Ruby Trautz was the first to die.
On Aug. 27, 2006, the 81-year-old Nebraska woman was rushed to the hospital. She was in so much pain that morphine was administered. Four days later, she succumbed to a food-borne infection later identified as a virulent strain of E. coli.
Two weeks after Trautz's death, on Sept. 14, the Food and Drug Administration took an unprecedented step: It told Americans to stop eating bagged spinach, a staple of healthy diets, until its safety could be assured. A day later, the FDA extended the warning to include all fresh spinach and almost as quickly, it vanished from grocery shelves, salad bars and menus.
By this time, two more people had died.
Before the outbreak of E. coli O157:H7 was over, at least five people were dead after painful, bloody illnesses. More than 205 others in 26 states had endured a sickness that left them vulnerable to future health problems. And the agricultural industry, government regulators and consumers were shaken by the vulnerability of America's system for delivering fresh produce to markets.
Since early this year, USA TODAY has interviewed dozens of key government officials, food producers, survivors who ate contaminated spinach and relatives of those who died. They offer new insight into the behind-the-scenes panic throughout the agricultural industry and government offices as the crisis unfolded nationwide, and of the detective work that led officials to suspect that the E. coli — commonly found in cow manure — came from spinach grown on a 2.8-acre plot in central California.
The FDA would partially lift the spinach advisory on Sept. 22, but it would be six months before federal and state investigators released their report.
The outbreak would ultimately cost the leafy green industry more than $350 million as the nation turned away from its growing appetite for fresh, ready-to-eat spinach. It's an appetite that has not returned: Sales of packaged spinach are still off about 20% from pre-outbreak levels, industry executives say.
The interviews reveal vivid details of the gruesome illnesses caused by the contaminated spinach, and show why such a deadly crisis remains possible today. In the past year, the industry has made strides in keeping produce safe, says Michael Doyle, head of the Center for Food Safety at the University of Georgia and a consultant to Natural Selection Foods, which processed the tainted spinach.
But while companies have imposed higher standards for farmlands and have increased testing of the greens before they get to the consumer, it's still possible for bacteria to get through the safety net.
In the past four weeks there have been two leafy green recalls, one for E. coli in mixed greens and another for salmonella in spinach. No illnesses were reported.
"Raw produce, even if you put it in a bag and seal the bag, is still raw produce. It's a high-risk food, even if the American consumer doesn't realize it is," says Oregon state epidemiologist William Keene.
One year ago, that risk changed families, an industry and consumer attitudes toward fresh spinach.
In July, the month before Trautz died, a 2.8-acre section of a 51-acre field was planted in spinach by grower Mission Organics at the Paicines Ranch in central California, an 8,000-acre spread largely devoted to cattle grazing.