A premium alkaline bottled water company was ordered to pay nearly $229 million in damages to several plaintiffs Wednesday after its product was linked to liver illnesses, including one death.

Jurors in Clark County, Nevada, found Real Water liable for $200 million in punitive damages and $28.5 million in compensatory damages Wednesday. Two other defendants, Hanna Instruments and Milwaukee Instruments, were also found liable for compensatory damages.

Public health officials warned people not to drink the Las Vegas-based brand’s water in 2021 after linking it to liver illness in five hospitalized children. Will Kemp, an attorney who represented the majority of the plaintiffs, said the water was contaminated with hydrazine, a chemical used in rocket fuel.

Plaintiffs in the case included the families of a 69-year-old woman who died after drinking the water and of a 7-month-old baby who was hospitalized with liver failure, according to Kemp.

"If you have a basic product like water that's contaminated, how are people going to trust the food delivery system?" Kemp told USA TODAY.

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Real Water recalled product after reports of hepatitis

Real Water recalled its product in March 2021 after finding it may have been linked to non-viral hepatitis cases reported around November 2020 in the Las Vegas area, according to a company announcement posted by the Food and Drug Administration. Real Water agreed to cease operations months later until it could comply with federal requirements.

Non-viral hepatitis is inflammation of the liver and can lead to the organ’s failure, according to the Centers for Disease Control and Prevention. Symptoms include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay or gray-colored bowel movements, joint pain, yellow eyes, and jaundice.

Affinitylifestyles.com has been in Las Vegas since 1998 and was headed by Brent Jones, a former one-term Republican Nevada state Assembly member. It marketed the water as "infused with negative ions" and "the healthiest drinking water available."

The alkaline water brand has faced a slew of lawsuits for its contaminated water, which was sold on Amazon.com and across multiple states, including Nevada, Arizona, California, Tennessee, New York and New Mexico.

The lawsuit also names Hanna Instruments and Milwaukee Instruments as defendants, claiming the companies' faulty testing equipment contributed to water contamination, Kemp said. The companies were found liable for compensatory damages but not punitive damages.

Federal agencies probe Real Water

Federal public health agencies launched an investigation into the water product, finding 21 probable cases and four suspect cases of non-viral hepatitis linked to Real Water. 

Twenty-three hospitalizations and one death may have been caused by Real Water’s product, the agency found, with the vast majority of cases in Nevada and the remaining three in California.

The CDC said an epidemiologic investigation supported the presence of a link between the company’s alkaline water and acute non-viral hepatitis but did not identify the contaminant. 

About 100 people suffered acute liver failure as a result of Real Water, Kemp alleged, and this was the first lawsuit of many. The vast majority of plaintiffs represented by Kemp are based in the Las Vegas area, in addition to two people from California who drank the company’s water during a visit to Nevada, he noted.

The second case is scheduled for January and will include a man in his 20s who underwent liver transplant surgery after drinking Real Water, Kemp said.

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