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More and more, the beef industry is using machines with automated, double-edged blades to cut through muscle fibers and connective tissue to penetrate tougher cuts of meat.

Hollow needles are sometimes used to inject flavorings, or what the industry calls “digestive agents.” Marinades also may be added to meat, which can add to contamination risks.

Surveys of beef producers by the USDA found that most use mechanical tenderization to improve quality. A large percentage of mechanically tenderized meat – the industry produces at least 50 million pounds a month – winds up in family-style restaurants, hotels, hospitals and group homes.

For Big Beef, mechanically tenderized meat is all about bigger profits, according to food safety advocates. However, the beef industry doesn’t widely publicize the process, and some food safety advocates say the reason is such labeling can lead to sales declines.

The American Meat Institute, citing a 2008 USDA study, has maintained that the risk of illness from E. coli O157:H7 in such products “is not significantly higher.”

But a more recent study published last year in the Journal of Food Protection found that bladed and marinated steaks were two to four times riskier than those that had not been mechanically tenderized.

Some experts say Big Beef is relying on the process more and more because beef is getting tougher.

Changes in animal feeding practices are causing cattle to come to market sooner, said David Theno, a beef industry consultant and leading food safety expert. Those animals often “have less marbling and may be less tender than animals that spend more time in feedlots,” he explained.

Theno, who helped the Jack in the Box restaurant chain reform its practices after an E. coli O157:H7 outbreak in the 1990s, said problems with mechanically tenderized meat can arise because many consumers don’t want their steaks overcooked. But failing to heat them sufficiently can allow pathogens to survive.

Such risks have been identified “for quite some time,” said Carlota Medus, principal epidemiologist for Minnesota’s health department.

“We have seen it (mechanically tenderized meat) as a vehicle for outbreaks since 2003,” she said. “It’s not as risky as ground beef, but it is definitely riskier than an intact steak.”

USDA research also discovered an ominous phenomenon in mechanically tenderized and marinated meat. The 2011 Journal of Food Protection article warned that cooking highly contaminated bladed steaks on a gas grill – even at 160 degrees like hamburger – might not kill all E. coli bacteria.

Those remaining living pathogens, ironically called “fortuitous survivors” by scientists, survive because of cold spots in the meat.

The American Meat Institute has said that blade-tenderized steaks are just as safe as other steaks if “the meat is properly cooked.” The institute also found that if researchers had allowed the steaks to “rest” and continue cooking for an additional three minutes before taking their samples, those remaining “fortuitous survivors” may have been killed.

Food-safety advocates, however, point out that most consumers, restaurants and grocery stores don’t know they’re buying bladed meat and therefore don’t know it should be cooked more thoroughly. The Safe Food Coalition “strongly believes” such products pose “a serious and unnecessary threat to public health.”

Not every beef company uses mechanical tenderizers, though all of the big four packers acknowledged using them at some point in their production process. But Big Beef’s slaughterhouses are only the first stop in the meat distribution network, and mechanical tenderization can happen anywhere up to and including the point of sale, such as grocery stores.

“It doesn’t matter where in the process it occurs,” said Pat Buck, who co-founded the Center for Foodborne Illness, Research and Prevention after her 2-year-old grandson, Kevin, died from eating E. coli-contaminated ground beef.

“But once it occurs, whether it’s at processing, retail or somewhere in between, we believe it is the obligation of the person who does it to label it.”

Problems with contaminated mechanically tenderized beef are growing and becoming international in scale.

Just this fall, an estimated 2.5 million pounds of E. coli-contaminated meat, including mechanically tenderized cuts quietly crossed the Canadian border into the United States before being caught by inspectors.

The bad meat came from XL Foods Inc. and triggered the largest meat recall in Canadian history.

As of late October, according to the Canadian Food Inspection Agency, 17 people became sick in that country, including at least five who ate mechanically tenderized steaks. The Canadian recall came too late in the United States. Some of the meat already had been distributed in at least 30 states to retailers such as Wal-Mart and Sam’s Club.

By now, the contaminated meat has likely been eaten, frozen or thrown away, and so far no illnesses connected with the outbreak have been documented in the United States. The Centers for Disease Control and Prevention is still investigating.

But if you’re reading about the contaminated Canadian meat for the first time, it’s probably because the outbreak received scant attention in the United States.

Rather than recall the imported meat, the USDA issued what it called a “Public Health Alert” in late September. An alert is a lower enforcement action than a recall.

“While the Canadian Food Inspection Agency has actually issued recall announcements, (the U.S. government) is still releasing vague ‘Public Health Alerts,’” said Wenonah Hauter, executive director of Food & Water Watch.

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E. coli outbreaks, for mechanically tenderized steaks and ground beef, are difficult to trace to their source because the beef production system is complex and the food safety enforcement system is broken, according to food safety advocates and members of Congress.

The Star found that Robert Danell, a 62-year-old man with Down syndrome, died after he and one other at a group home in Sauk Rapids, Minn., fell ill as part of the same E. coli outbreak involving the steak that made Lamkin sick.

