1/27/2015
Food Borne Illness, Employees & Your Restaurant –
How They All Interact
Pamela J. Ritz, MS, ARM, SPHR, CRM
President, Specialty Risk Management, Inc.
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Even If You Are Doing Everything You Can to Monitor your Employee’s Health and Exclude any Symptomatic Employees …
A “Regular” customer (retiree) walks into your restaurant and seats himself at his usual table. On his way, he stops to grab his own silverware accidentally touching other pieces of silverware. Little does he know he is a carrier of Norwalk virus …
He visits with his favorite wait staff. She has been an acquaintance and server for almost two years. He finished his meal and she clear the dishes while serving his final cup of coffee…
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Illness is Building … HD ‐ Slow to Respond …
WeeK 1
Sunday:
Customer infected (9 ill guests, 1 ill employee)
with Norovirus eats at restaurant
Wednesday: Server calls in sick
Thursday: Server returns to work
Saturday: 8 guests eat – sick within 48 hours (Server working)
Week 2
(45 ill guests, 13 ill employed)
Sunday:
14 guests eat – sick within 48 hours (Server working)
Monday: 3 employees call in sick
‐ 3 guests eat – sick within 48 hours
Tuesday: 6 employees call in sick
‐ 6 guests eat – sick within 48 hours
Wednesday: 2 employees call in sick
Thursday: 9 guests eat – sick within 48 hours
Friday: Employee calls in sick
First inspection related to customer complaints –HD gets involved
Saturday: Employee calls in sick
‐ 13 guests eat ‐ sick within 48 hours
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
1
1/27/2015
Warning Signs are Often Missed…
Week 3
(24 ill guests, 2 ill employee)
Sunday:
9 guests eat ‐ sick within 24 hours
Week 4
Sunday:
Intense cleaning
Monday: Restaurant calls SRM for help
Monday: Re‐inspection
‐ 1 employee calls in sick
Tuesday: Re‐opened restaurant
‐ 4 guests eat – sick within 24 hours
Tuesday: 1 employee calls in sick
‐ 3 guests eat – sick within 24 hours
Wednesday: 4 guests eat – sick within 24 hours
Thursday: 1 guest eats – sick within 24 hours
Friday: 3 guests eat – sick within 24 hours
‐ Confirmed death from complications
‐ Restaurant closes
Saturday: Media circus begins / Intense cleaning
100 sick 8 hospitalized
1 death
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Norovirus ‐
How is it Spread?
 Person to person – fecal oral route
 Aerosolized particles contaminate surfaces or hands
 Contaminated surfaces leads to transfer ‐ water & food – survives freezing
 Resistant to common disinfectants
 Can even be in irrigation 
water, shellfish (contaminated water) © 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
AGENDA
• Foodborne Illness events – Examples
• How do they happen?
• How do they affect business?
• Risks to Restaurants is “Uninsured” loss of business foot traffic
• What can we learn about these Illnesses/Pathogens?
• Employees are the more frequent “cause” of these outbreaks
• Do we have any way to control these risks?
• Are there any unusual food borne illness trends Risk Managers need to be on the lookout for in 2015? (Salmonella)
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
2
1/27/2015
Food Borne Illness Crisis Management
Since 1997 – On Behalf of Lloyd’s of London
Hiring a specialist or multiple unique specialists in specific areas does not translate into effective crisis management 24/7 Restaurant and Recall Crisis Management
We have had to create a closely integrated team, not separate contractors:
• Food Law
• Public Health Law
• Communicable Disease/Pathology
• Media
• Marketing Response
• Customer Response
• Employment Practices
• Business Recovery
• Stakeholder Coordination
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Our Staff has Experience with Years of Outbreak Response and Depth of Expertise
Master of Science/Food Safety
• Part of College of Veterinary Medicine
• Lead College for the National Food Safety & Toxicology Center (NFSTC) US Food Defense Master of Science Degree Curriculum
• U.S. Food Laws & Regulations
• International Food Laws & Regulations
• Foodborne Disease Epidemiology
• Foodborne Pathogens
• Food Safety Management (On‐Site Farms, Fields, & Mills)
• Food Toxicology
• Food Disease Control
• Food Protection & Defense • Food Research Methods
• Applied Projects in Food Safety
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
“Trade Name” or “Brand” Exposure –
Growing Area of Financial Risk
The decision to go to a restaurant or avoid a restaurant
The decision to purchase a product or not purchase a product
All based upon what you have seen or heard on the news
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
3
1/27/2015
If you Never Hear About our Trade Names …(Success)
WE HAVE DONE OUR JOB
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
SRM does not do “Private Consulting”
Part of Lloyd’s Business Interruption Policies
• We have seen a large volume of Food Borne Events Historically
• Purchasing these BI policies is a cost effective way to make sure there is:
‐ Immediate help & expertise
‐ Benefits from most current crisis management knowledge
Underwriters pay cost to maintain 24/7 expertise
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Crisis Management Must Focus on “Loss Control”
to Prevent or Endure Public Events
