Bill Marler and the other attorneys at Marler Clark have been litigating E. coli O157:H7 cases for sixteen years.  I have done it now for six.  Collectively, we have seen E. coli illnesses ranging from a few days of diarrhea to some of the most agonizing deaths imaginable . . . and everything in between.  It doesn’t matter how it happens–at least not to the parents of the kids getting sick.  Whether its lettuce, hamburgers, stagnant pond water, or contaminated venison, the results can be tragic.

Many of the saddest cases we have been involved came from California produce.  Ruby Trautz is a perfect example.  She was a beloved mother and grandmother who lived in Bellevue, Nebraska.  Ruby died a death more befitting of a capital murderer . . . and only because she ate contaminated spinach.  Read more about Ruby’s E. coli O157:H7 illness here.

Kelly Cobb is yet another example.  Kelly was also infected by California produce, though her illness arose from a different outbreak than Ruby Trautz.  Kelly was more fortunate than Ruby, but only because her younger body was more capable of fighting the severe infection than Ruby’s was. 

Nonetheless, Kelly’s E. coli O157:H7 infection also resulted in hemolytic uremic syndrome.  See  Here is the story of Kelly’s illness:

In the early morning hours of May 16, 2008, Kelly was roused from sleep, at first by a strange bloated feeling and then a bad bout of diarrhea. It seemed as if there was a rock under her rib cage causing an overwhelming feeling of nausea, yet she did not vomit. This was followed by crampy pain in the upper part of her stomach, with sharper spasms of pain coursing through her torso every ten minutes or so. With the pain came diarrhea, which by 5:00 AM had turned to blood.

Kelly was seen in the emergency room of Good Samaritan Hospital in Tacoma, Washington from 6:00 AM until 11:00 AM. She described to the doctors the surprisingly severe, sudden onset of the nausea, abdominal cramping and bloody diarrhea. The history taken by the triage nurse revealed nothing out of the ordinary: Kelly had been in good health, she was not pregnant, her children had not been sick.

But blood tests showed an elevated number of white blood cells, the sign of a bacterial infection. The presence of gallstones was picked up by an abdominal ultrasound, yet there was no evidence that Kelly had cholecystitis, an active gallbladder attack. A watery stool was guaiac positive—in other words, there was blood in it. This was sent to be cultured and also for Clostridium difficile toxin-testing. Kelly was initially given intravenous fluids and pain medication, then sent home with prescriptions for the antibiotic Ciproflaxin, as well as oral pain and anti-nausea medications. She was told to see her primary care physician in a day or two, or return to the emergency room if other problems arose.

Other problems did crop up, almost immediately. Kelly could not drink or eat anything, including her prescribed medications, without vomiting. The diarrhea was unrelenting, and the watery rectal discharge was mostly bright red with blood. She was also suffering from intense pain. Kelly returned to the Good Samaritan Hospital emergency room on May 17, and this time she was admitted to the hospital for treatment. She was severely dehydrated, with depressed levels of serum electrolytes, blood urea nitrogen and creatinine. She was started on IV fluids and given something for the pain.

A colonoscopy performed on May 18 showed pancolitis, a form of severe, ulcerative colitis that is manifested by an irritation throughout the length of the colon and that typically is the result of an infection. The pathologist suspected that the source was likely E. coli O157:H7, but could not rule out the possibility of ulcerative colitis. Bowel tissue biopsies showed inflammatory pseudomembranes. These findings were nonspecific, so still did not explain the cause of the problem.

On May 19, the doctor noted that Kelly’s abdominal pain was relatively better, and that she no longer felt nauseated and was not vomiting. Her pancolitis was improving and there was no blood in her stool. The plan was to take her off intravenous medications, switch her to oral treatments and then let her go home.

On the morning of May 20, the mystery of Kelly’s symptoms was solved. A stool sample collected on May 16 had grown out E. coli O157:H7 bacteria. The Ciproflaxin was discontinued. Kelly still rated her abdominal pain as a seven on a scale of one to ten, and she was nauseated again. But doctors were encouraged that she could finally keep down food and water and that there had been no bouts of bloody diarrhea overnight, so they discharged her to go home around midday.

The following day, May 21, Kelly’s symptoms returned worse than ever. She had awakened overnight feeling quite ill and began to vomit again repeatedly. She was absolutely unable to keep any fluids down. Her family took her back to the hospital on May 22 after she had been up the whole night with awful nausea and vomiting.

Laboratory tests now indicated that she was anemic. Since her discharge May 20, her hematocrit and platelet counts had decreased significantly, while her BUN and creatinine levels had increased since her recent discharge. These were ominous signs that Kelly’s kidneys were beginning to lose filter function and that she appeared to be developing hemolytic uremic syndrome (HUS), the dire complication of an E. coli O157:H7 infection. Kelly was told her kidney function was at 50 percent of normal.

Kelly was once again admitted to the hospital, where a catheter was inserted so she could receive intravenous fluids and for blood draws. She was tired and miserable. Whenever she opened her eyes she felt dizzy and sick to her stomach.

