Using a study from a team of independent researchers, officials in Puerto Rico said they're raising the official death toll from Hurricane Maria to 2,975 from 64.

Interested in Hurricanes? Add Hurricanes as an interest to stay up to date on the latest Hurricanes news, video, and analysis from ABC News. Add Interest

Researchers have determined that an estimated 2,975 people died from September 2017 through the end of February 2018. The independent study, from George Washington University's (GWU) Milken School of Public Health, was commissioned by the Puerto Rican government.

Alvin Baez/Reuters, FILE

At a press conference Tuesday in San Juan, Gov. Ricardo Rossello announced he would be raising the island's official estimate to match that of the study.

Rossello called the announcement "painful" and said it's a time for Puerto Ricans to mourn and reflect.

The GWU report also showed that the risk of dying in the aftermath of Maria was 60 percent higher for those in the poorest communities and 35 percent higher for those aged 65 or older.

"There are huge inequalities in Puerto Rico that were brought up by the hurricane," said Carlos Santos-Burgoa, one of the principal investigators of the study.

The estimate of 2,975 was determined using a mathematical model based on historical patterns, with adjustments made for age and sex, researchers said. That sum is more than 4,500 percent higher than the original estimate of 64.

Gerald Herbert/AP, FILE

President Donald Trump, who visited Puerto Rico in the days following the storm, initially told a crowd of Puerto Ricans to be "very proud of all of your people" because the death toll was so low.

"If you look at a real catastrophe like Katrina, and you look at the tremendous hundreds and hundreds and hundreds of people that died ... 16 people versus in the thousands," he said. Hurricane Katrina claimed more than 1,800 lives, according to the National Hurricane Center.

On Wednesday, a day after the announcement that thousands of lives were lost to Hurricane Maria, the president remained steadfast that his administration did a "fantastic job." The storm was a "tough one," Trump said, but he blamed the level of destruction on the island's geography and faulty electrical system.

"Puerto Rico was actually more difficult because of the fact it's an island," Trump said. "With Texas, you're land-based, with Florida it was land-based ... I only hope they don't get hit again."

In a statement to ABC News, San Juan Mayor Carmen Yulin Cruz strongly disagreed with the president's characterization.

“President Trump continues to demonstrate his inability to understand what his job in this crisis was all about: This was never about him, this was never about politics, this was about saving lives," Cruz wrote. "His lack of sensibility is beyond offensive -- 2,975 people died because of his inability to get the job done. We will never forget!”

Dr. Lynn Goldman, dean of the Milken School of Public Health, told ABC News the death rates have still not returned to the baseline, and that the deaths for the poor and elderly did not stop after the study concluded in February.

"We thought we would capture all the deaths if we looked at the period between September 2017 and February 2018, but in reality, even in February, there was still some excess deaths among the poor and the elderly," Goldman said. "It might make sense to follow through for the next six months to see when the death rates actually return to baseline."

Hurricane Maria "caused problems for people for months -- loss of electricity, issues with getting food and water, healthcare and other things people needed," Goldman added.

The GWU report also offered a blistering criticism of Rossello and his government, saying there was "inadequate preparedness and personnel training for crisis and emergency risk communication."

These factors "decreased the perceived transparency and credibility of the Government of Puerto Rico," the report said.

Rossello said he takes responsibility for what happened as a result of the passing of the storm.

"Yes, I made mistakes," he said. "We could have done things differently."

Boston Globe via Getty Images, FILE

The governor announced the creation of a commission that will start by working off the GWU recommendations to improve public health and safety as well as the creation of a registry of people considered vulnerable to future disasters. Rossello also said the commission would update Puerto Rico's preparedness plans to endure stronger hurricanes.

A memorial at the University of Puerto Rico to commemorate the lives lost because of Maria also is planned, the governor said.

On Wednesday, Trump offered praise for the governor.

"We're still helping Puerto Rico, the governor is an excellent guy," he said. "And he is very happy with the job we've done."

