The recent E. coli O145 outbreak linked to romaine lettuce, which has caused several children to develop hemolytic uremic syndrome (HUS), parents of severely injured kids are certainly questioning whether warnings to the leafy greens industry were ignored.  To recap, there are 29 confirmed and probable illnesses, and realistically many many others, in the outbreak, as well as multiple cases of HUS, linked to Freshway Foods romaine lettuce.  The grower is thought to be Andrew Smith Company; and the lettuce likely came from Yuma, Arizona.

What were the warnings?  For starters, here is a table showing 34 outbreaks linked to lettuce or other leafy greens over the course of the last two decades, courtesy of

ecoli "e. coli outbreak" "e. coli o145" "romaine lettuce outbreak"

The warnings also have been stated more explicitly, and on two occasions, directly to the leafy greens industry.  On February 5, 2004, the FDA wrote a letter to the lettuce and tomato industries to voice its concern about the frequent outbreaks linked to those products. In the letter, the FDA counted 14 such outbreaks since 1996 that it had investigated. Among other things, the letter stated:

In view of continuing outbreaks associated with fresh lettuce and fresh tomatoes, we strongly encourage firms in your industries to review their current operations in light of the agency’s guidance for minimizing microbial food safety hazards in fresh lettuce and fresh tomatoes, as well as other available information regarding pathogen reduction or elimination on fresh produce. We further encourage these firms to consider modifying their operations accordingly, to ensure that they are taking the appropriate measures to provide a safe product to the consumer. Since the available information concerning some of the recent outbreaks does not definitively identify the point of origin of the contamination, we recommend that firms from the farm level through the distribution level undertake these steps.

On September 30, 2005, a year and a half after the FDA’s 2004 letter to the lettuce industry, the Minnesota Department of Health issued a press release stating that 11 Minnesota residents had been infected by E. coli O157:H7 from contaminated Dole romaine lettuce. Two days later, the FDA issued a nationwide public health alert regarding Dole pre-packaged salads. Further investigation indicated that 22,321 cases of potentially contaminated Dole romaine lettuce had been sent to market from a processing facility in central California. Ultimately, at least 32 people were sickened in the outbreak.

One month after the 2005 Dole lettuce outbreak, the FDA wrote the industry again. The November 4, 2005 letter began as follows: “This letter is intended to make you aware of the Food and Drug Administration’s (FDA’s) serious concern with the continuing outbreaks of foodborne illness associated with the consumption of fresh and fresh-cut lettuce and other leafy greens.” The letter continued:

FDA is aware of 18 outbreaks of foodborne illness since 1995 caused by Escherichia coli O157:H7 for which fresh or fresh-cut lettuce was implicated as the outbreak vehicle. In one additional case, fresh-cut spinach was implicated. These 19 outbreaks account for approximately 409 reported cases of illness and two deaths. Although tracebacks to growers were not completed in all 19 outbreak investigations, completed traceback investigations of eight of the outbreaks associated with lettuce and spinach, including the most recent lettuce outbreak in Minnesota, were traced back to Salinas, California.

And after all this, the spinach outbreak happened in September 2006, causing 204 confirmed illnesses nationally; 102 hospitalizations, 31 with hemolytic uremic syndrome (HUS); and three deaths . . . at least by the CDC’s official count. Among the dead were an elderly Wisconsin resident; a two-year-old Idaho boy named Kyle Algood; 81-year-old Ruby Trautz; 86-year-old June Dunning; and 83-year-old Betty Howard.

The result of all these warnings to the industry?  I guess we’ll found out in litigation with Freshway Foods and Andrew Smith Company.  The result for the families of the unfortunate children who contracted E. coli O145 from Freshway romaine lettuce and developed HUS:  a life-time of medical care, including possible kidney transplants, and millions of dollars in medical costs.