Sludge Watch ==> Spinach Recall -USA Today Remembers 5 Agonizing Deaths

[Maureen Reilly]

September 21, 2007



Spinach recall: 5 faces. 5 agonizing deaths. 1 year later.
By Elizabeth Weise and Julie Schmit, USA TODAY

Ruby Trautz was the first to die.

On Aug. 27, 2006, the 81-year-old Nebraska woman was rushed to the hospital. 
She was in so much pain that morphine was administered. Four days later, she 
succumbed to a food-borne infection later identified as a virulent strain of 
E. coli.


YOUR THOUGHTS: Do you worry about eating "pre-washed" spinach right out of 
the bag?
REPORT: Investigation of an E. coli outbreak associated with Dole 
pre-packaged spinach (pdf)
INDEX: Environmental investigation reports
Two weeks after Trautz's death, on Sept. 14, the Food and Drug 
Administration took an unprecedented step: It told Americans to stop eating 
bagged spinach, a staple of healthy diets, until its safety could be 
assured. A day later, the FDA extended the warning to include all fresh 
spinach and almost as quickly, it vanished from grocery shelves, salad bars 
and menus.

By this time, two more people had died.

Before the outbreak of E. coli O157:H7 was over, at least five people were 
dead after painful, bloody illnesses. More than 205 others in 26 states had 
endured a sickness that left them vulnerable to future health problems. And 
the agricultural industry, government regulators and consumers were shaken 
by the vulnerability of America's system for delivering fresh produce to 
markets.

Since early this year, USA TODAY has interviewed dozens of key government 
officials, food producers, survivors who ate contaminated spinach and 
relatives of those who died. They offer new insight into the 
behind-the-scenes panic throughout the agricultural industry and government 
offices as the crisis unfolded nationwide, and of the detective work that 
led officials to suspect that the E. coli — commonly found in cow manure 
— came from spinach grown on a 2.8-acre plot in central California.

The FDA would partially lift the spinach advisory on Sept. 22, but it would 
be six months before federal and state investigators released their report.

The outbreak would ultimately cost the leafy green industry more than $350 
million as the nation turned away from its growing appetite for fresh, 
ready-to-eat spinach. It's an appetite that has not returned: Sales of 
packaged spinach are still off about 20% from pre-outbreak levels, industry 
executives say.

The interviews reveal vivid details of the gruesome illnesses caused by the 
contaminated spinach, and show why such a deadly crisis remains possible 
today. In the past year, the industry has made strides in keeping produce 
safe, says Michael Doyle, head of the Center for Food Safety at the 
University of Georgia and a consultant to Natural Selection Foods, which 
processed the tainted spinach.

But while companies have imposed higher standards for farmlands and have 
increased testing of the greens before they get to the consumer, it's still 
possible for bacteria to get through the safety net.

In the past four weeks there have been two leafy green recalls, one for E. 
coli in mixed greens and another for salmonella in spinach. No illnesses 
were reported.

"Raw produce, even if you put it in a bag and seal the bag, is still raw 
produce. It's a high-risk food, even if the American consumer doesn't 
realize it is," says Oregon state epidemiologist William Keene.

One year ago, that risk changed families, an industry and consumer attitudes 
toward fresh spinach.

The victims

In July, the month before Trautz died, a 2.8-acre section of a 51-acre field 
was planted in spinach by grower Mission Organics at the Paicines Ranch in 
central California, an 8,000-acre spread largely devoted to cattle grazing.

The 1,002 pounds of spinach from that 2.8-acre section was harvested on 
Monday, Aug. 14, and processed the next day by Natural Selection Foods, one 
of the nation's biggest processors of leafy greens. The spinach went mostly 
into bags of Dole Baby Spinach, each tagged with the production code P227A. 
It was shipped nationwide.

FDA and California investigators would later say that spinach from this 
small section of the Paicines Ranch most likely carried the deadly E. coli 
strain into the homes of unsuspecting consumers.

They were consumers such as Polly Costello, who on Monday, Aug. 21, bought a 
package of Dole Baby Spinach at No Frills Supermarket in Bellevue, Neb. She, 
her husband and her mother, Ruby Trautz, would eat spinach from the bag over 
the next few days.