Goldman said assistance provided to Puerto Rico needed to include assistance to the island's understaffed Department of Health.

The GWU team plans to conduct a second phase of the study to better understand everything that contributed to the death toll. They're looking for funding for additional phase.

Mario Tama/Getty Images, FILE

The study's findings come after nearly a year of questions, uncertainty and political sparring over the human toll of the storm.

Cruz tweeted following the release of the study: "The # of deaths 2,975 reinforces the pain inflicted on the people of PR and the violation of our human rights. THEY WILL NOT BE FORGOTTEN."

She added in the subsequent tweet: "I am sure the small minded will now compare studies and concentrate on the difference in #s. Remember, no matter the # thousands died."

"We need to come to terms with the fact," Goldman told ABC News, "that these storms are getting bigger and there are more of them and we all need to be prepared for them."

On Tuesday, White House press secretary Sarah Sanders said the federal government will continue to support Rossello's efforts "to ensure a full accountability and transparency of fatalities resulting from last year's hurricanes -- the American people, including those grieving the loss of a loved one, deserve no less."

"We are focused on Puerto Rico's recovery and preparedness for the current Hurricane season," Sanders said.</s>Far more people died in Puerto Rico in the wake of Hurricane Maria than initially thought, according to a new study.

From September 2017 to February 2018, 2,975 people died, according to the study by George Washington University's Milken Institute School of Public Health, which was commissioned by the Puerto Rican government.

That total is a dramatic increase from the official death count of 64, which the administration of Gov. Ricardo Rossello maintained in the 11 months since the storm. The death toll from this study would make Maria the second-deadliest hurricane in U.S. history.

The study found doctors on the island were ill-equipped to properly classify deaths after a natural disaster and the government failed to prepare them before the 2017 hurricane season.

It found that government emergency plans in place when Maria hit were not designed for hurricanes greater than a Category 1. Maria was a Category 4 with 154-mph winds. Damage was estimated at more than $100 billion.

“The inadequate preparedness and personnel training for crisis and emergency risk communication, combined with numerous barriers to accurate, timely information and factors that increased rumor generation, ultimately decreased the perceived transparency and credibility of the Government of Puerto Rico,” the report said.

The official death toll from Maria has been a point of contention since the storm ripped through the middle of the island Sept. 20, destroying homes and island infrastructure, displacing thousands and plunging the island into a blackout for months.

Maria did not discriminate. People from all social and economic backgrounds perished in the storm, though the death count was higher for Puerto Ricans in poorer communities and elderly men.

"The latest study, commissioned by the Puerto Rican government, puts the tragedy of Hurricane Maria on the same scale as the September 11th attacks," Rep. Bennie Thompson D-Miss., ranking member of the House Committee on Homeland Security, said in a statement. "Because FEMA and the Federal government were simply unprepared, thousands of our fellow American citizens have perished – and we now know that the poor and elderly were the most at risk."

Rossello acknowledged that the official toll of 64 was probably low but hesitated to raise that number until the GWU study was completed.

Besides those directly killed by the storm, scores of others died when they weren’t able to access hospitals over impassable roads, couldn’t plug in dialysis machines when the island went dark or couldn't cope with the stress after the storm.

The low official death count sparked protests in San Juan and hindered the island's recovery. This year, Puerto Ricans laid thousands of pairs of shoes outside the island’s Capitol building to represent the uncounted dead.

Some media and academic studies estimated the death toll at more than 1,000 and a government report to Congress conceded that there may have been 1,400 more deaths in Puerto Rico after the storm than the previous year.

The Center for Investigative Journalism, Puerto Rico, in a joint project with CNN, is analyzing thousands of post-Maria death certificates to try to determine an accurate death count.

The GWU study would put Maria as the second-deadliest hurricane in U.S. history. The hurricane of 1900 in Galveston, Texas, killed 8,000 to 12,000, according to the National Oceanic and Atmospheric Administration. Hurricane Katrina killed about 1,800 along the Gulf Coast in 2005.

