The E. coli O157:H7 contamination of fresh produce and stomach-and bowel-churning norovirus captured headlines in 2006, but in 2007 it is viral Hepatitis A that has been taxing the good will of thousands of restaurant patrons and employees and could ultimately cost restaurateurs plenty.
Since January, employees of at least seven chains or multiunit companies have been diagnosed with infections from Hepatitis A, a disease of the liver linked to fecal matter exposure that can, in a small percentage of cases, prove deadly. Those diagnoses caused more than 7,000 restaurant customers and workers to seek immune globulin shots from public clinics or private sources to prevent the onset of Hepatitis A symptoms.
The latest round of Hepatitis A incidences involved single branches of The Cheesecake Factory in Providence, R.I., Houlihan’s in Geneva, Ill., Marble Slab Creamery in Katy, Texas, and Pappasitos Cantina in Houston. Also involved were outlets of Pizza Ranch in Slayton, Minn., and Texas Roadhouse in Cranston, R.I. Outlets of Whataburger in Harlingen and Raymondville, Texas, were implicated because an employee sickened with Hepatitis A worked at both stores.
Operators industrywide can only be inspired by the latest Hepatitis A developments to continue their search for ways to augment basic training initiatives in the quest to create virally correct venues.
“Even before we ever sell food, we sell the concept that people are safe eating within our restaurant environment,” says Brent De Mesquita of Park Ridge Midwest Restaurants, based in St. Louis.That concept, he indicates, is why his company has invested more than $50,000 to buy Hepatitis A vaccinations for all 680 employees of its 15 Bandana’s Bar-B-Q restaurants in Missouri and Illinois.
PRMR operates some restaurants in Saint Louis County in Missouri, which since July 2000 has been one of a handful of jurisdictions nationwide to require Hepatitis A vaccinations for food handlers. Clark County in Nevada is another. Los Angeles County recently considered such a mandate for hundreds of thousands of restaurant personnel, but then shelved the proposal because its own research suggested that in California, only state officials could enact such a rule.
De Mesquita, PRMR’s vice president of human resources and training, says his company has had its vaccinations-for-all policy for about four years and also recommends it to the operators of seven franchised Bandana’s units. He says his group exceeded the Saint Louis County vaccination rule—by vaccinating all employees, not just food handlers, in multiple counties—because a full-coverage strategy seemed more prudent than a piecemeal approach.
Park Ridge Midwest Restaurants has negotiated with urgent-care facility operators to get the two-stage vaccinations at a discounted price of about $40 per dose, De Mesquita notes.
“For openings, they bring in a nurse to give the shots,” he adds.
St. Louis Wings LLC in St. Louis, a four-unit franchisee of the Richardson, Texas-based Wingstop chain, also has taken the Saint Louis County vaccinations rule on the road. A representative says his company requires vaccinations for employees at its Saint Joseph County store, even though that county does not mandate such measures.
O’Charley’s Inc., the Nashville, Tenn.-based operator of more than 350 O’Charley’s, Ninety Nine Restaurants and Stoney River Legendary Steaks dinnerhouses, four years ago was snared in a Hepatitis A outbreak that killed one person, sickened at least 80 and forced hundreds to seek immune globulin shots. Public health officials ultimately exonerated the company, saying the outbreak likely was caused by green onions tainted during growing or shipping in a way that made the virus impervious to washing and cooking.
Gregory L. Burns, O’Charley’s chief executive and chairman, indicates that his company is using legal action against some suppliers associated with the 2003 outbreak to help reduce product-linked Hepatitis A problems in restaurants.
“It’s up to the restaurant industry to take action, otherwise things never change,” Burns says of the role, including that of litigant, the operator community must play when the supply chain fails to deliver safe products. “We cherish our vendors, but if there is a [safety] issue, we need to know about it and deal with it.”
The National Restaurant Association Educational Foundation, or NRAEF, is intensifying its focus on Hepatitis A and norovirus. Its ServSafe materials are the basis for many restaurant training programs.