Actions Designed
Contain or Resolve Event
Minimize Impact of Event
Maximize Effectiveness of Early Recovery Activities
Stabilize Business Operations and Prepare for Recovery
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
4
1/27/2015
“EMPLOYEES ARE OUR WILD CARD…”
Since 1997 – Our Historical Collection of Shigella Events Show:
 Most frequent source is our high school male employees
 Sports and locker room transmission
 They bring it into our restaurants
Shigella is a Tough Pathogen Causing Bloody Diarrhea
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Even Before the First Liability Lawsuit…
Foodborne Illness Events Cost Months of Lost Revenue, & Unexpected Costs of Response • Loss of Foot Traffic
• Cost of Special Response
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Sandwich Shop Example
SHIGELLA
LOMBARD, ILLINOIS
“EMPLOYEE CAUSED ILLNESS EVENT” –
2 employees report for end of week/weekend work (with diarrhea)
2
ILLNESSES
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
5
1/27/2015
Lombard, IL
News Stories Present Ever Increasing Illness Counts
– Sounds Active/“On‐Going”
Eating Dates:
Mar. 4
February 23 –
March 1
First Announcement
News Release Store Closed,
4 Hospitalized
8 Lab Confirms
Mar. 24
13 Hospitalized
116 Sick
Apr. 14
June 24
125 Sick
Remains Closed Re‐Opening
Still “Employee Investigating
Illness Testing 328 Sick Count Confirmed
2x to Return”
After cleaning / training
DOCTOR OFFICES REPORT LATE
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Investigation and Headlines Begin…
CLOSED March 1st ‐ same day as reported illnesses began
News Stories Explode Focus on “Severity”, Ongoing “Mystery” and Still Present but Growing
Headlines Erupt in DuPage County:
• “DuPage County Health Department News Release”
• “Shigellosis confirmed”
• “4 of 8 ill hospitalized”
• “Eating dates February 24 ‐ March 1st ”
• “Call the Health Department if sick ”
CLOSED
8 ILLNESSES
FEBRUARY
MARCH APRIL
MAY
JUNE JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Lawsuits + Media Also Affect Business Flow
•
Plaintiff Attorney ‐ Marler Clark Contacted 51 Victims – Adds To Media Impact •
Restaurant is “Epicenter of a major Shigella
outbreak” •
“Fresh sandwiches – lots of opportunity for infected workers to contaminate during food preparation”
•
Certain food handlers have tested positive for Shigella
•
Long Term Risks (plaintiff view)
DAY 20
CLOSED
50 ILLNESSES
FEBRUARY
MARCH
Don’t “wrongly believe” it is “a stomach bug”
“Children and elderly at great risk”
“Brutal symptoms – diarrhea, fever, stomach cramps” ‐ Bloody diarrhea 25‐50% of time with rectal spasms
APRIL
MAY
JUNE
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
6
1/27/2015
Negative Impact Due to Continual News Stories
+ Very Slow Health Department Investigation
Postings on the Internet Articles by “Shigella Lawyers”
• Caused by bacteria ingestion
• Sudden severe diarrhea
• Spread person‐to‐person
• Stopped with careful hand washing
“ It is scary…students go to this restaurant after school and practices” DAY 25
CLOSED
116 ILLNESSES
FEBRUARY
“It’s sad that so many people were seriously sickened by a disgusting and preventable adulteration of food” “Our client has suffered and will continue to suffer great pain due to an collapse of food safety measures “ ‐ Attorney
‐ Attorney
– Nearby School Principal
MARCH
APRIL
MAY
JUNE
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Restaurant Reopens Six Weeks Later
Difficult Recovery/Loss of Permits
Health Department:
Discarded:
‐ Location scrubbed
‐ All food
‐ Disinfected ‐ Straws, cups, lids, ‐ Several times
bags, napkins “Reinstated permits and we are confident of our food safety policy and procedures” ‐Owner
‐ Employees stool tested twice before released to work
‐ Retrained by Health Department
DAY 44
REOPENED
125 ILLNESSES
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Crisis Management Done Right
Identifying the sick people immediately – not over 6 weeks –
along with number of non‐
diseased people to complete government + case control study
Public health skills can speed health officials toward the government requirements ‐ disease frequency, distribution & mechanisms for illness
REOPENED
125 ILLNESSES
FEBRUARY
MARCH
APRIL
Quicker testing & management of employees (stool cultures) along with appropriate cleaning/ sanitization
Week 5 News Story/ Health Department – “Still looking for people who ate and did not get sick”
MAY
JUNE
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
7
1/27/2015
CONSERVATIVE ESTIMATED FINANCIAL IMPACT ON TRADE NAME BASED ON:
$148,369 (Average Location Loss)
x 20 (Stores Affected) 42% Profit Margin Across All Locations
$1M Average Gross Revenues per Location
= $2,967,386
TOTAL Loss for Event
Non epicenter loss calculations not included (26,476 store locations)
Does not include Advertising Expenses/Remarketing and Rebuilding/Restoration of Community Reputation, Crisis Management/Public Relations, Customer/Crisis Hotline, Media Response Expenses
(6) Month Recovery Period
1 Store Location Closed
328
ILLNESSES
*These restaurant events were not insured to our knowledge
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
****DISCLAIMER – The above information is meant for discussion purposes and is not meant to be a representation of Coverage. Please see policy wording for Coverage.
