The1992–1993 Jack in the BoxE. coli outbreak occurred when theEscherichia coli O157:H7 bacterium (originating from contaminated beef patties) killed 4 children and infected 732 people across four US states.[1][2] The outbreak involved 73Jack in the Box restaurants in California,Idaho,Washington, andNevada, and has been described as "far and away the most infamous food poison outbreak in contemporary history."[3][4] The majority of the affected were under 10 years old.[5][6] Four children died and 178 others were left with permanent injury including kidney and brain damage.[7][8][9][10][11]
On February 10, 1993, newly inaugurated PresidentBill Clinton participated in a televised town meeting program from the studios ofWXYZ-TV inDetroit, Michigan. He fielded questions from the studio audience as well as studio audiences inMiami, Florida, andSeattle, and responded to questions from the parents of Riley Detwiler – the fourth and final child to die in theE. coli outbreak.[12] 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 firstE. 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 byMcDonald's restaurants inOregon andMichigan). Before the Jack in the Box incident, there had been 22 documented outbreaks in the United States resulting in 35 deaths.[13]
On January 12, 1993, Phil Tarr, then a pediatric gastroenterologist at theUniversity of Washington and Seattle's Children's Hospital, filed a report with theWashington State Department of Health (DOH) about a perceived cluster of children with bloody diarrhea andHemolytic Uremic Syndrome (HUS) likely caused byE. coli O157:H7.[14] 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."[15]
Health inspectors traced the contamination to Jack in the Box fast food restaurants' and their "Monster Burger" which had been on a special promotion (using the slogan "So good it's scary!") and sold at a discounted price.[13][16] 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.[17]
On Monday, January 18, 1993, DOH officials went public with an announcement about the source of theE. coli 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.[15] Two days later, on the same day of PresidentBill Clinton's inauguration, a powerful storm swept through thePuget Sound area (Seattle andKing County). The storm ravaged the area, knocking out power for thousands of residents across three counties, with some living in the dark for 5 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.[15]
At a 1993 press conference, the president ofFoodmaker (the parent company ofJack in the Box) blamedVons Companies, the supplier of their hamburger meat, for theE. coli epidemic. However, the Jack in the Box fast-food restaurant chain had knowledge of but disregarded Washington state laws which required burgers to be cooked to 155 °F (68 °C), the temperature necessary to completely killE. coli. Instead, it adhered to the federal standard of 140 °F (60 °C). If 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.[18]
The subsequent investigation by theCenters for Disease Control and Prevention (CDC) identified fiveslaughterhouses in the United States and one in Canada as "the likely sources of ... the contaminated lots of meat."[19] 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.[20]
A total of 732 cases were confirmed, with 171 people requiring hospitalization.[21] The majority of those who presented symptoms and were clinically diagnosed (but not hospitalized) were children under 10 years old.[5][6] Of the infected children, 45 required hospitalization – 38 had serious kidney problems and 21 required dialysis.[22]
Four people, all of whom were children, died:
Six-year-old Lauren Beth Rudolph of Southern California died on December 28, 1992, due to complications of anE. coli O157:H7 infection later tied to the same outbreak. (Lauren Rudolph E. coli case)[8][9][10][11][23]
Two-year-old Michael Nole of Tacoma, Washington, died on January 22, 1993, at Children's Hospital Medical Center in Seattle of heart failure stemming from kidney failure caused byE. coli O157:H7.[24][25]
Two-year-old Celina Shribbs ofMountlake Terrace, Washington, died on January 28, 1993. She became ill due to asecondary contact (person-to-person) transmission from another child sick withE. coli.[26][27]
Seventeen-month-old Riley Detwiler of Bellingham, Washington, died on February 20, 1993, following secondary contact (person-to-person) transmission from another child sick withE. coli.[15] 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 forE. coli. The first boy's mother suspected her son hadE. 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 forE. 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.[7][26] 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 PresidentBill Clinton resulted in the ensuing national news coverage giving a human face to the events.[28] On Tuesday, February 23, 1993, 3 days after Riley's death, theAmerican Meat Institute (AMI) sponsored an industry briefing in Chicago to discuss theE.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."[29]
In 1993, attorneyWilliam "Bill" Marler represented the then 9-year-old Brianne Kiner in litigation against Jack in the Box following anE. coli O157:H7 outbreak, securing a $15.6 million settlement.[30]
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.[31][better source needed][32]
Victims of the Jack in the BoxE. 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 Inc. 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 Inc. 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 was that they had failed to check the meat supply to deem it safe to eat and that they withheld information for their benefit from the company.[33]
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. In hopes to improve the company's reputation, the chairman of Jack in the Box, Jack Goodall, publicly announced 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 all of the customers affected withE. coli.[33]
"Chasing Outbreaks: How Safe is our Food?".Retro Report short film dated May 10, 2015, discussing the Jack in the Box outbreak and how it led to major changes in industry practices and government oversight of the food supply. (Duration: 11 mins 8 secs)
SenatorRichard Durbin (D-IL), addressing acongressional hearing on food safety in 2006, described the outbreak as "a pivotal moment in the history of the beef industry."[34] James Reagan, vice president of Research and Knowledge Management at theNational 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."[35] David Acheson, a former U.S.Food and Drug Administration (FDA) Associate Commissioner for Foods, in 2015 toldRetro 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."[36]
As a direct result of the outbreak:
E. coli O157:H7 was upgraded to become areportable disease at all state health departments.[37]
The US FDA increased the recommended internal temperature for cooked hamburgers from 140 °F (60 °C) to 155 °F (68 °C).[4][37][38]
TheUnited States Department of Agriculture (USDA)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.[4][37] The labels and the education campaign came with criticism and objection from the industry.[7]
The FSIS introduced testing forE. coli O157:H7 in ground meat.[4]
The NCBA created a task force to fund research into the reduction ofE. coli O157:H7 in cattle and in slaughterhouses.[4]
Jack in the Box completely overhauled and restructured their corporate operations around food safety priorities, setting new standards across the fast food industry.[35]
Roni Rudolph, mother of Lauren Rudolph, and many other parents of affected children formedSTOP 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.[42]
Parents of the affected children played key roles in spreading awareness and advocating for change – speaking directly to PresidentBill Clinton, meeting with Vice PresidentAl Gore, testifying before the Clinton Healthcare Task Force, working with theSecretary of Agriculture, and discussing food safety issues with lawmakers in Washington, D.C.[43][44]
Darin Detwiler, who lost his son, Riley, toE. coli-causedhemolytic–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 atNortheastern University.[45] In 2018, 25 years after his son's death in the outbreak, Dr. Detwiler received theFood Safety Magazine "Distinguished Service Award" for 25 years of contribution to food safety and policy.[46]
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.[47] 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.[48]
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.[49]
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.[50] The book later became the basis of the 2023 Netflix documentary,Poisoned: The Dirty Truth About Your Food.[51]
^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).
Benedict, Jeff (May 16, 2011).Poisoned: The True Story of the DeadlyE. coli Outbreak That Changed the Way Americans Eat. Buena Vista, VA: Inspire Books.ISBN9780983347804.
"Chasing Outbreaks: How Safe is our Food?".Retro Report short film dated May 10, 2015, discussing the Jack in the Box outbreak and how it led to major changes in industry practices and government oversight of the food supply. (Duration: 11 mins 8 secs)
