1992–1993 Jack in the Box E. coli outbreak explained

1992–1993 Jack in the Box E. coli outbreak
Bacteria Strain:	Escherichia coli O157:H7
Location:	Western United States
First Outbreak:	Seattle, Washington
First Reported:	January 12, 1993
Date:	December 18, 1992 – February 23, 1993
Source:	Contaminated beef products at Jack in the Box restaurants
Confirmed Cases:	732
Severe Cases:	178
Deaths:	4

The 1992–1993 Jack in the Box E. coli outbreak occurred when the Escherichia coli O157:H7 bacterium (originating from contaminated beef patties) killed four children and infected 732 people across four US states.^[1] The outbreak involved 73 Jack in the Box restaurants in California, Idaho, Washington, and Nevada, and has been described as "far and away the most infamous food poison outbreak in contemporary history."^[2] The majority of the affected were under 10 years old. Four children died and 178 others were left with permanent injury including kidney and brain damage.^{[3] [4] [5] [6]}

On February 10, 1993, newly inaugurated President Bill Clinton participated in a televised town meeting program from the studios of WXYZ-TV in Detroit, Michigan. He fielded questions from the studio audience as well as studio audiences in Miami, Florida, and Seattle, Washington, and responded to questions from the parents of Riley Detwiler – the fourth and final child to die in the E. coli outbreak.^[7] The wide media coverage and scale of the outbreak were responsible for "bringing the exotic-sounding bacterium out of the lab and into the public consciousness," but it was not the first E. coli O157:H7 outbreak resulting from undercooked patties. The bacterium had previously been identified in an outbreak of food poisoning in 1982 (traced to undercooked burgers sold by McDonald's restaurants in Oregon and Michigan). Before the Jack in the Box incident, there had been 22 documented outbreaks in the United States resulting in 35 deaths.

Sources

On January 12, 1993, Phil Tarr, then a pediatric gastroenterologist at the University of Washington and Seattle's Children's Hospital, filed a report with the Washington State Department of Health (DOH) about a perceived cluster of children with bloody diarrhea and Hemolytic Uremic Syndrome (HUS) likely caused by E. coli O157:H7.^[8] Tarr contacted John Kobayashi, the Washington State Epidemiologist, who started the epidemiological trace-back, linking these cases to undercooked hamburger patties. Dr. Kobayashi recalled the conversation in an interview: "I knew that, when Phil called me,...for him to say, 'this is something that I've never seen before,' that was a big red flag."^[9]

Health inspectors traced the contamination to Jack in the Box fast food restaurants' "Monster Burger" which had been on a special promotion (using the slogan "So good it's scary!") and sold at a discounted price. The ensuing high demand "overwhelmed" the restaurants' food-safety protocols, such that the patties were not cooked long enough or at a high enough temperature to kill the bacteria.^[10]

On Monday, January 18, 1993, DOH officials went public with an announcement about the source of the O157 outbreak at the state lab. After that press conference, Jack in the Box agreed to stop serving hamburgers and to quarantine the meat patties.^[9] Two days later, on the same day of President Bill Clinton's inauguration, a powerful storm swept through the Puget Sound area (Seattle and King County). The storm ravaged the area, knocking out power for thousands of residents across three counties, with some living in the dark for five days. The power outage impacted restaurants' proper cooking temperatures and safe refrigeration temperatures and even hindered thorough hand-washing – all critical factors in preventing foodborne illnesses.^[9]

At a 1993 press conference, the president of Foodmaker (the parent company of Jack in the Box) blamed Vons Companies, the supplier of their hamburger meat, for the E. coli epidemic. However, the Jack in the Box fast-food chain knew about but disregarded Washington state laws which required burgers to be cooked to 155F, the temperature necessary to completely kill E. coli. Instead, it adhered to the federal standard of 140F. Had Jack in the Box followed the state cooking standard, the outbreak would have been prevented, according to court documents and experts from the Washington State Health Department.^[11]

The subsequent investigation by the Centers for Disease Control and Prevention (CDC) identified five slaughterhouses in the United States and one in Canada as "the likely sources of ... the contaminated lots of meat." In February 1998, Foodmaker agreed to accept $58.5 million from Vons and eight other beef suppliers to settle the lawsuit, which had been initiated in 1993.^[12]

A total of 171 people required hospitalization.^[13] The majority of those who presented symptoms and were clinically diagnosed (but not hospitalized) were children under 10 years old.