“We follow the Centers for Disease Control’s trends [guidance], and viruses are becoming more of a threat than bacteria,” says LeAnn Chuboff, the NRAEF’s director of science and regulatory relations.
In response, she says, the NRAEF has compiled facts about viruses and strategies for reducing their danger to create, “Viruses—They Are In Your Hands,” the foundation’s contribution to National Food Safety Education Month 2007. While safety month activities don’t officially kick off until September, the virus materials should be available beginning in mid-May at the foundation’s website,
In general, Chuboff explains, operators can reduce potential problems from viruses by teaching and reinforcing proper “hand washing and personal hygiene and by minimizing bare-hand contact” with uncooked prepared foods, such as salads. She says that the NRAEF advises operators to certify the integrity of suppliers of foods commonly associated with viruses, such as raw shellfish, and it suggests that managers “have a plan in place to encourage employees not to come to work sick.”
With the advent of licensed vaccines in the United States in 1995, the annual number of reported acute cases of Hepatitis A infection fell by about 86 percent from the 1996 level to 4,482 in 2005, the most recent year for which data is available from the Centers for Disease Control & Prevention in Atlanta. Reported U.S. deaths from Hepatitis A numbered 12 in 2005, down from an average of about 100 annual fatalities in the decade before vaccines were available.
Hepatitis A infection creates flulike symptoms in many, while producing jaundice of skin and eyes, but it can prove fatal to the very young or old and people with immune-system deficiencies. The disease is particularly hard to deal with because of its long incubation period and because infected people may not display obvious symptoms at the time in which they are most contagious.
On top of the publicity resulting from requirements that employers report to health officials any worker illnesses from Hepatitis A, operators also must worry about class-action lawsuits by customers who didn’t get sick, but were advised to get immune globulin shots. Such suits seek reimbursement on behalf of shot recipients for lost wages, travel or medical expenses and emotional distress from worries about contracting Hepatitis A.
The Seattle-based Marler Clark law firm, which in past immune globulin shot lawsuits has negotiated settlements of $200 per claimant, recently filed such a suit against Houlihan’s restaurants Inc. of Leawood, Kan. That suit stems from the Geneva Hepatitis A incident that prompted 2,060 people to get shots.
“We believe we’ve done nothing wrong and that we reacted responsibly and appropriately,” HRI chief executive Bob Hartnett says in response to the lawsuit.
WHEN LIFE GIVES YOU LEMONS… Teach and constantly reinforce proper hand-washing technique and discuss proper work grooming and healthy personal hygiene. Explain to employees the importance of not working while sick and reporting any sudden-onset illness while on the job; consider offering paid sick leave if that is financially feasible. Certify the integrity of suppliers of foods that have been associated with Hepatitis A, norovirus and other virus outbreaks, such as raw shellfish. Consider requiring or offering Hepatitis A vaccinations for employees; don’t forget to negotiate price. If your establishment is implicated in a Hepatitis A or norovirus problem, consider contacting media organizations to share information about your company’s efforts to prevent such problems and how it acted responsibly in resolving the matter. If caught up in a viral outbreak, build up credibility and good will by cooperating fully with government agencies and by being as open as possible with employees and your community. Check out the educational materials at the National Restaurant Association Educational Foundation’s website at
Hartnett says his company followed all reporting laws and cooperated with public health officials and that its ill employee contracted the Hepatitis A infection outside the restaurant. He adds that no other employee or customer was diagnosed as having contracted the bug.
Regarding other large immune globulin shot programs, the Minnesota Department of Health reports that shots were given to 2,289 patrons of the Slayton Pizza Ranch because of possible exposure to Hepatitis A between April 9 and May 1. And in Texas, Harris County Public Health and Environmental Services representatives say shots were provided to 2,020 customers of Pappasitos Cantina possibly exposed to Hepatitis A by an infected waitstaff member between Jan. 23 and Feb. 9.
The Slayton Pizza Ranch is franchised from Hull, Iowa-based Pizza Ranch Inc. Houston-based Pappas Restaurants owns Pappasitos.