Health officials were never able to pin down whether Danell or the other victim at the group home ate mechanically tenderized steak, contaminated hamburger also found in the same outbreak, or instead were exposed to the feces of those who did.

Danell was hospitalized on Jan. 9, 2010, suffering from bloody diarrhea. He died of kidney failure 10 days later.

Today, Danell’s brother, Bill, can only wonder why the E. coli contamination couldn’t have been prevented.

“They figured out it was E. coli, and by that time, there was no way to treat it, and that pushed him into his early death,” said Bill Danell, whose family didn’t take legal action.

Even though his brother lived much longer with Down syndrome than anyone predicted, his death was unexpected. Now all his family is left with are memories.

“Sometimes he would take the bus downtown, transfer to another bus and go to the Army recruiting station and try to join up. He did that every day for a while,” Bill Danell said.

In the end, victims such as Lamkin often must go to court to find out why they became ill.

Early last year, Lamkin sued Oklahoma-based National Steak Processors, the company that allegedly mechanically tenderized the beef that Lamkin ate at Applebee’s. The company declined comment.

Lamkin’s steak was claimed to be part of a USDA recall announced on Christmas Eve 2009. It involved 248,000 pounds of meat from National Steak. Those steaks, and additional contaminated ground beef, sickened 25 people in 17 states, according to the Minnesota Department of Health.

Health department records show that 14 of the 25 known victims reported eating steak, some of which were mechanically tenderized, at one of several family-style restaurants.

Health officials believe, and lawsuits alleged, that the original source of the contaminated steaks was a JBS plant.

Those records indicate JBS’ Colorado plant may have provided contaminated meat that was mixed into ground beef in Kansas and distributed in Minnesota and elsewhere.

But the USDA told Minnesota health officials that “the trace back investigation was not considered sufficiently strong to conclusively implicate that company (JBS).”

USDA officials told The Star that JBS’ Greeley plant was “a supplier of interest,” but ultimately they “could not find information sufficient” to make that conclusion.

After Lamkin sued National Steak Processors, the company then sued JBS, alleging that JBS had provided them with the E. coli-contaminated steaks in the first place.

JBS denied the allegation in court, but when Lamkin’s lawsuit was settled in August, JBS and National Steak both contributed to her settlement. The details of that settlement, which did not assign blame, are not part of the court record.

JBS told The Star that the settlement is not an acknowledgement that they sold the contaminated meat blamed for Lamkin’s illness. Instead, spokesman Cameron Bruett insisted, it is an acknowledgement of the “potential costs and the uncertainty in any litigation claim like this. I think both us and National felt it was in the best interest of the consumer to . . . share the costs of this settlement.”

As for JBS being the source of the additional contaminated ground beef identified in the same outbreak, Bruett said, “We’ve never seen any proof of that claim.”

Applebee’s, which was not named in Lamkin’s lawsuit, said all the restaurant chain’s menus include “an FDA-compliant consumer advisory reminding guests that consuming raw or undercooked meat may increase the risk of contracting a foodborne illness.”

The statement added that “all of the quality meat products that Applebee’s is proud to serve . . . are sourced from USDA-compliant suppliers.”

Until now, E. coli has been primarily a concern with ground beef. Part of the problem is that some plants mix ground beef from different countries and different cattle, commingling the meat to get the right level of fat content.

Medus, the epidemiologist who directed the Minnesota investigation, said the case illustrates how difficult it is to unravel a “common source outbreak involving two different products (ground beef and mechanically tenderized meat.)”

Although the contaminated steak was recalled, “bottom line, we didn’t go to the next step, which would have been a recall at JBS,” she said.

Earlier this year, the USDA proposed improvements in its system for tracing contaminated meat.

But some large packers agree more needs to be done.

“We believe there is room for improvement . . . that will lead to more timely actions and potentially fewer illnesses,” Cargill officials told The Star.

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Lamkin’s and Danell’s illnesses, and those of two dozen others, shouldn’t have come as a surprise to federal regulators and the beef industry.

For years, the USDA has urged the industry to voluntarily label such products, but found in 2008 that few beef plants were doing so. Costco is among stores which do label such products as being bladed. Those labels advise consumers that “for your safety USDA recommends cooking to a minimum temperature of 160 degrees.”

Not labeling mechanically tenderized beef jeopardizes consumers and puts health officials at a disadvantage if there’s an outbreak of E. coli, experts said.

“The meat associations do not want labeling on their products because they believe that it will cause confusion and reluctance to buy the product,” said Buck of the Center for Foodborne Illness.

Pleas to the USDA to force the labeling of mechanically tenderized meat went unheeded for years.

Even one food industry group complained that restaurants can’t tell the difference between a regular steak and a mechanically tenderized steak, especially when frozen. The Conference for Food Protection asked the USDA in 2010 to require labels for it.

“Without clear labeling . . . food retailers including restaurants and retail stores, and consumers do not have the necessary information to safely prepare these products,” the conference said.

The recent Canadian E. coli outbreak prompted health officials there to consider labeling mechanically tenderized steaks and the Canadian government advised food preparers to cook them to 160 degrees.

In the United States there has been no such public advisory and there still are no special labeling requirements.