Of the infected children, 45 required hospitalization – 38 had serious kidney problems and 21 required dialysis.^[14]

Four children died:

• Six-year-old Lauren Beth Rudolph of southern California died on December 28, 1992, due to complications of an E. coli O157:H7 infection later tied to the same outbreak.^[15]
• Two-year-old Michael Nole of Tacoma, Washington, who died on January 22, 1993, at Children's Hospital Medical Center in Seattle of heart failure stemming from kidney failure caused by the bacteria E. coli O157:H7.^{[16] [17]}
• Two-year-old Celina Shribbs of Mountlake Terrace, Washington, died on January 28, 1993. She became ill due to a secondary contact transmission from another child sick with E. coli.^{[18] [19]}
• Seventeen-month-old Riley Detwiler of Bellingham, Washington, died on February 20, 1993, following secondary contact (person-to-person) transmission from another child sick with E. coli.^[9] The 18-month-old boy who infected Riley had spent two days with bloody diarrhea in the daycare center before a clinical laboratory could return the positive test results for E. coli. The first boy's mother suspected her son had E. coli but did not tell the daycare staff for fear that she would be compelled to care for him at home. When the test results came in positive for E. coli, county health officials could not reach the child's parents during the workday. Both of the first boy's parents worked at Jack in the Box, where they regularly fed their son hamburgers. Riley, on the other hand, had never eaten a hamburger.^[18] Some experts speculate that, while most media coverage focused on the company and the government – treating the affected as faceless and nameless statistics – the interaction of Riley Detwiler's parents with President Bill Clinton resulted in the ensuing national news coverage giving a human face to the events.^[20] On Tuesday, February 23, 1993, three days after Riley's death, the American Meat Institute (AMI) sponsored an industry briefing in Chicago to discuss the E.coli O157:H7 outbreak tied to contaminated hamburgers sold at Jack in the Box. Jim Marsden, AMI's vice president for scientific and technical affairs, started off the meeting by informing the group that "Riley Detwiler, the 17-month-old son of the parents who you just saw featured at the town meeting with President Clinton, died last Saturday."^[21]

Lawsuits

In 1993, attorney William "Bill" Marler represented the then nine-year-old Brianne Kiner in litigation against Jack in the Box following an E. coli O157:H7 outbreak, securing a $15.6 million settlement.^[22]

Marler represented hundreds of other victims of the outbreak in a class-action suit against Jack in the Box, settling for over $50 million. At the time, it was the largest-ever payout related to foodborne illness.^[23]

Victims of the Jack in the Box E. Coli crisis sued Foodmaker Inc. because they were responsible for supplying the meat for Jack in the Box Restaurants. Sheree Zizzi was a spokesperson for Foodmaker when the lawsuit of Riley Detwiler was settled, she had a positive view on the lawsuit by referring to it as fair and equitable. However, another Foodmaker official, Robert Nugent was not pleased and viewed the lawsuits as poor settlements with the franchisees as a whole. The main argument made against Foodmaker Inc. in these lawsuits were that they had failed to check the meat supply to deem it safe to eat and that they withheld information for their benefit of the company.^[24]

• The irresponsibility shown by Jack in the Box was seen when they covered their bases by shifting the blame to others involved such as Foodmaker Inc and the cooks at the Jack In the Box location. The chairman of Jack in the Box, Jack Goodall publicly announced in hopes to make the company look better that the company shared their sympathy and prayers to the families of the victims of the crisis. He added that Jack in the Box would pay the hospital bills for the all the customers affected with E. Coli.

Legacy

Sen. Richard Durbin (D-IL), addressing a congressional hearing on food safety in 2006, described the outbreak as "a pivotal moment in the history of the beef industry."^[25] James Reagan, vice president of Research and Knowledge Management at the National Cattlemen's Beef Association (NCBA), said that the outbreak was "significant to the industry" and "the initiative that moved us further down the road [of food safety] and still drives us today."^[26] David Acheson, a former U.S. Food and Drug Administration Associate Commissioner for Foods, in 2015 told Retro Report that "Jack in the Box was a wakeup call to many, including the regulators. You go in for a hamburger with the kids and you could die. It changed consumers' perceptions and it absolutely changed the behaviors of the industry."^[27]

