Phoenix's heat killed more people in 2016 than ever before

Rita Ortiz was a mother who once dug ditches for a cable company to provide for her family.

Katilynn Daniel was a teenage girl who loved to binge watch scary movies with her best friend.

Curtis Goldman was a son who once asked his parents if he could donate all of his bar mitzvah money to charity.

They led divergent lives, but a word within each of their autopsies binds them together in death.

Heat.

Rita Ortiz died after her air-conditioning went out, found by her daughter and grandson lying next to her pool. Katilynn Daniel died after hiking with her grandmother. Curtis Goldman died after he was found in the courtyard of an apartment complex on a 109-degree day in August.

They died because they got too hot.

Last year was the deadliest on record for heat-associated deaths in Maricopa County, according to the Department of Public Health: 150 people are confirmed dead from the heat, with five more cases pending. That’s 65 more people dead from heat than in 2015 and 89 more than in 2014. The second-deadliest year on record was 2012, with 110 heat-associated deaths.

"We were certainly on this very promising trend downward, and now things have changed," said Kate Goodin, an epidemiologist with the Maricopa County Department of Public Health.

The human cost of heat

The Arizona Republic talked to the loved ones of 30 of the people who died of heat in 2016. Click here to read their stories.

No one is immune from the heat

It's easy to dismiss heat in a city where its onslaught is near constant, now with 100 days a year over 100 degrees. But for a rising number of vulnerable residents, the threat is real.

Some people had no place to go, perishing in vacant lots and alleyways before they could escape the heat. Others lived and then died without air-conditioning. A few simply gambled with their ability to tolerate the outdoors in the summer — and lost.

The public-health department began tracking heat-associated deaths more than a decade ago, in 2006. Since then, the heat-surveillance program has given way to astonishingly detailed data about who dies of heat-associated causes in the state’s most populated county.

READ MORE FROM THIS SPECIAL REPORT:

Phoenix's heat is rising — and so is the danger

Even Seattle, Portland are getting hotter

How heat discriminates

Heat's extra toll on people with mental illness

The human cost of heat: 30 stories

In recent years, epidemiologists have broken down everything from air-conditioner status, whether someone was homeless and even if they died in a mobile home.

They are using the data to refine heat-relief projects in the county, to try to get more people off the street and into cooled places like libraries.

But the precise reasons for the spike in deaths from 2015 to 2016 is unknown.

Though 2016 was warm, the heat itself wasn't different enough to cause the spike. "The particular way the temperatures fell seems to have been relatively favorable for avoiding heat-related deaths," David Hondula, a senior sustainability scientist at Arizona State University, said in an email. By that measure the death total should have been about the same as in previous years.

The sudden rise to 150 deaths more likely points to potential blind spots in county and state public-safety nets, an Arizona Republic analysis of these deaths found. The spike coincides with an increased number of men and women sleeping on the street, feeling the heat ripple from the asphalt. The dead are people with mental illness lost in a shuffle of the behavioral-health case-management system. They are vulnerable empty-nesters with broken air-conditioning units. Preteens and visitors to the state who set out on morning and afternoon hikes.

Climate change, experts say, is likely not the primary factor in 2016’s heat-associated deaths, but it is a looming specter ready to charge at the state’s most overlooked populations in the future.

Last year’s deadly summer shows no one is immune to the heat, the most fatal weather event in Arizona. It’s an often underestimated force for state residents known to shrug their shoulders at the thought of yet another blistering summer day, even when those days stretch into fall.

June 8, 2016: A broken A/C

Rita Ortiz wasn’t the first to die of heat last year. Temperatures had already hit a high of 115 degrees on June 4 in Phoenix. By June 8, 2016, the day Ortiz was pronounced dead, at least six cases had rolled through the Maricopa County Medical Examiner’s Office, according to an analysis of heat-related autopsy reports.

If Rita’s family members had known, they would have dragged her out of the house as soon as they heard the air-conditioning was out, her son Jerome Ortiz said. Rita did things her way. She was stubborn and she told her kids if it got too hot, she would jump in the pool to cool off. Someone would come fix the broken air-conditioning.

Like many others, she thought she could endure a few days of heat.

THE HUMAN COST OF HEAT: Rita Ortiz

Rita had worked hard her entire life. When she was younger, she cleaned houses for the U.S. Department of Housing and Urban Development. Anything to help keep a burgeoning family financially afloat. She made sure her kids carried the same work ethic.

