Puerto
Rico Is Burning Its Dead, And We May Never Know How Many People The
Hurricane Really Killed
People
whose bodies are cremated are largely not being counted in the
official death toll.
28
October, 2017
AGUADILLA,
Puerto Rico — Funeral directors and crematoriums are being
permitted by the Puerto Rican government to burn the bodies of people
who died as a result of Hurricane Maria — without those people
being counted in the official death toll.
The
result is a massive loophole likely suppressing the official death
count, which has become a major indicator of how the federal
government’s relief efforts are going because President Trump
himself made it one.
During
Trump’s photo-op visit to the US territory — whose residents are
US citizens — three weeks ago, he boasted that the death toll was
just 16. It doubled by the time he returned to Washington that same
day. The death toll is now at 51, a figure widely contradicted by
what funeral homes, crematoriums, and hospitals on the ground tell
BuzzFeed News.
Then,
last week, when asked how he would rate the White House’s response
to the crisis, Trump said, "I’d say it was a 10.” More than
a month after the storm made landfall on Sept. 20, 2.6 million people
are without power, at least 875,000 people don’t have access to
running water, and 66% of the island still doesn’t have cell
service.
Trump
added, “I’d say it was probably the most difficult when you talk
about relief, when you talk about search, when you talk about all of
the different levels, and even when you talk about lives saved.”
Meanwhile, two US representatives and 13 senators recently wrote
letters to the acting head of homeland security requesting
investigations into the death toll.
Last
week, BuzzFeed News visited 10 funeral homes and crematoriums in two
Puerto Rican municipalities on the territory’s western coast,
Aguadilla and Mayagüez, at least two hours away from the bustling
San Juan. The findings include:
Communication
between the central institute certifying official hurricane deaths,
called the Institute of Forensic Sciences, and funeral homes or
crematoriums appears to be fully broken, with each side waiting for
the other to take action.
The
central institute is also giving crematoriums permission to burn
bodies of potential hurricane victims — which is happening more
because it is cheaper and logistically easier as families rebuild
their lives — without examining them first, which means they are
not being counted in the official death toll.
Disaster
experts say this lack of a transparent and consistent approach to
counting deaths means the toll is likely inaccurate.
And
experts also say an inaccurate official death toll potentially cheats
families out of FEMA relief funds and could hurt how future disasters
are handled.
The
funeral home and crematorium directors told BuzzFeed News that they
had received dozens of bodies of people who died of hurricane-related
causes — just the cases from these two municipalities would
potentially more than double the death toll if they were included.
The Forensic Institute permitted the bodies of at least 42 potential
hurricane victims to be burned, according to one crematorium
director.
Puerto
Rico’s safety department says the funeral and crematorium directors
should send any potential hurricane-related victims to the institute
before they’re burned — but admit they haven’t actually
officially communicated that to them.
John
Mutter, a professor of earth sciences and public affairs at Columbia
University who studied how the death count was handled after
Hurricane Katrina, said Puerto Rico’s procedures seem to be
“deliberately trying to keep the numbers low,” which he called
“unconscionable.” Other experts called it a failure of
bureaucracy.
The
White House and the office of the Governor of Puerto Rico, Ricardo
Rosselló, didn’t respond to a request for comment.
Asked
directly if the number of hurricane-related deaths in Puerto Rico is
being undercounted, a spokesperson for the Puerto Rico Department of
Public Safety dodged, saying, “We can’t infer or reach any
assumptions or inferences. If there really are cases like this, they
have to present them to the authorities.”
But,
at this point, many of those bodies have been burned to ash.
“I
never expected all of this”
In
Aguadilla, a municipality of around 60,000, the official
death toll currently counts three fatalities from the hurricane: one
person who drowned in flooding, one person who fell off his roof
while trying to repair hurricane damage, and one person who died of
a bone infection.
But
staff at the only crematorium in the municipality, Crem del Caribe,
said they were given permission by the forensic institute to cremate
at least 42 bodies of other people who had died as a result of the
hurricane. That included people who died due to a lack of oxygen
supply, failure of dialysis and oxygen machines because of the lack
of electricity, and people who died of heart attacks. (Seventy-five
percent of the island still has no power, and questions
are being raised about
the firm contracted to fix it.)
“A
lot of people have died as an indirect result of the hurricane,”
said Jaime Domenech, crematorium director at Crem del Caribe.