Calculations were based on analysis of news articles published regarding the event
Copyright  2013-2015 PLIS®, Inc. and its licensors. All rights reserved.
“Shigella”… The Rest of the Story”…
“Employee” Caused Illness Event
Dupage County and the State of Illinois collaborated to complete the
Lombard Sandwich Restaurant Investigation
State & County Food Cause:
“2 Employees test positive same strain of Shigella infecting customers
(employees ill days before outbreak)
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Businesses Are Impacted by Food Borne Illness Resourcing and Managing Through Labor/Knowledge
Health Department have all the Authority but are Short on:
Resources
Staff
Businesses ultimately have to “Resource” these investigations to “quickly manage” events and lower impact
Drive
Restaurants are in Peril by “8am ‐4pm Health Department Mentality”
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
8
1/27/2015
SECOND OUTBREAK – SALMONELLA
SAME AREA – SAME TRADE NAME
ILLINOIS
FIRST SHIGELLA OUTBREAK
SECOND SALMONELLA
OUTBREAK
FEB
MARCH
APRIL
JUNE
MAY
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
“One, Two, Three Strikes You’re Out”
Strike One (Shigella), Strike Two –(Salmonella) 2 Months Later
Illinois Health Department: Threw out all:
investigating 34 different Salmonella illnesses lettuce, green peppers, red onions and tomatoes –
replaced produce
14 counties
About 300 locations in Central Illinois
discarded all vegetables
Annual Illinois Salmonella Hvittingfoss Serotype 2 cases/year – “109 cases caught everyoneʹs eye”
Employees at 49 restaurants must complete (2) negative stool tests before allowed to work
At least 12 food handlers test positive for salmonella illness
34
ILLNESSES
FEBRUARY
MARCH
APRIL
JUNE
MAY
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Salmonella “Hvittingfoss”
“We sincerely apologize to all our customers, those who have fallen ill, and those who now may hesitate to come back for a while. We are truly sorry for the difficulty this situation has caused you, our customer, and are working diligently to solve this mystery and to regain your trust.”
‐ Company spokesman Illness Ranged from April 25 – June 30
• Ages affected 2‐88 years of age
• Cases include Illinois residents & travelers
• Rare Strain
• Alerted Health Departments to Sandwich Shop Outbreak
97
ILLNESSES
FEBRUARY
MARCH
APRIL
MAY
JULY
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
9
1/27/2015
Business Revenue & Location Impact
Peoria & Champaign‐Urbana Locations: 4 Franchisees –
Heavy Media revenues down “Summer is traditionally our best time –
it couldn’t have come at worse time …”
480 workers tested 49 restaurant locations 28 counties
Staffing hours cut Springfield Locations: Revenues down 30‐50% ‐
20% to 30%
Springfield area locations • Employees can’t
more than a month after dozens of franchises threw make rent or out vegetables
house payments
•
•
•
•
FEBRUARY MARCH
APRIL
MAY
30% ‐50%
109
ILLNESSES
JULY
JULY
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
Conservative Estimated Financial Impact
on Trade Name – Second Event
BASED ON:
$148,369 (Average Location Loss)
x 49 (Stores Affected) 42% Profit Margin Across All Locations
$1M Average Gross Revenues per Location
(6) Month Recovery Period
= $7,270,081
PARTIAL Loss for Event
Non epicenter loss calculations not included ‐ 26,476 store locations:
($522,000,000)
Does not include Advertising Costs/Remarketing, Rebuilding/Restoration of Community Reputation, Crisis Management/Public Relations, Customer/Crisis Hotline, Media Response Expenses
No Store Closures
109 ILLNESSES/
90 SUSPECTED/
480 WORKERS TESTED
*These restaurant events were not insured to our knowledge
FEBRUARY MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
****DISCLAIMER – The above information is meant for discussion purposes and is not meant to be a representation of Coverage. Please see policy wording for Coverage.