“We’re hardworking ... we’re all driven,” said Ariane Gonzales, her youngest daughter.

A broken air-conditioner seems like an inconvenience, not a fatal threat. And Rita was 62, hardly considered elderly. Still, 41 percent of all heat-associated deaths in the county in 2016 were for those age 50 to 64, according to the most recent yearly heat-mortality report from the Maricopa County Department of Public Health.

“As you age in general, your body has a more difficult time regulating temperatures and the normal systems you have that tell your brain: ‘I’m too hot right now, I need to get out of the heat,’ ” said Dr. Rebecca Sunenshine, a medical director with the department.

Acute heat stress was ruled a contributing cause in Rita’s death, according to her autopsy. The main causes were stroke and diseases of the heart, labeled atherosclerotic and hypertensive cardiovascular disease.

Rita struggled with health issues as she got older, but they seemed like normal issues for a woman her age. Her doctor recently noted something abnormal with her heart and scheduled an appointment with a cardiologist, said Luis Ortiz, her husband.

“She never made it.”

Heat and chronic illness

Like many adults who die from heat, other chronic illnesses or diseases play a large role in their deaths. Dr. David Eisenman, a professor of medicine at the University of California, Los Angeles, researches heat illness and heat death. An older population, he said, is particularly vulnerable to heat illness.

“A lot of times, people do not come in with heatstroke, they come in with effects of heat on their chronic illness,” he said. “Typically, somebody is older, already has some heart disease, already has some kidney disease, maybe some diabetes. ... Once they get dehydrated, they go into worsening kidney failure, which cascades to affect their heart and their diabetes, and anything can happen from there.”

Rita was lying by the pool when her daughter, Riley Padilla, and teenage grandson found her. They administered CPR. They called 911.

It was too late.

Rita was pronounced dead at the hospital. She had gone without air-conditioning for about two days, her husband said. He was out of state on a job when she died.

The dead lost an average of 22.7 years of their lives, the public-health department reported. For Rita, those were years lost with her grandchildren, children and husband. The day she was pronounced dead, the high in Phoenix was 108 degrees, June heat familiar to people living in metro Phoenix.

“She underestimated it,” Padilla said. “And we all can underestimate, you know, the temperatures. They sneak up on you.”

July 13, 2016: Summer hiking

By mid-July of 2016, the county’s Department of Public Health was investigating at least 79 heat-associated deaths for the heat season. Ten deaths were already confirmed. In all, at least 44 people died that July.

And not everyone was over the age of 40.

At least three people under the age of 20 died of heat-related causes last year. Two occurred during July hikes. Cody Flom, 12, died of environmental heat exposure after hiking the Sidewinder trail in north Phoenix. Katilynn Daniel was 14, from Washington state. She was hiking with her grandmother, Karen Walls, at Estrella Regional Park in Goodyear.

For at least three months out of the year, often more, setting out on the region's trails becomes a fatal hazard.

Walls sobbed recounting the hike. Kati had forged ahead of her grandmother, so by the time Walls reached her in the parking lot, she was face down on the ground, her glasses lying several feet away from her. Her face was turning purple.

“I tried my best to try to revive her,” Walls said. “I was under distress myself.”

THE HUMAN COST OF HEAT: Katilynn Daniel

The loss was devastating for her parents, both in Washington.

“It’s something I don’t see ever getting over,” said her father, Jason Daniel, his voice cracking.

At least two other out-of-state hikers died of heat-related causes. One of them, Remo Pancaldi, was a 26-year-old hiker from Switzerland, according to his autopsy report. At the hospital, he had a body temperature of 109.1 degrees. It was Sept. 9.

“You have to become inured to heat in the summer in Maricopa County,” said Dr. Diana Pettiti, a professor at University of Arizona’s medical school.

Pettiti said even athletes can underestimate heat’s effects on the body. But hyperthermia — when the body stops normally regulating heat and its temperature increases — can impact anyone, at any age.

Walls wonders if the trails should be shut down after the temperature outside hits 90 degrees.

Dawna Taylor, a spokeswoman for Maricopa County’s Parks and Recreation Department, said the department does have signage up on trails and online campaigns warning of extreme heat. But shutting down the parks would be “almost impossible” logistically, especially for parks like Estrella, where five employees oversee more than 19,000 acres.

It’s difficult to fear heat. You can't see it.

