In November of 2006, 85-year-old Mora Lou Marshall came to live with her son David, his wife Terri, and their son Colin. She had recently been treated for colon cancer and although she was independent and capable of living on her own David and Terri thought it was best for Mora Lou to live with them.
David and his family expected Mora Lou to remain with them for many years and David weighed several options for their arrangement. As he recalls, “We thought since she was independent, then the best thing to do was to add on a mother-in-law suite to our home with a small bedroom, den and kitchen. I started sketching plans and even went down to the city permit office to see if there were zoning ordinances for this add-on. We considered buying her a small house so she could have her own place and a yard to work in.”
The family’s plans changed permanently that December, when Mora Lou became ill with a Salmonella infection.
An Unlikely Source
In late 2006, public health officials from several states and the Centers for Disease Control and Prevention (CDC) began investigating an increase in Salmonella serotype Tennessee infections nationwide. After a lengthy investigation, both Peter Pan and Great Value brand peanut butter produced at ConAgra’s Sylvester, Georgia, plant with a product code beginning with 2111 were implicated as the source of the outbreak.
On February 14, 2007 the U.S. Food and Drug Administration (FDA) announced that ConAgra was recalling all Peter Pan and Great Value peanut butter products with a product code beginning with 2111 for potential Salmonella Tennessee contamination. Three strains of Salmonella Tennessee were ultimately associated with the contaminated peanut butter.
At least 425 people in 44 states were confirmed with Salmonellosis, the illness caused by the ingestion of Salmonella bacteria, during the outbreak. Twenty percent of all ill individuals required hospitalization as a result of their illness.
Mora Lou Marshall was one of them.
A Peanut Butter Fan
Mora Lou has been a Peter Pan peanut butter devotee since September 2006, when her dentist recommended that she eat a tablespoon of peanut butter every day for supplemental vitamins and nutrients.
Because she had always loved peanut butter and it was affordable, Peter Pan was Mora Lou’s product of choice between September 2006 and February 2007, when her family finally learned the source of her illness.
After Mora Lou became ill, her granddaughter Debbie remembered seeing Mora Lou consume peanut butter on numerous occasions. “She was able to fix her own meals and, the whole time this was going on, she would bring her peanut butter from the bedroom to the kitchen to make sure she ate some with every meal.”
Mora Lou fell ill with nausea, vomiting, and diarrhea on December 29, 2006. Her daughter-in-law, Terri, remembers, “The only thing she was trying to eat was the contaminated Peter Pan Plus peanut butter,” which the family did not find out was contaminated until several months later.
Mora Lou’s illness progressed over the next several days and on January 2, 2007, David and Terri called an ambulance. She was taken to Willis-Knighton Medical Center in Shreveport.
Mora submitted a stool sample for culture on January 3. It later grew a strain of Salmonella Tennessee that matched one of the outbreak strains.
Mora Lou received antibiotics and IV nutrition throughout much of her brief stay at Willis-Knighton Medical Center, but she held fast to her dietary habits, bringing a jar of Peter Pan peanut butter with her to her hospital room. Because the family was unaware that Mora Lou was suffering from a Salmonella infection, much less that the peanut butter was its source, David made sure that the jar stayed by Mora Lou’s bedside so she could access it whenever she wanted some.
As Mora Lou’s first Salmonella-related hospitalization came to an end, her doctors noted that although she had made some minor improvements, she was highly debilitated. They determined that she would not be able to return home and Mora Lou was transferred to LifeCare Hospital, an acute long-term care facility, on January 5, 2007.
At LifeCare, Mora Lou was placed under strict quarantine to avoid further transmission of her infection.
She had become so weak that she could only leave bed for short amounts of time to sit in a wheelchair. Even this small movement would make her exhausted, and she would have to return to bed soon after.
Eating, once a great joy in Mora Lou’s life, was now next to impossible. She struggled to get down even a few bites of food. She often took anti-nausea medication to ensure she could keep down the tiny amounts she could eat.
From January 9 to 10, Mora Lou’s diarrhea continued to be especially bad, and she suffered constant abdominal cramps. Even when her awful symptoms eased slightly, she still felt miserable.
Mora Lou longed to get out of bed, but that was not possible. She wanted to regain sufficient mobility so she could go home to her family, but as time passed it became clear that Mora Lou’s recovery would not come easily. Returning home seemed less and less likely.
With the passage of time, Mora Lou regained some of the weight she had lost and her diarrhea slowed considerably. On January 30, Mora Lou’s medical team determined that she was well enough to be transferred to a nursing home where she could still receive round-the-clock care, and she was transferred to Garden Park Nursing Home in Shreveport.
A Nursing Home
On arrival at Garden Park Nursing Home, Mora Lou made it known in no uncertain terms that she was ashamed of her helpless condition. The formerly active woman was too weak to do anything other than spend her time resting in bed.