For now, the USDA recommends cooking all beef steaks – mechanically tenderized of not – to a minimum internal temperature of 145 degrees, then letting them sit for 3 minutes.

While slow to respond, however, the USDA has begun a complex and lengthy process that could eventually require more specific labels for mechanically tenderized beef steaks. As part of that process the beef industry, the public and consumer groups will have an opportunity to comment on the proposal, which could be changed, or even dropped.

The USDA’s Food Safety and Inspection Service declined to discuss specifics of the proposal, including its risk assessment, because it’s under review.

The American Meat Institute’s position on the issue may be changing.

In 2009, after the outbreak that sickened Lamkin and the others, a statement on the Institute’s website called for an investigation, but noted that USDA research had found that mechanically tenderized steaks are “comparable in safety” to other steaks.

As a result, they added, “we don’t believe that special labeling declaring the mechanical tenderization process will provide meaningful or actionable information to consumers.”

Today, Institute officials maintain that statement does not mean they oppose labeling those products.

“Our position … was the right position at that time,” Institute spokeswoman Janet Riley told The Star recently. “We are on the cusp of a great deal of new information (from the USDA) that will prompt careful review and, possibly, a change.”

However Riley added: “Labeling is not a magic bullet. We know consumers often don’t read labels or follow the instructions that are there.”

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The USDA’s Office of Inspector General reported in March that it visited six large beef slaughter plants and determined that “overall industry was taking appropriate steps to help ensure that U.S. beef is safe from E. coli contamination.”

As the inspector general put it: “When positive test results were found, plants were conducting investigations to determine the cause and applied corrective actions.”

But the key phrase, critics point out, is “when positive test results were found.” Some meat processors, they suspect, don’t look hard enough.

That’s because the federal government’s meat inspection program, called Hazard Analysis and Critical Control Points (HACCP), is implemented by meat producers, not government.

The government requires meat plants to verify that their food safety systems work, but it does not require them to actually test meat, nor does it set standards for plants that do.

For example, some in the beef industry acknowledge that they do not test their mechanically tenderized steaks for E. coli, as they do ground beef, because they believe the risk of illness is lower. JBS acknowledged they don’t test those steaks.

Plants that do test meat must make results available to federal inspectors if asked, but they are not required to alert the government of results that are positive for pathogens.

Indeed, some federal meat inspectors have sarcastically suggested that HACCP should stand for “Have a Cup of Coffee and Pray” or “Hardly Anyone Comprehends Current Policy.”

“Our food safety system is broken,” former U.S. Rep. Bart Stupak, a Michigan Democrat, declared during a 2008 congressional hearing after the USDA initiated 20 beef recalls in 20 months.

Although the scientific principles behind HACCP are sound, Stupak said, “many experts contend that it actually decreased federal oversight because of industry’s self-reliance on self-inspection.”

The internal USDA audit this year found that federal inspectors need to provide plants with better guidance. In some cases, plants were able to use their HACCP programs to “sidestep regulations.”

Such loopholes, the audit noted, led to problems such as a 2011 incident in which “a plant shipped about 80,000 pounds of beef after it received multiple positive E. coli tests.”

USDA officials said they are always looking for ways to improve their oversight. Those officials, who wouldn’t speak for attribution, said: “There has been a whole shift in our focus, and we are much more a scientifically based public health regulatory agency than ever before.”

When contaminated beef does hit the market, recalls are the primary tool the USDA uses to minimize risk to consumers. But their effectiveness is limited, federal data show.

For instance, an analysis by The Star shows that since 2005, nearly 18 million pounds of E. coli contaminated beef has been recalled. Of that, far less than half was recovered.

Yet another victim of the same E. coli outbreak that sickened Lamkin and Danell wishes today that the bad meat she ate wasn’t on the market.

Ashley Ashbrook’s parents took her to dinner at Applebee’s in her hometown of Ashtabula, Ohio, in early November 2009, to celebrate straight A’s she earned during her senior year in high school.

Ashbrook, who was 17 at the time, ate a medium-rare sirloin steak that she did not know had been mechanically tenderized. She later contracted an E. coli 0157:H7 infection that was complicated by hemolytic uremic syndrome, the most common cause of kidney failure in children. Ashbrook sued National Steak and JBS in a case settled Nov. 26 for an undisclosed amount, although both companies denied any liability.

Ashbrook’s kidneys shrunk to half their normal size, her kidney function remains abnormal, and she suffers from high blood pressure and anemia, she said.

Eventually, she may need dialysis or a kidney transplant.

“I still have high blood pressure and I get very fatigued because of the anemia. I have to take a break going up the stairs of my apartment and I feel like an old lady sometimes,” said, Ashbrook, now 20 and a student at Kent State University’s Ashtabula campus.

“I had never heard of anything like this (mechanically tenderized steak) before. . . . I went to a small restaurant recently – not a chain – and I asked the lady if it was blade tenderized, and she didn’t know. She said she had no clue, so I said, ‘I’ll have it well-done.’ ”

The Kansas City Star’s Bob Cronkleton contributed to this report.