In reviewing oleander toxicity cases seen in-hospital, Lanford and Boor concluded that, except for children who might be at greater risk, "the human mortality associated with oleander ingestion is generally very low, even in cases of moderate intentional consumption (suicide attempts)." In 2000, a rare instance of death from oleander poisoning occurred when two toddlers adopted from a Siberian orphanage ate the leaves from a neighbor's shrub in El Segundo, California. A spokesman for the Los Angeles County Coroner's office stated that it was the first instance of death connected to oleander in the county, and a toxicologist from the California Poison Control Center said it was the first instance of death he had seen recorded. Because oleander is extremely bitter, officials speculated that the toddlers had developed a condition caused by malnutrition, pica, which causes people to eat otherwise inedible material.