Because public health officials had not yet determined that the source of the nationwide Salmonella outbreak was ConAgra peanut butter, Mora Lou’s family brought her the jar of Peter Pan Plus peanut butter and a spoon, so she could continue to eat it in the nursing home.
On February 16, 2007, a staff member entered Mora Lou’s room at Garden Park Nursing Home and found her slumped over in a recliner. She was unresponsive after attempts to rouse her. She was rushed back to the Willis-Knighton Medical Center, where she was readmitted.
A Second Hospitalization
Mora Lou’s admitting diagnosis at Willis-Knighton was weakness with inability to move her legs and inability to eat. After much debate, it was decided that she should receive a feeding tube to help supplement her nutrition as her doctors and family feared that without such a device, her limited ability to eat would cause her to continue to waste away.
Several days later, the Marshall family learned of the Peter Pan peanut butter recall. When they gathered up the two jars of peanut butter belonging to Mora Lou, they noted both were coded with the first four numbers 2111, matching the recalled peanut butter.
On February 23, Terri and David received confirmation that Mora Lou tested positive for Salmonella Tennessee, the same strain implicated in the Peter Pan outbreak.
A Return to Long-Term Care
Upon Mora Lou’s return to LifeCare Hospital, doctors noted her significant weakness and severe malnutrition. She also now suffered from dementia, and depression when she was lucid.
Despite the best efforts of the staff, correcting Mora Lou’s malnutrition proved challenging. On March 6, doctors determined that she was at high risk for silent aspiration due to swallow delay, and she was ordered to take nothing by mouth.
Mora Lou did not progress as hoped in her physical therapy sessions, and physical therapy stopped due to her extensive weakness.
After several delays, Mora Lou was discharged from LifeCare and transferred back to Garden Park Nursing Home. Her diagnoses included dementia and depression, malnutrition, and other medical issues.
Back to the Nursing Home
Mora Lou has remained at Garden Park Nursing Home since admission there on April 19, 2007, although she has been hospitalized several times for progressive functional decline.
She is bedridden and immobile and continues to receive supplemental feeding through a nutrition line into her stomach. Because of her inability to get out of bed, Mora Lou has been catheterized and in diapers since January of 2007.
“Mom has lost a lot of her hand strength and coordination. She cannot feed herself, use the remote control for the TV, push the nurse call button, comb her hair, or other basic hand and arm skills we all take for granted,” said David.
David and Terri hired an aide to stay with Mora Lou during the day to ensure she has the attention and care she needs. This means assistance to encourage her to eat what she can, lift her into her wheelchair, minimize her bed sores and diaper rash, and help her through the little things in the day.
Fighting for Food Safety
Mora Lou’s decline has been heartbreaking for her family. She will never return home to live with them again. And with little hope of recovering her mobility, she will never walk unassisted again, much less fish, cook, garden, or travel like she once did.
Terri Marshall traveled from Shreveport to Washington, DC to testify before the U.S. House Subcommittee on Oversight and Investigations in April of 2007. She told the committee, in part:
. . . It seems Mora Lou has literally lost her life without physically dying. She has been either hospitalized or in the nursing home since January 2, 2007. She cannot walk, get out of bed, use the bathroom, shower, read the newspaper, or talk on the telephone. All aspects of her former life are gone. Her nutrition is now supplied from a feeding tube. She cannot swallow even pureed foods or water without aspirating most of the time.
The testimony I have given today is a very brief overview of what our entire family has experienced this year. We will forever be changed in how we purchase, prepare and trust whether the food we are buying is safe for us to eat.
It would take more time than I am allowed in this forum to fully explain our challenges, so I will close with one final comment.
The topic for this hearing is “Diminished Capacity: Can the FDA Assure the Safety and Security of the Nation’s Food Supply?” If I could change it to relate to our personal experience, it would read: “Mora Lou’s Complete Incapacity: Can anyone prevent it from happening to someone else?”
Terri returned to Washington, DC in the fall of 2009 to meet with Congressional leaders during a Lobby Day in support of food safety legislation.
After Lobby Day she wrote, “It has been two years since I testified before the Congressional hearing on food safety. I was hopeful some progress would have been made since that testimony, but every time I hear news of another food illness outbreak I realize there is still so much more work to be done. So that is why I was honored to be a part of the Lobby Day last week.
“I was able to meet with the staff members of Congressman John Fleming, Senator Mary Landrieu and Senator David Vitter. Whether by accident or design, it was explained how key elements of proposed food safety legislation could have made a difference in my mother-in-law’s illness. One requirement would give the FDA the authority for mandatory recall of suspected problem foods. Mora Lou’s initial confirmed contamination was January 2, 2007, and she continued to eat the peanut butter even in the hospital for another 5½ weeks until the voluntary recall on February 14, 2007. What a difference a few weeks would have made for our family.”