Alberta’s government has accepted, and has said it will work to act on every recommendation they can, made by a review panel following the Sept. 2023 Escherichia coli (E. coli) outbreak at multiple daycares in Calgary.

The panel delivered 12 primary recommendations, and 27 sub-recommendations, following an investigation into the illness that affected 448 people at 17 licensed child care facilities.

The panel recommendations included changes to the culture of food safety in Alberta, strengthening the public health inspection system with increased accountability by food establishments and child care providers, and increasing communication around food safety between the province and child care providers.

“It’s our government’s intention to act on every recommendation we can to protect children’s safety and to restore trust in the system,” said Premier Danielle Smith.

“Last year’s E. coli outbreak had a devastating impact on families, and we are committed to making sure an event like that never happens in our province again. The review panel we set in place has done important work to review the overall outbreak situation to provide recommendations to prevent a similar outbreak from happening.”

During the outbreak, 38 children and one adult were hospitalized. A total of 23 patients were identified with hemolytic uremic syndrome, and eight received dialysis.

Some of those patients have continued to be under the care of the specialists who initially provided care following the outbreak, officials said.

Outbreak was the largest in the history of Alberta

The E. coli outbreak was the largest in the history of the province.

Premier Smith said that the government needed a clearer understanding of why the outbreak happened to prevent something similar from ever happening again.

She said that they would be acting immediately on some recommendations, but others would require legislative changes and consideration and consultation as to how they would affect child care operators.

“We want to make sure that we’re implementing these policies in a way that isn’t overly burdensome and achieves the goal that we want,” Premier Smith said.

Minister of Health Adriana LaGrange said that work was already being undertaken to increase the frequency of public health inspections and to improve response times in child care facilities with food safety concerns.

“Planning is underway to implement the recommendation to raise awareness of reporting mechanisms for parents and staff, enabling them to report food safety concerns and unsafe handling within licensed child care facilities and food establishments serving these facilities. This will also include the option for anonymous reporting, and we know how important that is,” she said.

Matt Jones, Minister of Jobs, Economy and Trade, said that it was essential to get the changes right.

“We are also examining potential legislative and regulatory changes to strength strengthen our food safety standards, while introducing penalties for non-compliant parties to ensure adherence to the high quality standards expected in the sector. We will work with childcare providers throughout this process, while also investing in increased risk informed monitoring and inspection,” he said.

“Our approach prioritizes immediate actions to enhance food safety and licensed child care. We’re also considering long term recommendations that will take some time to implement. We will have more to say on those in the coming weeks and months.”

Panel provides more than a dozen recommendations to government

A review panel was struck by the government in September of 2023.

The panel was headed by former Calgary Police Chief Rick Hanson, and included pediatrician and infectious disease specialist at the Children’s Hospital Dr. James Kellner, University of Alberta professor emerita of agricultural, life, and environmental sciences Dr. Lynn McMullen, owner and operator of Annabelle’s Kitchen and Bar Meslie Echino, owner of Hopscotch Child Care Typer Shapka, and president and CEO of YMCA Calgary Shannon Doram.

“I am confident these recommendations reflect the lessons learned and provide a path forward for improved food safety,” said Hanson.

“Our mandate was to provide the Government of Alberta with recommendations on how applicable legislation, regulations, standards, guidelines and operating procedures could be strengthened to assure food safety for children in licensed child care facilities and the kitchens that serve these programs.”

He said they consulted with stakeholders, affected families, performed a literature and legislative review, and engaged with a third-party investigator.

A briefing was provided to parents of the children infected during the outbreak, on the morning of July 29.

In a response to questions about oversight in the child care system, Minister Jones said that they do see some operators who do not consistently implement a culture of food safety into their work.

“That’s why it’s important, why the panel’s recommendations are so important, so that we as government can improve the standards. We can raise the bar even higher, and they are. We are going to put in tools to hold people accountable, and we’re going to increase transparency so the parents can see an operator’s track record,” Jones said.

An investigative report into the causes of the E. coli outbreak by Alberta Health Services, and delivered to the government at the end of June, found that the strain of E. coli that effected patients was genetically identical to a strain found in patients who had contracted E. coli from privately purchased and likely unsuspected beef.

Although the report and Minister Jones stressed that no investigative link could be found between the private sales of beef and the infections at the daycares.

“There was a very fulsome look back that included the Canadian Food Inspection Agency, that was able to take a look again at the sales of and the receipts of all of the beef that had actually come into that centralized kitchen,” said Dr. Laura McDougall, senior medical officer of health, Alberta Health Services

“So what exactly that connection is of this circulating strain, and the daycare, and the kitchen… still remains unknown.”

That same genetic match was found in five cases discovered in another province in 2022. The investigation, said AHS, remains ongoing.

Minister Jones said that the government saw that there was a need to do a thorough examination of the entire food chain, including looking at private sales.

“I don’t want anybody in here to think that this is just what happened when my dad used to go in with my uncle and buy a quarter of a beef off the farm. That still happens, and that’s what not what this is about,” he said.

“This is about people who know that they’re obtaining animals illegally, in some cases, they’re processing them in an illegal manner under the most unsanitary conditions you can imagine, and then they’re packaging them up and they’re selling them to people and the average person would be unaware.”

Panel recommends strengthened regulations, involvement of police and courts

The panel said that their guiding principles were centred around restoring the lost of trust in the food safety system, increasing accountability, and putting focus on the interests of children and their families.

Among those recommendations were to increase the licensing of food handlers in the province from a one-time test to a requirement for retesting and licence renewals.

Currently, the Alberta Government requires one supervisor of management position to hold a food handling licence when six or more food handlers are on site of a commercial kitchen. With five or less, only one individual who has control of the operation must have a food handling licence, and is not required to always be on the premises.

“The Review Panel believes this level of leniency in food certification requirements presents a considerable risk, potentially leading to lapses in safe food handling during daily operations. Alberta is the only province in Canada that specifies food handler certification requirements depending on the number of workers present,” read the report.

“Other provinces and territories that require food handler training and/or certification as part of their food safety legislation set parameters where at least one person with food handler training and/or certification must be on-site during all hours of operation regardless of the number of workers present.”

Greater involvement of the police and the courts were also suggested by the panel, along with strengthened memorandums of understanding between health organizations and levels of government.

“These formalized processes, potentially including MOUs, aim to foster a collective understanding and streamline the collaboration needed during foodborne illness outbreaks. The goal is to enshrine collaboration and effective information sharing into routine practices, overcoming the current barriers posed by the restrictive interpretations of the [Health Information Act],” the report read.

“This will facilitate quicker identification of outbreak sources and support potential legal actions when public safety is compromised due to unsafe food handling practices.”

Hanson said that the recommendation of an anonymous tip line was to ensure that food care handlers can alert the authorities without jeopardizing their employment.

“I would never expect parents to have to rely on an anonymous tip line, but I would expect that those that are employed who are working within a daycare or any kitchen and are seeing unsafe practices as a matter of general management, they need to feel safe that they can alert the authorities that something’s going on,” he said.

Recommendations by the review panel