“Monsoons, everyone sees, it’s dramatic,” Eisenman said. “But the heat is invisible and we kind of just, we have a part of our brain that does not get scared by just these kind of quotidian risks like heat.”

July 20, 2016: No air-conditioning

Ten days. For 10 days in July, almost no one saw Henry Magos. His autopsy report last documents him alive on July 10, when a co-worker saw him at the marble shop where he worked. His sister, Esperanza Magos, said a neighbor spotted him on July 18. He didn't look good.

His sister discovered him dead on July 20.

The Maricopa County Medical Examiner's Office ruled the cause of Henry's death as complications of environmental heat exposure. Before he died, Esperanza warned him that the coming days were supposed to be hot. Temperatures on five of those 10 days reached 110 degrees.

Henry was used to living without air-conditioning. He lived a simple life in an old house in south Phoenix, using swamp coolers.

"He struggled with money, and that’s a big problem when you’re always barely making ends meet," his sister said.

THE HUMAN COST OF HEAT: Henry Magos

In some pockets of Phoenix, old houses have no air-conditioning. And even in the ones that do, families struggle to afford its toll on their electric bill.

When she found her brother's body, his electricity was out. Records show it had been out for eight days.

Henry used a pay-as-you-go electricity plan. When he needed to add money to his account, he went to Food City to add funds through a plastic card issued by his electricity provider, Salt River Project. According to company records, someone purchased $10 in credit for Henry's account on June 25. It was the last time the account would be refilled before his meter self-disconnected on July 12.

Scott Harelson, a spokesman for SRP, said in an email that the company’s policy is not to disconnect electricity when the National Weather Service issues an excessive-heat warning. There were no excessive-heat warnings in the 10 days when Henry was not seen. This year is the first SRP has included pay-as-you-go plans in this policy.

Harelson said customers should call the company if they are having financial trouble, noting that resource counselors assist more than 20,000 people every year.

Esperanza believes her brother was too sick to refill his account before he died. She said she called the company after his death and a representative told her that he should have called. He did not have a phone. She thinks he was too weak to take the bus to Food City.

Last July, SRP involuntarily disconnected power to 5,220 customers, a number that amounts to 0.61 percent — less than 1 percent — of the company’s total customers. Harelson said many disconnections occur in vacant homes, when a customer has already left.

"If we know there's a circumstance, whether it's medical or financial, there are things that we can do," he said. "Let us know in advance."

Aug. 13, 2016: Heat and mental health

Medical officials began to harvest Curtis Goldman's organs on Aug. 13. Before then, the county medical examiner investigated at least one heat-related death every day that month except for one. Sometimes, there were several in one day. There were four on Aug. 3.

Curtis’ death came after a long battle with homelessness and mental illness, his mother, Deborah Goldman, said.

THE HUMAN COST OF HEAT: Curtis Goldman

He was likely homeless when officials found him lying in the hot courtyard of an apartment complex on Aug. 8, alive, but barely. His skin was “warm, dry and pink,” his autopsy reported noted. He was in acute respiratory failure.

His death was grueling, drawn-out in an Abrazo Heart Hospital room as his mother, who flew in from New York, and other family members collected at his bedside.

Curtis was diagnosed as having schizophrenia, Deborah said. He had spent years incarcerated and in the state’s behavioral-health system. Often, when he wasn’t in jail or prison, he was homeless.

Deborah tried to help. She couldn’t get through to him. Sometimes it felt like his death was a tragic, foregone conclusion.

“I just knew this was coming,” she said. “I had been involved in watching Curtis’ case management for years.”

Out of the 150 heat-associated deaths, at least 23 autopsy reports said the deceased had a history of mental illness.

In a June 2013 survey from Arizona State University's Morrison Institute, 37 percent of the homeless people in Arizona said they had been treated for mental illness and 14 percent said mental health was a reason why they were homeless.

The increase in the number of homeless deaths was one of the most staggering changes in heat-associated deaths from 2015 to 2016. In 2015, just 10 percent of all heat-associated deaths were of people experiencing homelessness. In 2016, that number rose to 33 percent, with at least 43 dead.

A housing crisis and homelessness

The heat-surveillance program at the Maricopa County Department of Public Health had started because of homeless deaths in the first place, said Goodin, the epidemiologist.