Researchers counted deaths from Maria over the span of six months — a much longer period than usual — because so many people were without power during that time, which probably led to more deaths.

“That caused a number of issues,” said Lynn Goldman, dean of the Milken institute. “It’s fairly striking that you have so many households without electricity for so long. That’s unusual in the U.S. after a disaster.”</s>Gov. Ricardo Rossello raises Puerto Rico's official toll from Hurricane Maria from 64 to 2,975 following new study

SAN JUAN, Puerto Rico (AP) — Gov. Ricardo Rossello raises Puerto Rico's official toll from Hurricane Maria from 64 to 2,975 following new study.</s>Aug. 28 (UPI) -- Independent researchers from George Washington University on Tuesday said the death toll from Hurricane Maria was more than double the 1,427 people the Puerto Rican government calculated.

The study, a collaboration between GWU's Milken Institute School of Public Health and the University of Puerto Rico Graduate School of Public Health, blamed the Category 5 storm in September for 2,975 deaths on the island territory. The toll included both direct and indirect deaths between September and February.

Researchers determined the figure by examining deaths on the island from 2010 to 2017 and compared that to the data from the six months after Hurricane Maria made landfall. They determined there were 22 percent more deaths in Puerto Rico from September to February than expected.

"The results of our epidemiological study suggest that, tragically, Hurricane Maria led to a large number of excess deaths throughout the island," Carlos Santos-Burgoa, the study's lead researcher, said in a statement. "We hope this report and its recommendations will help build the island's resilience and pave the way toward a plan that will protect all sectors of society in times of natural disasters."

Puerto Rican Gov. Ricardo Rosselló, who commissioned the study, told El Nuevo Dia that the territory had not been adequately prepared for a direct hit from a major hurricane.

"This denotes the magnitude of the catastrophe," he said, adding that his administration is "not perfect."

"At that time we had a protocol. We did not realize until a little later that it was totally insufficient ... unfortunately there was no formal process to prepare [doctors] for the devastation," he added.

Earlier this month, the Puerto Rican government said 1,427 people died in the aftermath of the storm, a sharp increase from the 64 it originally reported.

When the hurricane hit Puerto Rico, it essentially wiped out the entire electrical grid and much of the island territory's infrastructure, including roads, hospitals, water supply and telecommunications networks. The National Hurricane Center said Hurricane Maria caused an estimated $90 billion damage in Puerto Rico and the U.S. Virgin Islands, the third-costliest hurricane in U.S. history.

In the aftermath of the storm, medical conditions such as diabetes and sepsis soared. Many people died from lack of healthcare or because there was no power to run medical equipment like dialysis and breathing machines.

But a Harvard study released in May put the toll at 4,645, with most deaths blamed on delayed medical care.

San Juan Mayor Carmen Yulin Cruz, who was vocal in her criticisms of the federal government's handling of relief efforts after the hurricane, said the deaths reported Tuesday were due partly to negligence.

"For you can kill people with a gun or you can kill them with neglect. The second happened" in Puerto Rico, she tweeted. The number "of deaths 2,975 reinforces the pain inflicted on the people of [Puerto Rico] and the violation of our human rights. They will not be forgotten."</s>SAN JUAN, Puerto Rico - Hurricane Maria killed far more people in Puerto Rico than initially thought, accounting for an estimated 2,975 deaths on the island from September 2017 through February 2018, according to a new analysis. The study found that those in low-income areas, and elderly men, were at greatest risk of dying.

The independent analysis was commissioned by the governor of Puerto Rico and conducted by researchers at George Washington University's Milken Institute School of Public Health. CBS News obtained a report on the findings from Carlos Mercader, executive director of the Puerto Rico Federal Affairs Administration.