By that Saturday, Trautz was sick with nausea, vomiting, abdominal cramps 
and diarrhea. On Sunday she began passing blood, and her daughter and 
son-in-law rushed her to Creighton University Medical Center in Omaha.

When a nurse examined her on Sunday, Aug. 27, Trautz was light-headed and in 
extreme pain. On Thursday, after five days of increasing weakness, Trautz 
began to hallucinate and have seizures. She died at 6:15 a.m. that day.

Her doctors had no idea what had killed her. It wasn't until Sept. 25 that 
tests on the spinach from her daughter's refrigerator showed she had been 
infected with E. coli O157:H7.

The second death came Sept. 7, a week after Trautz's, when 77-year-old 
Marion Graff of Manitowoc, Wis., succumbed to kidney disease. Graff had 
always been a healthful eater. "My mother would cover her plate in salad," 
says her daughter, Leah Duckworth.

A woman who'd blossomed with age, Graff was with friends on a bus trip to 
Minneapolis for a weekend of museums and theater when she lost 
consciousness.

Graff deteriorated so quickly that Duckworth, on vacation in Canada, 
couldn't get home in time. Her sister, Annie Banks, held the phone to their 
mother's ear and Graff said, "I love you, my little mommy. Now it's time." 
Their mother died about 90 minutes later.

Next was June Dunning who, even at 86, was "a very proper British lady" who 
made a point of leading a healthy life, says her son-in-law, Chuck Swartz. 
Dunning lived with Swartz and her daughter Corinne in Hagerstown, Md. She 
got sick Friday night, Sept. 1, several days after eating lightly steamed 
spinach from a Dole bag. True to her stiff-upper-lip nature, Dunning didn't 
bother her family about the pain.

The next morning Corinne went into Dunning's room "and found this huge 
bloody mess all over," Swartz says. Corinne took her mother straight to the 
hospital.

It wasn't until Wednesday, Sept. 6, that tests showed she had E. coli 
O157:H7. "I said, 'What's that? That sounds like something from Mars,' " her 
son-in-law says. "The infectious-disease doctor said it came from hamburger. 
We said, 'She doesn't eat hamburger; she loves vegetables.' " Dunning lasted 
for another week.

The fourth fatality was the youngest, 2-year-old Kyle Allgood of Chubbuck, 
Idaho. Kyle had been born at home before his mom and dad could make it to 
the hospital. "He was in a hurry coming into this world, and he was in a 
hurry to leave it," says his mother, Robyn Allgood.

Kyle came down with flu-like symptoms on Friday, Sept. 15. His mom had 
worked hard to make sure her kids got good nutrition. A favorite trick was 
the veggie smoothie. "If you put enough berries and juice and yogurt in 
them, you can put spinach in, so I did," she says.

But it soon became clear that Kyle had something much more serious than the 
flu. The whole family got sick, but his mom, dad and his older sister fought 
it off. Kyle couldn't. He was rushed to the local hospital, then to Primary 
Children's Medical Center in Salt Lake City.

There, Kyle developed hemolytic uremic syndrome (HUS). His kidneys shut 
down. On Wednesday, Sept. 20, he had a heart attack and died, his parents at 
his bedside.

The last death occurred on Jan. 26, 2007, when Betty Howard of Richland, 
Wash., succumbed to heart failure after a long battle with HUS. Howard, 83, 
got sick after eating a turkey sandwich garnished with spinach. She went 
into the hospital on Sept. 7 and from there to a convalescent facility, 
never returning home.

Howard and Dunning were not counted in the Centers for Disease Control and 
Prevention's final list of victims. Seattle-based Bill Marler, considered 
the nation's pre-eminent E. coli lawyer, who represents Howard's and 
Dunning's families, says the bacteria that felled both matched the spinach 
outbreak strain. Their medical bills were paid by Natural Selection's 
insurer, Marler and Dole say. Natural Selection declined to comment.

Dozens of others would become dangerously ill. Of the 200 confirmed cases of 
sick people, 102 were hospitalized and about 15% would suffer kidney failure 
— a condition that could affect them for the rest of their lives.

In Milwaukee, two of Ana Maria Zientek's children, David, then 6, and 
Caroline, then 3, were sickened by the spinach salad they'd eaten at dinner 
on Aug. 28, suffering severe cramps and diarrhea.