That first year, 2006, 38 percent of all heat-associated deaths were of people experiencing homelessness. After that, the percentage dropped precipitously, averaging about 11.5 percent over 2012 to 2015. It seemed like community-wide interventions were working, she said.

Then, 2016.

“We had nothing really about how we were providing services or how things were being accessed. ... So we had been expecting for the trend to stay the same if not continue to decrease,” Goodin said.

Street homelessness jumped by 27.7 percent from 2015 to 2016, according to point-in-time count data from the Maricopa Association of Governments, though those counts can fluctuate.

When asked about that statistic, Sunenshine, with public health, wrote in an email: "As with all epidemiology data, we can’t say that one circumstance definitively led to the other but I think it’s safe to say that lack of shelter along with rising temperatures likely contributed to increased deaths among the homeless."

The jump could point to a burgeoning housing crisis, said Leanette Henagan, the chief integration officer at Partners in Recovery. The organization is a behavioral-health-care provider in Maricopa County, which sees thousands of people with serious mental illnesses each year.

Housing plays a role in behavioral-health case management. Staff members are often assigned to help clients find housing, which has become more of a challenge in recent years. Affordable-housing cuts, too, seem to be making an impact, staffers speculated.

“Now the system is stressed because you have an additional population of people coming into the system of homelessness,” Henagan said.

THE HOUSING CRISIS:

PART 1: Can't afford the rent, can't afford to move

PART 2: Lack of affordable housing spurs renters to settle

PART 3: Eviction rates rise as affordable housing dwindles

PART 4: Renters often stuck between help and affordability

The organization does its best to help clients battle heat in the summer months, placing people in hotels or footing the bill to get electricity turned back on. One psychiatrist at a downtown location of Partners in Recovery, Dr. Winona Belmonte, said she keeps a box of sunblock in her office to hand out.

While downtown Phoenix experiences more development, Henagan said she’s also noticed that it gets harder for the homeless population to find shaded spots.

At night, heat radiates from the concrete. For the human body, a constant barrage of heat is hard to survive, according to Eisenman.

“If you don’t cool down eventually, if you don’t get some amount of cooldown during your day in 24 hours, then you’re at risk,” he said.

A year later: Aug. 27, 2017

On a hot Sunday afternoon later in August, Marcus Allen sat in a blue chair in Margaret T. Hance Park. The sun peeked through the tree that shaded him. It’s his third summer living in Arizona. He's homeless.

“I’m from Colorado, I’m not used to this kind of heat,” he said. He moved here for a job that fell through. He's stuck in Arizona, with no money to return.

Yes, he said, he knows people who have died over the last two years, he believes from heat. Their deaths — two women and one man, three of his closest friends — were heart-wrenching for Allen.

The man, he remembered, seemed sick and upset before he died.

“The combination of the heat, and the lack of water and the lack of rest, probably contributed to him passing away,” Allensaid.

He declined to give their names.

But names from last year jump off page after page of the autopsy reports. Suzanne O’Banion, whose daughter lost track of her after mental illness spiraled. Roger Rutenber, a father of three lost in drug addiction and found dead in an alley. Nora Nemmers, living in a double-wide mobile home with no electricity or running water.

Heat-associated deaths did not stop coming into the Medical Examiner’s Office until November of last year.

And the cases picked back up again in March.

So far, 64 are confirmed dead with heat as a factor this year, with 119 deaths pending. MAG counted 413 more people sleeping on the street from 2016 to 2017.

Dallas County, Texas’ public-health department tracks heat-associated deaths, too. But, like the temperatures in Dallas, the statistics are more temperate. Just one person died of heat-associated causes last year, two in 2015.

Goodin said part of the reason the number of deaths likely swell and recede from year to year has to do with public awareness. When communities are talking about the risk of heat-associated death, they are likely to be more cautious.

Eisenman believes prevention is relatively simple: getting the most vulnerable people out of the heat and into cool spaces. The problem, he said, will magnify with climate change. But no one should die from heat.

“If you've got 150 deaths," he said, "those are 150 deaths that are unnecessary.”

READ THE REST OF THE SERIES:

PART 1: Phoenix's heat is rising — and so is the danger

PART 2: How heat discriminates

The human cost of heat: 30 stories

Environmental coverage on azcentral.com and in The Arizona Republic is supported by a grant from the Nina Mason Pulliam Charitable Trust. Follow The Republic environmental reporting team at OurGrandAZ on Facebook, Twitter and Instagram.