

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.

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.














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.
















The investigation























For some, this will never be over.






"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?