Blood "literally poured" out of Caroline as her mom bundled her up in a 
sheet and raced to the hospital. David was hospitalized for six days, his 
sister for 13.

For Jillian Kohl of Milwaukee, the nightmare began on Wednesday, Aug. 30, 
with a spinach salad. Being a thrifty grad student, she ate a lot of it, 
because the expiration date on the bag was that day.

Over the next few days the 25-year-old marathon runner started to feel tired 
and worn out. By the weekend she was feverish and nauseated. She called her 
mother, who told her to rest and take aspirin. But on Monday, the bleeding 
started, putting her in a hospital's intensive care unit for eight days.

At one point, as her body began to shut down, she thought, "I give up. I had 
a good 24 years in life, and I hate that my family is going to have to see 
me die like this."

The regulators

In the early days of the outbreak, Wisconsin and Oregon, both known for 
their strong public health departments, took the lead in trying to figure 
out what was making people sick.

Wisconsin, which has an aggressive E. coli monitoring network, was the first 
state to realize that something was wrong.

When the week of Sept. 4 began, chief state epidemiologist Jeffrey Davis 
knew that he had a cluster of five E. coli O157:H7 cases. But most of the 
victims had gone to the Manitowoc county fair — a common place for E. coli 
to spread, because cows and other animals excrete the bacteria in feces.

And small clusters aren't uncommon; in any year Wisconsin may have around 
200 cases. Davis adopted a wait-and-see approach.

But there was one confusing twist. Graff, who would become the second 
fatality, hadn't gone to the fair.

By midweek, there was an outbreak in another county, and a pattern was 
emerging. On Thursday, Sept. 7, the day Graff died, the director of the 
BloodCenter of Wisconsin told Davis he'd gotten requests for plasma for five 
people at five hospitals, all of whom had HUS. "That was very, very 
unusual," Davis says.

Wisconsin confirmed that all the hospitalized people had the same strain of 
E. coli O157:H7 and posted three of the test results Friday to PulseNet — 
a national database launched in 1998 that allows public health officials 
nationwide to track food-borne illnesses.

Davis then called Chris Braden, chief of the Outbreak Response and 
Surveillance Team at the CDC, to alert the federal agency.

By themselves, the Wisconsin cases didn't mean much. "There's always a 
certain number of background cases," says Robert Tauxe, chief of the 
food-borne and diarrheal diseases branch at CDC. In August, for example, 
PulseNet had had nine different E. coli strains from nine states.

The Wisconsin cases were different from the usual, unrelated cases but no 
one knew that yet. But they were now out there, waiting to see if anyone, 
anywhere else in country, was also infected with the identical E. coli 
strain.

By Tuesday, two other states had posted matches, PulseNet records show.

On Wednesday, Sept. 13, Robert Brackett, head of the FDA's Center for Food 
Safety, got an e-mail from Wisconsin asking if there was contamination 
reported in lettuce.

As lettuce had been the major source of more than a dozen O157:H7 outbreaks, 
it was a good question. But the FDA wasn't tracking anything in lettuce, so 
the answer was "no."

Oregon had a little E. coli cluster going, as well. But it wasn't initially 
viewed as a big deal — until Sept. 13. Melissa Plantenga, an investigator, 
told senior epidemiologist William Keene that of the six people who were 
sick, five said they'd eaten bagged spinach, although they named four 
different brands.

Keene wasn't surprised: Fresh spinach was a very plausible vehicle for E. 
coli O157:H7 because there is no guaranteed "kill step" in readying it for 
consumption. Bagged salads are washed and re-washed in processing plants, 
making them safe to eat straight from the bag, companies say. But the wash 
doesn't eradicate all bacteria.

Keene might have reacted more forcefully if he'd been able to check PulseNet 
and see that other states were reporting E. coli cases, too.

But he couldn't do that because the state had been bounced off PulseNet. A 
CDC-issued device that generates the security codes that allow states to log 
into the computer network had expired and the new one hadn't yet arrived in 
the mail.

Keene called officials in California, where most of the nation's leafy 
greens are grown, and learned that it isn't unusual for multiple brands of 
packaged bags to come from the same plant.

