Ruby Trautz, a retired registered nurse from Bellevue, NE, was the first fatality in the 2006 E. coli O157:H7 outbreak linked to Dole bagged baby spinach produced in the Salinas Valley of California. Trautz, 81, died Aug. 31, 2006, after several days in the hospital.
She was one of four people who passed away after eating the tainted spinach, although the hospital listed her official cause of death as clostridium difficile, a bacterial infection. It took about three weeks until the Nebraska state epidemiologist reported Trautz’s death as E. coli-related.
By the time the 2006 spinach-linked E. coli outbreak was over, it had caused more than 200 people to become ill and at least 30 to develop hemolytic uremic syndrome (HUS), a serious and potentially fatal kidney condition associated with E. coli infection.
Trautz’s tragic death was the beginning of food-safety awareness for her daughter and son-in-law Polly and Ken Costello, with whom Ruby lived. The couple doesn’t believe that she was appropriately diagnosed and, given her symptoms, they think doctors should have more quickly recognized the cause.
“Through the process of events, we kind of did a family discovery of what happened, because one of the things that we’re still concerned about is that when people come into a hospital with symptoms of a foodborne illness, they don’t find out for a while,” Polly says.
“There was so much not being done, so much room for improvement,” Ken adds. “Certainly when you see a loved one die, it’s kind of a galvanizing force, and, if you can make that better, you want to.”
In the aftermath of Ruby’s death, her family began piecing together details of what happened to her along with information being circulated about the outbreak. Between news reports and conversations with friends and relatives in the medical field, they began to realize the dimensions of the problem and that they probably still had the contaminated spinach in their refrigerator. And, sure enough, a sample was tested and matched the outbreak serotype.
“In the beginning, obviously we were concerned about what happened to her, but we were also concerned about all the things that happened after she was ill. I told Ken to Google her symptoms, and the first thing that came up was E. coli,” Polly recalls.
Meanwhile, Ken, who had also eaten the bagged baby spinach, began to have symptoms of a foodborne illness on the same day his mother-in-law passed away. He remembers that they lasted for eight or nine days and were first misdiagnosed as diverticulitis. It took three weeks to find out that his problems stemmed from an E. coli O157:H7 infection.
“For me, it felt like I had 10 pounds of lead in my stomach, and it just ached,” he says. “I just wanted to go to sleep until I felt better. I just hurt.”
While the Costellos and other affected families ended up reaching monetary settlements with those responsible for the contaminated spinach, they would like to see more education and training about E. coli diagnosis and treatment.
They have become active about food safety issues, met with other foodborne illness survivors and family members of those who died from foodborne illnesses, and regularly visit Capital Hill to speak to lawmakers about changes to oversight and regulation.
And, in 2009, Ken joined the board of the Center for Foodborne Illness Research and Prevention, representing that group in testimony to the Food and Drug Administration about implementation of the Food Safety Modernization Act (FSMA) at a March 2013 meeting in Chicago:
“After the spinach-borne E. coli outbreak of 2006, we were thrilled to see the processor of Dole baby spinach follow the lead of the ground beef industry and institute a model bacteriologic-testing program. We believe all consumers deserve similar safeguards and are hopeful the final rules will reflect a similar requirement from the FDA.
“On behalf of my family and the entire food safety community, we are here to thank the FDA. I can see the hard work of all advocates I have met in these proposed rules. Our jobs, however, will not be complete until the Food Safety Modernization Act is fully implemented and our food supply is as safe as we deserve.”
Polly also gave testimony to FDA at that meeting, concluding with this statement:
“The contamination that killed my mother is unfortunately not unique. Foodborne bacteria show no bias based on product or farm size. As I believe they are outlined in the proposal, exemptions in the final produce rule should be as narrowly defined as possible. In doing so, fewer daughters will be forced to say goodbye to their mothers because of a foodborne illness. My fervent wish is that we all experience safe food.”
However, she points out that she and her husband aren’t advocates for more government regulation in general.
“We are not for more control, but after this happened, we would like to see more happen,” Polly says. She adds that statistics from the U.S. Centers for Disease Control and Prevention indicate there are more foodborne illnesses being reported now than when her mother died, a situation she calls “startling.”
“At the time of my mother-in-law’s death, there had been quite a few outbreaks in the few years prior,” Ken notes. “I would have thought the industry would have done whatever they could to make sure this product is as pure as possible, because, if something happens, we’ll be out of business or close to it. But since then, there have been all kinds of outbreaks.”
Late last month, the couple, who now live in Wyoming, again traveled to Washington, D.C., to carry their message to lawmakers. Ken recounts that they met with Rep. Cynthia Lummis (R-WY), Sen. John Barrasso (R-WY) and staff members of Sen. Mike Enzi (R-WY).
“We discussed the impact of the results of foodborne illness and the need to fully fund and formulate the details of the FSMA. No other family should experience avoidable death and illness from contaminated food,” Ken told Food Safety News in an email.
Today, the Costellos occasionally eat fresh spinach, but they don’t dine out as often, and they’re more careful about what and where they consume produce and how they handle food at home, Polly notes. However, they also realize there’s no guarantee of safety.
“Every time an outbreak is reported, the first thing they tell you is you should be doing good food-handing. You should be washing your product,” she says, adding, “Mother’s and Ken’s was grown in the leaf, so washing wouldn’t help.”
In FDA’s final report on the 2006 outbreak, released March 2007, the agency makes a similar point but still advocates washing all produce before consumption. “Although washing produce would not have prevented the recent E. coli outbreak involving spinach, washing can reduce the risk of contamination from some other causes,” the report read. “FDA advises consumers that all produce should be thoroughly washed before eating.”
The agency’s final report also acknowledged that the joint investigation by FDA and the California Department of Health Services never found the source of the 2006 outbreak.
“The investigators successfully identified the environmental risk factors and the areas that were most likely involved in the outbreak, but they were unable to definitely determine how the contamination originated,” the report states.
However, using product codes from bags of implicated spinach, along with DNA fingerprinting from bacteria on the bags, investigators matched environmental samples of E. coli O157:H7 from one field to the strain that caused the outbreak and thus narrowed down the list of culprits: “Potential environmental risk factors for E. coli O157:H7 contamination at or near the field included the presence of wild pigs, the proximity of irrigation wells used to grow produce for ready-to-eat packaging, and surface waterways exposed to feces from cattle and wildlife.”
While studies or final reports can help with data and illness outbreaks in the future, the Costellos are painfully aware that nothing will bring Ruby back nor replace the precious time they and their two children, JK and Christy, might have spent with her if she hadn’t prematurely passed away.
The best they can do now is advocate for better regulations and safer food practices, lobby for full implementation of FSMA, and hope that nobody else has to go through a similar experience.
“We would never want anybody to have to watch someone who is relatively healthy die in four days the death that my mom died,” Polly says. “I know we all feel that way about cancer and things like that, but this is what happened to us… My mother’s death was preventable.”© Food Safety News