Falling Victim to Colorado's 2011 Listeria Cantaloupe Outbreak

America is approaching the 2-year anniversary of an outbreak of foodborne illness that was linked to 147 illnesses in 28 states, including 33 deaths and one miscarriage. The crisis at Jensen Farms in Southeast Colorado would mark one of the largest outbreaks of listeriosis in U.S. history. Food Product Design took an indepth look at how the crisis impacted one Colorado family. This is Part 1 of a three-part multimedia report on the outbreak and its aftermath. Read Part 2 here.

MONUMENT, Colo.It was hours past midnight on Sept. 11, 2011. Mike Hauser, a 68-year-old retired podiatrist, still hadn't hit the sack. A night owl, it wasn't unusual for him to be reading a medical journal amid the droning cadence of CNN while the rest of Colorado slept.

"I went downstairs and said, 'honey are you coming to bed,'" recalls Mike's wife Penny, a former elementary school teacher who had been married at the time for nearly half a century (45 years).

He was sitting in a recliner before the big screen TV, holding his hands to his raging headache. In a decision that was out of character for Mike, he had popped half a Vicodin. Penny explains her husband refused pain medication despite living with multiple myeloma cancer.

When Penny woke up at 5:30 a.m., it was clear Mike had been suffering for hours from an incorrigible migraine. Mike asked Penny to rouse his son-in-law, Stuart. A family physician, Stuart was temporarily living with his in-laws because he and his familyhis wife Heather, the Hausers' middle daughter; and their young child Audrinahad moved back to Colorado from Missouri.

The Hauser family sought to ease the pain in Mike's neck and head with Codeine, but he couldn't hold it down. The podiatrist walked into the kitchen, opened the silverware drawer and vomited.

"He became like incoherent. All of a sudden you couldn't talk to him," recalls Penny.

Interjects 30-year-old Macaria, Penny's and Mike's youngest daughter: "He started repeating himself."

As Macaria recalls, Heather mentioned that their dad "kept looking at her [Heather] and saying 'hey hun, when did you get here?' She had been home for hours before that and he kept thinking she had just walked in the door."

They needed to get Mike to University of Colorado Hospital in Aurora. He couldn't walk so the kids carried him to the car. Normally a back-seat driver, Mike didn't say a peep on the ride up to the hospital while his wife sat behind the wheel of her Lexus SUV.

When Macaria separately arrived in the parking lot in front of the ER, her dad couldn't get out of the car. He was breathing heavy and trying to place his hands on his throbbing head. But he couldn't do it.

"He was just acting so loopy and weird like I've never seen him," observes Macaria, an emergency medical technician, "that I knew something was really wrong with him."

On Aug. 17, 2011, Penny Hauser visited the Sunflower Market in Colorado Springs. Among her seemingly insignificant purchases: a Rocky Ford Cantaloupe.

Mike was still bouncing back from a stem-cell transplant he received four months prior. Macaria, who had been living with her boyfriend Andy in Denver, had moved in at the beginning of the year with her parents, putting her weddingand lifeon hold for her dad. It wouldn't be the last time she would do so.

Mike's recovery from cancer was extraordinary, his 43-year-old daughter Holly Pixler explains, because an initial biopsy revealed the stem-cell transplant wasn't working. During a family meeting, doctors counseled Mike to brace for the end of life.

"I said to him that was the worst meeting I have been to,'" Holly, Mike's oldest daughter, recalls. "Basically they told him you are dead in a short amount of time."

In spite of the gloomy diagnosis, Holly says, her dad managed to keep his sense of humor, pointing out the meeting was certainly no picnic for him either. But only a few weeks later, Mike was strong enough to stand behind his wheelchair, leaning on the handles.

"His doctor walked in," Holly reminisces, "and nearly had a heart attack."

Mike Hauser was beating cancer.

"They said, 'it's amazing. It's like there is nothing there anymore,'" recalls Macaria. "You could see growth in his new cells and he was putting on weight and his hair was growing back and it [stem cell transplant] worked extremely well."