It was all falling into place. Keene pounded out a somewhat cryptic e-mail 
to the CDC: Oregon had a cluster of O157:H7 cases, and he wondered if anyone 
else was seeing anything similar. Ten minutes later, the CDC e-mailed him 
back, saying yes, there were a lot of other cases out there.

So Keene also called Braden, the CDC's top food-borne illness 
epidemiologist. Wisconsin's Davis was patched in, and the three men began 
comparing what they knew. "At that point, Phase One of the investigation was 
over," Keene says. Wisconsin and Oregon had shown the outbreak was O157:H7 
from spinach. Within 24 hours, the rest of the nation would know as well.

That day, June Dunning died in Maryland.

That night the CDC asked all 50 state public health departments if anyone 
else was seeing E. coli cases. The next morning, Sept. 14, the CDC had heard 
from eight states reporting 50 cases. It was looking like a nationwide 
problem.

By noon, CDC and FDA officials were having their own conference call with 
their state counterparts. The CDC asked each of the eight states to list the 
number of cases, the number of hospitalizations, how many kids, how many 
with HUS and how many dead. The FDA's chief medical officer, David Acheson, 
took notes.

"I'm writing this all down, and I get to page three and I'm thinking, 'Oh 
dear,' " he says. For every reported case, he knew there would be many more 
that hadn't yet been reported or noticed by state health officials.

Some states had sick consumers reporting eating lettuce; some said 
strawberries. But more said spinach, even bagged spinach with 
household-brand names on it, including Dole.

Indeed, 80% of the consumer cases at that time recalled eating spinach, an 
incredibly high number to be coincidental as only about 17% of the U.S. 
population routinely eats spinach.

The call lasted at least two hours. At the end of it, "We were looking at 
each other saying, 'This was big,' " Acheson says.

The FDA team met in what would become their war room, a slightly worn 
conference room on the 12th floor of the Office of Emergency Operations at 
the agency's Rockville, Md., offices.

In the next two hours, the 10 or so people in that room would decide to tell 
the American people to stop eating a single product. Not a brand. Not a lot 
number. Not a production day. An entire product — bagged spinach.

The FDA, concerned that consumers may not know if bagged spinach was dumped 
out of bags and into loose-leaf bins at grocery stores, expanded the 
advisory the next day, Sept. 15, to cover all fresh spinach.

The pronouncement was so big that FDA lawyers questioned the agency's press 
officer, Julie Zawisza. She remembers them asking: "Do you realize that 
you're saying, 'Don't eat any raw spinach from any source, anywhere, 
anytime?' "

The FDA did, Zawisza responded, and the media onslaught began.

Acheson was driving home when he got a call: CNN wanted to do a phone 
interview. When would he be home? He finally dropped off to sleep shortly 
before midnight. One of his lingering thoughts: "Could this have been 
deliberate?"

The industry

The news hit the processors and growers of America's $3.5 billion 
packaged-salad market hard. In California's Salinas Valley, nicknamed 
"America's salad bowl," producers of leafy greens gaped at CNN as they 
listened to the FDA's warning that an E. coli outbreak was likely underway.

Executives — scattered on Sept. 14 — quickly got back to their offices. 
Dole Fresh Vegetables President Eric Schwartz was on the East Coast for a 
business trip. Natural Selection President Charles Sweat was in San Diego 
visiting customers. Both immediately caught flights home.

Tanios Viviani, president of Fresh Express, the biggest maker of packaged 
salads in the USA, turned on CNN and learned that a big part of his industry 
had been shut down. "It was like an earthquake," he says. "I was thinking to 
myself: 'Why am I learning about this from CNN?' "

Barbara Cassens, district director of the FDA's San Francisco office, got on 
the phone with executives from companies that made or sold spinach that sick 
consumers reported eating: Dole, River Ranch and Natural Selection.

For Sweat, one tidbit from that conversation would plunge his company into 
the biggest crisis of its 22-year history: About 6 out of 10 consumers who 
reported illnesses thought they'd eaten Dole spinach. Natural Selection made 
that product.

California officials suggested a recall, Sweat says. The next day, Natural 
Selection recalled products made at its plant in August and September for 28 
brands, including Dole. None other than the Dole Baby Spinach processed by 
Natural Selection would ever test positive for the E. coli outbreak strain.

In fact, the contaminated produce appears to have been concentrated in 
42,000 bags of Dole Baby Spinach processed during a single shift in one 
plant.

