Killer in Our Food - Detroit Free Press - August 24, 1999 (Part 1)

Killer in Our Food
By: Jeff Taylor and Janet L. Fix
Free Press Staff Writers
August 24, 1999

What could be more wholesome than a turkey sandwich, more American than a hot dog? We eat them all the time without much thought.

Hot dogs and lunch meats, made in Michigan under such trusted brand names as Ball Park and Sara Lee, carried a virulent strain of bacteria that killed at least 21 people, sickened 80 more and prompted the largest meat recall in U.S. history.

This is the story of that outbreak: how it splintered lives, shook a reputable company and sent scientists on a frustrating quest for clues to a mystery that was never quite solved.

The aftermath left unsettling conclusions. Precooked foods aren't always ready to eat. Dangerous gaps exist in the food safety system. And even now, we have no firm answers as to what went wrong at Bil Mar Foods, the plant blamed for the outbreak.

In a five-day series beginning today, you'll learn about sanitation problems inside the massive plant. You'll go behind the scenes with medical sleuths who traced the outbreak through high-tech genetic fingerprinting and old-fashioned instinct. You'll go inside the company boardroom where executives jostled with the tough choice to order the $76-million recall.

And you'll meet the people who paid the highest price of all, with their health and lives.

Federal regulators say Bil Mar Foods was a typical plant. That may be the most disturbing thing of all.

MARCH 12, 1998
Inside the Bil Mar Foods plant, Borculo, Mich.

The damp room offered a splendid opportunity for bacteria to spread.

Beads of water hovered from pipes and overhead fixtures, splashing down onto two racks of freshly made turkey franks. It was an unappetizing sight, for sure.

But more than that, it was dangerous. Disease-causing bacteria can lurk and grow in condensation droplets. They thrive in a moist environment.

Inspector Brian Ford had seen the problem before.

He and other federal meat inspectors had cited the plant numerous times for condensation buildups. On this morning, the plant was about to be hit twice more for such violations.

Just an hour after Ford found the dripping water at 8:05 a.m., another inspector found condensation buildup elsewhere along the hot dog production lines.

"Fluid was dripping onto exposed franks," the inspector wrote, "and these franks were being conveyed down the line to packing machine."

In his report, Ford noted a particularly disturbing detail - that only 15 minutes before he arrived, a Bil Mar employee had verified that the area was clean, sanitized and ready for work to continue.

At Bil Mar, where workers churned out as much as a million pounds of hot dogs and other meats each day, keeping the plant clean was a monumental job. Bil Mar was the largest meat plant owned by Sara Lee Corp. It often ran seven days a week, producing some of America's favorite foods, including Ball Park hot dogs and Sara Lee Premium deli meats.

To sanitation employees, it seemed that there was hardly enough time to get the work done.

Shawn Maguire couldn't believe the pressure.

Most nights were a race against dawn, as her cleaning crew and others tried to scrape, spray and cleanse away the greasy residue left each day throughout the huge plant near Zeeland.

The job was exhausting, with so many dirty floors, counters, mixers, vats, conveyors, ovens and other equipment spread across a main plant bigger than 10 football fields.

Workers were supposed to clean every inch of it, especially surfaces and equipment that touched the hot dogs and other meats. That meant scrubbing meat residue from a lot of hard-to-reach places, and then sanitizing the work surfaces with chemicals against an unseen danger: bacteria.

Maguire, 30, had never worked in a meat plant before she was hired through a temporary agency to work at Bil Mar in April 1998. Before that, she had held a variety of jobs; she had worked at a yogurt plant and driven a school bus.

She hoped to find better pay at Bil Mar, where workers were paid around $10 an hour, and could make a lot more with overtime. For a woman with a young son, that was inviting.

Maguire says she was quickly put in charge of a sanitation team. They worked the graveyard shift, cleaning in the hot dog production area.

They were expected to get the work done in time for the morning start-up, but it was a struggle.

