SAN JUAN, Puerto Rico – Eight days after Hurricane Maria devastated Puerto Rico, Efrain Perez felt a pain in his chest.
Doctors near his small town sent him to the main hospital in Puerto Rico for emergency surgery for an aortic aneurysm. But when the ambulance stopped in the parking lot of the capital, San Juan, after a trip of more than two hours, a doctor ran out to stop him.
"He said:" Do not bring him here, I can not take care of him, I have no power, I do not have water, I do not have an anesthesiologist, "recalls Perez's daughter, Nerybelle.
Perez, 95, died when the ambulance took him back to the southwest of Puerto Rico, but is not included in the official number of hurricane fatalities on the island of 64 people, a figure in the center of a growing legal and political battle over the response to the Category 4 storm that hit Puerto Rico on September 20, 2017.
Facing at least three lawsuits demanding more data on the death toll The government of Puerto Rico released Information on Tuesday added details to the growing consensus that hundreds or even thousands of people died as an indirect result of the storm.
According to the new data, there were 1,427 more deaths between September and December. 2017 than the average for the same period of time in the previous four years. In addition, September and October had the highest number of deaths of all months since at least 2013. But the statistics do not indicate whether the storm and its consequences contributed to the additional deaths.
The Puerto Rican government says it believes more than 64 people died as a result of the storm, but it will not increase its official toll until the George Washington University completes a study of the data that is being carried out on behalf of the US territory.
The problem is marred by the fact that the government and the states and territories of the US. UU they do not have a uniform definition of what constitutes a death related to the storm. The National Hurricane Center counts only deaths caused directly by a storm, such as a person killed by a falling tree. It does not count indirect deaths, like someone whose medical equipment fails in a blackout.
Puerto Rico began counting the majority of direct deaths, with some hints. Then he stopped updating his toll completely while waiting for the George Washington University study, to be held later this summer.
The recount of death has had political implications. When visiting Puerto Rico on October 3, two weeks after the storm, President Donald Trump asked Governor Ricardo Rosselló what the death toll was.
"Sixteen," answered Rosselló
"Sixteen people certified," said Trump. "Sixteen people versus thousands You can be very proud of all your people and all the people who work together Sixteen versus literally thousands of people You can be very proud Everyone can be very proud of what happens in Puerto Rico "
On Monday, two Democrats presented a bill to Congress controlled by Republicans that would establish federal procedures to count deaths after a natural disaster, saying that it will help improve the federal response and be key to the allocation of federal funds. The proposed $ 2 million project would allow the US Federal Emergency Management Agency. UU Contract the National Academy of Medicine to conduct a study on the best way to evaluate deaths during and after a disaster, given that the process is currently left to the states and territories of the United States. UU
"No one who rebuilds his life after a natural disaster should suffer the neglect we have seen in Puerto Rico," said Rep. Raúl Grijalva of Arizona. "Too many Puerto Rican families are suffering additional burdens today because officials will not recognize the death of their loved ones."
Like Pérez, thousands of sick Puerto Ricans could not receive medical attention in the months after the storm caused the worst blackout in the country. history of the United States, which continues to this day, with 6,983 households and businesses still without electricity.
Data published on Tuesday showed increases in several diseases in 2017 that could have been related to the storm: cases of sepsis, an infection Severe bloodstream, usually caused by bacteria, increased from 708 in 2016 to 835 last year.Diabetes deaths went from 3,151 to 3,250 and deaths from heart disease increased from 5,417 to 5,586.
The data was not disaggregated per month, which prevented analysis of whether diseases increased after Hurricane Maria.
CNN and Pue rto The Rico Center for Investigative Journalism sued the Puerto Rican government after it refused to publish a detailed report of the deaths in the wake of the storm. On June 5, a judge handed over to the government until Tuesday to publish a database with the causes of death of all the deceased from two days before the storm until today, along with all death certificates and burial certificates and cremation of the same period.
"People still do not have a clear idea of how many lives were lost due to lack of food, medicines, health services or simply because of an ineffective response to an emergency, which is why it is urgent to shed light on all components of government preparedness and response, "Judge Lauracelis Roques wrote in her ruling.
The government requested more time to release all death certificates, saying that Social Security data had to be written out of 48,000 individual documents. The judge rejected the request and the government planned to announce its next steps later in the day.
Meanwhile, thousands of Puerto Ricans hoped that the disclosure of information would lead to their loved ones being included in the storm's toll, something that, for example, will provide a sense of closure and will show the American public the true cost of the hurricane.
Until now, Pérez has been "one of those who do not count," his daughter told The Associated Press. "That is a lie".
Lucila Pardo, 96, spent nearly four months in a suffocating nursing home that had no electricity and developed bed sores when she was moved in early January to another house where electricity had been restored. By then, the sores had become infected and she was taken to a hospital where she passed two weeks before dying of septicemia.
"That figure of 64 is a lack of respect for those who died for other consequences," said Pardo's granddaughter. Analz Nazario
"The hospital wrote a letter apologizing," Nazario told the AP and added that they did not have enough staff.
A Harvard study published last month estimated that there were 4,600 more deaths than usual in the three months after Maria, although some independent experts questioned the methodology and numbers in that study. Still, previous studies have found that the number of direct and indirect deaths related to hurricanes is higher than the official figure, including a 2017 report that said there were almost 500 more deaths than usual on the island in September.
Days before the government was ordered to disclose the new data, the Statistics Institute of Puerto Rico sued the demographic registrar for the information. On June 1, the agency disclosed information showing that there were 1,397 additional deaths from September to December 2017 compared to the same period of the previous year.
Among those who died the first week of October was Raúl Antonio Morales, 95 years old. – Old diabetic who did not have the insulin he needed because the nursing home where he lived had no electricity or a generator, according to his granddaughter, Maytee Sanz. She said that relatives tried to obtain a generator, but that none were available. A doctor in the nursing home certified that Morales died of natural causes, and is not included in the official death toll.
"I think the government has been extremely inept and inefficient with respect to statistics," Sanz said. "There were many deaths certified as natural simply because … they were not electrocuted or drowned, but they were the result of the hurricane.When they do not have access to insulin or a breathing machine, they have no way of surviving."
Associated Press journalist Larry Fenn in New York contributed to this report.
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