The recall was much bigger because, at the time, no one was sure how many 
products or processors were involved. Within seven days of Natural 
Selection's recall, five more companies would recall produce. All had 
products made for them by Natural Selection.

As soon as the outbreak was confirmed, investigators began hunting for 
production records that could lead back to the point of contamination, 
something that had never been accomplished in 19 previous E. coli 
leafy-green investigations since 1995.

Everyone in the Salinas Valley produce community was fearful, says Bradley 
Sullivan, a lawyer for grower Mission Organics, which would later be 
identified as the most likely grower of the tainted spinach.

Sullivan says growers and processors were on the phone constantly, sharing 
rumors and details. "In those first days, everybody was nervous. All the 
processors. All the growers," he says. "They were asking, 'If it is me, 
could I go to jail?' "

Otto Kramm, managing partner of Mission Organics, which is 85% owned by the 
same investors who own two-thirds of Natural Selection, was feeling pretty 
safe, Sullivan says. He thought his spinach had been harvested too late to 
make it into bags that were beginning to sicken people on Aug. 23. "We 
thought it would still be sitting in a cooler somewhere," Sullivan says.

That would turn out to be a wrong assumption. Of the 850 soil, water and 
feces samples collected by California and FDA investigators, only those from 
the Paicines Ranch, where Mission Organics farmed, would match the outbreak 
strain.

None of that was known on Sunday, Sept. 17, when executives from Natural 
Selection, River Ranch and Fresh Express, which by now had also been named 
by sick consumers, met at the Residence Inn in Salinas with regulators.

The dozen participants, in casual dress, rearranged the tables in the 
hotel's meeting room into a horseshoe shape so they could see each others' 
faces. Some executives had boxes of production records before them, says Jim 
Lugg, food safety chief at Fresh Express, which had prepared a one-page 
document explaining how it would gather electronic records. The doors were 
shut, and then there was silence.

No one knew how to get started as "we were all equals," Lugg says. By the 
time the one-hour meeting ended, the companies had told the officials how 
they would gather production records for the past three months. Lugg 
suspects the officials had expected to get them that day.

That, too, would turn out to be a wrong assumption.

The investigation

With at least three processors to check out, it would take almost two weeks 
for investigators to narrow their search from 12 fields to the final four. 
Investigators even pulled empty spinach bags out of consumer garbage cans to 
get clues. "It was like a big treasure hunt," says the FDA's Cassens.

Indeed, tracing the contaminated produce that people ate back to the greens 
processed by Natural Selection and the field they came from involved 
thousands of pages of documents, some handwritten.

Even with a record in hand, Kevin Reilly, then an investigator for the 
California Department of Health Services, says investigators must verify 
that what is on the record jibes with what plant managers and workers say 
happened. "It is a CSI-like investigation," he says, referring to the 
popular CBS show.

A big break came on Sept. 20, when researchers in New Mexico proved that the 
strain of O157:H7 from the P227A Dole bags of spinach was identical to the 
strain that was infecting people. The code indicated the product was made at 
Natural Selection's south plant (P) on the 227th day of the year, (Aug. 15) 
on the first of two shifts (A). "It was the first time we had a code, a bag 
of product and an E. coli match," says the FDA's Cassens.

That was also the day on which 2-year-old Kyle Allgood died.

Even with the confirmed P227A code, Cassens says it would take investigators 
seven days of poring through records to narrow the investigation to what 
turned out to be the four ranches that supplied the P227A product.

On Sept. 22, the FDA felt confident enough to tell consumers that it was 
safe to eat spinach grown outside three California counties: Monterey, San 
Benito and Santa Clara. The contaminated product, it was later discovered, 
most likely came from San Benito and the 2.8-acre slice of the 51-acre field 
on Paicines Ranch.

That entire field now sits fallow along a lonesome stretch of highway that 
cuts through a narrow valley between hillsides covered in brush and grass. 
Natural Selection says an extensive risk assessment will be done before it 
will be considered for leafy greens again.

The grower, Mission Organics, didn't have an outside company check the 
field's food-safety risks before last year's outbreak, investigators said. 
Sweat of Natural Selection says the company requires such third-party audits 
for every ranch that supplies it, and now checks to make sure its growers 
comply.