Calculations were based on analysis of news articles published regarding the event
Copyright  2013-2015 PLIS®, Inc. and its licensors. All rights reserved.
The “Eeewwww” Factor is Unpredictable
The financial impact of a food borne illness event can be severe and lengthy…all based on “public perception”
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
10
1/27/2015
It is Always a Shock –
Since 1991 – Consistent Impact
Revenue Drops 80% ‐ 90%
Affected Locations –
Immediate $$ Losses
The “Brand” or “Trade Name” is Impacted
10000
9000
8000
7000
6000
Actions Affect Recovery
5000
4000
3000
2000
1000
0
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
These Industries May Need More Than Just “Traditional” Coverages
Policy
Coverage
Property
Replacement of building, contents and time element (extra expense including loss of profit)
General Liability
Guest injury or illness from products or premises
Workers Comp
Employee illness or injury from employment
Contingent BI
Time Element ‐ expenses and lost profit from “other” events (ie: food borne illness)
Copyright © 2003 – 2014 PLIS®, Inc. and its licensors. All Rights Reserved.
Copyright  2015 PLIS®, Inc. and its Licensors. All Rights Reserved.
Contingent Business Interruption (TNR) and General Liability are 2 Separate Policies When it Comes to Food Borne Illness (peril)
Contingent Business
Interruption (TNR)
P&C/GL
Yes
No
Yes
No
(Food Borne Illness)
Yes
No
Loss of Profits
Yes
No
Advertising Expenses
Yes No
Continuing Expenses
Yes
No
Immediate 24/7 Crisis Management
Yes
No
Injury Costs
No
Yes
Defense Costs
No
Yes
Judgments
No
Yes
Restaurant
Accidental Contamination
‐ Biological, Chemical & Physical
Malicious Contamination
‐ Biological, Chemical & Physical
Public Announcement
Coverage Applies to Insured Trade Name Locations (Trade Name Trigger)
Property Casualty/General Liability does not necessarily address the business interruption or lost income impact of a food borne illness Incident.
Copyright  2015 PLIS®, Inc. and its Licensors. All Rights Reserved.
11
1/27/2015
If Sales have Dropped Dramatically, Think of What the Company Still Pays for Monthly ‐‐ Continuing Expenses:
Ongoing Expenses
$ Telephone & Utilities
$ Rent
• Land/Building
• Equipment
• Property Taxes & Licenses
$ Franchise Fees
$ Insurance
• Employee Health • Property
Controllable Expenses
$ Product Cost
• Food
• Beverage
• Supplies
$ Labor
• Hourly
• Management
• Training
$ Other operating costs
$ Other
• Advertising
• Royalties
• Paper Cost
• Supplies
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Additional Costs
With a Crisis Affecting Revenue, the Company will Spend Additional Money:
•Crisis Management Costs
•Expertise and Assistance with:
• Health Department
• Testing
• Customer 1‐800 response hotline
• Media response
• Customer follow‐up
• Re‐building efforts
•Business Recovery
• Outreach
• Incentives to return
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Growing Challenges We See Currently
Health Departments Are Fast to Identify Events –
Slow to Solve
Quick to Recommend Shots – Hepatitis & Slow to Acquire “Controlled Serums:
• Often charge restaurants for staff and shots – (2,000 patrons @ $110 = $220,000)
• Not able to address the quantities of questions/concerns of sick patrons
• Long periods of investigation
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
12
1/27/2015
© 2015 Copyright Specialty Risk Management, Inc. All Rights Reserved.
The Human Body is Invaded through 3 Typical Routes
The Skin
Wounds
Absorption
Respiratory
Digestion
Inhaling
Consumption
The Food Industry Rules and Practices are Focused on Digestive Invasion
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
These “Bugs” are Different –
“Opportunistic”/Intelligent
They can live outside the body on surfaces and food
They enter through the intestine
“Severe Symptoms” Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
13
1/27/2015
The Human Immune System Gives us Some General Protection from Most “Germs” “Germs”
Coliform
Human
Shield
Bacteria
Parasites
Virus
“3 Second Rule Applies!”
