For other people, it’s just a child strolling through the mall. But for 11-year-old Amber Brister, a trip to the mall is a very big deal. Amber is out of the hospital, and happy to be shopping again with her mom and sister.
Amber was a healthy child until last September, when she had a frightening brush with death.
Amber Brister: My stomach hurt really bad and I just didn’t feel good.
Her mother Lori Olson says suddenly and out of the blue, Amber became violently ill.
Lori Olson, Amber's mother: She had kidney failure. She had to have a tube inserted through her abdomen and she was hooked up to a dialysis machine for 24 hours a day for about 18 days.
Amber was gravely ill. She couldn’t eat solid foods, had to be fed intravenously, and needed four blood transfusions. Lori said the doctors told her there was a real chance amber could die.
Lori Olson: It was horrible. When she started the dialysis, there was one point that she was in so much pain they gave her morphine and it didn’t even help. It was a really awful thing to watch.
The same week Amber was fighting for her life, across town in Minneapolis, 54 year-old-old Roi Dahl was also having serious medical problems.
Roi Dahl: It scared the hell out of me. I cried.
He had been sick for days, but says he figured it was just something he would get over. But then came the pain—he says he was doubled over, unable to move, and hemorrhaging.
His family rushed him to the emergency room where doctors tried to stop the bleeding.
Dahl: The first night I was there they were holding their breath whether I was going to make it through the night or not. And the next day, they wanted to take out my entire colon and put a colostomy bag on me. And they still weren’t sure what was wrong.
Ten similar cases hit Minneapolis hospitals in three days, and no one was sure what was causing it. A public health investigation was launched.
Teams began calling patients to find out what they had eaten.
Dr. Steve Swanson of the Centers for Disease Control and the Minnesota department of public health suspected a food borne illness.
Dr. Steve Swanson: We were actually contacting people who were ill and interviewing them while they were still in the hospital.
Because of the symptoms, Swanson thought it might be an outbreak of E.coli 0157 bacteria. E.coli comes from animal or, sometimes, human feces and is usually associated with undercooked ground beef. But health officials found the victims hadn’t eaten ground beef --- but they all had eaten something that you might never suspect of giving you food poisoning—bag salad.
Dr. Swanson: It’s a remarkable fact that most are not aware of that next to ground beef, lettuce is the most commonly implicated food item for E.coli 0157 infections.
Dr. Swanson and the CDC issue a public health warning about contaminated bag salad. Roi Dahl saw it and realized he still had part of the partially eaten bag in his refrigerator.
Dr. Swanson: He called me from the hospital and spoke with me, and said he believed that he was one of our outbreak victims. We then mobilized some people to get over to his house and to get the lettuce before it had decomposed too much. We sent it to our laboratory.
It was Roi Dahl’s leftover lettuce that cracked the case. At the lab, scientists showed us how they were able to extract and isolate E.coli 0157 in the lettuce, then, using DNA markers, they compared it to the strain of E.coli that sickened Dahl, Amber Brister and the others. It was a perfect match.
Dr. Swanson: It’s the first time ever in an outbreak of E.coli 0157 from lettuce that the outbreak strain has ever been found in the lettuce. That’s the proverbial ‘smoking gun.’
Dole Foods issued a voluntary recall for the ‘American Blend’ and ‘Classic Romaine’ bag salads implicated in the outbreak, but not before at least 26 people in three states had gotten very sick. Dr. Swanson believes there were probably many more victims.
Dr. Swanson: Those who become ill, and come to our attention in public health, are just the tip of the iceberg. In fact, with E.coli O157, probably 20 times as many people get ill during an outbreak as you actually know about.
Lori Olson says she still can’t believe it was bag salad that made Amber so sick.
Lori Olson: Who would think that you could eat lettuce and almost die?
Most consumers would have no reason to suspect their lettuce. After all, it’s become part of the American diet. In fact, the industry says six million bags of salad are sold every day in this country.
Jim Gorney, food industry consultant: It’s a great product. It’s convenient, it’s wholesome, and it’s ready to go.