As a direct result of the outbreak:

• E. coli O157:H7 was upgraded to become a reportable disease at all state health departments.
• The Food and Drug Administration (FDA) increased the recommended internal temperature for cooked hamburgers from 140°F to 155°F.^[28]
• The USDA's Food Safety and Inspection Service (FSIS) introduced safe food-handling labels for packaged raw meat and poultry retailed in supermarkets, alongside an education campaign alerting consumers to the risks associated with undercooked hamburgers. The labels and the education campaign came with criticism and objection from the industry.^[3]
• The FSIS introduced testing for E. coli O157:H7 in ground meat.
• The United States Department of Agriculture (USDA) reclassified E. coli O157:H7 as an adulterant in ground beef.
• The USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Points (PR/HACCP) program.^[29]
• The NCBA created a task force to fund research into the reduction of E. coli O157:H7 in cattle and in slaughterhouses.
• Jack in the Box completely overhauled and restructured their corporate operations around food safety priorities, setting new standards across the fast food industry.^[26]
• Roni Rudolph, mother of Lauren Rudolph, and many other parents of affected children formed STOP Foodborne Illness (formerly Safe Tables Our Priority, or S.T.O.P.), a national non-profit organization dedicated "to prevent[ing] Americans from becoming ill and dying from foodborne illness" by advocating for sound public policy, building public awareness, and assisting those impacted by foodborne illness.^[30]
• Parents of the affected children played key roles in spreading awareness and advocating for change – speaking directly to President Bill Clinton, meeting with Vice President Al Gore, testifying before the Clinton Healthcare Task Force, working with the Secretary of Agriculture, and discussing food safety issues with lawmakers in Washington, D.C.^{[31] [32]}
• Darin Detwiler, who lost his son, Riley, to E. coli-caused hemolytic–uremic syndrome during the outbreak, later served as a regulatory policy advisor to the USDA for meat and poultry inspection. Detwiler became a professor of Food Policy and the Director of Regulatory Affairs of Food and Food Industry at Northeastern University.^[33] In 2018, 25 years after his son's death in the outbreak, Dr. Detwiler received the Food Safety Magazine "Distinguished Service Award" for 25 years of contribution to food safety and policy.^[34]
• A short time after the outbreak, Jack in the Box launched an ad campaign that brought back the original company mascot Jack as a savvy no-nonsense businessman who seeks revenge on the executives who "blew him up" in 1980. This campaign was intended to convince the public that they were no longer the company plagued by the food safety crisis.
• E. coli-related events that are reported by the media outlets, often cite the Jack in the Box example because of its significance with its brand and the people. The repetition of negative media on a restaurant tarnishes its history because the consumers of the media will uphold that negative image for long periods of time.^[35] Foodmaker Inc., officials defended themselves and their brand by taking the blame away from their cooking practices because they believed they had not caused the outbreak. However, the Health Department would find that their burgers were undercooked under state-approved regulations. The officials would then issue their apology regarding their part in starting the outbreak.^[36]
• Due to this crisis, Jack in the Box as a whole would have to face the accusations of being irresponsible for their actions and ignoring safety regulations that are set in place, as well as having poor communication when addressing the crisis to their customers.^[37]
• Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat was a 2011 book by Jeff Benedict that followed the events of the outbreak and the development of Bill Marler, an attorney who fought against Jack in the Box.^[38] The book later became the basis of the 2023 Netflix documentary, Poisoned: The Dirty Truth About Your Food.^[39]
• 2023 was the 30th anniversary of the E. coli outbreak, which instigated improvements to food safety practices and handling of meat and poultry products in the US.^[40]

See also

• 1996 Odwalla E. coli outbreak
• List of food contamination incidents
• STOP Foodborne Illness

