Florida officially recorded 123 fatalities from last year's hurricanes, but the federal government has paid funeral expenses for at least 315 deaths, including those of a man who shot himself and a stroke victim hospitalized more than a week before the last storm hit.
In one case, a Federal Emergency Management Agency worker tried unsuccessfully to persuade a coroner to count among the hurricane casualties a "morbidly obese" heart patient who purportedly was "scared to death."
"If you were to call around to all the medical examiner offices, people would say, `No way did we have as many deaths as FEMA is saying,'" said Dr. Stephen Nelson, head of Florida's Medical Examiners Commission. "It's just an incredible number -- a difference of 192. This is the Free Funeral Payment Act."
The discrepancy is even greater because the families of some victims counted as storm casualties by the medical examiner said they received no help from FEMA, the South Florida Sun-Sentinel found in its continuing investigation of hurricane aid.
FEMA officials declined requests for an interview, instead releasing a statement: "FEMA is in Florida to help the victims of the worst series of hurricane disasters in over 100 years, including helping those families who have suffered the loss of loved ones to this disaster."
The newspaper's analysis of FEMA claims in Florida shows the government paid $1.27 million for storm-related funerals as of March 10. The agency refuses to identify recipients of disaster aid, including those with funeral-related expenses, citing privacy laws. The Sun-Sentinel has filed a federal lawsuit to force release of the names.
Funeral eligibility is "not based exclusively on medical or coroner reports," FEMA's statement said. "FEMA may contact organizations like the Red Cross, hospitals, coroners' offices, police and fire departments, and/or ambulance companies for additional details."
The state's medical examiners said their records constitute the official death toll from the storms. "We're the keepers of the count," Nelson said.
In Palm Beach County, where FEMA paid 39 funeral claims from hurricanes Frances and Jeanne, the medical examiner recorded a total of eight storm-related deaths, the biggest gap in the state.
"I don't know where [FEMA] came up with those numbers," said Dr. Michael Bell, the county's medical examiner. Applicants are "probably inflating it so they get more money."
In Miami-Dade County, where FEMA's payment for a funeral last fall fueled suspicions of fraud, the agency has since approved four more funerals from Frances. The Labor Day weekend storm made landfall 100 miles to the north, and the county medical examiner recorded no Frances-related deaths.
After learning from the newspaper of the number of funeral payments statewide, Nelson said he will urge the Medical Examiners Commission at its April 27 meeting to press the government for information about the death claims.
"If in fact FEMA has 192 extra cases, and they're basically not providing information to the medical examiners in those counties ... we as a commission want to know, what are the circumstances that FEMA believes [are] storm-related?" Nelson said.
"What kind of proof are they [requiring] to disburse federal funds?" Nelson added. "Can I just call and say Aunt Myrtle's death was hurricane-related?"
The agency's hurricane payments are already under investigation by a U.S. Senate committee, prompted by legislators' concerns over $31 million given to Miami-Dade residents after Frances. Last month, 14 FEMA aid recipients in the county were arrested on federal fraud charges.
The bulk of disaster aid in Miami-Dade went for appliances, TVs and other items residents claimed were damaged by Frances, even though the storm brought no hurricane conditions to the county. The government approved $23,608 for the five funeral claims in Miami-Dade.
FEMA pays for funerals, burial, cremation and other expenses "related to a death caused by the disaster" for families with no insurance to cover the costs, according to its Web site.
"Disaster-related deaths are not limited to only those deaths that occur during the actual event," FEMA said in its statement to the newspaper. "Someone may die of a heart attack while cleaning up heavy disaster debris, from injuries sustained in a fall while repairing a damaged roof, or trauma suffered from dangers."
Medical examiners use the same criteria when ruling deaths as storm-related, Nelson said.
His Central Florida district, encompassing Polk, Hardee and Highlands counties, got hit by three of the four hurricanes. FEMA paid 23 funeral claims in those counties; the medical examiner certified 19 storm-related deaths.
After the storms, Nelson said, FEMA and American Red Cross representatives "inundated" his office with requests to link additional deaths to the hurricanes.
"In almost every instance, their phone call or fax was the first we even heard of these deaths," Nelson said. "The only thing they could tell us that would even make this storm-related was maybe they had a heart attack or just happened to die at the time of the storm. ... We finally told them, `That sounds a lot like fraud to us.'"
One FEMA worker, Mary Ann Carlisle, stopped by Nelson's office, asking the medical examiner to reconsider his finding of natural death for Annie Brown Nichols and to attribute it to the hurricanes.