Industry Consultant Dr. Jim Gorney says bagged salad really is the greatest food innovation since, well, sliced bread. And millions do eat it safely every day. He says the outbreak that sickened Amber Brister and the others was unfortunate.
Gorney: My heart goes out to those people who have become ill. I have a 7-year-old myself and it’s really a tragedy when someone gets ill. It shouldn’t occur.
While the E.coli outbreak was unusual, it is not an isolated incident. The Food and Drug administration says there have been at least 19 food borne illness outbreaks linked to leafy greens—including raw spinach since 1995 —425 people have become seriously ill, and two have died.
Dr. Robert Brackett, head of food safety at the FDA: I’m very concerned about the welfare of the consumers.
Dr. Robert Brackett is head of food safety at the federal government’s Food and Drug Administration. He is worried about E.coli contamination of produce, especially lettuce.
Brackett: Over the last five years or so, we have noticed a real increase in the number of outbreaks that were traced back to fresh produce. Lea Thompson, Dateline’s chief consumer correspondent: Would you consider these outbreaks a serious public health issue?Brackett: Outbreaks of E. coli 0H157 are always a serious public health issue. E.coli can debilitate, it can kill, even a few cases is too much for us.
E.coli in beef is usually killed by thorough cooking, but Dr. Brackett says if fresh lettuce is contaminated by E. coli, the person eating it is likely to get very sick.
Brackett: Because unlike ground beef or unlike some other products, there is no heating step. So, the interesting part here is that you have opportunities for contamination all the way from before the product is even planted, right up unto the consumer’s table.
Dr. Brackett says finding how E.coli is contaminating lettuce is a lot like trying to find a needle in a haystack. There are millions of acres of lettuce, and thousands of workers, processors and shippers involved in bringing salads to American tables.
Brackett: It could be something as simple as a deer walking through the field that contaminated a few heads or it could have been from a flooding. Or it could have been an ill food worker. Thompson: Right now it’s really a mystery?Brackett: It really is a mystery how this happened. But it’s one we have to solve.
Looking at bright, green fields of lettuce, it’s hard to believe it could ever make you sick. But if lettuce is contaminated with E.coli, it can be deadly.
Lori Olson says she’ll never eat a bagged salad again. Her daughter Amber almost died last fall after eating dole bag salad. Olson and others who got sick want some answers, and are suing Dole foods.
In a letter to Dateline, Dole says it is “unable to comment” because of the pending lawsuits, and adds “food safety always has and will be our top priority.” The company says it is working “closely with government...to provide the freshest, cleanest fruits and vegetables possible.”
To solve the mystery of how bag salad is contaminated, state and federal health officials have launched a wide-ranging investigation. So far, that investigation shows that lettuce implicated in last fall’s outbreak was grown in seven different fields in the Salinas valley of California. It was processed at a Dole packing plant in Soledad. Beyond that, the government has no idea where the E.coli came from and spokesman Jim Gorney says the industry is just as mystified.
Lea Thompson, Dateline chief consumer correspondent: How does E.coli get into the lettuce?Jim Gorney, food industry spokesperson: That’s the $10,000 dollar question. We’re really perplexed as to how this is occurring.
To see just how lettuce is handled, we decided to go out to the fields, and talk to farmers, scientists and experts.
Vic Smith owns a lettuce farm in Yuma, Arizona. Smith says he takes every precaution to keep his crop clean, even requiring workers and visitors to cover their hair when they walk in his fields.
Vic Smith, lettuce farm owner: The workers cut the lettuce, cutting each individual head, taking off the outer wrapper leaves and then they have a ring core thing - they take the core right out of it.
The practice of coring the lettuce right in field only started a few years ago, about the time the E.coli outbreaks took an upturn. While it speeds the cutting and processing time, some food scientists wonder if the cutting creates an opportunity for E.coli to enter the plant.
Smith: All the lettuce is funneled through a disinfectant chamber, to basically heal the cut, then it is immediately conveyed into a lined bin container.
