusions. She recovered but Serena did not.

Now, Katie has a message for other parents.

“I want the public to know,” she said. “You got to push doctors. If they tell you, ‘No, go home,’ – push it, ask for blood work, because my daughter wouldn’t be here today if I wouldn’t have done that.”
A KATU reporter called the Linn County Health Department to see what it is doing about this possible connection. The reporter was told that this was the first it had heard about it.

Oregon 4-year-old girl diagnosed with E. coli dies

Four-year-old Serena Profitt died Monday at Doernbecher Children’s Hospital in Oregon, after being diagnosed with E. coli and a 6-year-old family friend is also sick.

serena1Doctors, at this point, do not know the source of the E. coli.

The pastor said the families played “in a pond in the Lebanon area, playing in a river, and they did eat at a restaurant here in the Lincoln City area. The family has said the one thing those two children did that none of the other kids did was share a sandwich at this particular restaurant.”

The pastor did not name the restaurant.

Serena went into kidney failure and had a stroke Sunday night, KOIN 6 News learned. She suffered severe brain damage and died on Monday.

KOIN 6 News does not know the condition of the 6-year-old boy, who is reportedly being treated in the Tacoma area.

Portland boil water alert lifted: Here’s what to do

The Oregon Health Authority has lifted Portland’s boil water alert that was issued on Friday.

But, as Lynne Terry of The Oregonian writes, before using tap water, running-tap-wateror using ice from a machine, here’s what residents need to do:

  • Flush pipes and faucets by running cold water faucets continuously for at least two minutes or until water runs cold.
  • Flush water coolers by running those with direct water connections for five minutes, according to the Centers for Disease Control and Prevention.
  • Flush home automatic ice makers by making three batches of ice cubes. Discard all three batches.
  • Run water softeners through a regeneration cycle.
  • Drain and refill hot water heaters set below 113 degrees Fahrenheit.
  • Change all point-of-entry and point-of-use water filters, including those associated with equipment that uses water.