“Especially older people, who because of their health conditions
many of them depended on electricity.”
The
majority of those cases came from funeral homes in the area, like
Vitin Alvarez, 68, who died a week after the hurricane made
landfall.
Alvarez
had Alzheimer’s disease, and his death certificate states his
primary cause of death was respiratory failure. His wife, Blanca
Alvarez, 63, told BuzzFeed News he died because she couldn’t get
gasoline to power the generator he needed for his oxygen machine.
There’s no mention of the lack of electricity on his certificate.
“It’s
so difficult to get gasoline. And there wasn’t a way to
communicate with anyone,” Alvarez told BuzzFeed News outside her
home in Aguadilla.
Alvarez
cremated her husband because of financial concerns and because she
was overwhelmed handling basic things like finding food and water
after the hurricane. He was the first person in the Alvarez family
ever to be cremated instead of buried.
“We
were always together. I’m still trying to adjust to life without
him,” said Alvarez. “I never expected all of this to be
happening at the same time.”
Several
funeral directors told BuzzFeed News they’re seeing an increase in
cremations over burials after the hurricane, in part because it’s
less expensive and requires less planning as people rebuild. They
had already seen an uptick in the number of cremations as a result
of the financial crisis in Puerto Rico, they said, but said the
numbers have increased even more in Maria’s aftermath.
The
cremation cost Alvarez $1,300, she said. One funeral home director
said burial services cost between $4,000 and $12,000 in Aguadilla.
She
said her husband had life insurance but she’s still waiting for
the payout. Alvarez wasn’t aware that FEMA has
a disaster funeral assistance program “to
help with the cost of unexpected and uninsured expenses associated
with the death of an immediate family member when attributed to an
event that is declared to be a major disaster or emergency.” FEMA
did not respond to multiple requests for comment.
A
confusing process
The
Puerto Rican government has said that the island’s
Institute of Forensic Sciences, in San Juan, must examine and
certify the bodies of any hurricane-related deaths before they are
counted in the official death toll. When the region isn’t dealing
with a disaster, the bodies of people who killed themselves,
suffered a suspicious death, or were possible victims of a crime are
sent to the institute for investigation.
The
spokesperson for the Puerto Rico Department of Public Safety,
Karixia Ortiz Serrano, acting as spokesperson for the institute,
told BuzzFeed News that the institute does not have guidelines for
which hurricane-related deaths to add to the official death toll and
which to keep off, and said they’re making decisions on a
“case-by-case” basis.
“There
are no specific categories, but they look at the situation,”
interview family members, “analyze it, and come to their decision
— and everything has to be scientifically-based,” she said.
Here’s
where things go awry.
The
public safety department says it’s the responsibility of funeral
homes, crematoriums, and hospitals to notify and send or bring
bodies to the forensic institute if they’re possible
hurricane-related deaths.
But
all 10 funeral homes and crematorium directors BuzzFeed News spoke
to said they haven’t received any specific guidance on what
they’re supposed to do with the bodies of people who died as a
result of the hurricane. Ortiz confirmed to BuzzFeed News that no
official guidance was sent to funeral homes and crematoriums, many
of which take in bodies that don’t need to go to the hospital
first.
Ortiz
says the directors of the facilities should know better. “They
know that the place that they do all the scientific investigations
is at the institute,” she said. “The funeral homes are in
constant communication with the institute because they’re the ones
that bring the bodies and take them back.”
Still,
cremating a body requires written approval from the forensic
institute — which has the option to ask for the bodies to be sent
to San Juan for examination before they’re burned. But the funeral
and crematorium directors who spoke to BuzzFeed News said the
institute has given them permission to cremate dozens of bodies of
people who died of hurricane-related causes, and were not asked to
send them to the institute.
Asked
specifically about this, Ortiz reiterated it’s on crematoriums and
funeral homes to communicate with the forensic institute if they
think a death should be examined for inclusion on the death toll.
“We
have heard,” that possible hurricane victims were being cremated
without examination, Ortiz said. “We aren’t saying that they’re
totally true or totally false. But what we are saying is, if you
have a case like that, send us all the information to be able to
look at it” before cremation.
“Natural
causes”
Many
funeral directors have conflicting definitions of what counts as a
hurricane-related death and what doesn’t.