"The sanitation crew that I was working with was horrible," Maguire said. "We were all brand new. And we learned together, and we did the best job we could do."

The crew often got started late because workers who made hot dogs during earlier shifts got behind. That put sanitation crews in a squeeze to finish by morning.

"I would come in and go, 'My God, the chain on this linker is a mess. What have you guys been doing?' “Maguire said, referring to machinery used to form hot dogs into links.

But she knew her crew was trying. "We didn't have time to do what we were supposed to." As employees tried to keep pace with the demands, they often had inspectors such as Ford looking over their shoulders.

"Brian walked around like he owned the place and he busted us in the frank plant all the time," Maguire said. "We were trying to get contact surfaces clean, and he'd say, 'Hey, there's a speck of meat on the ceiling.' How could he see it? It was 40 feet up. But most of the time he was right."

Maguire's inexperience, and ongoing sanitation problems in the hot dog production area, prompted the company to move her to a job monitoring ovens, she said.

It was more manageable. Even so, she said, she quit in August and returned to the less stressful job of driving a school bus.

1998 GETS OFF TO A SHAKY START

The year had gotten off to a shakier start than Bil Mar managers had wanted.

They already were trying to rebound from a costly setback at the end of 1997. That November, the U.S. Department of Agriculture temporarily shut down the plant for ongoing condensation and sanitation problems. The plant had been flagged by the USDA for having too many critical sanitation violations at the time.

A shutdown is a serious action to which the USDA seldom resorts. Thus, there was serious concern at the Chicago headquarters of Sara Lee.

The plant was allowed to reopen the same month, subject to close monitoring by the regulators.

The Bil Mar meat processing plant is in Borculo, which is west of Grand Rapids.

The plant showed some improvement, USDA records indicate, but continued to struggle with sanitation violations as the new year began. In February 1998, Bil Mar Vice President Mary Delrue sent a memo to managers and implored them to cut down on the number of problems being cited by the USDA.

She reminded them that the plant's performance was measured by how often it was written up for food safety violations.

"We control our own destiny,” Delrue wrote, adding: "We are very proud of the fact that we are the leading producer of meat products labeled under the Sara Lee brand name. We must do our utmost to protect this brand, along with all of the products we produce, by insuring they are manufactured under the highest quality and food safety standards possible. Quality Products made by Quality People! "

During the first six months of 1998, government inspectors cited the plant for 112 violations. Both Sara Lee and the USDA say that was an improvement over the previous year. Most of the new violations were fairly routine slip ups. But other lapses were serious.

Inspectors caught workers dropping knives on the dirty slaughtering room floor and returning to work without washing the tools. They found scraps of old meat lodged in equipment that supposedly had been cleaned and sanitized. They discovered slaughtered turkey carcasses stained with excrement, waiting to be processed into lunch meats or hot dogs. They found rust, plastic chips, metal shavings and other debris in food moving along the processing lines.

At times, just as inspector Ford did when he found water dripping on the hot dogs __ inspectors hounded the plant about not correcting problems that kept cropping up.

Inspector Rodney Mueller reached the boiling point on April 1.

After earlier in the day discovering rodent droppings in a spice room, which had been a problem cited before, Mueller ran into another repeat offense in an area where employees were carelessly handling food.

Mueller, in a handwritten note to his supervisor, blasted plant employees for failing to immediately correct problems when they came up.

Mueller said he did "not believe the plant employees should be able to contaminate product by ripping it open and getting dirt on the product, and then just leave it and maybe someone else will catch it. If they contaminate product, it should be either corrected or taken care of."

It was a frustrating time for federal meat inspectors. They were unhappy about a new inspection system that had been put in place at 300 of the nation's largest meat plants.

Bil Mar was in that first wave. The new system, for the first time, put the primary responsibility for food safety on the plant workers and managers and placed USDA inspectors in a backup, spot-checking role. Before, USDA had the primary responsibility for food safety checks.