Unconfirmed reports by Houston television station KPRC suggest that Pappas Restaurants may have tried to head off a class action lawsuit by the likes of Marler Clark, while eliciting the goodwill of patrons. The station reported that Pappas Restaurants offered cash and dining cards to patrons receiving immune globulin shots if they would waive their right to sue over the matter.
Pappas Restaurants officials declined to comment about the matter.
Pizza Ranch Inc.’s vice president, Ryan Achterhoff, says his chain’s recent experience with Hepatitis A—the only such experience in its 25-year history—generated “major publicity,” not all of it bad. He characterizes as “positive” a follow-up story by the Minneapolis Star Tribune highlighting how the chain and its franchisees cooperated with health department officials and otherwise tried to serve the best interests of employees and patrons.
PAID LEAVE AN RX FOR HEALTH RISKS? Some studies suggest that better training to spot sick employees and deal with them might aid in reducing virus-related problems in restaurants, but some camps believe that paid sick leave might get the job done faster. A review of 369 restaurants during the period from June 2002 to June 2003, including 22 restaurants involved in foodborne-illness incidences, found that operations with certified kitchen managers were less frequently the cause of outbreaks than those without such trained personnel. That analysis was highlighted in a 2006 Journal of Food Protection article titled, “Systematic Environmental Evaluations To Identify Food Safety Differences between Outbreak and Nonoutbreak Restaurants.” “However, neither the presence of a certified kitchen manager nor the presence of policies regarding employee health significantly affected the identification of an infected person or carrier” of illness, said the study’s authors, who included public health professionals and academics. “These findings suggest a lack of effective monitoring of employee illness or a lack of commitment to enforcing policies regarding ill food workers.” Some workers may intentionally deceive supervisors about their health because they can’t afford time off from a job without compensated leave, say advocates of sick leave say. Partly as a result of such arguments, and despite the protests of some restaurateurs among other business owners, San Francisco voters last year mandated that employers in that city provide paid employee sick leave. Critics of such proposals contend that not all businesses have a margin structure that would enable them to fund such benefits, and they say malingering employees may abuse such laws. The National Restaurant Association opposes paid-leave mandates, in favor of more “flexible” approaches, says Brendan Flanagan, vice president of federal relations. “In an industry with 3-percent to 4-percent profit margins that is heavily reliant on labor…the [financial] resources [pool] is only so large,” Flanagan says. Because of that, he says, new mandated benefits, such as paid sick leave, “may have to come out of the wages or benefits in another area [of the business].” Flanagan says Congress is considering expanding the federal Family and Medical Leave Act to include paid sick leave as well as the unpaid leave the law now addresses. —Alan J. Liddle
Despite a five-day closure to sanitize the restaurant and investigate the source of the Hepatitis, as well as media reports on the massive immune globulin shot clinic, Achterhoff said the reopening of the Slayton unit saw “an above-average day’s sales,” adding that the franchisee who operates the unit was “encouraged.”
As it turned out, the employee who first became ill contracted Hepatitis A off the job. As of the second week of May, two other Slayton Pizza Ranch employees and a patron of the restaurant had been diagnosed with Hepatitis A infections.
“In terms of the southern Minnesota region, it doesn’t appear we had a reduction in sales last week,” Achterhoff says. “We haven’t had any reports of significant sales drop-offs.”
Such news contrasts greatly with what happened at O’Charley’s four years ago.
In late 2003, O’Charley’s said the Hepatitis A outbreak depressed quarterly net profits by about $445,000 and pushed down sales at nine of the chain’s Nashville-area restaurants by 20 percent. The company got past that hump by being “very cooperative” with the government and by displaying an extraordinary “openness” with its local constituency, chief executive Burns says.
“The whole Knoxville market went down significantly in sales,” Burns says of the time during and immediately after the Hepatitis problem. “Let’s say there was a point when we asked, ‘Are we going to keep them open?’”
Though recovery was “a painful process” that included the resolution of 56 lawsuits, he says the Nashville region today “is one of our top-performing markets.”
Burns adds, “I give a lot of credit for that [turnaround] to our people.”