It is then chopped, sliced, mixed, and washed again at the packing plant. Experts fear in the process, even a small amount of E.coli contamination can be spread around, and end up in many bags of salad, which then are shipped and distributed all over the county.
But E. coli has been found in heads of romaine and iceberg lettuce too, which is not washed at all. It’s bagged in the field, refrigerated, and shipped directly to grocery stores. At Smith’s ranch, workers chop and wrap the whole heads right next to the coring.
And what about those workers?
Thompson: I noticed you even got porta-potties over here so that nobody even thinks about relieving themselves in the field.Smith: Absolutely, that’s a case for dismissal.
Since E.coli can be present in human and animal waste, there’s also concern about the use of fertilizer. Smith says he doesn’t use raw manure fertilizer anymore - most lettuce growers don’t. But, there is always the chance birds could be nesting or dropping on the lettuce. Smith says he does what he can to keep them away.
Thompson: You’ve been growing lettuce for a long time, what do you think is causing this contamination?Smith: Well, I couldn’t answer. I know we are doing everything we possibly can to control the risk exposure that we have with any potential contamination.
In California’s Salinas valley, water contaminated with animal feces is the leading suspect in three of the E.coli outbreaks. Investigators found before each one, these low lying fields had been flooded with creek water. A sample of the creek bed tested positive for E.coli 0157. And that’s a problem.
Scientists believe E.coli bacteria might have been absorbed by the lettuce plant’s root system. If that happens, washing the lettuce won’t do any good—the E.coli is already growing inside.
But Jim Gorney of the United Fresh Fruit and Vegetable Association says all the theories are just that—theories.
Gorney: We believe California Department of Health services has put forward this flooding theory. But we don’t have any data to support that theory. I mean we’re really finding it difficult to understand exactly what went wrong.
Gorney says there’s no real proof the contamination is coming from the lettuce at all.
Thompson: Are you suggesting that this E.coli may not have come from bagged salad? Gorney: Well, we have no smoking gun evidence to show that it’s definitely the bag lettuce.
But wait: In Minnesota, the Center for Disease Control's Dr. Steve Swanson actually found E.coli inside a Dole bag salad, and its DNA matched the E.coli strain that sickened 26 people. He said it was a proverbial smoking gun.
The industry’s theory is somehow the outside of these lettuce bags was contaminated - in shipment, at the grocery store, or even in consumer’s homes. It suggests the E.coli only reached the lettuce after the bag was opened.
Dr. Steve Swanson, CDC: I personally think that’s a preposterous theory. There is actually no way you can have contamination to the outside bag of the lettuce across three states, six different chains and different distributors. Thompson: The Food and Drug Administration and the California authorities say that the E.coli outbreaks came from bag lettuce. You disagree?Gorney: Well, it’s certainly their firm belief and we take it seriously. And we’re working on doing our best to reduce the possibility of illnesses to zero. At this point, it’s fairly unclear.
But the federal government is losing patience with growers and processors.
Dr. Robert Brackett, Food and Drug Administration: When the most recent outbreaks from Minnesota happened—that was sort of the last straw.
In a tough letter to California growers and processors, Dr. Robert Brackett of the food and drug administration expressed “serious concern,” with the “continuing outbreaks of food borne illness associated with fresh and fresh-cut lettuce.” He wrote, industry “claims that ‘we cannot take action until we know the cause’ are unacceptable.”
Brackett: We have a problem here. We seeing these outbreaks. You know, please pay attention to what you’re doing. We want the industry to think like the whole industry and see this as their problem.
So what do you do while we wait for the scientists and the experts to figure it all out?
- Even though bag lettuce is pre-washed, and is labeled ready to eat, experts say it doesn’t hurt to wash it again.
- Make sure your hands are clean and you keep the vegetables away from any raw meat.
- Keep that salad refrigerated.
- Check the expiration date before you eat it. Even if the lettuce looks good, you should know E.coli can grow quickly in deteriorating greens.
Brackett: One case is one too many, and if we can find a way to solve the problem, to stop it in the future, that’s what we’re going to do.