The USDA was hoping that the plant would take on greater responsibility for preventing and catching problems that could jeopardize food safety.

To do that, the plant had to begin doing more to police itself -- while maintaining voluminous records about every critical operation in the plant, from monitoring oven temperatures to keeping cleanup logs.

It was all supposed to make America's meat plants safer. But was Bil Mar up to the challenge?

Managers hope to get rid of their worst headache.

Fourth of July Weekend
The hot dog lines, Bil Mar

The Fourth of July holiday shutdown was drawing near at Bil Mar, and the plant managers would finally have time to get rid of one of their worst headaches.

Or so they thought. They had been planning for months to replace a faulty refrigeration unit in the area known as the retail hopper room, where hot dogs bound for grocery stores were sorted before being packaged.

The large, ceiling-mounted unit kept the temperature in the frank room cool. But the piece of equipment had been a lingering problem.

It was one of the chief offenders in the plant's condensation problems.

Bil Mar managers had originally planned to remove the unit in May 1998. But the removal was pushed back to the July 4 holiday weekend.

The job turned out to be a bear. The chilling unit was so large and bulky that workers had to dismantle it with saws before lugging it out of the plant.

The work may have kicked up a lot of dust around the hopper room and in nearby areas. Workers also tramped through other parts of the plant as they hauled the dismantled cooler away.

Cleaning up the construction mess was critical, to ensure that the room was sanitary when production resumed. The plant did a cleanup, but it may not have been enough.

For most of 1998, Bil Mar's sanitation workers had routinely used testing kits to swab samples from equipment, floors and other surfaces. The tests detected the presence of a variety of cold-loving bacteria that could thrive in the plant's moist, refrigerated environment. Some of these bacteria were harmless, but one in particular -- Listeria monocytogenes -- could be deadly.

When tests came back positive, as they did from time to time, there was no way to tell whether they had detected harmless or dangerous bacteria. Either way, the bacteria weren't supposed to be there, and a bad sample meant equipment and work surfaces had to be re-cleaned and re-sanitized, then checked again for bacteria.

After the Fourth of July construction was finished and the hot dog lines resumed production, there was a sudden increase in the presence of bacteria.

Over the next six weeks, 11 of the 12 swab samples taken came up positive for cold-loving bacteria. Only three of the previous 12 swabs had detected bacteria in the weeks before July 4.

Maybe the increase involved only harmless bacteria.

Or maybe not. The only way to know whether the rare and dangerous listeria bug was present was to do more-complex testing. Those tests weren't required.

And they were never done.

Inspectors remain concerned about sloppy cleaning efforts.

Monday, July 27, 1998

USDA inspectors' office, the Bil Mar plant As the bad swabs continued, inspectors remained concerned about sloppy cleaning efforts.

On back-to-back days -- July 26 and July 27 - inspectors forced cleaning crews to return for two to three hours to re-clean dirty areas along the hot dog lines, USDA records show.

Not only were areas unsanitary, plant workers had passed them off in their housekeeping records as being ready for production.

John Stephenson, a senior USDA official assigned to the plant, expressed "major concern" in a memo to Bil Mar Vice President Mary Delrue.

Stephenson noted that the problems weren't confined to the hot dog lines. Other areas of the plant, he said, "appeared to have been neglected for a significant period of time."

Delrue promised that the plant would do better.

Thursday, August 13, 1998
The Bodnar home, Memphis, Tenn.

As he had done every day for the past 25 years,76-year-old John Bodnar pulled out the black loose-leaf binder that served as his diary and prepared to recount the day's events.

Without fail, Bodnar took time daily to jot down the momentous as well as mundane details of life with his wife Helen, the woman he called "Mom." He recorded where they shopped, what they ate and when they slept. After a quarter of a century, his log runs more than 3,000 pages and fills more than a dozen thick three-ring binders.

On page 2,650, Bodnar recorded what they did the evening of Aug. 13: For dinner, "we had soup and hot dogs for our meal, watched 'Promised Land' and 'Diagnosis Murder' -- darn mystery is continued next week. Bed by 9:30 for both."