To arrive at the 2,975 figure, the study looked at historical death patterns from 2010 to 2017 to estimate how many people would have died had Hurricane Maria not hit the island. That figure was then compared to the actual number of deaths from September 2017 through February 2018 — obtained in records provided by the Puerto Rico Vital Statistics Records division of the Puerto Rico Department of Health — to determine what the report describes as the "estimate of excess mortality due to the hurricane."

The study found that while all age groups and social strata were affected by the hurricane, the risk of death was "45% higher and persistent until the end of the study period for populations living in low socioeconomic development municipalities."

It also found that men age 65 and older were at heightened risk of death through February, the end of the study period.

"Overall, we estimate that 40% of municipalities experienced significantly higher mortality in the study period than in the comparable period of the previous two years," the report says.

In the aftermath of the devastating storm, which barreled into Puerto Rico last September, Puerto Rico's government initially reported 64 deaths blamed on the hurricane. Since then, several studies have indicated the actual death toll was much higher, though researchers have arrived at a range of different figures.

In May, a Harvard University study said Maria was likely responsible for more than 4,600 deaths from the day of the storm, September 20, until December 31, 2017 — a figure that was based on results of a door-to-door survey of 3,299 randomly selected homes across the island. Earlier this month, Puerto Rico said in a report to Congress there were 1,427 more deaths "than normal" in the four months after Hurricane Maria and Hurricane Irma, which churned on a path just north of the island two weeks before Maria hit. That report said, however, those 1,427 deaths "may or may not be attributable to the hurricanes."

The latest study says that from the period ranging from September to December 2017 alone, there were an excess of 2,098 deaths, and 2,975 from September 2017 to February 2018.

The report offered insight as to why the initial count of 64 was so much lower than this new figure.

"The official government estimate of 64 deaths from the hurricane is low primarily because the conventions used for causal attribution only allowed for classification of deaths attributable directly to the storm, e.g., those caused by structural collapse, flying debris, floods and drownings," the report says. "During our broader study, we found that many physicians were not oriented in the appropriate certification protocol. This translated into an inadequate indicator for monitoring mortality in the hurricane's aftermath."

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.</s>(Reuters) - The official death toll on Puerto Rico from Hurricane Maria, the most powerful storm to strike the Caribbean island in almost a century, was raised on Tuesday from just 64 to nearly 3,000, based on a study ordered by the governor of the U.S. territory.

The report found that an estimated 2,975 deaths could be attributed directly or indirectly to Maria from the time it struck in September 2017 to mid-February of this year. The figure was derived from comparisons between predicted mortality under normal circumstances and deaths documented after the storm. (Study: bit.ly/2wwqEqF)

The emergency response to Maria became highly politicized as the Trump administration was criticized as being slow to recognize the gravity of the devastation and too sluggish in providing disaster relief to Puerto Rico, an island of more than 3 million residents.

The study, conducted by George Washington University’s Milken Institute School of Public Health and released Tuesday, also found that the risk of death from the hurricane was substantially higher for poor people and elderly men.

Researchers said they adjusted for various factors that could account for fluctuations in mortality, most notably the population flux from some 241,000 residents who fled the island in the immediate aftermath of the storm.

The second phase of the study will examine causes and contributing factors behind the deaths, said Carlos Santos-Burgoa, a professor of global health who was the lead investigator of the study.

Nevertheless, Santos-Burgoa said the high death toll, ranking Maria among the worst natural disasters in U.S. history, was evidence that “we lack a culture of preparedness.” He also said that financial instability and a fragile infrastructure made Puerto Rico especially vulnerable to such calamities.

The report was conducted in collaboration with the University of Puerto Rico Graduate School of Public Health and was commissioned by Puerto Rico Governor Ricardo Rossello.

Speaking at a news conference from in Puerto Rico’s capital, San Juan, Rossello said his government was adopting the findings as the official account of human life lost in the disaster.

“Even though it is an estimate, we are officially changing, we are putting an official number to the death toll,” he said. “We will take the 2,975 number as the official estimate for the excess deaths as a product of the hurricane.”

