How inspectors traced origin of food poisoning
From a phone call Sunday to a surprise Tuesday, state officials scrambled to figure out what had gone wrong
By RODDIE BURRIS
May 28, 2005
EDITOR’S NOTE: Through interviews with state and local health officials, The State’s Roddie Burris pieced together the first critical hours of the public health crisis that unfolded last week, starting in Camden.
CAMDEN — Emergency room director Tommy Norris saw the tip of the salmonella iceberg and knew what he was looking at.
On duty Friday morning, May 20, at the Kershaw County Medical Center, Norris encountered the first case of what authorities said last week is the largest investigation into a food-borne illness in recent state history.
At least 287 people in two states have reported symptoms of food poisoning after eating at a now-closed Camden restaurant. Fifty have been hospitalized.
“I tried to admit him, but he wouldn’t allow it,” Norris said of the first victim, who suffered from atypical gastroenteritis. Norris prescribed an antibiotic, and the patient left.
As he did, an ambulance rolled up to the emergency room carrying the body of a Lugoff man, James Arledge, who was bound for the hospital’s morgue. Kershaw County Coroner Johnny Fellers had ordered an autopsy for Arledge, 58.
Arledge had not sought medical attention, the coroner said.
Results later would show he died of cardiac arrhythmia — an abnormal rate of muscle contractions in the heart — after contracting a blood infection from salmonella.
Four more people with symptoms came to the hospital Saturday, Norris said, including the wife of the first victim he treated Friday morning.
She thanked Norris.
But hospital medics knew something was very wrong.
SUNDAY — 12:30 P.M.
On a typical Sunday afternoon in Manning, Sara Wells had just returned home from church.
This weekend, Wells, clinic coordinator for the state Department of Health and Environmental Control’s Clarendon County Health District, was wearing a beeper — a special beeper — and it went off.
Fifty miles away in Kershaw County, unusual numbers of patients were showing up at Kershaw County Medical Center’s emergency room. Each complained of symptoms consistent with gastroenteritis — an inflammation of the stomach and intestines.
Victims told hospital staff they had been vomiting, were nauseated and had diarrhea.
South Carolina is divided into health districts. Hospitals and medical staff in each of the districts have a local, 24-hour phone number that they can call to contact state health officials if an emergency arises that could affect public health.
At the hospital in Camden, eight to nine patients already were in the emergency room being evaluated for the same symptoms. Some were sick enough that they were in beds, waiting to be admitted.
Much to their credit, state officials said, when the Kershaw hospital staff contacted Wells by beeper, they already had an idea that a local restaurant was involved.
“We think we have a food- borne illness,” a hospital staffer told Wells, an epidemiological nurse — one who specializes in the causes, distribution and control of disease in populations.
Wells’ first call after speaking with the hospital was to Gil Potter, DHEC’s district medical director for the Wateree Health District that includes Kershaw, Sumter, Clarendon and Lee counties.
SUNDAY — 1:30 P.M.
Potter had just returned to his Columbia home from attending services at Blythewood’s Long Creek Church of Christ.
Wells told Potter the Kershaw hospital was seeing an elevated number of ingestion cases –those suspected of being caused by something the patients ate.
“That concerned me,” said Potter, who immediately phoned Norris, the emergency room director at Kershaw Medical. “They told me they thought the food-borne illness was associated with a local restaurant.”
Everyone has heard the story of international leaders who carry suitcases wired to set loose guided missiles.
There’s also a suitcase when it comes to a public health emergency in South Carolina.
It is filled with information about outbreaks of disease. Potter grabbed his suitcase and headed for Camden, realizing, he said, that he didn’t know what he was walking into.
“We knew there was something there — we didn’t know what — but it was something serious enough to get us involved,” Potter said. “Kershaw hospital recognized it right away and got things cooking.”
Potter then called Wateree district health director Derrick Mims at home. He also called the district office to call out a DHEC team.
“I felt everybody should assemble at the hospital,” Potter said. “We needed to be on the scene.”
SUNDAY — 2:30 P.M.
Eight to nine DHEC staffers arrived and, for the first time, state officials heard a restaurant’s name.
“They gave us that name — Old South — and indicated it might be involved, Potter said. “At 2:45 p.m., we had food inspectors at Old South.”
The food inspectors went through the Old South Restaurant making general assessments, said Brad Collier, DHEC’s district environmental health director.
The investigation into the cause of the sicknesses and their source was in its infancy.
Investigators said they first searched the buffet-style restaurant looking to see if any glaring violations jumped out at them.
For example, a steam table used to keep food hot might not be producing steam. Or a lamp light might not be keeping meat at the right temperature.
Inspectors found nothing out of order, Collier said.
However, inspectors were in for a surprise.
“At that time, we thought we were dealing with something that had occurred on Thursday,” Collier said, “so we acquired their menus from Thursday.”
Typically, many food-borne agents, including salmonella, have a 72-hour incubation period and are caused by undercooked poultry.
Old South closed at 3 p.m. Sunday, just as usual.