By May 23, the doctors agreed that plasmapheresis, or plasma exchange, would be necessary as soon as possible to remove waste products from the blood that were accumulating as Kelly’s kidney function diminished. Plasmapheresis involves withdrawing whole blood from the patient, removing the plasma from the blood cells through a cell separator, and then returning the blood cells to the patient while replacing the plasma with donor plasma.


Over the next eight days, Kelly would undergo eight total plasmapheresis sessions, receiving 81 units of fresh, frozen plasma through these procedures. In addition, four units of packed red blood cells were administered to Kelly between May 23 and May 27. Her hemoglobin, hematocrit and platelet counts bottomed out from May 24 to 26, but then began to slowly respond to the treatment. On May 25, her BUN and creatinine levels peaked and then began to decline as her kidney function improved. To help rebuild red blood cells, she was given ongoing folate, iron and B12 replacements. Kelly recalls that throughout the two weeks in the hospital, she endured more than 50 blood draws, two ultrasound examinations, a CAT scan, a colonoscopy, seven IVs and had a central line inserted in her neck.

On May 23, when Kelly first learned that she would need phasmapheresis treatments, she began to question whether she would survive. She recalls thinking that she needed to talk to her mom to let her know what she wanted for her kids if she died.

I remember getting my meds before my plasma exchange and having such a bad reaction that I had intense chest pain and blacking out. At that point I remember holding my husband’s grandmother’s hand and thinking that’s how I was going to die, in that hospital bed and wasn’t able to say goodbye to my husband and kids. Thinking that my kids would grow up without me, with that thought I made myself open my eyes and listen to what the nurses were saying to me.

All of these procedures were done while Kelly was enduring intense, debilitating pain that continued despite ongoing pain medication. But the physical pain does not begin to describe her emotional trauma. Already worried about her husband and father being in harm’s way in the Middle East, Kelly now had to inform them that she, too, faced a potentially life-threatening ordeal. The message to her husband had to be sent via the Red Cross; her father was told during one of his phone calls home. Kelly was terrified that Matt’s concern for her might distract him to the point where he or one of his men could be hurt.

Prior to her hospitalization for her E. coli O157:H7 infection, Kelly had been away from Liberty only once before, and then only briefly—for two nights when her son Matthew was born. Matthew had never before been separated from his mother. The children stayed with Kelly’s mother, who had to wake at 4:00 AM every day, an hour and one half before her regular routine, so that she could take Liberty and Matthew to their other grandmother’s home. After work each day, Kelly’s mother picked up the children and brought them to the hospital to see Kelly.

Kelly recalls that was the best part of her day—seeing her babies—although saying good-bye to them each night was beyond heart-breaking. Liberty asked every day when Kelly would come home to take care of her. Matthew cried inconsolably every night as his grandmother pulled him away from Kelly to go home. Kelly worried constantly that she was putting too much of a burden on her mother and mother-in-law. Always at the back of her mind was the dreaded thought that she was not going to make it and that she might not see her children again, that she might not live to see them grow up.

Kelly is a capable and tough woman, used to the responsibility of being a single mother while Matt was in Iraq and managing the worry of not knowing whether her husband and father are safe each day. But her hospitalization took her to the breaking point:

My hospital stay was pure hell. I’ve never had a harder two weeks in my life. The pain that I felt was unbelievable. For the first few days I really wasn’t sure what was going on. Most days were spent by myself, with nurses coming in and out of my room. I remember being so swollen at one point that I couldn’t even bend my fingers. I went from 140lbs to 180lbs. It hurt to get out of bed because I was so swollen. During my plasma exchange I would sleep to help the time go by faster; there was just something about the blood being cycled out of me that was hard for me to handle. I remember the floor I was on lost four people the first four days I was there, and I can remember thinking, “Why did they put me here, everyone around me is dying?” I couldn’t shower for eight days because of the central line in my neck; I could only take sponge baths. My hair was so dirty when I left the hospital that I went to a hairdresser to have her wash my hair. When it came time to have my central line out I had to lay on my back for 30 minutes and when the nurse pulled it out it felt like I was giving birth out of my neck.

Kelly’s E. coli infection has changed her. She no longer eats any produce she cannot wash herself. She cannot even watch someone eat a salad—it makes her sick to think about. She now has to get blood draws every six months to monitor her kidney function. She has been told that if she gets pregnant she should be seen immediately because of the potential health effects from her infection. She now suffers from chronic heartburn. And she is angry that her husband had the additional burden of serving in Iraq while wondering if his wife was going to make it through a life-threatening illness and who was taking care of his kids.

And Kelly hopes lessons have been learned by those involved in bringing her contaminated lettuce.

I want the party at fault to know that they took a stay at home mother away from her children for two weeks. That because of them I went through pain that no person should ever have to go through. I would rather have a baby with no meds than have the pain of E. coli again. I would ask them to really think about changing their policies. And to think about how they would feel if it was their mother, father, daughter, son, husband or wife that was lying in that same bed as me, with all the tubes and wires that I had. That it could have just as easily been one of my children who ate that salad, that a small child could have been just as sick, if not worse, than me because of a mistake they made.