The Bodnars had met in 1945 at a B29 bomber base in Salina, Kan. She was in the Women's Army Corps, he was a mechanic.

They married within a year. Later he earned a living as a service manager at a Cadillac dealership in St. Louis. After he retired, they moved around the country, eventually settling in Memphis to be near a daughter.

As he aged and his memory faltered, Bodnar found that the log came in handy when he or his wife disagreed over what they had done and when.

"I could always check my log," he said, "to see if I was right."

One thing they didn't share was a love of hot dogs. "I'm not crazy about hot dogs, but Mom sure liked them," Bodnar said. His wife always bought the Ball Park brand "because they were plumper than other brands," he said.

On Aug. 22, when Helen again ate hot dogs, her husband ate other things. "We ate shrimp, hot dogs and Polish sausage sandwiches and ice cream before bed," he recorded in his log.

Over the next two months, Bodnar continued to recount in his journal the ordinary, slow-paced life of a retired couple content to enjoy their garden, their four children and grandchildren, and each other.

For fun, they'd make the four-hour drive in their Saturn to a gambling spot in Tunica, Miss. There they'd play nickel slots and enjoy the company of other retirees.

Everything seemed to be going so well. That all changed Oct. 3.

Thursday, August 13
The Bodnar home, Memphis, Tenn.

That's when Helen, who had seemed perfectly healthy, crumpled into a pile on the kitchen floor.

"Mom opened the screen door to talk to me -- next I heard a big thump. I ran inside and found her lying flat on her back from the stove to the door," Bodnar wrote. "Helen was as white as a sheet and didn't say anything for about 30 seconds ...About to call 911when she started to come to, so I lifted her up and walked her into our bedroom where she put on her gown and laid down on the bed."

In the middle of the night, Helen woke up, wracked by pain. Her husband took her to the emergency room at St. Francis Hospital, where she was admitted. For two days, doctors ran a battery of tests. But they could find nothing wrong and sent her home Oct. 5.

Within 24 hours, Helen was back in the emergency room and placed in intensive care. Her fever had spiked to 104 degrees and her belly was grotesquely bloated.

"She looked like she was nine months pregnant again," her husband said.

Helen's condition progressively worsened. Doctors suspected meningitis and ordered a CAT scan and spinal tap. They warned her family her chances of surviving were slim.

"The chaplain came in to say a prayer with us," Bodnar wrote. "Dr. took the spinal tap. Fluid should be clear, but it's cloudy. May be a sign of meningitis,an analysis should show the results."

By the time the meningitis diagnosis was confirmed, Helen had fallen into a coma. Doctors couldn't lower her fever and she needed a respirator to breathe. In the simplest of language, they explained that Helen had picked up a germ. They didn't use the germ's full name: Listeria monocytogenes.

This deadly bacterium can cause several serious conditions, including meningitis.

Over the next few days, the family kept a vigil and prayed. Sister Regina splashed holy water on Helen's forehead as she recited a Hail Mary.

"Helen, please open your eyes," Bodnar wrote in his diary Oct. 14.

She never did.

On Oct. 19, Helen's blood pressure plummeted and her heart finally failed.

"Mom lying there peaceful at last," her husband wrote. "She looks much better with all that equipment removed. I kissed her good-bye, told her that I would see her soon."

First Week in October
State Health Department, Columbia, Tenn.

Donna Gibbs felt a trace of alarm as she read the report. Two people from Shelbyville had been diagnosed with illnesses caused by Listeria monocytogenes.

In her 25 years with the Tennessee Health Department, Gibbs had seen listeria reports only occasionally, maybe once every four or five months. But she had never seen two cases in one week -- let alone in a town of just 14,000 people.

Donna Gibbs was puzzled: Four sudden cases of listeriosis, with no link. Concerned and persistent, she enlisted the resources of the CDC. It was the beginning of the trail that led to Bil Mar.