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
The Human Gut can Function as a Warm Growing Environment
Salad preparation
Ice
Lemons in Drinks
Bread Service
Silverware
Food Borne Illness Invaders “TRICK” the Human Immune System ‐ Gain Entrance to the Body
NOROVIRUS
SALMONELLA
HEPATITIS A
HUMAN
SHIELD
E. COLI
STAPH
Opportunistic/ Intelligent Bugs
Establishes a base of operations, growth and transmission
E. COLI
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
14
1/27/2015
Food Borne Illness Bugs Enter Through the Digestive System ‐
Multiply and occupy the
Intestinal Tract & spread
via hands to food or
surfaces –
Illness Spreads…
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Vomiting and Diarrhea are “Infectious Events” that Settle on Surfaces ‐ Eventually
“FECAL – ORAL ROUTE”
Bacterial Cloud
Viral Cloud
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Parts Per Million Scenario
Vomit Event
Bathroom Event
300,000
particles/gram
1,000,000,000,000
particles/gram
Aerosolization (droplets) contaminating surfaces –
spread illness
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
15
1/27/2015
Its Hard to Imagine an Infectious Event Where “Hands” are Not Massively Contaminated
Where do you put your purse?
How do you take your shoes off right?
Viral particles pass through toilet paper
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Washing Your Hands May Not be Enough
Recent studies ‐ neither detergents nor sanitizers used in current cleaning protocols are effective against the Norovirus at the currently used concentrations – (Special Products exist)
Studies show:
• PPM – Concentration of virus is focus
• Hand washing 20 sec.
• Most Sanitizers ineffective Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Top Illness Offenders including Human to Human –
“Opportunistic & Aggressive Pathogens”
Infectious Dosage Amounts are Small:
Salmonella
Shigella
E‐Coli
• 15‐20 cells
• 10 cells
• 10 organisms
Hepatitis
• 10 ‐ 100 virus particles
Norovirus
• 10 ‐ 100 Virus Particles
Food impossible to screen or test for virus
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
16
1/27/2015
Even Hand Washing in the Food Industry is a Science –
But it’s a “Game of PPM” (parts per million)
(Fingertips on Petri Dish)
Unwashed Hand
Hand Washed 20 sec.
(soap & water)
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Parts Per Million Scenario
Just one fingerprint = 1000’s of Particles
Thimble Size
2,000,000 E. Coli 0157
= 2,000‐20,000 people infected
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
History Shows that “Restaurant Caused/Employee Based Issues” = Prolonged Media Events
Historical Database:
4%
Supplier Contamination Events
Employee Health Contaminations 96%
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
17
1/27/2015
Federal Food Code = 709 Pages of Required Enforcement # of
Pages
Section
Table of Contents
12
Previous Editions of Code
2
Introduction
20
Preface
12
Chapter 1 – Purpose & Definitions
22
Chapter 2 – Management & Personnel
24
Chapter 3 – Food
53
Chapter 4 – Equipment, Utensils & Linens
43
Chapter 5 – Water, Plumbing & Waste
20
Chapter 6 – Physical Facilities
16
Chapter 7 – Poisonous or Toxic Materials
7
Chapter 8 – Compliance & Enforcement
23
Annex 1 – Compliance & Enforcement
24
Annex 2 – Reference
68
Annex 3 – Public Health Reasons / Administrative Guidelines
170
Annex 4 – Management of Food Safety Practices
34
Annex 5 – Conducting Risk-Based Inspections
34
Annex 6 – Food Processing Criteria
20
Annex 7 – Model Forms, Guides & Other Aides
36
Summary – Summary of the Changes
13
Supplement
56
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Revised Monitoring Expectations for Employers
1999 Requirements have Carried Over to Today:
• Diarrhea
• Vomiting
• Jaundice
• Sore Throat with fever
• Uncovered, infected cuts or wounds or lesions containing pus on the hand, wrist, an exposed body part or other part of the body
FDA FOOD CODE
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
1999 Federal Food Code Transferred all Responsibility to the Food Industry Manager
Managers are Expected to Know:
Any employees diagnosed
Any employees with symptoms
BIG 4 WAS THE FOCUS:
•Hepatitis •Salmonella •E. Coli
•Shigella
Any employees previously ill
Any employees with sick family members or who have recently traveled outside U.S.
