The FBI is assisting Dominican authorities in probing the deaths; the results of toxicology studies are expected in the coming days. But the families have ordered autopsies of their own, and in the case of the Maryland couple, at least, a separate toxicology study.
“The family wants to know the truth,” said Steven Bullock, who is representing the survivors of Cynthia Ann Day and Nathaniel Edward Holmes. “They don’t want investigations to be skewed. I’m not suggesting that would be the case, but they simply want to take no chances.”
Day, 49, and Holmes, 63, were found dead May 30 in their room at the Grand Bahia Principe La Romana. Miranda Schaup-Werner, 41, died five days earlier at the neighboring Luxury Bahia Principe Bouganville.
The Bahia Principe company, which owns the hotels, is waiting for toxicology results “to determine what caused the deaths and whether there’s any link,” a spokesman said.
The State Department has confirmed the deaths of 11 U.S. citizens in the past year and a half. U.S. and Dominican officials say that’s not an unusual number for an island that receives more than 2 million Americans annually.
Dominican Tourism Minister Francisco Javier Garcia has said all of the deaths appeared to have been from natural causes, and the number of Americans who have died there has fallen by more than half in the past three years.
Dominican officials say preliminary autopsy findings show that Schaup-Werner died of a heart attack. Medical examiners concluded that the death was “purely natural.” Santos Jimenez Paez, the forensic doctor who examined her body in Santo Domingo, said it showed “no signs of intoxication of any kind.”
Her family is waiting for the results of an independent investigation in the United States, attorney Joseph Cullen said.
The deaths together of Day and Holmes remain unexplained.
“We were all surprised that they had died together,” said the medical examiner who performed autopsies on the couple in the Dominican Republic. She spoke on the condition of anonymity because she was not authorized to comment publicly.
“We found that they were both hypertense, but it’s still extremely weird that they both died at the same time.”
The examiner said there was no indication of violence, and pesticide poisoning — one theory — seemed unlikely because the hotel was full and no other deaths were reported during those days.
Before Day died, according to Bullock, the attorney, she asked an American friend at another resort to bring her a medication to control diarrhea. Day told her that she and Holmes were feverish and vomiting, Bullock said, and asked that she extend their stay because they couldn’t travel in their condition.
Day and Holmes were engaged to be married. Their funerals were this week.
“The family is devastated,” Bullock said. “They are hoping to know exactly what happened and move forward. We expect our results and the FBI results will achieve that, and that they will coincide.”
Media coverage of the deaths has led hundreds of people to report to the website iwaspoisoned.com illnesses they say the suffered while traveling in the Dominican Republic. Many said they suspected tainted alcohol or pesticides. None of the reports were independently verified by The Washington Post, and there is no evidence to link them to any of the deaths. Officials and doctors in the Dominican Republic say they have not seen an unusual number of illnesses among tourists.
Hal King, an infectious diseases specialist and public health consultant based in Georgia, said pesticide poisoning could cause illnesses and deaths — but the fact that the deaths took place in different hotels reduces the likelihood of any connection.
“I want to be clear,” he said. “No conclusion can be made without epidemiological data. For now, we can only speculate.”
Barbarajean Magnani, director of toxicology at the Tufts Medical Center in Boston and chair of the toxicology committee of the College of American Pathologists, said pathologists ordinarily decide what to test for based on the symptoms the victims reported before dying.
In cases where pesticide poisoning is suspected, she said, investigators could look for enzyme activity in red blood cells. In cases where tainted alcohol is suspected, they could look for the presence of methanol.
Correction: An earlier version of this article misidentified the couple that was engaged to be married before they died in the Dominican Republic. The couple was Cynthia Ann Day and Nathaniel Edward Holmes.