Gibbs, a communicable-disease coordinator for 12 counties in south-central Tennessee, was familiar with this germ.

It causes listeriosis and is one of the deadliest food-borne pathogens. It kills a far greater percentage of victims than better-known bacteria such as salmonella and E. coli 0157:H7.

Past listeriosis outbreaks had been linked to certain types of soft cheeses, milk, pate and vegetables. Cooking kills Listeria monocytogenes, but unlike most other food-borne bacteria, this one thrives and multiplies in the cold.

Since 1985, when the listeria bug killed 48 people during an outbreak in Los Angeles that was linked to contaminated cheese, the number of listeriosis cases had steadily declined. About 1,850 cases are reported nationally each year.

But it's believed that many more people suffer from listeriosis without knowing it. In healthy people, listeria causes symptoms that often are dismissed as the flu - nausea, vomiting, diarrhea. But it can kill the most vulnerable: the elderly, young children and people with weakened immune systems, such as people with HIV and cancer. It can cause miscarriages and stillbirths.

Concerned, Gibbs called one of the state epidemiologists in Nashville.

"He agreed that two cases were weird, but we had no way to link them," she said.

But Gibbs remained troubled. Food-borne diseases generally show up in clusters. And within two weeks, two more cases of listeriosis landed on her desk.

Gibbs alerted the state epidemiologist again. "What's going on? Something is going on," Gibbs told Dr. Allen Craig, the deputy state epidemiologist. "We've got to find out what's going on."

Craig agreed and fired off an e-mail Oct. 20 to the U.S. Centers for Disease Control and Prevention in Atlanta, urging the federal infectious disease experts to figure out whether Tennessee's listeriosis cases were linked in some way.

While they waited for a reply, Gibbs puzzled over what she knew already. She hoped to find a link between the victims. But what could it be? Three were men -- ranging in age from 30 to 60 -- who had become ill in September and early October. But one case involved an infant.

Gibbs was a go-getter. She started as a typist in 1974 at the Tennessee Health Department and quickly advanced. In the 1980s, when AIDS began its deadly spread, Gibbs went door-to-door warning people about the danger of sexually transmitted diseases.

Gibbs' job was tough on shoe leather, and on the soul. Nobody was happy when she came knocking, and they always knew who it was at the door. A Loretta Lynn look-alike, Gibbs still drives the 1978 ice-blue Corvette she did then. "Even if people didn't know me," she said, "they knew my car."

She knew on Oct. 20 that figuring out which food harbored Listeria monocytogenes could be impossible. The bug can take up to 70 days after food is eaten to develop symptoms. And in these cases, there was no obvious link.

The three men lived far apart. They didn't work together, hadn't eaten at the same restaurants.

The 2-week-old infant had been rushed in August to a hospital by her parents because she had a 104-degree fever and no appetite. Doctors did a spinal tap and found she had listeriosis.

The infant's case deepened the mystery for Gibbs. "What kind of food could a 2-week old baby and a 60-year-old man have both eaten?" she wondered. "These four people have absolutely nothing in common."

With the baby's case dating back two months, Gibbs wondered how many other listeriosis cases had not yet been reported to the Health Department. She feared the worst.

Centers for Disease Control and Prevention, Atlanta The e-mail from Tennessee didn't set off any alarms for the nation's top medical epidemiologists at the CDC.

"We get e-mails like the one from Tennessee every week. Most will not turn out to be much of anything, and very few turn out to be an outbreak," said Dr. Paul Mead, who oversees investigations of food-borne illnesses.

Nonetheless, the CDC asked Tennessee officials to send in lab samples for further testing.

"Because of the diffuse nature of food-borne illnesses, a handful of cases in one state doesn't necessarily stand out as a catastrophe," Mead said. "But if 20 states call, you know you have a big problem."

By mid-November, the calls from other states were pouring in.

