All of these cases of foodborne illnesses occurred in Fulton County eating establishments. But don't bother asking which ones; county officials won't tell you.
Fulton County isn't alone in its hesitation to identify restaurants where a foodborne illness outbreak may have occurred. Other counties in the metro area don't routinely name restaurants in their investigations either.
Without names, it's impossible to pull routine inspection reports that show whether a kitchen has a history of mishandling food. And there is no way to find out whether the department has taken action -- such as probation, a heavier schedule of inspections or license revocation -- to prevent future outbreaks.
"[T]he establishments involved ... have an incentive to participate and cooperate with the health department if they are given some sense of anonymity," a Fulton County staff attorney wrote in a letter dated Nov. 1. The letter attempted to explain why the health department intended to withhold its reports of foodborne illness outbreaks, which Creative Loafing had requested from Fulton County in September.
The attorney's argument sounds weak to Hollie Manheimer, head of the Georgia First Amendment Foundation. For the health department to withhold a restaurant's name, the department must cite a specific state statute that protects the information, she says.
"I'm not aware of any particular exception that would shield the restaurants," Manheimer says. "And anonymity [in exchange] for the cooperation of the restaurants doesn't fly."
Indeed, it took two months -- as well as intervention from the state Attorney General's office -- for the health department officials to release the reports at all. And when they finally did, the documents were void of restaurants' names and other vital info, such as follow-up inspections.
The documents that were released came from the department's epidemiological division and describe the lab work done to identify the source of the illness. The documents also contain a checklist of restaurant conditions that may have caused the outbreak.
There may be more to the investigation that was not released.
Kevin Jones, a manager of environmental services for the Fulton County health department, says his division conducts an investigation in tandem with the epidemiological division.
"That [restaurant's name] would be on the inspection report generated out of environmental health," Jones says.
Jones describes how his division's investigation of a foodborne illness outbreak requires a visit to the restaurant as soon as possible, then a second inspection within 24 hours.
If the restaurant fails to remedy any violations of county health code, restaurant managers or owners may have to take food safety training courses -- or could be served with a citation to appear in environmental court to fight being closed down, according to Jones.
"Usually, most restaurateurs don't want to go that far," he says. "Usually, they would voluntarily close and try to straighten things out before they would want the health department to hang a sign that says, 'Closed by the health department' or 'Closed by environmental court.' "
Only one restaurant suspected by the Fulton health department of a foodborne illness outbreak has been identified, and that's because a diner died and his widow spread word of his death, then filed suit against the restaurant.
In April, Ron Bonds went to the El Azteca on Ponce de Leon Avenue and ordered a lunch that contained ground beef. The restaurant's ground beef and Bonds' stool, a health department epidemiological report would later show, contained sickening amounts of the same bacteria, Clostridium perfringens. The bacteria grow in cooked meat that is not properly cooled or reheated. Ingestion of high levels of the bacteria proves fatal in roughly 1 out of 2,000 reported cases, according to statistics from the federal Centers for Disease Control and Prevention.
The morning after he ate at El Azteca, Bonds died. For years, he had suffered gastritis, a swelling of the stomach, and diverticulosis, a tiny pouch-like scarring of the colon and intestinal walls. These conditions made him more susceptible to complications from ingesting Clostridium perfringens, which is listed as the cause of death on Bonds' autopsy.
Improper holding temperature was what allegedly led to the outbreak at El Azteca. And only in the case of El Azteca is it possible to find out what action the health department has taken against a restaurant or cafeteria where a foodborne illness outbreak occurred.
The department put El Azteca on probation, according to documents provided by the attorney who filed suit on behalf of Bonds' wife. Health officials were supposed to test samples of beef weekly until two consecutive weeks passed without notable amounts of the bacteria. The first two tests proved relatively bacteria free, so the department ceased testing.
It takes a "substantial or imminent health hazard to the public" for the department to revoke a restaurant's license, according to department rules. But Fulton health department Director Adewale Troutman did not reach that finding in the El Azteca outbreak. In fact, Jones, one of Fulton's environmental services managers, says he does not recall any time during the past three years that a restaurant in the Atlanta area was closed due to a foodborne illness outbreak.
When asked what should be done after a diner's death, Jones says, "I would hope that there are going to be some extra precautions put in. I can't really say that we've got a procedure set up for that."
County Commission Chairman Mike Kenn, himself a restaurant owner, was not available for comment.
In September, the same bacteria that brought on Bonds' death showed up in the stool of two people who got sick after eating pork, stuffing and gravy at an unnamed restaurant, according to health department documents. No sooner than a day later, department officials went to the restaurant to collect samples of the food. The samples did not test positive for the bacteria, although a county epidemiologist scribbled on the bottom of the investigative report: "Food is left on steam table entire day."
At another restaurant, the epidemiologist could not link the virus found in another diner's stool to the pizza that four people ate before they got sick. The virus, which is passed via feces, is most often spread by food handlers who use the bathroom and then don't wash their hands, Fulton County epidemiologist Priti Kohle says.
Kohle also noted on her report that the refrigerator where the pizza cheese was kept was too warm -- a violation of health department rules.
The department could find no bacteria or virus to blame in an another outbreak affecting 17 students -- all of whom got sick in November 2000 after eating a turkey dinner at school. But the health department noted on the investigative report that the cafeteria left food sitting at room temperature for several hours and failed to properly refrigerate it.
When asked why the eateries aren't named in the epidemiological reports, which are passed to the CDC, Kohle says there's no need for names.
"We're more interested in the epidemiological view of it," she says. "We want to see how many cases were there, the onset of illness, what were their symptoms."
The same is true in Cobb County, and possibly DeKalb.
Murl McCall, director of environmental services for the Cobb health department, says his staff has investigated foodborne outbreaks of both salmonella and hepatitis A. "When we write up reports, we don't normally name the restaurants," McCall says. "We'll call it 'restaurant A.'"
DeKalb health department Director Paul Wiesner says his staff looked into 64 complaints of food sickness this year and 20 last year, but none turned out to be a foodborne illness outbreak. As for whether his department would release the name of a restaurant where an outbreak occurred, Wiesner says, "I don't know if that's ever come up."