Eating Spize bento meal hours after preparation may have led to SATS officer's death, coroner's court hears

SINGAPORE: An auxiliary police officer, who died of sepsis and multi-organ failure a week after eating from a bento box, had consumed the food hours after it was prepared. 

Mr Mohamad Fadli Mohd Saleh, a 38-year-old employee of ground-handling firm SATS, had eaten the food prepared by Spize restaurant between 2.53pm and 4pm on Nov 6, 2018.

The coroner's court heard on Thursday (Aug 15), the first day of the inquiry, that the food had been prepared at Spize's River Valley outlet between 9.30am and 10.30am that day, and that Mr Fadli ate his portion about five hours later.

READ: Salmonella behind Spize mass food poisoning incident; outlet to be shut

A post-mortem conducted initially stated that the cause of death was cardiorespiratory failure. A report later found that he had died of sepsis and multi-organ failure following acute gastroenteritis.

Two government agencies were involved in the investigations on the case: The Ministry of Health (MOH) and the Singapore Food Agency, which at the time included the National Environment Agency (NEA) and the Agri-Food and Veterinary Authority.

MOH linked seven separate suspected food-borne incidents to Spize between Nov 6 and Nov 9.

A total of 211 people consumed food from Spize. Of this, 73 people fell sick, with 47 people hospitalised including Mr Fadli and 36 testing positive for salmonella.

The other 35 have recovered, said MOH assistant director Pream Raj, who was one of four witnesses who took the stand on Thursday, led by State Counsel Gabriel Choong.

He testified in court that the salmonella outbreak was "unusually severe", despite the bacteria being a common source of such outbreaks.

In general, it is a "self-limiting disease", with an incubation period of between 12 and 36 hours.

However, in this incident, the immediate incubation period was shorter, within just eight hours, and there was a high hospitalisation rate.

An investigation ruled out the possibility of there being a virulent strain of pathogens leading to the more clinically severe salmonella outbreak.

Instead, the high hospitalisation rate and short incubation rate was probably due to the increased bacteria loads of contaminated food items, said Mr Raj.

This points to widespread environmental contamination and poor food hygiene practices, he added.

He said that when food is left in a room for an extended period, favourable conditions are provided for bacteria to proliferate. He added that Singapore is warm and that there is moisture in bento boxes.

He said that it was possible this gap between when the food was prepared and consumption of the food may have contributed to death.

ACCOUNT OF EVENTS

According to Senior Staff Sergeant Raveen Kumar Praim Kumar, the investigating officer on the case, Mr Fadli was attached to security company Brink's Singapore, which catered bento boxes for a Deepavali celebration that day.

A total of 88 bento boxes were ordered for the occasion for Brink's two premises at Kaki Bukit and Tai Seng.

Between 9.30am and 10.30am on the morning of the incident, Spize prepared the food at its River Valley premises.

There were three types of rice placed in the bento boxes: Indonesian rice, which included egg fried rice, prawn omelette mung beans and tofu; Malaysian rice, which included kampung fried rice, chicken sambal and stir-fried morning glory; and Chinese rice, which was egg fried rice with Chinese sausage, omelette, crispy fish and other ingredients.

DELIVERY DRIVER ATE A BOX, DID NOT FALL ILL

A delivery driver picked up the food at 11.10am that morning and ate one set himself between 10.30am, and 11am, but did not fall sick.

He placed the boxes in the boot of his personal car and delivered the food, arriving at Kaki Bukit at 11.33am according to closed-circuit television (CCTV) footage.

When he delivered the food, he told the staff that it had to be consumed within one hour from the time of delivery. An invoice handed over indicated that the consumption of food beyond an hour was not recommended and that the company would not be held liable for the health of guests who did so.

Based on CCTV footage, Mr Fadli arrived at the Kaki Bukit premises at 2.53pm with the rest of his team.

He called his wife at 4pm and said he had just eaten. Investigations were unable to establish which type of bento set he ate and when exactly he ate it, but he is believed to have consumed the food between 2.53pm and 4pm.

Mr Fadli, a father of two children, went home between 6pm and 7pm that day and felt pain in his stomach at around 8.30pm, according to his wife.

He suffered multiple spells of diarrhoea and vomiting throughout the night and went to Raffles Medical Clinic at Waterway Point with his wife the next day at about 10am.

READ: Food poisoning - What are the chances of getting it from catered food?

MR FADLI WENT TO SEE A DOCTOR DAY AFTER

He reported having multiple episodes of diarrhoea and nausea and had a fever of up to 39.9 degrees Celsius along with body aches.

The doctor diagnosed him with gastroenteritis and prescribed antibiotics, anti-diarrhoea medication and other medicine for his ailments.

The doctor advised Mr Fadli to go quickly to an emergency department if he saw no improvement or if his symptoms worsened.

While the doctor did not give Mr Fadli a referral letter to any hospital, he was told that he could walk into the emergency department of any hospital for treatment.

Mr Fadli's condition did not improve despite being prescribed medication, and instead worsened at around 2pm the next day, on Nov 8.

His family called for an ambulance and he was unconscious when it arrived and took him to Sengkang General Hospital.

He was warded in the intensive care unit from Nov 8 to Nov 14, and suffered a heart attack on Nov 14.

Despite resuscitative efforts, he was declared dead at 7.19pm that day.

WIDESPREAD CONTAMINATION, POOR FOOD HYGIENE

Of the 34 food handlers working at Spize at the time, two tested positive for food poisoning virus or norovirus and were banned from handling food.

NEA collected food samples and did environmental swabs of the premises for microbial analysis and found salmonella bacteria in food.

Swabs uncovered faecal coliforms, bacteria found in faeces, on a door handle, chopping board and knife. 

The Spize River Valley outlet was suspended and later lost its operating licence after the mass food poisoning.

The coroner will deliver her findings next Friday (Aug 23).