Besides the four known cases in Tennessee, Ohio had 35 reported cases, Connecticut had eight, New York had 15. (Two people had fallen ill in Michigan, but the cases had not yet caught the attention of state health officials.)

New York officials were especially concerned.

The state had been working with Cornell University scientists to monitor and analyze the genetic makeup of various food-borne bacteria found in New York.

Cornell professor Martin Wiedmann had discovered that half of the state's 15 listeriosis cases shared the same genetic fingerprint. And that mutual fingerprint, later dubbed the E pattern, was extremely rare. That meant all the victims shared something in common and likely had been sickened by food from the same manufacturer.

Wiedmann, Mead and the state health officials were convinced: They had a major, multistate outbreak on their hands.

They had to trace its source. Fast.

Listeria monocytogenes could be a virulent killer.

"Twenty to thirty percent of those who get it die," Wiedmann said. "So if you move fast, you may save lives."

The hunt for the killer germ begins.

Sunday, November 15, 1998
Hills & Dales Hospital, Cass City, Mich.

In their 57 years together, Dottie Eberlein had never seen her husband this sick.

Art Eberlein had always been so vibrant, with a sparkle of mischief in his blue eyes. Even at age 80, the retired high school band teacher had stayed active. He was a popular figure in his hometown of Sebewaing, a one-stoplight village on the shore of Saginaw Bay, where he directed a 38-piece community band that was a highlight of local holiday festivals.

But now he lay still in a hospital bed, an intravenous line sunk in one arm, his wiry, 125-pound body aching and spent. His doctor was still searching for a diagnosis, but suspected food poisoning.

What could have attacked so quickly, with such force? The previous day, Eberlein had eaten a turkey sandwich from a box lunch served at a senior-day event at Delta College in Bay City.

Less than a day later he was suffering miserably with severe stomach cramps and diarrhea. He was dehydrated, in awful shape and in an even worse mood. He had an important engagement to prepare for, a winter holiday concert he had directed without fail for 13 years. From his bed, Eberlein could see the sun setting beyond the window. He knew that Dottie, 77, would be nervous about driving 20 miles home in the dark.

"You go on home," he told her.

Reluctantly, she finally did, hoping that nothing terrible would happen to him while she was away from his side.

A few hours after she left, Art spiraled into a fight for life. His blood pressure plummeted to 60/40, perilously low. His heart raced and he labored to breathe. He was on the verge of slipping into a coma, or worse.

Watching over Eberlein was his longtime family physician, Dr. Surendra Raythatha. Locals simply called him Dr. Ray.

Dr. Ray had been treating the Eberleins since he began his practice in 1980. A graduate of Wayne State University's medical school, as well as a medical school in India, Raythatha had grown fond of the small towns and friendly people in the Thumb during a rural residency in 1978.

About 10 years ago, he had discovered some precancerous cells in Art Eberlein's esophagus, necessitating removal of the esophagus to prevent future disease. Ever since, Art Eberlein had been healthy; and over the years the couple had grown to trust and admire Dr. Ray for the personal attention he had always given them.

Now, Eberlein needed that attention more than ever.

He was going into septic shock because of the bacteria growing in his body. Unchecked, the infection would kill him.

Raythatha already suspected some type of food poisoning although he had no lab results at the time.

"We were giving him massive amounts of IV fluids," a half-liter every hour, plus a dopamine drip to maintain his blood pressure, Raythatha recalled. "He was a very, very sick man. I was in there with him literally every half-hour the entire night. He was very ill."

It would be another day before Eberlein's blood tests came back. The tests revealed a rare food-borne bug that his doctor knew about but had never treated before: Listeria monocytogenes.

Tuesday, November 24, 1998
Michigan Health Department, Lansing

The outbreak was spreading.

But up to now, word still hadn't reached health officials in most states, including Michigan.

Although experts at the U.S. Centers for Disease Control and Prevention had concluded 12 days earlier that an outbreak appeared to be emerging, they had waited for further evidence before sending out a nationwide alert.

