This report has been updated.
The news out of the Dominican Republic just keeps getting stranger. Following a slew of American tourist deaths in resorts throughout the country, the questions began piling up.
Here’s what we know about the recent deaths — and what we still don’t know.
How many Americans have died under mysterious circumstances in the Dominican Republic this year?
According to news reports and the U.S. State Department, 10 Americans have become ill and died this year in the Dominican Republic, under circumstances that are prompting questions.
The first three to gain widespread attention happened in close proximity, both in time and place, in neighboring resorts on the southern coast that shared an owner. Miranda Schaup-Werner, a 41-year-old from Pennsylvania, checked into the Luxury Bahia Principe Bouganville on May 25 and started to feel sick after taking a drink from the minibar. She died within a couple of hours.
Maryland residents Cynthia Ann Day, 49, and Nathaniel Edward Holmes, 63, were supposed to have checked out of the neighboring Grand Bahia Principe La Romana on May 30 when a hotel worker found them dead in their room.
After word of their deaths made news, family members of vacationers who died earlier in the year started sharing their stories.
Family members told WKYC in Ohio that 78-year-old Jerry Curran, a retiree who lived in Florida, died in January after falling ill on the island.
Tracy Jester Jr., 31, of Georgia, died March 17 during a vacation with his sister, his mother told ABC News. She told the network that the death certificate for her son, who had lupus, said he died of respiratory issues. The night before Jester’s death, he told his mother he drank soda that didn’t taste right, she told WSB-TV in Atlanta. According to news reports, he vomited and complained that he couldn’t breathe before he died.
67-year-old Robert Bell Wallace, of California, died unexpectedly after getting sick at the Hard Rock Hotel & Casino in Punta Cana on April 14, a family member told Fox News. The family member said Wallace became ill after drinking a scotch from the minibar.
The U.S. State Department confirmed that a Staten Island woman, Leyla Cox, died June 11. Her son told NBC News that he questioned the ruling that his mother, who was 53, died of a heart attack.
Joseph Allen, 55, of New Jersey, was found dead in his room June 13 at the Terra Linda Resort in Sosua, on the country’s northern coast, his sister told ABC.
The total grew again the following weekend. Family members told News 12 in Long Island that Vittorio Caruso, 56, of New York, died in the country on June 17. Citing police, CNN reported that Caruso died at a hospital in Santo Domingo of respiratory failure, though autopsy results were pending.
News of another death came the following week. Family of Khalid Adkins, a father of two from Denver, told KDVR Fox 31 that he was sick on Sunday when he tried to fly back to the United States, but was forced to get off the plane because of his illness. He was taken to a hospital in Santo Domingo with respiratory problems and failing kidneys. In response to a question about Adkins, the State Department confirmed the June 25 death of a U.S. citizen in the Dominican Republic.
What caused the deaths?
Officials have not said what caused Wallace’s death; his stepson said that family members are expecting toxicology reports by the end of June.
Government officials said June 6 that autopsy results showed that Schaup-Werner, Day and Holmes all had enlarged hearts, internal bleeding and pulmonary edema, or fluid in the lungs. According to the hotel, Schaup-Werner’s husband said she had had a heart condition. But a family spokesman told Fox News she had been treated for an issue 15 years ago and was healthy ever since. Prescription drugs, including blood pressure medication and five-milligram doses of the painkiller oxycodone, were found in the room that Day and Holmes had been staying in.
More information will be known when results of toxicology tests, which check for drugs, alcohol, poison and other toxic substances in the body, are available.
How long will those tests take?
In the United States, comprehensive toxicology results are usually available in approximately two weeks, according to Laura Labay, a forensic toxicologist and director of toxicological services at NMS Labs in Pennsylvania. But depending on what the results show and how much more testing needs to be done, she says that time frame could expand into six to eight weeks — which means family members might still be waiting for answers in late July.
Labay says that if tests show a positive result for some kind of drug or other substance, then that would need to be confirmed through additional testing. And an initial negative result could prompt further analysis. “If you have a case where you suspect it’s some kind of drug or chemical exposure that’s caused a death and the initial round is negative, you probably will go on to do more specialized testing.”
Francisco Javier García, the country’s tourism minister, said in late June that the results in the cases of Schaup-Werner, Holmes and Day were expected within 30 to 40 days, in the middle or end of July.
Didn’t other tourists say they got sick, too?
Many have, and more seem to be cropping up every day. A couple from Colorado — 29-year-old Kaylynn Knull and 33-year-old Tom Schwander — told CNN they got terribly sick during a visit to the Grand Bahia Principe La Romana in June of last year. They have since sued the hotel’s ownership, claiming they were exposed to chemicals typically found in pesticides, CNN reported. Visitors from Georgia, Florida, Pennsylvania and New York have also told news outlets that they got sick at resorts in the country between June 2018 and May of this year.
Nearly 50 Jimmy Buffett fans — on a trip with the Central Oklahoma Parrothead Association — reportedly got sick in April while staying at the Hotel Riu Palace Macao in Punta Cana, a travel agent who is also a group member told KFOR.
The site iwaspoisoned.com includes recent claims from more than 1,000 users who said they got sick in the Dominican Republic, though some of those cases dated back months or even years.
Family members of at least three other people who died in the country of heart attacks between July of last year and this April have also come forward since hearing news of the recent deaths.
Friends and family of 41-year-old Chris Palmer, of Kansas, told Fox News he died April 18, 2018, in Punta Cana. They said they were told he died of a heart attack and also had fluid in his lungs.
