Let me put it bluntly. I have been fighting for food poisoning victims since 1993. A then 9-year-old girl almost died after eating a Jack in the Box burger. The villain back then was ground beef. We fixed that problem. Or most of them have been fixed. I used to tell people that they could expect a serious E. coli outbreak and that they could recall it happening like clockwork almost every spring or summer. There was no outbreak in 2003. The beef industry has done that to its credit. In fact, I was worried that I would quit the business.
I wasn’t so lucky. The problem has just been moved.
early warning signs
In July 2002, an E. coli O157:H7 outbreak infected 78 attendees of a dance camp at Eastern Washington University. These were middle and high school students from Washington, Montana, and Minnesota. Case-control studies have strongly linked the disease to Caesar salad made with romaine lettuce. That was a warning. No one paid attention to it.
In April 2012, an outbreak of E. coli O157 infected 28 people and was linked to romaine lettuce. The pattern was becoming clear. By 2017, 17 illnesses had been reported in 13 states, including two people with hemolytic uremic syndrome (HUS), an acute kidney failure, and one death in California. Canada has already figured out it’s romaine. We were still risk averse.
2018: Yuma Changes Everything
Then the disaster I had feared occurred. In April 2018, local, state, and federal public health and agriculture agencies announced an outbreak of E. coli O157:H7 associated with romaine lettuce in the Yuma, Arizona growing region. In total, 240 people across 37 states have been reported infected with the outbreak strain. Of the more than 201 people with available information, 104 were hospitalized, including 28 with HUS. The deaths were counted as 5 in Arkansas, California, and 2 in Minnesota and New York.
We found out why. The outbreak strain was detected in water samples from a site along a 3.5-mile section of the Welton Irrigation Canal next to a romaine lettuce farm and an intensive feeding facility housing about 105,000 cattle. 150,000 cows. Waste from the feedlot was entering the irrigation water. Water was flowing over the lettuce. Lettuce was going into the salad.
2019 and beyond: The pattern repeats itself.
In 2019, there were three separate outbreaks that were being investigated simultaneously. Each was caused by a different strain of E. coli. This is a notable development that suggests the problem is not isolated but widespread.
And the 2019 Salinas investigation told us something even more chilling. The E. coli O157:H7 strain was detected in a fecal-soil composite sample collected from a cattle grid on public land less than 2 miles uphill from a produce farm with several fields involved in the outbreak. Other STEC strains were found in samples from the border area of the farm, right next to a cattle pasture on a hillside above a leafy green field. Visualize this picture. Cows on the hill, salad growing below.
Between 2015 and 2021 alone, romaine contaminated with E. coli O157 has been implicated in seven outbreaks in the United States, six of which occurred in multiple states, resulting in 4,274 laboratory-confirmed illnesses, 766 hospitalizations, and 11 deaths.
Fresh fruits and vegetables, not ground beef, now occupy most of our company’s attention following the 2018 E. coli outbreak linked to romaine in Yuma. A romaine lettuce outbreak led to the replacement of ground beef as the primary ingredient in Marler Clark’s practice.
The cow next door, who is responsible?
Here’s what makes everyone uncomfortable, including those in the livestock industry:
During the 2018 outbreak, environmental contamination was likely caused by an adjacent concentrated feed operation (CAFO), as cattle are well-documented reservoirs of pathogenic E. coli O157. This is no secret. This is not surprising. Airborne transmission of viable E. coli has been documented at several locations adjacent to, and at progressively greater distance from, large-scale livestock and composting operations nearby. Analysis of the air, water, and lettuce leaf microbiome showed that dust accumulates from cattle sheds into nearby water and land, suggesting that dust from factory farming facilities may play a role in E. coli transmission. It’s not just water. It’s air. The wind carries it.
And this is what really fascinates me. It would take 105,000 cattle nearby to cause an outbreak. Even small-scale livestock farming near romaine fields can be risky. You don’t need a large industrial feedlot to poison children. There’s a small bunch on the hill above the lettuce fields, and all it takes is a little runoff after it rains.
So who is responsible? The answer right now is actually this: No one runs the cattle. The updated Arizona Leafy Greens Marketing Agreement Standards do not require CAFOs to take additional steps to prevent their operations contaminating water used for crops in the area. Lettuce growers bear all the legal and economic consequences. The aviary next door is not binding. This is a fundamental injustice and policy failure.
Now is the time for all stakeholders – leafy greens growers, processors, and retailers – to work together with the livestock and dairy industries and local, state, and federal health agencies to find solutions to persistent, systemic environmental problems. We cannot allow E. coli disease and death to continue. "Costs of doing business."
It is clear what the problem is, but the solution will not be easy because forcing land use change across land lines is difficult in practice. Leafy vegetable farmers have little control over the use of land adjacent to their fields and may be powerless to stop construction of nearby CAFOs, even if there are clear concerns about food safety. It’s a zoning and regulatory issue. Currently, the FDA can inspect lettuce farms. You can’t walk into a cattle farm and demand change. Change is needed.
2024-2025: Silence in Washington
Now we have a new problem layered on top of the old one. Since the Trump administration took office, the CDC and FDA have not released details about the romaine lettuce E. coli O157:H7 outbreak that sickened 89 people in 15 states, hospitalized 36, caused kidney failure in seven states, and killed one person. The epidemiologist at my company had to piece this together because the government doesn’t tell you. If the disastrous CDC and FDA don’t do their job, we will.
What needs to change
I have said this for years and will continue to say it for years to come. These outbreaks will continue to occur unless environmental contamination from lettuce grown in close proximity to cattle is addressed.
A section of lettuce contaminated with E. coli can be cut, processed, mixed with other lettuce, and then cross-contaminated various bagged salad packages. E. coli outbreaks linked to romaine lettuce have exploded over the past 15 years because we’ve been craving bagged salads. Industrial agriculture and convenience are killing us.
The solution isn’t mysterious. Mandatory buffer zones between feedlots and produce fields, requiring testing and treatment of irrigation water before it hits crops, FDA authority to test CAFOs for pathogens that endanger nearby farms, and actual traceability from ranch to retail store. We have the technology. We have the intelligence to know how to solve these problems. The question is whether we have a moral obligation to do so. When I’ve seen so many people in intensive care and been to so many funerals of people whose only mistake was eating, I feel like something is essential. We have to get there.
I beat the beef industry to do the right thing. The livestock industry next to the lettuce fields needs to understand that you are part of the problem and you must be part of the solution.
William “Bill” MahlerHe has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli outbreak documented in the book.“poisoning”And at the recent Emmy Awards:netflix documentaryWith the same name. Bill’s work was featured in the New Yorker;“A bug in the system;”Seattle Times,“30 years since the deadly E. coli outbreak Outbreak, Seattle Lawyers Still Fighting for Food Safety.”washington Post,“He helped make hamburgers safer. Now he’s fighting food poisoning again.”andMany other things.
