Food for thought

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The rise of fast food and people eating out has led to an increased occurrence of food-borne diseases. Elliot Bishop and Dr Steven Mann warn that the consequences can be more serious than an upset stomach

When an alleged bout of food poisoning struck Tottenham Hotspur Football Club players recently, the restaurant accused of causing the incident was threatened by the club with a claim for £10m. The cause was found to be a virus and the restaurant has since been cleared but this demonstrates the potential such incidents have to exceed the relatively small values of past food poisoning claims.

Furthermore, the award of damages exceeding £1.2m to a victim of food poisoning by the Court of Session in Edinburgh last year should be enough to warn personal injury practitioners that such claims could potentially bypass the usual fast-track jurisdiction.

Several decades ago, food-borne illnesses were considered nothing more than a social inconvenience. Since then, several more diseases and long-term consequences have emerged, and there are currently at least 200 recognised agents that may harm when ingested in food - including microbes and chemicals.

The likelihood of contracting a food-borne disease has increased for three reasons. Firstly, the move toward a global economy has facilitated rapid transport of perishable and unusual foods from around the world. Secondly, eating patterns have changed and, finally, consumer knowledge of safe food preparation may have declined.

An increasing number of meals are eaten away from home, enhancing the opportunity for outbreaks of food-borne illness. The increased market for convenience foods makes careful handling and storage of foods mandatory but food services managers often carry out these responsibilities using a relatively unskilled labour force with a high staff turnover.

Food poisoning has traditionally been considered a short-lived and mild illness but it is now recognised to be associated with morbidity and, worryingly, mortality. Conditions such as arthritis, meningitis, autoimmune disorders, renal failure and hepatitis can arise from a food-borne illness.

From 1996 to 2000, more than 1.7 million cases of food-borne disease were documented in England and Wales, resulting in 21 997 hospitalisations and 687 deaths. However, reports undervalue the true incidence of infectious food-borne disease as it is estimated that two million people a year suffer from an attack of diarrhoea or vomiting due to food poisoning but most do not consult their doctor.

Serious symptoms

In England and Wales, more than 50,000 campylobacter bacteria cases are reported each year and there are no signs of a decline in incidence. Although infection usually causes a mild, self-limiting illness, serious symptoms - including Guillain-Barre syndrome, which causes progressive neurological deficits that may develop into limb paralysis and respiratory failure - and death occur in approximately 1 in 1000 and 1 in 20,000 infections, respectively.

Contaminated chicken is the most significant cause of food-borne disease, giving rise to 398 420 cases of food poisoning and 141 deaths. Salmonella and clostridium perfringens caused most deaths; listeria and E. coli together accounted for 15% of all deaths; and 4% of all reported illnesses were cases in which humans - food handlers - were considered to be the cause of infection.

The majority of food poisoning cases occur outside the home and are usually preventable, which has obvious implications in terms of liability. However, contrary to public perception, most cases are isolated incidents.

So, in legal terms, what are the key clinical features that support a diagnosis of food-borne illness and what information would the medical expert require to support such allegations?

Clinically, the timing of the disease following ingestion of the suspect food items and the predominant symptoms - vomiting, diarrhoea, abdominal pain - can assist clinicians in determining a likely cause or at least a shortlist of culprit organisms.

The symptoms of food poisoning can last several days and include abdominal pain, diarrhoea, vomiting, nausea and fever. These usually start suddenly but can occur several days after eating the contaminated food. This means the onset of symptoms is not always after the most recently ingested meal. Environmental health officers should be contacted if there is any doubt that the claimant has a food-borne illness.

In obtaining initial instructions, claimants' solicitors must establish the onset of symptoms; history of similar symptoms; family history of gastrointestinal problems; other symptoms such as weight loss, bloating, flushing; the claimant's occupation; recent foreign travel; close contacts also affected; and foods eaten the previous week.

Defendants, or insurers, should raise these questions as soon as possible after notification of the claim if the information has not been incorporated in the Letter of Claim. A careful review of previous medical records will confirm if these symptoms are long-standing and cannot be blamed on food poisoning.

More than 90% of outbreaks of acute gastrointestinal illnesses in the developed world are due to Norwalk-like viruses, which attack the intestines.

Outbreaks have been reported in nursing homes, school campuses and military bases but it is cruise ships - and the subsequent litigation - that have made headlines in recent years. The extent of spread in a closed environment can reach nearly 100% of exposed individuals due to the large number of organisms present in stool and vomit.

As mass production food continues to be sold in supermarkets and food outlets, there remains a clear opportunity for food-borne pathogens to infect and poison large numbers of consumers. There are guidelines and standards for food preparation but a slip-up can have catastrophic consequences for consumers and insurers.

Elliot Bishop is a solicitor at Hill Dickinson and Dr Steven Mann is a consultant gastroenterologist at Barnet Hospital

FOOD ITEMS AND COMMONLY ASSOCIATED ORGANISMS

Raw seafood: hepatitis A, Norwalk-like virus

Raw eggs: salmonella

Undercooked meat/poultry: salmonella, campylobacter, clostridium perfringens

Unpasteurised milk: salmonella, campylobacter, yersinia

Unpasteurised soft cheeses: salmonella, campylobacter, yersinia, listeria

Homemade canned goods: botulism

Raw hot dogs, deli meat: listeria.

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