The document discusses how to settle a foodborne illness personal injury claim. It covers topics like determining liability of manufacturers, distributors and suppliers. It also addresses classifying illnesses as short-term or long-term and how that affects settlement, as well as best practices for valuation discussions. Delayed health consequences and future medical expenses from foodborne illnesses are factors that affect compensation. The document provides an example of an E. coli outbreak investigation that implicated prepackaged lettuce through epidemiological methods like interviews, a case-control study and traceback of the contaminated product.

1. How to Settle a
Foodborne Illness
Personal Injury
Claim

2. Topics to Debate
• Understanding how each side assesses strengths
and weaknesses of the claim to negotiate the best
result.
• Determining liability of various parties involved –
manufacturer, distributer, supplier.
• Short-term v. long-term classification of a food-
borne illness and what this means for settlement.
• Best practices for engaging in a valuation
discussion – when to begin the process and what
to reveal.
• How delayed consequences and future medical
expenses of foodborne illnesses affect a
compensation package.

3. Strict Product Liability
• Negligence
– Are you a
product seller?
– Did you act
“reasonably”?
• Strict Liability
– Are you a
manufacturer?
– Was the product
unsafe?
– Did product
cause injury?
• Punitive Damages
/Criminal Liability
– Did you act with
conscious disregard
of a known safety risk?

4. Investigative Partners
• Laboratory investigators
– Microbiologic diagnosis
– Molecular analysis
• Epidemiologic investigators
– Individual case interviews
– Outbreak investigation
• Cohort studies
• Case/control studies
• Environmental investigators
– Facility investigation
– Environmental sampling
– Product traceback

5. Epidemiology–Basic Tools of the Trade
• Symptoms
• Incubation
• Duration
• Food History
• Medical Attention
• Suspected source
• Others Ill
Real-time interviewing with a broad-based
exposure questionnaire

6. Pulsed Field Gel Electrophoresis (PFGE)
• Process separates
chromosomal fragments of
intact bacterial genomic DNA
grown from patient isolate
• Results in 10 to 20 DNA
fragments which distinguish
bacterial strains
• Genetic relatedness among
strains is based on similarities
of the DNA patterns
• Outbreak strains are those
that are epidemiologically
linked AND genetically linked
A Powerful Outbreak Detection Tool

7. Questions to Consider in Assessing
PFGE Clusters
• How common is the
PFGE subtype?
• How many cases are there?
• Over what time frame
did cases occur?
• What is the geographic
distribution of cases?
• What are the case
demographics?
• Do any of the cases
have a “red flag” exposure?

8. Pathway of a Foodborne Illness
Investigation

9. Pathway of a Foodborne Illness
Investigation
If there are more ill persons
than expected, an
OUTBREAK might be
underway.

10. Pathway of a Foodborne Illness
Investigation

11. An Example of Outbreak Detection
September 27, 2005
• Three E. coli O157:H7 isolates with
indistinguishable PFGE patterns identified by
Minnesota Public Health Laboratory
• PFGE pattern new in Minnesota,
rare in United States
– 0.35% of patterns in National Database
• Patients reported eating prepackaged salad;
no other potential common exposures evident

12. E. coli O157:H7 Cases Associated
with Dole Prepackaged Lettuce
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
Initial cluster of 3 isolates
among MN residents
identified.

13. Outbreak Investigation - Methods
September 28–29, 2005
• Additional O157 isolates received
at the MDOH and subtyped by PFGE
– 7 isolates demonstrated outbreak PFGE
subtype
• Supplemental interview form created
• Case-control study initiated

14. E. coli O157:H7 Cases Associated
with Dole Prepackaged Lettuce
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
Initial cluster of 3 isolates
among MN residents
identified.
Case-control study initiated.

15. E. coli O157:H7 Cases Associated
with Dole Prepackaged Lettuce
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
Initial cluster of 3 isolates
among MN residents
identified.
Case-control study initiated.
Case-control study implicated Dole salad.

16. E. coli O157:H7 Cases Associated
with Dole Prepackaged Lettuce
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
Initial cluster of 3 isolates
among MN residents
identified.
Case-control study initiated.
Case-control study implicated Dole salad.
CDC, FDA notified.

17. E. coli O157:H7 Cases Associated
with Dole Prepackaged Lettuce
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
Initial cluster of 3 isolates
among MN residents
identified.
Case-control study initiated.
Case-control study implicated Dole salad.
CDC, FDA notified.

18. Minnesota
Additional states
Date of Onset 2005
15 16 17 18 19 20 21 22 23 24 25
NumberofCases
26 27 28 29 30 1 2 3 414
1
2
3
4
5
6
7
September October
WI
WI
OR
E. coli O157:H7 Cases Associated with
Dole Prepackaged Lettuce (N=26)

19. Shared common "Best if Used By”
Date and production code
Dole Classic Romaine Salad Recovered
from Case-Households

20. Product Traceback
• Single processing plant (Soledad, CA)
• Production Date of September 7, 2005
• Lettuce harvested from any 1 of 7 fields

21. PFGE Patterns of E. coli O157:H7
Isolates from Lettuce
Source
Initial Minnesota
Case-patient
Classic Romaine
Bag #2
Classic Romaine
Bag #1

22. Are Things are Different Today?

23. Did We Cover It - Questions
• Understanding how each side assesses strengths
and weaknesses of the claim to negotiate the best
result.
• Determining liability of various parties involved –
manufacturer, distributer, supplier.
• Short-term v. long-term classification of a food-
borne illness and what this means for settlement.
• Best practices for engaging in a valuation
discussion – when to begin the process and what
to reveal.
• How delayed consequences and future medical
expenses of foodborne illnesses affect a
compensation package.