Penny and Macaria insist that by late summer of 2011, when Mike ate cantaloupe slices from Southeast Colorado, he was looking, and acting, more like the husband and father they knew and loved.

Macaria had returned home that summer to Andy and their dog, Bandit, whom Mike favored. A victim of Hurricane Katrina, Bandit had been retrieved from the Humane Society when she was just a pup.

"We had the conversation that, 'You are good enough now. You are healthy,'" Macaria remembers telling her dad. "You want to work on my car again. You can get dirty. You can take care of yourself.' And he said, 'Absolutely, you go back home.'"

It was just like Mike. Penny says her husband didn't doubt he would beat cancer, which he was first diagnosed with in 2003.

"Of course I'm improving," Mike would say. "Of course I'm in remission. Of course. It just was going to take time. A couple of months and I'm back to normal."

On Sept. 11, 2011, after arriving at University of Colorado Hospital, Mike Hauser was feeling anything but normal. He was taken into a triage room where he soon suffered the first seizure of his life.

"That was the beginning of the end. It was completely awful," Penny declares matter-of-factly.

Holly remembers holding her dad's hand while he was seizing.

"He almost levitated off of the table," she says. "That's the only way I can describe it because of the pain that was wracking his body."

Mike fell into a coma. Doctors weren't sure what had befallen their patient. Had he suffered a stroke?

Penny insists Stuart and her son Craig believed it was meningitis, a disease the U.S. Centers for Disease Control and Prevention (CDC) explains "is caused by the inflammation of the protective members covering the brain and spinal cord".

"They were on their cell phone yelling it was meningitis just because of the symptoms he had," Penny says.

Penny kept logs, recording Mike's daily activities. For about a month, he didn't say or do anything. Dozens of physicians"every kind of doctor you can imagine", explains Macariaexamined her dad.

Sometime in October, believing Mike was on the mend, doctors authorized his removal to a long-term acute-care facility, Select Specialty Hospital at Presbyterian/St. Luke's Medical Center in Denver. His stay there would be short-lived.

On Sept. 2, 2011, the Colorado Department of Public Health and the Environment notified the CDC that seven persons had become infected with the disease, listeriosis.

Cantaloupes, it was revealed, were the culprit. On Sept. 10, just one day before Mike Hauser fell ill, Colorado state officials and the U.S. Food and Drug Administration (FDA) inspected Jensen Farms in southeast Colorado.

The Granada, Colo.-based business, which Eric Jensen and his brother Ryan inherited from their father, had no prior history of food-safety problems. Government officials confirmed samples of whole cantaloupes and environmental samples at Jensen Farms' packing facility tested positive for Listeria monocytogenes, the bacterium that causes the infection listeriosis.

FDA Commissioner Margaret Hamburg, M.D. said it was the first time Listeria contamination in whole cantaloupes had been reported.

Eventually, the cantaloupes were linked to 147 illnesses in 28 states, including 33 deaths and one miscarriage. The crisis would mark one of the largest outbreaks of listeriosis in U.S. history.

Pregnant women, the elderly and individuals with compromised immune systems, such as those people who have undergone treatment for cancer, are most at risk of contracting the "rare but deadly disease", CDC Director Thomas Frieden, M.D., said on a conference call at the time of the outbreak. Listeria also is unusual, Frieden pointed out, because the "incubation time"between when a person eats the contaminated food and when the individual falls illcan be weeks or even months. Mike Hauser, for instance, fell ill weeks after Penny purchased cantaloupe.

Government regulators found the outbreak potentially was caused by a number of factorsall within the control of Jensen Farms.

It's not unusual for animals and decaying vegetation to be the guilty party in cases of Listeria monocytogenes. However, environmental samples tested in the fields where the cantaloupes were grown tested negative for the bacterium.