FDA and California investigators issued their report on March 23, almost two 
months after the death of Betty Howard. They didn't pinpoint how the spinach 
was tainted, saying the culprits that carried the O157:H7 might have been 
wild pigs that lived near the field or irrigation water from wells not 
grouted to prevent seepage from groundwater exposed to feces.

The investigators also said there was no evidence that the contamination 
started at the Natural Selections plant. But they said conditions inside the 
plant may have allowed pathogens to spread.

There were no indications that the contamination was the product of a 
deliberate act.

Epilogue

This outbreak was home-grown, unlike the most recent spate of food-safety 
scares involving products from China, which have re-ignited concerns about 
the nations' food-safety defenses. State and federal health officials say 
they will respond more forcefully because of the lessons learned in the E. 
coli outbreak.

Since last fall, companies have taken thousands of acres out of leafy-green 
production because they've been deemed too close to pastures, wildlife or 
other risk factors — and they've added miles of fencing, including on the 
Paicines Ranch.

Processors in California, where the bulk of the nation's leafy greens are 
grown, have also agreed not to buy from growers who don't meet a defined set 
of safety standards — an industry first.

Some companies are improving their ability to track a bag of produce back to 
where it was grown. That will aid investigators and help limit the size of 
recalls. Dole is implementing a high-tech system that it says will enable it 
within minutes to track a contaminated bag back to within 30 feet of where 
the product was grown in the field.

Companies are also doing more testing for E. coli and salmonella in raw, 
leafy greens and, for the first time, in the finished product, too.

While some companies say such testing may provide a false sense of security 
because such a small percentage of the product is actually tested, just such 
a system late last month may have prevented another illness outbreak caused 
by contaminated spinach.

California's Metz Fresh retrieved more than 90% of 8,118 cases of 
potentially salmonella-contaminated bagged spinach before they got to 
consumers. Metz had tested the bagged produce as it came off the processing 
line and detected salmonella, leading to a recall.

In the past, the salmonella may never have been detected until someone got 
sick. No illnesses were reported, the company says.

Parts of the industry — and some lawmakers — have advocated that the 
FDA, which already regulates processing plants, start to oversee growers. 
The FDA's Brackett says the establishment of mandatory federal rules for 
growers has been discussed as one of several options related to produce 
safety.

For some, this will never be over.


By Darren Hauck for USA TODAY
Paul Zientek runs as son David and daughter Caroline play near their home. 
The Milwaukee siblings became seriously ill after eating spinach last year, 
and both now carry a risk for kidney disease.

Milwaukee's Jillian Kohl has resumed her graduate studies in art therapy, 
which were interrupted in their first week by her hospitalization. Her 
kidney function is normal now, but her doctors say there is a 30% chance 
that in the next 10 to 20 years they could fail again

"By the time I am 40 to 45 years old, I could be laying in a bed hooked up 
to dialysis machines again. I know death is inevitable, but sometimes it 
feels like quite a load to carry, knowing a rough timeline has potentially 
been put on my life," she says.

Kyle Allgood's family decided not to sue Dole. "We really trust in God," his 
mom, Robyn, says. "We felt that if he'd meant for Kyle to stay, he would 
have helped him fight it."

Natural Selection's Sweat says he learned of Kyle's death on the eve of his 
45th birthday. "That was the one that took me to my knees," he says. "I was 
on my knees, in my home."

After Kyle died, the Allgoods' neighbors held a bake sale to buy benches in 
Kyle's name for a park in which he and his little sister played. Robyn 
wasn't sure she could walk past that park with her oldest daughter when 
school started this year. It was just too painful. But two weeks ago she did 
and was buoyed by what the benches represented.

"It's all the love there. I just don't think people understand what that 
meant to us."

For Zientek, grocery shopping is a different experience today. "We were 
somewhere, and my children naturally reached for some lettuce that was there 
and I had to stop myself from saying, 'No, put that down,' as if it was 
something really bad." She sighs. "I don't want them to grow up like that."

While the kids are healthy today, they, too, carry a greater risk for kidney 
disease and will need to be tested for the rest of their lives.

"People think life goes on," Zientek says. "But you're never really the 
same."

Do you worry about eating "pre-washed" spinach right out of the bag?








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