In the wake of Hurricane Ian, the living have struggled to account for all the dead.
Overwhelmed by the number of bodies to autopsy and thrown into a political debate over precisely how many lives the storm has claimed, many medical examiners in the hardest-hit parts of Florida face extraordinary challenges in accounting for all of the storm’s victims.
In Charlotte County, the longtime chief medical examiner was three days from retirement with no permanent replacement chosen yet when Ian hit on Sept. 28.
With many roads still flooded and impassable, in stepped Dr. Russell Vega, the chief medical examiner in neighboring Sarasota County, who had already been helping Charlotte County during its leadership transition.
Vega arrived last Saturday, three days after the storm made landfall, to find that the office already had twice as many bodies as it was built to handle.
“We were sort of stacking up bodies,” Vega said. “We had all these initial bodies and then more bodies were coming in.”
So far more than 130 deaths have been attributed to the storm, according to an NBC News count based on statements by local and state authorities. That makes it Florida’s deadliest hurricane since 1935.
Lee County Sheriff Carmine Marceno described how search teams using cadaver dogs had been combing through remnants of entire neighborhoods that were wiped out. “Sometimes — can’t believe what I’m looking at,” he said at a recent briefing.
More than half of the victims drowned, the Florida Medical Examiners Commission has reported.
“Flooding generally kills more people during hurricanes than any other cause,” said John Renne, the director of the Center for Urban and Environmental Solutions at Florida Atlantic University and an expert on emergency management.
Within days of taking over operations in Port Charlotte, Vega and his colleagues — local staff, along with reinforcements sent from elsewhere in Florida under a state-run mutual-aid system called the Florida Emergency Mortuary Operations Response System — were processing as many as 42 bodies in a facility designed to hold only a half-dozen or so at a time.
Meanwhile, the state and National Guard brought in portable refrigeration units for bodies. But not all the units were working properly, Vega said, so while those glitches were fixed, body bags containing remains were laid on the floor of the office’s refrigeration room.
From his experience with the pandemic, when the deaths from Covid-19 were unrelenting, Vega said he knew they had to get autopsies done and the deceased to funeral homes as quickly as possible.
But this was almost impossible in the immediate aftermath of Ian.
While the Port Charlotte office was not damaged, its phone line didn’t work for several days. There was no internet service. Cellphone and electricity outages across the county made it hard to obtain medical records needed to determine causes of death and identify the victims or reach next of kin. All local funeral homes were also without power, Vega said.
“The hurricane adds all the logistical problems of the lack of resources and utilities that you normally would count on,” Vega said.
Despite the large number of bodies — more than 40 — that were taken to the Charlotte County office, so far only about nine deaths appear to have been directly tied to the hurricane, Vega said. But reaching that conclusion is a painstaking process.
For example, Vega said, one body brought to the facility belonged to a person with Covid and respiratory disease who died at home after power outages left the person without access to supplemental oxygen.
“And so eventually that case was signed out as a death due to those lung diseases,” Vega said. “But a contributory factor was the lack of oxygen due to the power outage that that person suffered because of the hurricane. So it’s a hurricane-related death.”
When is a death storm-related?
Precisely how many have died as a result of Hurricane Ian is a point of contention.
Florida Gov. Ron DeSantis has pushed back on President Joe Biden’s insistence that Ian could wind up claiming more lives than other devastating storms that have hit his state. DeSantis, a Republican, has also indicated that he believes the number of reported hurricane-related deaths may have already been inflated.
“For example, in Charlotte County, they recorded a suicide during the storm,” DeSantis said last week. “They also had somebody pass away from a heart attack because you don’t have access to emergency services.”
Gretl Plessinger, a spokesperson for the Florida Department of Law Enforcement, which provides staff to the Florida Medical Examiners Commission, said the state’s medical examiners have a broader definition of what constitutes a storm death, including motor vehicle accidents during evacuations or heart attacks that turn fatal because the patient is cut off from medical care by the storm.
“District MEs use their own judgment when determining whether or not it’s storm-related,” Plessinger said in an email. “They do include both direct and indirect deaths.”
A “direct” death, according to the National Hurricane Center, is a drowning or a fatality from wind, rip currents and other forces of the storm.
“Indirect” deaths include accidents before and after the storm, like falls or carbon monoxide poisonings, according to the agency.
Determining that a fatality is indirectly storm-related can be tricky, especially in the days immediately following a hurricane, said Dr. Lynn Goldman, who is dean of the Milken Institute School of Public Health at George Washington University, as well as a physician. Goldman was part of a George Washington University team that investigated the death toll from Hurricane Maria, which in 2017 ravaged Puerto Rico, Dominica and Saint Croix.
“If that person is out in their yard cutting tree limbs and moving stuff around that fell on top of their car or house, and they wouldn’t be doing that minus the hurricane, and they have a heart attack, I think that’s attributable, based on the history, the scene, the investigation,” she said. “But on any day in the state of Florida, a heart attack could be occurring.”
Suicides — which mental health experts say are rarely caused by one single factor — may require a more thorough investigation to be deemed hurricane-related, Goldman added, unless there is an obvious connection found at the scene.
“Somebody just lost everything they had and they write a note that makes it really clear that minus that, they probably wouldn’t have done all this,” she said. “Losing everything you have and you’re already suicidal, maybe you’re already depressed, can be a trigger.”
An investigation of the Charlotte County suicide mentioned by DeSantis concluded that it was not related to the storm, Vega said.
Determining whether a death was storm-related can be a source of disagreement, even within families.
At least two Sarasota County families that lost older loved ones during the storm disagreed with initial reports that their relatives had died because of power outages from the hurricane, reported the Sarasota Herald-Tribune.
Sarasota County Sheriff’s Office spokesperson Kaitlyn Perez said in both cases the patients were on oxygen machines that stopped working when they lost power.
“While (the victims) did not die due to the physical weather event, the inability to respond may have changed the outcomes in both incidents,” Perez told the newspaper. “We have no way of knowing.”
Renne said what is clear is that people in southwest Florida were not prepared for Ian, largely because many are transplants from out of state.
“The communities hit by Hurricane Ian were places that have many new residents who had never experienced a major storm,” he said.
Vega pleaded with the public for patience as medical examiners worked as quickly as they could to determine how many storm-related deaths Ian caused.
“I think we live in a society where people are so used to getting something so immediately that it’s hard to imagine it takes days to get this data, but it does,” he said. “And we especially want to get it right.”