Bibliography

• Book: Benedict, Jeff. Poisoned: The True Story of the Deadly E. coli Outbreak That Changed the Way Americans Eat. Jeff Benedict. 9780983347804. May 16, 2011. Inspire Books. Buena Vista, VA.
• Book: Detwiler . Darin . Food Safety: Past, Present, and Predictions . 2020 . Elsevier Academic Press . Cambridge, MA . 9780128182192 . 1st .
• Morbidity and Mortality Weekly Report. Update: Multistate Outbreak of Escherichia coli O157:H7 Infections from Hamburgers – Western United States, 1992–1993. Davis. M.. April 16, 1993. 42. 14.
• Book: Drexler, Madeline. Secret Agents: The Menace of Emerging Infections. Penguin Books. New York, NY. Revised. December 23, 2009. 9780143117179.
• Food Safety Innovation in the United States: Evidence from the Meat Industry. Elise. Golan. Tanya. Roberts. Elisabete. Salay. Julie. Caswell. Michael. Ollinger. Danna. Moore. Agricultural Economic Report. 831. April 2004.
• Book: Hunter, Beatrice Trum. Infectious Connections. Basic Health Publications. Laguna Beach, CA. 2009. 9781591202448.
• Book: Manning, Shannon D.. Escherichia coli Infections. Chelsea House Publishers. 2nd. April 1, 2010. 9781604132533. New York, NY.
• Book: Nestle, Marion. Safe Food: The Politics of Food Safety. July 2, 2010. 9780520266063. 2nd Revised. University of California Press. Berkeley, CA.
• Book: Roberts, Paul. The End of Food. Paul Roberts (author). 2008. Bloomsbury Publishing. London. 9780747588818.
• Book: Schlosser, Eric. Fast Food Nation. Eric Schlosser. Penguin Books. London. 2001. 9780141006871. Fast Food Nation.
• Book: Chew On This: Everything You Don't Want to Know About Fast Food. Charles. Wilson. Eric. Schlosser. 2006. Houghton Mifflin Harcourt. New York, NY. 9780618593941. Chew on This.