NOW THE BIG 5:
•Hepatitis •Salmonella •E. Coli
•Shigella
(+)Norovirus
Added as of 2005
“Cruise Ship Disease”
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
18
1/27/2015
Food Code Law Makes These Available to All Restaurants Since 1999
(Website Access)
Applicant and Conditional Employee Interview
Requirements to Disclose:
• Symptoms
• Past Illnesses
• Historical Exposure
Copyright  2015 SRM®, Inc. and its licensors. All rights reserved.
One of the Greatest Risk Transfer Tools
Food Employee Reporting Agreement
Requirement to Disclose:
• Current Symptoms
• Future Medical Diagnosis
• Future Exposure
Copyright  2005 SRM®, Inc. and its licensors. All rights reserved.
“E‐Coli Lawyer Cleans Up, Makes Good Money from Bad Food”
(article from Associated Press 2/5/08)
Highest Plaintiff Attraction –
Restaurant Events OR
Supplier Issues at Food Manufacturing
You Will Lose Every Lawsuit – “No Food Code Forms”
(Consumer Law is Strict Liability)
Bill Marler ‐ $300 Million Awards as of 2009
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
19
1/27/2015
Updated 09 – 2014
www.eeoc.gov/facts/restaurant_guide.html
ADA Compliance Guide for Restaurants and Other Food Service
“ You may follow any state, county or local food handling law designed to protect the public health from infectious and communicable diseases identified by the CDC [see 42 U.S.C.. 12113(d)(3)…to include The Food Code”
“…Therefore – Following the FDA Food Code reporting requirements do not violate the ADA”
“ADA Recognizes the danger to Public Health presented by diseases transmissible through the handling of food [See U.S.C.12113(d)(1) and(2)]
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Updated 09 – 2014
www.eeoc‐gov/facts/restaurant_guide.html
Section 2‐
201.11(A) ‐
Employees must report diagnoses (Pathogens)
Section 2‐
201.11(B) –
Employees must report “symptoms”
Section 2‐
201.11(C) –
Employees must report “past illness”
Section 2‐
201.11(D) –
Report if they meet a “High Risk Condition”
Section 2‐201.13 ‐ An Employee must get medical clearance before an employer can lift an exclusion or restriction
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Updated 09 – 2014
www.eeoc‐gov/facts/restaurant_guide.html
“High Risk Conditions” – You Are Allowed to Be Invasive:
(1) Has symptoms of vomiting diarrhea, jaundice, sore throat with fever or a lesion or infected wound (all parts of body)
(2) Has been diagnosed with Norovirus, Hepatitis A, Shigella, E‐Coli, Salmonella
(3) Has had a diagnosed previous illness (above)
(4) Has been exposed to Norovirus ( 2 days), E‐Coli (3 days), Salmonella (14 days), Hep A (30 ) days (consumed or prepared food in outbreak)
(5) Exposed by attending, working or living in a household with a person who attends or works in a setting, or is diagnosed…
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
20
1/27/2015
Updated 09 – 2014
www.eeoc.gov/facts/restaurant_guide.html
“Most people who have a disease resulting from the Big 4 Pathogens are not disabled by them. These diseases are usually short‐term and/or minor. If a person does not have an ADA disability, the food service employer may follow the Food Code’s guidance on exclusion without considering the ADA”
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Similar Restrictions on Employee Health Exist in Other Areas of Law
Example: Commercial Drivers License and Driving Large Commercial Vehicles
Drivers who have had a “stroke” are restricted from driving trucks at least (1) year from driving
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
2009 Food Code “Response” Plan Required
2‐501.11 (reg) Clean Up Vomiting & Diarrhea Events
You Can Solve your OSHA & Food Code Requirements
Applies to employee and customer illness
Requires clearing areas
Special cleaning/disinfection
Treat like food borne pathogen plan
Food disposal and replenish with “new”
Reminder – Employee Reporting Agreements (Food Code Regs)
Technically restaurants should be meeting OSHA Bloodborne
Pathogen Training
Vomit Response should be formal; Worker or patron vomiting, Vomit “kits”, Cleaning sanitization
Training + response teams
Norovirus outbreaks are driving this “new standard”
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
21
1/27/2015
2009 Food Code “Response” Plan Required
2-501.11(reg) - clean up of vomiting
and diarrhea events
Requires clearing areas
Special cleaning/ disinfection
Treat like food borne pathogen plan
Food disposal and replenish with “new”
Applies to employee and customer illness
Reminder – Employee Reporting Agreements (Food Code Regs)
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Cleaning & Sanitization are Critical Processes in Healthcare, Food Manufacturing –
Now Restaurants
All cleaning/sanitizing products have to go through EPA approval
“Bleach Ban” could not have come at a worse time in history
Certain pathogens “outwit” cleaners and are “resistant”
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
End of 2014 – “Ebola Virus
Virology of Ebola
Ebola begins suddenly with Influenza like symptoms
Often starts similarly to Malaria & Dengue fever but progresses to bleeding stage
Vomiting and diarrhea are common method of “Spreading Disease” Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
22
1/27/2015
Compared to Healthcare, Restaurants have Similar Tactical Problems with Norovirus
•Food can become contaminated at any point through human contact (Ebola cannot transmit via food) •Infectious dosage as low as 10‐18 viral particles
•Aerosolization (droplets) contaminating surfaces – spread illness
•‘Shedding event’ ‐ feces produces up to 1 Trillion particles/gram ‐ vomit 300,000 particles/gram
•Surface survival routes 5 days – 2 weeks cleaning/sanitizing requires special efforts to eliminate ‘live” virus
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
http://www.epa.gov/oppad001/chemregindex.htm
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
23
1/27/2015
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Health Authorities Categorize Salmonella as a 115% Increase Compared to 1996‐1998
Copyright  2013 SRM®, Inc. and its licensors. All rights reserved.
