In 2017, three major hurricanes — Harvey, Irma, and Maria—struck Texas, Florida, and Puerto Rico, causing severe damage and deaths. After Hurricane Maria, questions were raised about how deaths related to the hurricane were identified and documented in Puerto Rico. States and local jurisdictions are responsible for identifying and documenting disaster-related deaths. Additionally, the federal government may play a role in helping to respond to disaster-related deaths, by, for example, providing Funeral Assistance for eligible funeral costs.
GAO was asked to review Puerto Rico’s process for identifying and documenting deaths related to Hurricane Maria, as well as other states’ related processes, and federal agencies’ assistance in this process. GAO studied, among other things, (1) how Florida, Texas, and Puerto Rico identified and documented deaths related to the 2017 hurricanes, and any challenges they experienced, (2) the support selected federal agencies provided to Florida, Texas, and Puerto Rico involving disaster-related deaths, and (3) the number of Funeral Assistance applications FEMA received, approved, and denied for the 2017 hurricanes.
GAO reviewed relevant laws and procedures from Florida, Texas, and Puerto Rico; and FEMA Funeral Assistance procedures and data for the 2017 hurricanes, as of March 2019, the most recent data available. GAO also interviewed state, territory, and federal officials about their efforts to address deaths related to the 2017 hurricanes.
Florida, Texas, and Puerto Rico reported that they followed their local processes to identify and document deaths related to hurricanes Harvey, Irma, and Maria in 2017. In Florida and Texas, medical examiners or other personnel were to complete death certificates. As of July 2019, Florida and Texas reported 84 and 94 deaths that were related to hurricanes Irma and Harvey, respectively. In Puerto Rico, physicians or medical officers were to complete death certificates, but in cases where cause of death was unknown, medical examiners at a central facility in San Juan completed the certificate. Florida and Texas officials told GAO the hurricanes did not impact their capacities to complete death certificates. However, Puerto Rico officials stated that damaged roads and power outages led to delays and impacted their ability to identify and document deaths related to Hurricane Maria. Puerto Rico officials initially reported 65 deaths in December 2017 directly related to Maria. Subsequently, because disruptions from Hurricane Maria made it difficult for Puerto Rico to identify the number of hurricane-related deaths, Puerto Rico commissioned a study by George Washington University on the number of observed deaths compared to expected deaths had the hurricane not occurred. The study estimated 2,975 excess deaths due to the hurricane as of August 2018, which is Puerto’s Rico’s current official death count.
Federal agencies—the Department of Homeland Security’s Federal Emergency Management Agency (FEMA), and the departments of Health and Human Services, Veteran Affairs, and Defense—supported Puerto Rico by providing cold storage equipment and other resources to help with disaster-related deaths. Florida and Texas did not need similar support as they did not face similar challenges as Puerto Rico.
FEMA approved a total of 976 out of 4,802 Funeral Assistance applications in Florida, Texas, and Puerto Rico, as of March 2019.