A study in May from a Harvard University-led research team estimated 4,645 lives were lost from Maria on Puerto Rico, and a Pennsylvania State University study put the number at 1,085.

The Harvard study was based on extrapolations from random surveys of about 3,300 households, with a wide margin of error.

Penn State researchers used a methodology similar to the GW University study but made comparisons with a smaller set of historical data and did not account for demographic and populations changes in the same way, Santos-Burgoa told Reuters.

The storm made landfall on Puerto Rico with winds close to 150 miles per hour (241 km per hour) on Sept. 17 and plowed a path of destruction across the island, causing property damage estimated at $90 billion and leaving much of the island without electricity for months.</s>Puerto Rico’s governor raised the U.S. territory’s official death toll from Hurricane Maria from 64 to 2,975 on Tuesday after an independent study found that the number of people who succumbed in the desperate, sweltering aftermath had been severely undercounted.

SAN JUAN, Puerto Rico — Puerto Rico’s governor raised the U.S. territory’s official death toll from Hurricane Maria from 64 to 2,975 on Tuesday after an independent study found that the number of people who succumbed in the desperate, sweltering aftermath had been severely undercounted.

The new estimate of nearly 3,000 dead in the six months after Maria devastated the island in September 2017 and knocked out the entire electrical grid was made by researchers with the Milken Institute School of Public Health at George Washington University.

“We never anticipated a scenario of zero communication, zero energy, zero highway access,” Gov. Ricardo Rossello told reporters. “I think the lesson is to anticipate the worst. … Yes, I made mistakes. Yes, in hindsight, things could’ve been handled differently.”

He said he is creating a commission to study the hurricane response, and a registry of people vulnerable to the next hurricane, such as the elderly, the bedridden and kidney dialysis patients.

Rossello acknowledged Puerto Rico remains vulnerable to another major storm. He said the government has improved its communication systems and established a network to distribute food and medicine, but he noted that there are still 60,000 homes without a proper roof and that the power grid is still unstable.

“A lesson from this is that efforts for assistance and recovery need to focus as much as possible on lower-income areas, on people who are older, who are more vulnerable,” said Lynn Goldman, dean of the Milken institute.

Tuesday’s finding is almost twice the government’s previous estimate, included in a recent report to Congress, that there were 1,427 more deaths than normal in the three months after the storm.

The George Washington researchers said the official count from the Sept. 20 hurricane was low in part because doctors were not trained in how to classify deaths after a disaster.

The number of deaths from September 2017 to February 2018 was 22 percent higher than during the same period in previous years, Goldman said.

The number of dead has political implications for the Trump administration, which was accused of responding half-heartedly to the disaster. Shortly after the storm, when the official death toll stood at 16, President Donald Trump marveled over the small loss of life compared to that of “a real catastrophe like Katrina.”

Hurricane Katrina, which struck New Orleans in 2005, was directly responsible for about 1,200 deaths, according to the National Hurricane Center. That does not include indirect deaths of the sort the George Washington researchers counted in Puerto Rico.

The White House issued a statement on Tuesday noting that it sent 12,000 personnel to Puerto Rico for response and recovery efforts, and said it would continue to support the island’s government and its communities in their recovery for years to come.

“The American people, including those grieving the loss of a loved one, deserve no less. The president remains proud of all of the work the federal family undertook to help our fellow citizens in Puerto Rico,” it said.

Yet many remain outraged at both the local and federal governments.

Rep. Nydia Velazquez, a New York Democrat, said the report shows the U.S. government failed the people of Puerto Rico.

“These numbers are only the latest to underscore that the federal response to the hurricanes was disastrously inadequate and, as a result, thousands of our fellow American citizens lost their lives,” she said in a statement.

There is no national standard for how to count disaster-related deaths. While the National Hurricane Center reports only direct deaths, such as those caused by flying debris or drowning, some local governments may include indirect deaths from such things as heart attacks and house fires.