Notes and References

1. News: Other big E.coli outbreaks. South Wales Echo. Cardiff. March 11, 2008. 9. ProQuest document ID 342321106.
2. News: The Christian Science Monitor. Boston, MA. Poisoned author Jeff Benedict examines the current state of food safety in the US. Rebekah. Denn. May 13, 2011. July 8, 2013.
3. Web site: Detwiler. Darin. Do Meat and Poultry Handling Labels Really Convey Safety?. Food Quality and Safety. Wiley Periodicals, Inc.. June 4, 2014. https://web.archive.org/web/20140714142700/http://www.foodquality.com/details/article/6033271/Do_Meat_and_Poultry_Handling_Labels_Really_Convey_Safety.html?tzcheck=1. July 14, 2014. dead.
4. News: Killer in beef spreads alarm. Lois. Rogers. The Times. London. April 16, 1995. 1. ProQuest document ID 318273338.
5. News: Children risk death from burger bug. Sylvester. Rachel. The Sunday Telegraph. London. June 11, 1995. 9. ProQuest document ID 309266408.
6. News: Foodmaker. Financial Times. London. February 25, 1998. 1. ProQuest document ID 248542525.
7. https://www.c-span.org/video/?c4495890/president-clinton-ecoli C-SPAN Video (February 11, 1993)
8. Web site: McNamara . Ann Marie . John H. Silliker Lecture: Heroes: Past and Future . IAFP Journal for Food Protection . International Association for Food Protection . .
9. Book: Detwiler . Darin . Food Safety: Past, Present, and Predictions . 2020 . Elsevier Academic Press . Cambridge, MA . 9780128182192 . 1st .
10. News: The Bug That Ate The Burger. Emily. Green. Los Angeles Times. Los Angeles. June 6, 2001. July 7, 2013.
11. News: Porterfield. Elaine. Berliant Mcclatchy. Adam. Jack in the Box Ignored Food Safety Regulations, Court Documents Say. June 5, 2014. The Spokesman-Review. The Spokesman-Review Co.. June 17, 1995.
12. News: Jack in the Box gets $58 mil in E. coli case. June 14, 2015. The Star Bulletin. Hawaii, Inc.. February 25, 1998.
13. News: Food Safety and the Civil Justice System. American Association for Justice. Washington, D.C.. 2015. November 25, 2015.
14. Book: The Natural Health Guide to Beating Supergerms. Richard P.. Huemer. Jack. Challem. Pocket Books. New York. 1997. 8. 978-0-671-53764-7. registration.
15. News: 20 Years Later – Remembering the First E. coli Victim. Food Poison Journal. Bill. Marler. December 24, 2012. November 25, 2015.
16. News: Jack in the Box's Worst Nightmare. February 6, 1993. The New York Times. New York. November 25, 2015.
17. News: Boy Dies From Tainted Meat – 2-Year-Old Is First Victim Of Food Poisoning. January 22, 1993. Greg. Heberlein. Warren. King. Judith. Blake. Margaret. Miller. The Seattle Times. Seattle. November 25, 2015.
18. News: 17-Month-old Is 3d Child to Die Of Illness Linked to Tainted Meat. February 22, 1993. The New York Times. New York. November 25, 2015.
19. News: Chronology Of E. coli Outbreak. July 7, 1996. Tina. Kelley. . November 25, 2015.
20. News: Gynn . Catherine . 1995 . Beyond objectivity and relativism: A view of journalism from a rhetorical perspective . . 151421789 .
21. News: Solution near on E. coli Crisis. April 1993. Daniel. Best. . April 15, 2019.
22. Web site: Directory Profile School of Law University of Arkansas . 2023-09-14 . law.uark.edu.
23. Web site: Brianne Kiner — The 1993 Jack in the Box E. coli Outbreak . 2022-11-15 . billmarler.com.
24. Web site: Littlefield . Robert . Jack in the Box: Lessons learned by Accepting Responsibility . September 29, 2023 . Lessons learned about protecting America's Food.
25. Food Safety: Current Challenges and New Ideas to Safeguard Consumers: Hearing Before the Committee on Health, Education, Labor, and Pensions, United States Senate, 109th Cong. 76 (November 15, 2006) (statement of Senator Dick Durbin).
26. News: Food Safety News. Jack in the Box and the Decline of E. coli. James. Andrews. February 11, 2013. July 8, 2013. Seattle, WA.
27. Web site: Scott . Michels. Drew . Magratten. Chasing Outbreaks: How Safe Is Our Food?. May 10, 2015. Retro Report. July 15, 2015.
28. Food Safety Innovation in the United States https://www.ers.usda.gov/webdocs/publications/41634/18038_aer831d.pdf?v=0
29. Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems, 61 Fed. Reg. 38806 (1996).
30. News: News Desk. Name Change for Food Safety Advocacy Group STOP. February 21, 2015. Food Safety News. Seattle . April 21, 2011.
31. News: Balter. Joni. Darin Detwiler: He Lost Son To E. coli, Now Is Hellbent On Making It To Olympia. June 5, 2014. The Seattle Times . January 9, 1994.
32. News: King. Warren. E. coli Victim Leaves Legacy Of Awareness. June 5, 2014 . February 25, 1993.
33. Web site: Canaday. Autumn. USDA Press Release No. 0186.04: Veneman Names New Member to National Advisory Committee on Meat and Poultry Inspection. USDA. USDA Office of Communications. June 5, 2014. https://web.archive.org/web/20140811231649/http://www.usda.gov/documents/NewsReleases/2004/05/0186.doc. August 11, 2014. dead.
34. Web site: Detwiler to Receive Food Safety Magazine Distinguished Service Award – Food Safety Magazine. foodsafetymagazine.com. July 16, 2018. June 1, 2018.
35. Seo . Soobin . Jang . SooCheong (Shawn) . Almanza . Barbara . Miao . Li . Behnke . Carl . 2014-05-01 . The negative spillover effect of food crises on restaurant firms: Did Jack in the Box really recover from an E. coli scare? . International Journal of Hospitality Management . 39 . 107–121 . 10.1016/j.ijhm.2014.02.011 . 0278-4319 . 7117015 . 32287858.
36. Web site: Littlefield . Robert . Jack in the Box: Lessons learned by accepting responsibility. . September 29, 2023 . Lessons learned about protecting America’s food supply.
37. Ulmer . Robert R. . Sellnow . Timothy L. . 2000-05-01 . Consistent Questions of Ambiguity in Organizational Crisis Communication: Jack in the Box as a Case Study . Journal of Business Ethics . en . 25 . 2 . 143–155 . 10.1023/A:1006183805499 . 142916103 . 1573-0697.
38. Web site: 2017-12-28 . Jack in the Box E. coli Outbreak – 25th Anniversary . 2023-11-02 . Food Safety News . en-US.
39. Web site: 2017-12-28 . Jack in the Box E. coli Outbreak – 25th Anniversary . 2023-11-02 . Food Safety News . en-US.
40. Web site: McNamara . Ann . March 30, 2023 . The Crisis That Revolutionized Food Safety . IFT.