Some
funeral directors classified cardiac and respiratory failure after
the hurricane as death by “natural causes” only. Others said
they consider those hurricane-related because they happened as a
result of the conditions created by the Maria: a lack of food,
water, electricity, and fuel. (The official death toll does include
people who had heart attacks, took their own life, and who died for
lack of oxygen and electricity for dialysis machines.)
Experts
said this goes back to a lack of guidance from the public safety
department.
“If
you wanted to make the count as small as possible that’s the way
to go about it,” Mutter, the Columbia professor, said about lack
of uniform procedure and communication about certifying
hurricane-related deaths. “Because somebody’s sitting there
saying, this is a disaster death, this one is not.”
Mutter
said that based on Puerto Rico’s poverty level and the strength of
the storm, he would have expected the death toll to be in the
hundreds by now.
“In
fact there’s a lot of deaths that come from the exacerbation of
preexisting conditions by the trauma of the disaster event. And they
are normally counted. They ended up being counted in Katrina. They
are considered disaster deaths. If you take them out you get a small
number,” he said.
A
review of the funeral homes and crematoriums BuzzFeed News visited
shows the discrepancies.
Monica
Rodriguez, of Funeraria Soto Rodriguez, said her funeral home has
received six bodies since the hurricane. Of those, four came from
senior homes — their death certificates say they died of cardiac
arrests. Another was a quadriplegic man who died of an infection
after arriving at a hospital too late to be treated effectively, and
another was a dialysis patient who died in their home when their
machine failed. Two of the six were cremated, Rodriguez said.
Here’s
her definition of a hurricane-related death: “You can’t exactly
say these people died because of the hurricane, because they were
old people or they already had health conditions,” she said,
adding that in general, death certificates don’t necessarily
account for the conditions in which someone died.
But
she also said she believed the conditions created by the hurricane
lead to these deaths.
“I
can tell you that we had four deaths of elderly people who were in
senior homes. They didn’t have air-conditioning. It’s possible
they didn’t have enough oxygen. I’m telling you about the
conditions that were caused by the hurricane, not causes of death as
they’re written” by doctors on death certificates, Rodriguez
said.
At
the Javariz funeral home in Aguadilla, 19 bodies have come in since
the hurricane. Of those, most died during the hurricane or because
of conditions created by the hurricane, said director Tomas Javariz.
Thirteen were cremated.
Javariz
considers two who died by suicide, five due to a lack of oxygen, one
from an organ failure, and 11 attributed to cardiac or respiratory
arrest as hurricane-related deaths.
He
sent the two who died by suicide to the forensic institute —
standard practice for suicide cases — but he said he didn’t send
the others because the institute never asked for hurricane-related
deaths. The institute gave him permission to cremate them.
Another
funeral home in Aguadilla, Funeraria San Antonio, received six
bodies since the hurricane. Those included one of the three counted
in Aguadilla’s official death toll — a man who fell off his roof
while trying to repair it — whose body was examined by the
forensic institute in San Juan. Another died of cancer and the rest
died of “natural causes,” an employee at the funeral home said,
which included cardiac and respiratory arrests.
Funeraria
Hernandez-Rivera, the fourth funeral home in the region, received 15
bodies since the hurricane, including five or six heart attacks,
according to funeral director Raul Hernandez-Rivera. He also said
that he didn’t believe those cases could be counted as
hurricane-related because they didn’t involve people drowning or
dying while trying to repair hurricane damage.
The
institute gave him permission to cremate 8 of the 15 bodies. He sent
one to the institute — the body of a woman who was bedridden and
drowned during the hurricane — and she is counted in the official
death toll.
In
the nearby municipality of Mayagüez, there were no
hurricane-related deaths, according to the official toll. That’s
at odds with the number of cases received by local funeral homes.
Funeraria
Fernandez received 13 bodies since the hurricane. They said at least
six of those people died because of a lack of oxygen supply, and one
died because of a dialysis machine not working, in addition to
several heart attacks. Nine of those were cremated. Five were sent
to the forensic institute for examination. None have been included
in the death toll.
Another,
Mayagüez Memorial, received 42 bodies since the hurricane, 10 of
which were cremated with the forensic institute’s permission
without an examination, according to a staff member there.
“There
were some that had to be the result of the hurricane,” said the
staff member, who asked not to be named.
Funeraria
Martell received 39 bodies since the hurricane — 16 were cremated
with permission from the institute without examination.