Researchers with George Washington said they counted deaths over the span of six months — a much longer period than usual — because so many people were without power during that time.

“That caused a number of issues,” Goldman said, explaining that people were forced to exert themselves physically or were exposed to intense heat without fans or air conditioning. “It’s fairly striking that you have so many households without electricity for so long. That’s unusual in the U.S. after a disaster.”

Power has not yet been fully restored to Puerto Rico nearly a year after the hurricane, and outages remain common.

Puerto Rico’s government released data in June showing increases in several illnesses in 2017 that could have been linked to the storm: Cases of sepsis, a serious bloodstream infection usually caused by bacteria, rose from 708 in 2016 to 835 last year. Deaths from diabetes went from 3,151 to 3,250, and deaths from heart illnesses increased from 5,417 to 5,586.

Bethzaida Rosado said government and health care officials were not prepared for the storm, and she is still angry her 76-year-old mother died because oxygen tanks were not available on the island after the hurricane.

“Do you know what it’s like to see your mother run out of oxygen?” she said. “I don’t wish that on anyone.”

Months ago, the Rossello administration stopped updating its official death toll at 64 and ordered the independent investigation amid suspicions the dead were substantially undercounted.

The first phase of the study cost $305,000. In the second phase, the researchers plan to focus on the causes of death.

The researchers found that the risk of death was 45 percent higher for those living in impoverished communities, and that men over 65 saw a continuous elevated risk of death.

They also reported that physicians and others told them that Puerto Rico’s government did not notify them about federal guidelines on how to document deaths related to a major disaster.

“Others expressed reluctance to relate deaths to hurricanes due to concern about the subjectivity of this determination and about liability,” the report said.

For the study, the researchers reviewed mortality data from July 2010 to February 2018. They also took into account an 8 percent drop in Puerto Rico’s population in the six months after the storm, when tens of thousands fled because of the damage.

However, they did not share details of their methodology, saying those will be released if the study is published in a scientific journal.

“We did not cherry-pick, I can promise you,” Goldman said. “We used very rigorous methodology.”

The study also found that government emergency plans in place when Maria hit were not designed for hurricanes greater than a Category 1. Maria was a Category 4 with 154 mph winds. Damage was estimated at more than $100 billion.

The researchers made several recommendations, including more emergency planning and government training for doctors on filling out death certificates. They also said the public health system needs to be strengthened, though Goldman said they don’t know yet whether those weaknesses contributed to storm-related deaths.

Rossello pledged to carry out the recommendations, though there are questions about Puerto Rico’s ability to do so. The island is trying to restructure a portion of its more than $70 billion public debt amid a 12-year recession.</s>SAN JUAN, Puerto Rico — Gov. Ricardo Rossello is raising Puerto Rico's official toll from Hurricane Maria from 64 to 2,975 in response to a new, government-commissioned study finding deaths from the storm were severely undercounted.

He's also creating a commission to implement recommendations in the new report, and creating a registry of the people expected to be most vulnerable in a future storm, such as the elderly, bedridden or kidney-dialysis patients.

The new estimate of 2,975 dead in the six months after Maria devastated the island in September 2017 was made by researchers with the Milken Institute School of Public Health at George Washington University. It was released Tuesday.

The new estimate of 2,975 dead in the six months after Maria devastated the island in September 2017 and knocked out the entire electrical grid was made by researchers with the Milken Institute School of Public Health at George Washington University. It was released Tuesday.

"We are hopeful that the government will accept this as an official death toll," said Lynn Goldman, dean of the institute. "A lesson from this is that efforts for assistance and recovery need to focus as much as possible on lower-income areas, on people who are older, who are more vulnerable."

The finding is almost twice the government's previous estimate, included in a recent report to Congress, that there were 1,427 more deaths than normal in the three months after the storm.

The George Washington researchers said the official count from the Sept. 20 hurricane was low in part because doctors were not trained in how to classify deaths after a disaster.