Another Pennsylvania woman, 51-year-old Yvette Monique Sport, died unexpectedly in June of last year during her stay at a Bahia Principe resort in Punta Cana, her sister told WTFX Fox 29. The sister, Felecia Nieves, said the official cause of death was listed as a heart attack; Sport drank from the minibar before she died, Nieves said.
And Brandywine, Md., resident Dawn McCoy told The Washington Post her husband, David Harrison, died at the Hard Rock in Punta Cana — the same place Wallace fell ill — in July of last year. He had a heart attack, but an autopsy showed he also had fluid in his lungs, as did the three tourists who died most recently.
What are U.S. authorities doing?
The FBI confirmed that it is “assisting the Dominican authorities with their investigation.” According to the U.S. Embassy in the Dominican Republic, local authorities asked for FBI help for “further toxicology analysis on the recent Bahia Principe, La Romana cases” — results that the FBI said could take up to 30 days.
“The U.S. Embassy in Santo Domingo is actively working with the Government of the Dominican Republic and the private sector at the highest levels to ensure that U.S. citizens are safe and feel safe while in the Dominican Republic,” the embassy said in a statement.
The State Department also said representatives helped officials in the country get in touch with the families of Day and Holmes and arrange for their bodies to be sent back home.
Department officials have said they have not seen unusually high numbers of deaths in the Dominican Republic and noted that the death rate there is not higher than in the United States.
Still, Rep. Frank Pallone Jr. (D-N.J.) has asked the State Department to reassess its safety information for the country.
On Thursday, Rep. Adriano Espaillat (D-N.Y.) told The Washington Post he planned to meet with officials to discuss the situation during a previously scheduled trip to the Dominican Republic in July. Espaillat, who is Dominican American, said he still believes the country is safe, but he wants the families of those who died to have answers.
“I do feel for the families and the fact that they lost loved ones,” he says. “And we should have the FBI, if possible, investigate each and every one of the cases and get to the bottom of them.”
Is the Dominican Republic safe for tourists?
According to the U.S. State Department, Americans should use increased caution because of crime. The country is ranked as a “Level 2” out of four under the advisory system for foreign destinations.
“Violent crime, including armed robbery, homicide and sexual assault, is a concern throughout the Dominican Republic,” a travel advisory says, noting that resort areas tend to have more of a police presence than urban areas such as Santo Domingo. “The wide availability of weapons, the use and trade of illicit drugs, and a weak criminal justice system contribute to the high level of criminality on the broader scale.”
The State Department also warns travelers not to drink alcohol alone or with new acquaintances, or to leave drinks unattended. It also cautions that U.S. citizens have been the targets of “date-rape drugs” at parties and resorts.
In a statement in June, the Hard Rock Hotel & Casino in Punta Cana said it would take several steps based on feedback from guests “to improve the experience and enhance safety moving forward.” Those include removing liquor dispensers from guest rooms, bringing in a U.S.-based health-care facility to examine the on-site clinic, and bringing in experts from a lab in the United States to inspect and test food, drinks and public areas.
Meanwhile, two high-profile crimes have drawn fresh scrutiny. David Ortiz, the retired Boston Red Sox player, was shot and wounded June 9 in Santo Domingo. And Delaware resident Tammy Lawrence-Daley, 51, reported that she was viciously beaten at a Punta Cana resort in January. The property, the Majestic Elegance Punta Cana, has questioned her account.
Experts have urged travelers not to avoid the country, arguing that a handful of cases shouldn’t taint the entire destination.
On June 21, the tourism minister criticized the recent extensive media coverage during a news conference.
“It’s not true that these deaths were mysterious,” García said. “Science also exists here in the Dominican Republic. We have determined the cause of death of all the deaths that have happened here.”
The Dominican Republic Ministry of Tourism announced Thursday that it is introducing new measures to reassure tourists about their safety. Those changes include establishing an emergency center for tourists in Punta Cana; requiring hotels to post contact information for emergency services in every guest room; and adding more hotel inspections, which will include a requirement that operators demonstrate “detailed food handling protocols” and provide information on all suppliers of food and drinks.
How safe has the country typically been for U.S. visitors?
Between the beginning of 2017 and the end of 2018, 30 Americans died in the Dominican Republic of nonnatural causes, according to the State Department. Those deaths were caused by drowning, accidents, suicide and homicide.
Last year, nearly 6.6 million people visited the country; more than 2.3 million of those were from the United States.
What happens if travelers cancel an upcoming trip to the Dominican Republic?
They may have to pay some fees. Individual hotels have varying policies about how far in advance cancellations are allowed without penalty. But airlines including American and United have said they will work with passengers who want to cancel on a case-by-case basis.
Delta is allowing travelers with flights to Punta Cana between June 21 and Aug. 15 to change to a different flight without having to pay a change fee, though passengers will have to pay any difference in fare. They can also cancel their trip and put the value toward a future flight, but would have to pay a fee and the fare difference.
JetBlue said in June it is waiving fees to change flights to, and from, the Dominican Republic. The airline will not charge a cancellation fee for anyone who cancels their flight; those travelers will get a credit for future JetBlue trips.
And then there’s the safety net of travel insurance, but travelers must have chosen the option that allows them cancel for any reason when initially booking the trip. With that coverage, a traveler can get back the bulk (but not all) of the money they spent.
[Editor’s note: This report will be continually updated.]
Allyson Chiu, Deanna Paul, Drea Cornejo, Isaac Stanley-Becker, Rick Noack, Arelis R. Hernández, Marisa Iati, Kyle Swenson, Eli Rosenberg, Dave Sheinin, Cindy Boren, Des Bieler, Andrea Sachs, Rachelle Krygier, Anthony Faiola, Lindsey Bever, Alex Horton and Maite Fernández contributed to this report.