Let me be blunt. I've been fighting for food poisoning victims since 1993, when a nine-year-old girl nearly died after eating a Jack in the Box burger. Back then, the villain was ground beef. We fixed that — or mostly fixed it. I used to tell people I could count on a significant E. coli outbreak and recall occurring like clockwork nearly every spring or summer. When 2003 came, there were no outbreaks. The beef industry, to its credit, did its job. I actually worried I'd put myself out of business.
I wasn't that lucky. The problem just moved.
The early warning signs
In July 2002, an outbreak of E. coli O157:H7 sickened 78 attendees of a dance camp at Eastern Washington University — middle and high school girls from Washington, Montana, and Minnesota. Case-control studies strongly linked the illness to Caesar salad made with romaine lettuce. That was a warning. Nobody heeded it.
In April 2012, an outbreak of E. coli O157 sickened 28 and was linked to romaine lettuce. The pattern was becoming clear. By 2017, seventeen illnesses had been reported across 13 states, with two people developing hemolytic uremic syndrome (HUS) — the acute kidney failure — and one death in California. Canada had already figured out it was romaine. We were still hedging.
2018: Yuma changes everything
Then came the disaster I'd been dreading. In April 2018, local, state, and federal public health and agriculture agencies announced an outbreak of E. coli O157:H7 linked to romaine lettuce from the Yuma, Arizona growing area. In total, 240 people infected with the outbreak strains were reported from 37 states. Of more than 201 people with information available, 104 were hospitalized, including 28 who developed HUS. Five deaths were reported from Arkansas, California, two in Minnesota, and New York.
We found out why. The outbreak strains were detected in water samples from sites along a 3.5-mile section of the Wellton irrigation canal — running adjacent to romaine lettuce farms and next to a concentrated animal feeding operation with approximately 105,000 cattle. One hundred and five thousand cows. The waste from the feedlots was getting into the irrigation water. The water was going onto the lettuce. The lettuce was going into your salad.
2019 and beyond: The pattern repeats
In 2019, there were three separate outbreaks under investigation simultaneously, each caused by different strains of E. coli — a notable development suggesting the problem was widespread, not isolated.
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 taken from a cattle grate on public land less than two miles upslope from a produce farm with multiple fields tied to the outbreaks. Other STEC strains were found in samples from a border area of a farm immediately next to cattle grazing land in the hills above leafy greens fields. Visualize this picture — cows on the hillside, your salad growing below.
Between 2015 and 2021 alone, E. coli O157-contaminated romaine was implicated in seven outbreaks in the U.S., six of which were multistate incidents, resulting in 4,274 laboratory-confirmed illnesses, 766 hospitalizations, and 11 deaths.
Since the 2018 E. coli outbreak linked to romaine from Yuma, fresh fruits and vegetables — not ground beef — now take up the bulk of my firm's attention. Romaine lettuce E. coli outbreaks have replaced ground beef as the staple of the Marler Clark practice.
The cattle next door: Who is accountable?
Here's the part that ought to make everyone uncomfortable — including the cattle industry.
In the 2018 outbreak, environmental contamination was likely caused by the adjacent Concentrated Animal Feed Operation (CAFO), as cattle are a well-documented reservoir for pathogenic E. coli O157. This is not a secret. This is not a surprise. Airborne transmission of viable E. coli was documented at numerous locations adjacent to and at incremental distances from a nearby large livestock and composting operation. Air, water, and lettuce leaf microbiome analysis demonstrated deposition of dust from cattle pens to nearby water and land, suggesting that dust from CAFOs may play a role in E. coli transmission. It's not just the water. It's the air. The wind carries it.
And here's what really gets me: it doesn't take 105,000 cattle nearby to cause an outbreak. Even smaller cattle operations near romaine fields may carry risks. You don't need a massive industrial feedlot to poison a child. A small herd on a hillside above a lettuce field, a little runoff after a rain — that's enough.
So, who is responsible? Right now, the answer is effectively: nobody with a cattle operation. The updated Arizona Leafy Greens Marketing Agreement standards do not require CAFOs to take any added actions to prevent their operations from contaminating water used on crops in the area. The lettuce growers take all the legal and economic hit. The feedlot next door faces no binding obligation. That is a fundamental injustice — and a policy failure.
It is past time for all stakeholders — growers, processors, and retailers of leafy greens — to work with the cattle and dairy industries, along with local, state, and federal health agencies to come to a solution to this ongoing and systemic environmental problem. We cannot allow E. coli illnesses and deaths to continue to be "a cost of doing business."
It's obvious what the problem is, but the solutions are not going to be easy because it's genuinely hard to compel changes in land use across property lines. Farmers of leafy greens have little control over the use of land adjacent to their fields, and they may be helpless to stop the construction of a nearby CAFO even if it presents a clear food safety concern. That's a zoning and regulatory problem. Right now, the FDA can investigate the lettuce farm. It cannot walk onto the cattle feedlot and demand changes. That needs to change.
2024–2025: Silence from Washington
And now we have a new problem layered on top of the old one. Since the start of the Trump Administration, the CDC and FDA have withheld from the public details about a romaine lettuce E. coli O157:H7 outbreak that sickened 89 people in 15 states, hospitalized 36, caused kidney failure in 7, and killed 1. My own firm's epidemiologist had to piece it together because the government wouldn't tell you. If the gutted CDC and FDA won't do the job, we will.
What needs to change
I've said this for years and I'll keep saying it. These outbreaks will keep happening unless we deal with the environmental contamination caused by growing lettuce in close proximity to cattle.
One head of E. coli-contaminated lettuce can be cut, processed, mixed with other lettuce, and then cross-contaminate many different packages of bagged salads. The E. coli outbreaks linked to romaine lettuce blew up in the last decade and a half because we wanted bagged salads. It's industrialized agriculture, convenience, and they are killing us.
The solutions aren't mysterious: mandatory buffer zones between cattle operations and produce fields, required testing and treatment of irrigation water before it touches a crop, FDA authority to inspect CAFOs for pathogens that endanger neighboring farms, and real traceability from ranch to retail shelf. We have the technology. We have the intelligence to know how to fix these problems. The question is whether we have the moral imperative to do it. When you've seen as many people in ICUs and gone to as many funerals for people whose only mistake was eating food — I feel there is an imperative. We need to get there.
I beat the beef industry into doing the right thing. The cattle industry sitting next to a lettuce field needs to understand you are part of this problem, and you need to be part of the solution.
William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli Outbreak which was chronicled in the book, “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others.