In a laboratory at the Michigan Department of Community Health, a fax machine churned out the notice. It warned health departments across the country to be on the lookout for illnesses caused by Listeria monocytogenes.

The fax explained that there had been a sharp increase inlisteriosis cases in New York, Ohio, Connecticut and Tennessee.

Michigan health officials checked their records: Only two listeriosis cases had been reported to them in recent weeks, one from October and the other from November. That didn't seem out of the ordinary for a state that annually sees about two dozen cases. Art Eberlein was one case. The other, dating to early October, involved a young woman enrolled at Western Michigan University in Kalamazoo.

The woman at first just had flu-like symptoms. The next day her roommate found her delirious in their dorm room, according to Dr. Rick Tooker, Kalamazoo County's chief medical officer. She was rushed to the emergency room at Bronson Hospital. There, doctors discovered she had meningitis, a dangerous swelling of the lining of the brain and spinal cord that can cause coma and death. A culture of fluid taken during a spinal tap revealed that the listeria bacterium was causing the meningitis.

Kalamazoo County health officials began the routine follow-up, quizzing the student about what foods or beverages she consumed.

"Every day, or nearly every day, she'd have a deli turkey sandwich," Tooker recalled in a recent interview.

When Tooker's office first investigated, the significance of the woman's lunch routine wasn't obvious. Later it would become crystal clear. Sara Lee Corp. sponsored the deli stands in dorms across campus, and the meat she had eaten came from Sara Lee's Bil Mar Foods plant, in nearby Borculo.

The woman eventually recovered, Tooker said. She was never publicly identified.

As the state health department reviewed the two cases, there were no obvious links. But following the CDC's instruction, they rounded up lab samples from the two patients and shipped them to Cornell University in New York for genetic fingerprinting, a way of identifying each bacterium's unique structure.

Michigan health officials could have run the tests; they consider themselves pioneers in the technology. But because of cost concerns, the department had a policy of only doing such tests after an outbreak had already been identified in the state.

While the state waited for results from Cornell, the toll of victims was growing in Michigan.

One woman was already dead.

Wednesday, November 25, 1998
Clinton Grove Cemetery, Mt. Clemens

On the day before Thanksgiving, Gloria Andrzejewski's family buried her and said their final good-byes.

She was just 56.

An active member of Zion United Church of Christ in Mt. Clemens, where she had served as secretary for 13 years, Andrzejewski was a woman of strong faith. Before her death, the Clinton Township woman had endured a 15-year struggle against multiple myeloma, which causes bone marrow tumors. The condition had weakened her immune system.

And that had made her vulnerable to infections.

So she was no match for a bacterium like Listeria monocytogenes.

Andrzejewski died on Nov. 22 at Harper Hospital in Detroit.

Her family and her best friend declined to talk about what happened. Their grief is still too strong.

They didn't learn she had been infected by the listeria bacteria until test results came back after her death.

And they had no idea her death had been linked through genetic fingerprinting to a nationwide outbreak until contacted by the Free Press this summer.

Thursday, November 26, 1998
A retirement complex in East Lansing

The day after Andrzejewski's funeral, George O'Brian began his own fight against death. It was Thanksgiving Day.

Up to then, O'Brian had enjoyed good health, especially for a man of 94. He was still independent, able to care for himself and get around on his own with the help of a walker. And he could still see and hear well enough to enjoy sports on radio and television, especially broadcasts of his beloved Michigan State Spartans and Detroit Tigers.

After watching football throughout the day, O'Brian began to feel ill. By bedtime, he couldn't get up out of his living room chair. He had a fever of 103 degrees but refused to go to the hospital.

The next morning he was still suffering. That was it. His wife, Mareda, insisted he go to the hospital. At Ingham Regional Medical Center, doctors began treating him with antibiotics. The diagnosis didn't come until three days later: listeriosis.

O'Brian was in agony. Stomach cramps wracked his body. His belly was bloated. His body burned with fever.