But there was ample blame to go around. FDA found several potential causes for the outbreak, including the location of a refrigeration unit drain line that allowed for water to settle on areas adjacent to the packing facility equipment. Among other FDA observations: the packing facility floor couldn't be easily cleaned; Jensen Farms failed "to remove field heat from the cantaloupes before cold storage"; and the business used equipment to wash and dry the cantaloupes that had been previously utilized for another type of produce: potatoes.

Contaminants also might have come from a truck that hauled cantaloupe to a cattle operation and sat adjacent to the packing facility. FDA further noted Jensen Farms failed to wash the cantaloupes with an antimicrobial solution, such as chlorine, deviating from the agency's guidance.

Congressional staff members launched a probe to investigate the outbreak. "FDA officials emphasized to" staff of the U.S. House Energy and Commerce Committee "that the new processing equipment and the decision to use a packing and washing technique involving non-chlorinated water were two probable causes of the outbreak," the committee stated in a Jan. 10, 2012, report.

FDA reckons Jensen Farms likely could have prevented the outbreak had it followed its guidance related to the production and distribution of melons.

Among the businesses congressional staff members questioned was Bio Food Safety. The Texas-based auditor had given Jensen Farms a 95% grade or "superior" score in a 2010 review in spite of finding a number of deficiencies, according to the report from the House Committee on Energy and Commerce.

Jerry Walzel, the president of the company, seemed to place the blame on regulators. According to the report, in a phone interview, Walzel told committee staff "'guidelines are opinions regulations are law'" and "'we are supposed to go by FDA's regulations FDA should have mandated that you cannot sell cantaloupes that have not been sanitized.'"

In a Jan. 10, 2012, letter to FDA's Hamburg, the congressional committee highlighted the contradictions between the relatively positive, third-party assessment of Jensen Farms prior to the outbreak and the food-safety flaws the agency later discovered.

"Weaknesses in third-party auditors represent a significant gap in the food-safety system," the lawmakers wrote, "because the auditors are often the only entities to inspect a farm or facility."

It was October 2011. Mike Hauser had only spent about a week at Select Specialty Hospital, located on the fifth floor of Presbyterian/St. Luke's Medical Center in Denver. A victim of foodborne illness, his health was not improving. Mike returned to University of Colorado Hospital in nearby Aurora where he was subjected to a seemingly endless barrage of surgeries.

Macaria explains surgeons inserted a shunt into his brain in order to drain into his stomach cerebrospinal fluid that had accumulated in his head. Later, she says, he received surgery on his spine because his spinal column was crushing his spinal cord.

Observes Macaria:"They [doctors] had never seen somebody with so many issues all at once. They couldn't figure it out."

Penny and Macaria essentially moved into the hospital, monitoring Mike's progress, giving the rest of the family updates and performing the crucial duty of advocating on his behalf.

Doctors would ask Mike to squeeze his hand as part of an exercise to check on his mental capacity and determine whether his nerves were functioning. Bedridden, Mike's muscles had withered in the hospital. But Macaria realized he could do other things. One day after the neurologist walked in the door, she asked her dad to stick out his tongue, turn his head and furrow his eyebrows, demonstrating that he was mentally alert and capable of certain physical movements.

Penny recalls waking up one night in the hospital as her husband was choking.

"And I ran over and I took the cap off the [tracheotomy] and all this vomit came out. If I hadn't been there and done that he would have died. He would have choked to death," she declares.

Sometime in the fall of 2011, Penny received a call from the El Paso County Health Department. Health officials wanted to know if Mike had eaten a cantaloupe. Penny couldn't remember.

"One of my jobs. I'm kind of a Type A personality," she says next.

That led her to findin the credit-card receipts she dutifully matched to her credit-card statementsa cash receipt. It was for the purchase of a few produce items, including a cantaloupe. She contacted the county health department.

"We didn't know it was cantaloupe," Macaria explains, "until El Paso County called and then they put the idea in our head by asking, 'has he eaten any cantaloupe specifically?'"