The number of deaths from September 2017 to February 2018 was 22 percent higher than the same period in previous years, Goldman said.

The number of dead has political implications for the Trump administration, which was accused of responding half-heartedly to the disaster. Shortly after the storm, when the official death toll stood at 16, President Donald Trump marveled over the small loss of life compared to that of "a real catastrophe like Katrina."

Hurricane Katrina, which struck New Orleans in 2005, was directly responsible for about 1,200 deaths, according to the National Hurricane Center. That does not include indirect deaths of the sort the George Washington researchers counted in Puerto Rico.

Rep. Nydia Velazquez, a New York Democrat, said the report shows the U.S. government failed the people of Puerto Rico.

"These numbers are only the latest to underscore that the federal response to the hurricanes was disastrously inadequate and, as a result, thousands of our fellow American citizens lost their lives," she said in a statement.

There is no national standard for how to count disaster-related deaths. While the National Hurricane Center reports only direct deaths, such as those caused by flying debris or drowning, some local governments may include indirect deaths from such things as heart attacks and house fires.

Researchers with George Washington said they counted deaths over the span of six months — a much longer period than usual — because so many people were without power during that time.

"That caused a number of issues," Goldman said, adding that people were forced to exert themselves physically or were exposed to intense heat without fans or air conditioning. "It's fairly striking that you have so many households without electricity for so long. That's unusual in the U.S. after a disaster."

Puerto Rico's government released data in June showing increases in several illnesses in 2017 that could have been linked to the storm: Cases of sepsis, a serious bloodstream infection usually caused by bacteria, rose from 708 in 2016 to 835 last year. Deaths from diabetes went from 3,151 to 3,250, and deaths from heart illnesses increased from 5,417 to 5,586.

Bethzaida Rosado said government and health care officials were not prepared for the storm, and she is still angry her 76-year-old mother died because oxygen tanks were not available on the island after the hurricane.

"Do you know what it's like to see your mother run out of oxygen?" she said. "I don't wish that on anyone."

Months ago, the Rossello administration stopped updating its official death toll at 64 and ordered the independent investigation amid suspicions the dead were substantially undercounted.

The first phase of the study cost $305,000. In the second phase, the researchers plan to focus on the causes of death.

The researchers found that the risk of death was 45 percent higher for those living in impoverished communities, and that men older than 65 saw a continuous elevated risk of death.

They also reported that physicians and others told them that Puerto Rico's government did not notify them about federal guidelines on how to document deaths related to a major disaster.

"Others expressed reluctance to relate deaths to hurricanes due to concern about the subjectivity of this determination and about liability," the report said.

For the study, the researchers reviewed mortality data, including deaths by age, sex and municipality of residence, from July 2010 to February 2018. They also took into account an 8 percent drop in Puerto Rico's population in the six months after the storm, when tens of thousands fled because of the damage.

However, they did not share details of the methodology, saying those will be released if the study is published in a scientific journal.

"We did not cherry-pick, I can promise you," Goldman said. "We used very rigorous methodology."

The study also found that government emergency plans in place when Maria hit were not designed for hurricanes greater than a Category 1. Maria was a Category 4 with 154 mph winds. Damage was estimated at more than $100 billion.

The researchers made several recommendations, including more emergency planning and government training for doctors on filling out death certificates.

They also said the public health system needs to be strengthened, though Goldman said they don't know yet whether those weaknesses contributed to storm-related deaths.

She added that she has doubts whether Puerto Rico, which is trying to restructure a portion of its more than $70 billion public debt amid a 12-year recession, can adopt any of the recommendations.

"I don't think they have the resources," she said. "That is a very critical issue."

