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slow-motion, monthslong disaster that kept Puerto Ricans from getting the care they needed for treatable ailments, even as President Donald Trump lauded his administration's response.
A year after Maria roared across the Caribbean, reporters for The Associated Press, the news site Quartz and Puerto Rico's Center for Investigative Journalism have put together the most detailed portrait yet of the agonizing final days of victims of the storm, interviewing 204 families of the dead and reviewing accounts of 283 more to tell the stories of heretofore anonymous victims.
Trump cast doubt on the storm's widely accepted death toll Thursday, tweeting that "3000 people did not die" when Maria hit after a nearmiss by Hurricane Irma in September, 2017. He said the death count had been inflated "by the Democrats in order to make me look as bad as possible," by adding unrelated deaths to the toll from causes like old age.
But the joint investigation reflects how Puerto Rico's most vulnerable fell victim to dire conditions created by the storms.
Disabled and elderly people were discharged from overwhelmed hospitals with bedsores that led to fatal infections. Medical oxygen ran out. People caught lung infections in sweltering private nursing homes and state facilities. Kidney patients got abbreviated treatments from dialysis centers that lacked generator fuel and fresh water, despite pleas for federal and local officials to treat them as a higher priority, according to patient advocates.
There was Ernesto Curiel, a diabetic who died of a heart attack after weeks of walking 10 flights twice a day to fetch insulin from his building's only working refrigerator. Alejandro González Vázquez, 47 — unable to obtain his anti-psychotic medication, he committed suicide instead of boarding his flight back to the U.S. mainland. Juana Castro Rivera, 52, dead of leptospirosis, a disease transmitted by contaminated water. After several visits to a community clinic, she was diagnosed — too late — by a hospital in a neighboring municipality.
Along with post-storm conditions, each death has a complex mix of causes that can include serious pre-existing conditions and individual decisions by patients, caregivers and doctors, making it difficult to definitively apportion blame in every case. But critics say many could have been saved by better preparation and emergency response.
"I was looking for help and no one came," said Maria Gonzalez Munoz, who spent 30 days after the storm caring for her sister in her blacked-out home.
The Gonzalez home is 3 miles (4.8 kilometers) from the convention center that served as headquarters for thousands of federal and local emergency responders for more than a month after the storm. Maria and her brother took Ramona to a hospital twice, and tried to get her aboard a Navy medical ship in San Juan harbor, but couldn't save their ailing sister.
"No one was asking after us, no one from the government," said Gonzalez Munoz, 66.
The hurricane's true death toll has fueled debate since the first days of the storm, in large part because of the nearunique nature of the disaster.