O'Brian loved turkey club sandwiches. His wife recalled that she usually bought the Sara Lee brand. Genetic fingerprinting would later confirm that he had been infected by the strain of listeria traced to the Bil Mar outbreak.

After weeks in hospitals and a nursing home, O'Brian finally returned home in mid-February. But he never really recovered.

The ravages of the disease stripped him of his independence, leaving him unable to walk or care for himself without assistance. And the illness nearly stole his will to live.

He began to tell his wife of 48 years, "I wish I had died, because the pain is so terrific."

Friday, Nov. 27, 1998
Lorain County Health Department, Ohio

Dr. Eileen Dunne had been on a long chase with no reward.

She was new at this kind of work, but she was also tireless and smart. She had joined the U.S. Centers for Disease Control and Prevention just five months earlier as an epidemic intelligence officer.

She worked with Dr. Paul Mead, the CDC epidemiologist in charge of the nationwide listeria outbreak investigation. He had dispatched her to Ohio to look into several listeriosis cases reported there.

Even though Dunne, 33, was a CDC newcomer, she had arrived on the job with substantial credentials. She had nine years of medical training, including an MD in public health from Tulane Medical School, a residency in internal medicine at Oregon Health Sciences University and specialty training in infectious diseases at the University of Colorado.

Until she began working with Mead on the listeria cases, Dunne had never before investigated a multi-state bacterial outbreak. Indeed, this was only her second epidemiological field study.

Dunne initially focused on three cases reported at Anchor Lodge, an upscale nursing home complex in the Cleveland suburb of Lorain, on Lake Erie. Those turned out to be false leads.

The genetic fingerprint of the listeria that sickened the nursing facility's residents didn't match the fingerprint of the outbreak strain. So she shifted direction. Working with the Lorain County Health Department, Dunne decided to go door-to-door and use the phone to question other listeriosis victims who had been interviewed previously, in hope of finding something that was overlooked the first time.

Her persistence paid off with a find that would turn out to be one of the crucial breaks in the investigation.

Dunne and a local health official contacted a woman in Lorain who had given premature birth to a girl in early November. Both mother and child had been diagnosed afterward with listeriosis.

"She remembered making and eating chili dogs on Oct. 3," Dunne recalled in an interview. "But she never got sick."

To Dunne's amazement, the woman had held on to that package of Ball Park hot dogs.

Dunne marveled at how eager the woman was to help, even while dealing with the stress of diapers, bottles and new motherhood.

"I thought it was neat," Dunne said. "Things were a little crazy for this woman. Her baby was screaming and there was baby stuff everywhere, but she really wanted to help so others didn't get sick."

Dunne packed the hot dogs in ice and shipped them off to the CDC's lab for testing.

Monday, December 14, 1998
U. S. Centers for Disease Control, Atlanta

Lots of victims. Not enough answers.

That's how it had been for weeks in the slow-moving investigation to find the source of the outbreak.

But a few important clues were finally emerging.

Health officials, after weeks of knocking on doors and quizzing people about what they had eaten, had hit on a common theme. Many of the 41 known victims had reported eating hot dogs. (Because of a flaw in the CDC's questionnaire, victims were not asked whether they ate deli meat.)

Three hot dog brands stood out -- Ball Park, Bryan and Khan. All were made by Sara Lee.

But Sara Lee was a huge company, with several meat plants producing hot dogs under these and other brand names. The package of Ball Park franks recovered from the refrigerator of the Lorain County woman offered a strong lead. The manufacturing codes on the package listed their maker as federal plant No. P-261.

The CDC was still running tests on the hot dogs to determine whether they were contaminated with listeria. Results were still three days away.

But another clue was pointing to Bil Mar.

In New York, experts at Cornell University had discovered some additional samples that tested positive for the outbreak strain of listeria. One came from a sample of Sara Lee chicken deli meat that also was made at the Bil Mar plant.

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