The report goes on to say that “physician unawareness of appropriate death certification practices after a natural disaster and the Government of Puerto Rico’s lack of communication about death certificate reporting prior to the 2017 hurricane season substantially limited the count of deaths related to Maria.”
The report, which analyzed processes related to death certification, says that physicians and forensic physicians are among those in Puerto Rico who are authorized to complete death certificates, but that most physicians have no formal training in how to do so. They are therefore unaware of “appropriate death certification practices, especially in a disaster setting,” the report found.
“Those interviewed said they did not receive information about how to certify deaths during, or in conditions created by, a disaster,” the report says.
It also says there was a communication problem between the Puerto Rico Vital Statistics Registry and other government agencies and those involved in the death certification and registration process.
“Many stated that the Puerto Rico Department of Health (DoH) and the Puerto Rico Department of Public Safety (DPS) did not notify them about the CDC special guidelines for correct documentation of cases, on the importance of correctly documenting deaths related to the hurricane or on an emergency protocol for handling these cases,” it says.