“I
would say that almost all of them were [related to the
hurricane],”said Germarie Hernandez, the funeral director. She
said she received 10 cases from Hospital Perrea and three from the
Centro Medico Mayagüez, all from the intensive care units. The
other 26 cases came from private homes or senior homes.
“That
is a failure of government”
The
lack of guidelines for creating an official death toll is a
recurring problem after large-scale disasters in the US, according
to experts, who say there is no federal standard because local
coroners and governments have jurisdiction over counting and
certifying deaths.
After
Hurricane Katrina, FEMA organized
teams of mortuary experts through
the Department of Health and Human Services (HHS) — known as
Disaster Mortuary Operational Response Teams or DMORT — to assist
the state of Louisiana in counting storm-related deaths. (Puerto
Rico’s safety department said they have 40 DMORT personnel
assisting the Institute of Forensic Sciences in San Juan.)
During
Katrina, FEMA also contracted Kenyon International, a private
company that specializes in recovering and identifying remains after
disasters. The company has not been contacted by federal agencies or
the Puerto Rican government for relief on the island, they told
BuzzFeed News. FEMA did not respond to a request for comment.
“One
of the things I advise governments to do is … come up with and put
out guidance on what is the time period, the definition, the cause,
manner, and mechanism [for counting deaths],” said Robert Jensen,
CEO of Kenyon International, which also assisted authorities after
9/11, the Oklahoma City bombing, and the Grenfell Tower fire in
London.
He
said instructions should be clear for funeral homes on what the
actions and reporting requirements are in cases like Maria.
“What
we want to be able to do is clearly identify what was the human cost
in this event and make it easier,” he said. “In the absences of
leadership or guidance, people are going to take action. The dead
can’t just sit.”
He
said the current lack of transparency and communication with those
handling burials and cremations across the island means the count is
less likely to be accurate.
“That
is a failure of government. That is part of the responsibility,”
he said, adding that having accurate death toll data can be used to
help governments prepare better for future disasters. For example,
“We have one generator— it needs to go to location A and not
location B.”
“Short
of having really clear guidance issued then you leave the decision
up to each individual funeral director, doctor,” he said. “I’d
love to say that it’s an intentional cover-up but it’s just
bureaucracy at its worst.”
The
forensic institute has heard from some funeral directors who said
they had cases of hurricane deaths that had not been examined by the
institute before burial or cremation, Ortiz said.
“There
were a few situations like this, and when [the director of the
forensic institute] asked for information and specific data, and
when she looked at the cases … it turned out that they were just
rumors, or that they couldn’t be substantiated.”
Ortiz
could not provide details about how many funeral directors had
raised such concerns with the institute, or the details about the
investigations that lead the institute to believe that they were
“just rumors.” But the institute is open to investigating any
case that’s specifically brought to them, she said.
“If
it’s a rumor they don’t register them,” she said.
Jensen
said the Puerto Rican government’s process is not consistent with
a scientific approach.
“Scientifically
based is great but the thing about science is it has to be repeated
given the same conditions and everyone has to be able to repeat it
given the same parameters,” he said.
Puerto
Rico Governor Ricardo Rossello said three weeks ago that he had
conducted a survey of the island’s hospitals and medical centers to
update the death toll. The Department of Public Safety, when asked
about the survey, said they will do them “periodically” but
couldn’t say when. They said the government is in contact with
hospitals but that there are communication difficulties that make it
hard to do another survey.
Jensen
said that after six months or a year, families will begin to think
about the deaths of their loved ones in the context of this crisis —
and whether they could have been eligible for more financial support
through insurance policies if their loved ones’ deaths had been
classified differently. One clear area they could have lost
financial resources, he said, was in receiving federal grants
through FEMA to assist with emergency funeral costs.
“Here’s
where it has an impact. It has an impact for different insurance
policies, it has an impact on families,” he said, adding that in
at least one other large-scale disaster Kenyon has worked on,
families hired forensic experts months later to determine whether
they had a legal case that first responders were at fault in their
family members’ deaths.
“In
a national disaster you’re one of however many and everyone is
focused on food, water, life support,” he said, “and that makes
it just a little bit harder for the families of the dead because it
feels like their life didn’t matter.” ●
CORRECTION
Karixia
Ortiz Serrano, who is acting as the spokeswoman for the Institute of
Forensic Sciences, works at the Puerto Rico Department of Public
Safety. An earlier version of this article said she worked for the
Puerto Rico Department of Public Health.
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