Salmonella
Like most bacteria (unlike virus) they can grow and multiply outside of a human host
Over 2000 different “strains” (serotypes)
Antibiotic resistance concern
Some are more “virulent” than others
Attacks other organs (Typhoid Mary – Spleen)
“outsmarts” natural human defense systems
Burrows through intestinal wall and “hitches a ride” through bloodstream
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
24
1/27/2015
Expect FSIS to Show Up Where you Have Not Seen Them Before
 Annual sampling plans along farm‐to‐table continuum, E. Coli, Salmonella, etc…
 New inspection locations (grocery stores & restaurants)
 Scaling back taste/quality/unfit for consumption activities
 More potential physical contamination issues expected – “bits & bones”
 Increased focus on humane slaughter
 Increase consumer awareness
 USDA Food Safety Discovery Zone Trailers & Advertising
 Mitigate harm across farm‐to‐table continuum
 New regulatory changes extending through distribution and into retail settings
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Salmonella/E. Coli and CORE
 FDA establishes CORE –
Coordinated Outbreak Response and Evaluation
 Leader/Coordinator – FoodNet, PulseNet, NORS, CDC, CaliciNet, FDA Traceback
 Laboratories of DNA databases on Pathogens are starting to build
 Multi‐state and “rare” isolates are bringing new focus
 Counts of 4 to 35 are as likely to bring attention as 500
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
The Only Thing Missing is “SkyNet”…
FoodNet – Foodborne Disease Active Surveillance Network
EHS‐Net –
Environmental Health Specialists Network –
Contributing Factor Surveillance
NORS – National Outbreak Reporting System
NNDSS – National Notifiable Diseases Surveillance System
NARMS – National Antimicrobial Resistance Monitoring System
CalciNet – National Electronic Norovirus Outbreak Network
PulseNet – National Molecular Subtyping Network for Foodborne Disease Surveillance
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
25
1/27/2015
Anticipating That Salmonella Statistics Will be Related to Poultry Manufacturing
Posts PFGE Patterns of Salmonella by Factory to Pulsenet
FSIS Begins Factory Product Sampling
GOAL: Early Illness Match by Factory Location
Copyright  2012 – 2013 SRM®, Inc. and its licensors. All rights reserved.