SUNDAY — LATE AFTERNOON, EVENING
Back at Kershaw Medical, six people were in the emergency room being treated for gastroenteritis. Two others already had been admitted; another was in the process of being admitted. Several others awaited medical attention.
DHEC staffers, eight or nine strong, began interviewing the sick — those in the emergency room, the waiting room and patients who already had been admitted. They also tracked down people who had come to the hospital the previous two days — Friday and Saturday.
They wanted to know specific food items that the sick had eaten, in order to develop a questionnaire.
“We were open to it (the source) being any other restaurant,” Potter said.
DHEC asked hospital patients what they had consumed during the past four to five days, what restaurants they had patronized, whether they had eaten at church during a potluck, for instance, or possibly a family reunion.
“We wanted to see if there were any common locations, common food histories,” Potter said.
State workers stayed at the hospital until 10 p.m.
That night, a hospital specimen taken by Norris “grew out,” indicating salmonella. The specimen has been taken from the first patient displaying symptoms Friday morning at Kershaw Medical Center.
On a conference call with Potter, Mims and Wells, the epidemiological nurse, DHEC decided to return to the Old South restaurant Monday morning.
“We would get into the restaurant as soon as we possibly could,” Collier said.
Meanwhile, Mims arranged with local officials to set up a headquarters in the county’s emergency operations command center. Multiple phone lines, top-flight Internet access and other amenities would be available for whatever lay ahead.
MONDAY — 9 A.M.
DHEC workers returned to the Old South Restaurant on Monday morning. Old South serves a breakfast and lunch menu several days a week and a dinner on other days.
DHEC also opened up new phone lines to the public at 11:30 a.m. Monday.
At the restaurant, investigators interviewed Old South employees — cooks, wait staff and others — asking them specifically about Thursday’s events.
They then checked food temperatures and food-handling processes. They inspected walk-in coolers and monitored freezer temperatures. They swabbed cutting boards, utensils and other surfaces to see if there were any contaminants left on them.
“We saw nothing abnormal,” DHEC’s Collier said.
However, inspectors made what would be a startling discovery. On Sunday, a customer had come in to Old South, purchased enough food for a group of 40 to 50 people, and delivered that food to a grieving family in an unrelated death.
DHEC contacted the family — whom officials would not identify — and discovered some of the food was left over. Samples were secured and sent to the laboratory for culture tests.
Phone banks remained open until 8 p.m. Monday, as state workers tried to tie information back to the Old South menu. There were no new calls Monday.
“We were narrowing it down to one meal on Thursday at Old South,” Potter said.
By Monday afternoon, 16 people had been hospitalized in four hospitals. DHEC issued a disease alert network advisory for all facilities in the Wateree Health District.
TUESDAY — 11 A.M.
“Things turn a little bit on Tuesday,” Potter said. “We’re getting calls from people who got sick from food they had eaten on Sunday.”
Potter said those calls were completely unexpected, considering the 72-hour window from Thursday, which spawned the initial wave of sickness. He told DHEC staff to go back to Old South and talk to its owners.
DHEC staffers arrived at Old South between 1:15 and 1:30 p.m. Tuesday and sat down with the owners — a father, a mother, a son and a daughter. The owners were “extremely cooperative,” Collier said.
“I met with them an hour, explaining where we were, and explaining to them that this was now more than a one-day event,” he said. “They were very concerned and disappointed.”
So was DHEC.
“When we were dealing with Thursday, we thought this was a one-day event,” Mims said.
By 2:30 p.m. Tuesday, the Old South owners, who had run the restaurant for six years, agreed to close down.
As reports of illness surfaced around the state, investigators struggled to get a count of just how many people were involved in the outbreak.
Camden, like other small, picturesque towns, lures out-of-town sightseers on weekends. Local events, such as Camden Military Academy’s graduation, held May 21-22, can draw crowds, too.
That meant there were plenty of chances for diners to have contracted the illness and carried it back home with them.
With 23 employees working the case, DHEC reissued the disease alert network advisory that originally went out regionally Monday.
This time, the warning went statewide.
WEDNESDAY — 8 A.M.
In the throes of a statewide event, DHEC’s phones rang all day Wednesday. DHEC staff conducted interviews, built case histories, compiled data and communicated statistics to the agency’s central office in Columbia.
“We needed all that information to help us research what type strain of salmonella we have and to know what the vehicle — or the food item involved — was,” Potter said.
The good news, officials say, is there is no record that anyone who ate at the Old South Restaurant on Monday or Tuesday became ill.
The cultures taken from patients, the examinations of patients and their symptoms, and the autopsy results of the lone victim who did not survive the poisoning, are all of the same bacterial family, Potter said.
“It would appear it’s salmonella, but we’re gonna get the subtypes and see what they say,” Potter said.
“You can be certain that whatever we find from the labs, we will follow it to the end of the trail, to help prevent this in the future, and know what the cause of the agent is.”
That could come as early as this week.
Reach Burris at (803) 771-8398 or firstname.lastname@example.org