"The family says the stress of the two storms were too much for her and she was literally `scared to death,'" an employee of Nelson's wrote in a note to him about Carlisle's Oct. 21 visit. "If you could just write one line ... FEMA could pay funeral expenses and help this family."
Nichols, 61, of Haines City, had been diagnosed with congestive heart failure five years before her death, said her daughter, Vera Lorrain Tarver of Auburndale, Polk County. Nichols' death certificate says she died of a heart attack and notes that she was "morbidly obese," Tarver said.
To collect disaster assistance for her mother's funeral, FEMA's Carlisle told her all she needed was "a paper signed by the medical examiner," Tarver said.
Carlisle tried to make it easy for the medical examiner, providing "sample letters" he could use as a guide.
"Mr. James Doe, a patient under my care during Hurricane [blank], was terminally ill when evacuated from his home," said FEMA's sample letter from a doctor. "The stress and trauma of the storm and evacuation may have, in my opinion, hastened his demise. Any help you can give Mrs. James Doe would be greatly appreciated."
Carlisle even included a sample letter for terminally ill hospice patients.
Nelson refused to classify the death as storm-related, writing in his files, "BS!"
FEMA denied the funeral claim, Tarver said.
Reached at her home in Texas on Friday, Carlisle said she didn't "even remember that case," and referred questions to FEMA.
In Avon Park, Highlands County, FEMA paid the funeral expenses of a stroke victim even though the medical examiner ruled it was unrelated to the storms.
Irma Cruz suffered from high blood pressure, heart disease and diabetes.
Eight days before Hurricane Jeanne, Cruz, 62, suffered a stroke, her second in a year, and died at a local hospital the day the storm came ashore.
Cruz spent Frances in a shelter, said her daughter, Wanda Colon. A shelter worker told Colon her mother was "very afraid."
"When she heard about Jeanne, she got very scared," Colon said.
Colon never thought to ask FEMA for help. But when she filed a damage claim on her home, a government worker asked if she had funeral expenses.
"I said, `Well, my momma, she died the same day of the hurricane,'" Colon said. "They say, `If you bring the paper, FEMA will pay.'"
Cruz's death certificate listed high blood pressure as the cause of death, Colon said.
Colon obtained a letter from her mother's doctor, who wrote that she "became decompensated in a local shelter" and developed accelerated high blood pressure and a stroke.
FEMA gave Colon about $7,000 for her mother's funeral, she said.
Medical Examiner Nelson still does not consider Cruz's death a result of the hurricane.
"Nowhere in any of the medical records that I have does anyone even raise the issue that her death may/might be related to a hurricane," he said. "She'd already been in the hospital for eight days before the hurricane even made land."
Michael Vierthaler of Madison, Wisconsin, was devastated but not surprised when his brother, Paul, of Innerarity Point, shot himself in the head Sept. 19, three days after Hurricane Ivan struck.
"He was struggling with mental problems," Michael Vierthaler said. "He was bipolar. And we had done some interventions with his drinking and stuff. I knew eventually this would probably happen."
According to Michael Vierthaler, a portion of a note his brother, 55, left to his children, states: "It's not Hurricane Ivan. Those are really good cleansing things. I'm just not happy anymore and am pretty much isolated from the world."
But Buddy NeSmith, an investigator with the Escambia Sheriff's Office, thought the death could be storm-related, referencing another part of the note. "Basically he said that he'd been having problems and that with the damage from the storm he felt like the little people were not, the government wasn't going to help the little people and it was no use going on," NeSmith said.
The Medical Examiner's Office in Pensacola, with input from the Sheriff's Office, initially ruled the death as hurricane-related, but then reversed that opinion on Oct. 6.
In early January, Michael Vierthaler said he received about $2,300 from FEMA.
The Sun-Sentinel found five families whose relatives were included in the official death count but did not receive FEMA funeral assistance.
One of them was Dutch Cole, whose body was found floating in the Intracoastal Waterway in West Palm Beach after Frances. A resident of a nearby assisted living facility and blind in one eye, Cole liked to help boaters launch their vessels at the local boat ramp, said daughter Wanda Cole of Marietta, Ga.
FEMA turned down the family's request for help with Cole's funeral, she said.
"They said it was a waiting list," Wanda Cole said. "Due to the fact we was in Georgia, they couldn't help us."
Cole's family borrowed $2,800 to bury him in West Palm Beach.
Staff Researchers Barbara Hijek and William Lucey contributed to this report. Sally Kestin can be reached at email@example.com or 954-356-4510.