Chicken and Salmonella
Chicken is allowed to be shipped raw with pathogens load – 10% ‐ 20%
Regulatory focus is “Load Reduction”
Carcass wash studies set a normal percentage of positive results
Chickens are tested at pre‐hang & post chill
Salmonella, Campylobacter, E. Coli
DNA/PulseNet strains are posted for manufacturing sites
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Chicken Carcass Wash Studies Establish Baseline Serotypes
Along with Percentages of Salmonella, Campylobacter, E. Coli
Facility results create a “baseline average” for the industry
“surface testing” chickens and post‐
slaughter rinse water
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
26
1/27/2015
Most Restaurant Salmonella Events Are Found Through a Couple Routes
Employee illness and eventual testing
A pattern of customer illnesses
Usually “rare” serotypes that catch the attention of health authorities Multiple tests to return to work
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Top 5 Salmonella Strains to Worry About – Remember “Odd” Strains Attract Attention and Investigation
Salmonella Enteritidis
Salmonella Typhimurium
Salmonella Newport
Salmonella Javiana
Salmonlla
Heidelberg
Most Common 
Copyright  2013-2014 SRM®, Inc. and its licensors. All rights reserved
The Search for Salmonella has Not Followed Predictable Routes However:
Serotype
Common Source
Unexpected Find
Enteritidis
Poultry
Shell eggs (500M, Eggs),
Alfalfa sprouts, pine nuts, ground beef
Typhimurium
Chicken
Ground beef, pork, cantaloupe, peanut butter, tomatoes
Newport
Turkey
Javiana
Amphibians
Heidelberb
Poultry
Cantaloupe, alfalfa sprouts
Mozzarella cheese, watermelon, poultry, lettuce, tomatoes
Eggs
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1/27/2015
This is One Likely Spot you will See FSIS/USDA in your Restaurant
Vendor information to include shipping and receiving analysis, temperatures, transport configuration
Any unique marinating processes and equipment will be subject to scrutiny
Expect “factory‐like” surface testing in search for “harborage” if a food borne event happens + employee testing
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
The Issues of Chicken, Salmonella and Illness at the Restaurant
 Fresh chicken is allowed to ship with a “pathogen load” – 15% to 30%
 Your restaurant is “adding value” and is responsible for safe handling
 The diagnosis time for humans is such that the food is often gone – 7 to 21 days
 For “liability purposes” – drawing in your chicken vendor is unlikely – Federal Poultry Rules allowing pathogen content
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
“Suburban Salmonella Outbreak Linked to Buffet Restaurant”
State Agencies are Investigating
• One person hospitalized
• 23 people sickened
• 11 people tested positive for Salmonella Enteritis
Bacterial infection affecting Maple Grove Restaurant…
State to Perform DNA Fingerprinting…
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
28
1/27/2015
Health Officials ID Source of Buffet Salmonella Outbreak – 1 Month Later
36 people likely sickened by bacteria eating at restaurant between Jan. 11 ‐ Feb 11
• “Rolls were likely cross contamination with Salmonella Enteritis from raw chicken used in restaurant.”
Health Department Says:
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
Endorsed Coverage Is Not the Same…
(requires multiple endorsements)
TRIGGERS
Accidental Contamination
Malicious Contamination
Extortion Threats
Does Not Require Voluntary Closure and/or Shut Down
Accidental Contamination
Requires Shut Down/Suspension
CRISIS
MANAGEMENT
Dedicated Crisis Management Team
24/7 Knowledgeable Responsive Staff
Various Services Included
No Crisis Management
Does Not Pay for Crisis Management
CO-INSURANCE
No Co‐Insurance Language
Typical Co‐Insurance Language
LOCATION
COVERAGE
Trade Name Location Coverage –
Multiple locations
Does Not Necessarily Address Other Locations Affected
DURATION
18 Month Period of Restoration
Period of Restoration 12 months or Less
Covers Broader Range of Illnesses
Automatically Includes Bacteria, Virus and Wet Rot Exclusions ILLNESS
Copyright  2015 PLIS®, Inc. and its Licensors. All Rights Reserved.
The following information is meant for discussion purposes and is not meant to be a representation of Coverage. Please see policy wording for Coverage.
Endorsed Coverage Is Not the Same…
(requires multiple endorsements)
FRANCHISEE
COVERAGE
Pays Franchisors for Revenue Loss or Pays Franchisees IOU’s
Does Not Address Monies to Corporate/Royalty Payments*
ADVERTISING
EXPENSE
Costs to Restore Business Income
‐ couponing
‐ specials
‐ advertising
‐ community campaigns
Does Not Address Advertising Expenses*
Aimed at Retaining All Staff
Aimed at Retaining Only Necessary Staff & Volume
LABOR FORCE
SUPPLIER
COVERAGE
Supplier Caused Coverage Available
INOCULATION
COVERAGE
Inoculation, Vaccination & Testing Expense Coverage for Employees & Customers
Does Not Address Supplier Events*
None or Limited Inoculation Expense Coverage*
*ISO can be endorsed for virtually anything, BUT low limits ($5 ‐$10K)
Copyright  2015 PLIS®, Inc. and its Licensors. All Rights Reserved.
The following information is meant for discussion purposes and is not meant to be a representation of Coverage. Please see policy wording for Coverage.
29
1/27/2015
Food Borne Illness, Employees & Your Restaurant –
How They All Interact
THANK YOU!
Pamela J. Ritz, MS, ARM, SPHR, CRM
President, Specialty Risk Management, Inc.
Copyright  2015 SRM®, Inc. and its Licensors. All Rights Reserved.
30