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.</s>An independent investigation ordered by Puerto Rico's government estimates that 2,975 people died within six months as a result of Hurricane Maria.The findings issued Tuesday by the Milken Institute School of Public Health at George Washington University contrast sharply with the official death toll of 64.It's also about double the government's previous interim estimate of 1,400.Researchers say there was a 22 percent overall increase in the number of deaths from September 2017 to February 2018 compared to previous years.They say the initial low counts came partly because physicians lacked training on how to certify deaths after a disaster.They say the elderly and impoverished were most at risk.A spokesman for Puerto Rico Gov. Ricardo Rossello did not immediately return a message for comment.</s>Snapped light poles and storm debris still line the streets of Villa Palmeras in San Juan. Residents here say they've been disappointed with the federal response following Hurricane Maria.

Nearly 3,000 people died in Puerto Rico in the chaotic, grueling aftermath of Hurricane Maria, a toll that far exceeds the original estimates, according to a new study.

From September 2017 to February 2018, 2,975 people died, according to the study by George Washington University's Milken Institute School of Public Health, which was commissioned by the Puerto Rican government.

That total is a dramatic increase from the long-held count of 64, which the administration of Gov. Ricardo Rossello left unchanged in the 11 months since the storm.

Tuesday, Rossello said the study's estimate, for now, would become the official death toll from Maria – making the storm the second-deadliest in U.S. history, trailing only the Galveston, Texas, hurricane that killed more than 6,000 people in 1900.

"It is painful," Rossello said at a news conference. "It's a continuing realization that a lot of people lost their lives, a continuing realization that a lot of people are going through hardships."

He said he ordered the creation of a commission to study how to implement the report's recommendations. The GWU researchers will look at specific cases to determine what causes of deaths were most prevalent in the storm's aftermath, he said.

The study found doctors on the island were ill-equipped to properly classify deaths after a natural disaster and the government failed to prepare them before the 2017 hurricane season.

It found that government emergency plans in place when Maria hit were not designed for hurricanes greater than a Category 1. Maria was a Category 4 with 154-mph winds. Damage was estimated at more than $100 billion.

“The inadequate preparedness and personnel training for crisis and emergency risk communication, combined with numerous barriers to accurate, timely information and factors that increased rumor generation, ultimately decreased the perceived transparency and credibility of the Government of Puerto Rico,” the report said.

The official death toll from Maria has been a point of contention since the storm ripped through the middle of the island Sept. 20, destroying homes and island infrastructure, displacing thousands and plunging the island into a blackout for months.

Maria did not discriminate. People from all social and economic backgrounds perished in the storm, though the death count was proportionately higher for Puerto Ricans in poorer communities and elderly men, according to the report.

"The latest study, commissioned by the Puerto Rican government, puts the tragedy of Hurricane Maria on the same scale as the September 11th attacks," Rep. Bennie Thompson D-Miss., ranking member of the House Committee on Homeland Security, said in a statement. "Because FEMA and the federal government were simply unprepared, thousands of our fellow American citizens have perished – and we now know that the poor and elderly were the most at risk."

Besides those directly killed by the storm, scores of others died when they weren’t able to access hospitals over impassable roads, couldn’t plug in dialysis machines when the island went dark or couldn't cope with the stress after the storm.

The low official death count sparked protests in San Juan and hindered the island's recovery. This year, Puerto Ricans laid thousands of pairs of shoes outside the island’s Capitol building to represent the uncounted dead.

Some media and academic studies estimated the death toll at more than 1,000, and a government report to Congress conceded that there may have been 1,400 more deaths in Puerto Rico after the storm than the previous year.

The Center for Investigative Journalism, Puerto Rico, in a joint project with CNN, is analyzing thousands of post-Maria death certificates to try to determine an accurate death count.

Researchers counted deaths from Maria over the span of six months — a much longer period than usual — because so many people were without power during that time, which probably led to more deaths.

“That caused a number of issues,” said Lynn Goldman, dean of the Milken institute. “It’s fairly striking that you have so many households without electricity for so long. That’s unusual in the U.S. after a disaster.”
A study from the Milken Institute School of Public Health finds that a total of 2,975 people died in Puerto Rico due to Hurricane Maria, bringing the official death toll up from 64.