The Dominican Republic is fast becoming known for something more than its pearl-white coastline - the mysterious deaths of American tourists.
Another American has died at a Dominican resort, the fourth in the last year, raising alarm among US tourists and the island-tourism industry that relies heavily on them.
The increasing number of mysterious deaths and reported sudden illness at resorts in the Dominican Republic have drawn unsettling attention to the nation of 10 million, prompting government officials there and the US ambassador to reassure travellers that the country is safe.
More Americans have visited the tropical island nation - with its value travel packages to all-inclusive resorts - in recent years than France, US Embassy officials said.
In the most recent reported incident, the State Department confirmed that an American tourist died but did not identify the person.
Fox News Channel, citing a relative, identified the tourist as Robert Bell Wallace. The California man died in April after becoming ill at a Hard Rock Hotel & Casino in Punta Cana. Wallace, 67, of California, became ill almost immediately after he had a scotch from the room minibar, his niece, Chloe Arnold, told Fox News.
An obituary for the 67-year-old said he "passed unexpectedly while vacationing in the Dominican Republic" on April 14. He was in the country to attend a wedding, according to the news network when he nearly immediately fell sick after going to his resort and died.
Miranda Schaup-Werner, 41, Allentown, Pennsylvania, was celebrating her 10th wedding anniversary when she died on May 25 within 24 hours of arriving at her hotel room.
Nathaniel Edward Holmes, 63, and Cynthia Ann Day, 49, both of Prince George's County in Maryland, had just become engaged before their Dominican trip. They were found dead in their room on May 30.
Amid the turmoil stirred by the tourist deaths, Red Sox legend David "Big Papi" Ortiz was shot in the back on Monday during an ambush at an outdoor restaurant and bar patio in the Dominican capital city.
The former major league slugger was flown to Boston for further treatment and local police say they have arrested one of two alleged attackers.
The spate of bad news from the Caribbean country has some American tourists reflecting afresh on their own tragic experiences.
Dawn McCoy of Brandywine, Maryland, has travelled many times to the same hotel where Wallace reportedly died.
Her husband, David Harrison, loved the resort and went as often as time permitted. The 45-year-old died there in July 2018 after unexpectedly falling ill. But at the time, his wife accepted the autopsy results showing that he had died of a heart attack.
McCoy had planned to honour her husband by revisiting the resort in mid-May with her son. But she cancelled after news broke of the death of the couple from her home county of Prince George's.
"That was his paradise," said McCoy, who works in a law office in suburban Washington. "We had booked the reservation. We enjoyed going there so much. But that was before, when I thought his death was just a fluke."
In three of the four death cases, the Dominican National Police released autopsy results citing similar causes of death for Schaup-Werner, Holmes and Day.
Dominican police and the attorney-general's office declined to comment until toxicology reports, which could take a month to complete, are released publicly. The FBI is assisting with those tests, according to the State Department.
The Hard Rock resort could not be reached to comment. A relative of Wallace's declined to comment to the Washington Post.
Local officials have offered reassurances as the disturbing news has gone global and imperiled a crucial sector of their economy.
Dominican officials have insisted that the island is safe, noting that more than two million Americans visit its beaches each year, accounting for about a third of the tourist population each year, according to the country's Tourism Ministry. Attorney-General Jean Alain Rodríguez told local journalists after the attack on Ortiz that the Dominican Republic is "secure but definitely has many challenges," according to a video published on the Listin Diario news site.
Francisco Javier Garcia, the country's Minister of Tourism, suggested that the deaths may simply be a coincidence.
"Sometimes in life there can be a law of sequences," he told reporters at a news conference last week. "Sometimes, nothing may happen to you in a year. But in another week, three things might happen to you."
The deaths appear isolated, according to Dominican National Police, and no link has been made between them. But the similarities, proximity and frequency of death among relatively healthy American tourists troubles McCoy.
Schaup-Werner fell ill shortly after consuming a drink from the hotel minibar at the Luxury Bahia Principe Bouganville in La Romana, a beach town about 110km west of Punta Cana. She was taking pictures on the room balcony and preparing for dinner when she became ill.
In a statement, the hotel said Schaup-Werner had died of a heart attack, adding that her husband confirmed that she had "a history of heart conditions." The Dominican's attorney-general's office released more details describing the woman's lungs filling up with liquid and her heart failing as a result.
Five days later, the bodies of Day and Holmes were found in their hotel room at the nearby Grand Bahia Principe La Romana on May 30. The couple became sick the night before, complaining of diarrhea, vomiting and sweating, said Steven Bullock, the families' lawyer. Bullock said they asked to see the hotel doctor, but upon realising they would be charged hundreds of dollars for the service, a relative obtained medication locally. The next morning, they were dead.
Investigators found blood pressure medication and several prescription pill bottles, including one that contained 5 mg doses of oxycodone, a painkiller, Galanpertin and Loxofen. Bullock did not know which medications were bought locally. A medical examiner in La Romana confirmed that some of the prescription pills came from a local pharmacy.
The three visitors all had hemorrhaging, pulmonary edema and enlarged hearts, according to autopsy results released by the Government.
"This is just describing a natural disease. Without a full report, it's hard to know," said Grace Dukes of the College of American Pathologist's Forensic Pathology Committee. "It's not a clear picture of the cause of death. Just snapshots. If these are natural deaths, you would need negative toxicology results to prove that."
Both establishments are owned by the same company, Bahia Principe Hotels & Resorts. In a statement, hotel officials said their employees followed all appropriate security protocols and "misinformation" has damaged the "image and reputation" of one of the Dominican Republic's most prestigious hoteliers. The brand owns 14 properties on the island and has the greatest number of "hotel beds in the country," hosting about 700,000 guests a year, the statement said.
The hotel company did not respond to questions about cancellations or a falling number of reservations due to the deaths.
But a Colorado couple who stayed at the same resort a year ago told their local news station that they smelled something strange after entering their room at the La Romana hotel.
Before long, Kaylynn Knull and Tom Schwander were drooling, experiencing intestinal pain and woke up sweating. They went home and were told by a local doctor that they had been poisoned by insecticides containing "organphosphates," they said in the local TV interview.
Attempts by the Post to reach the couple have not been successful.
Dr Barbarajean Magnani, a Tufts University pathologist who chairs the toxicology committee for College of American Pathologists, said the symptoms described by the couple appear to be consistent with poisoning.
Organophosphates - nerve agents and the chemical sarin are derivatives of the substance - contain an enzyme that breaks down a critical neurotransmitter in the brain that is necessary for normal functioning.
Poisoned patients complain of diarrhea, excessive secretions such as urine and tears, and respiratory arrest. Specialised laboratories can test for the specific chemical in blood and tissue samples. The toxic insecticide ingredient can be inhaled, absorbed through the skin or be transmitted from contaminated hands into water and food products. Organophosphates, Magnani said, have a particularly strong odor similar to garlic.
But Magnani said investigators would need to know more about pre-death symptoms before suspecting poison.
"There is a wide spectrum of things that could have happened and underlying medical issues that could have contributed to the death," she said. "You must wait for the toxicology report to put the whole picture together."
McCoy is questioning whether her husband's death was something more. In addition to a heart attack, a copy of Harrison's death certificate obtained by the Washington Post listed pulmonary edema, an accumulation of fluid in the lungs that can cause respiratory failure, and atherosclerosis as causes of death.
Harrison, she said, was "relatively healthy" other than having high blood pressure, which he regulated with medicine. The couple had "no issues" until the afternoon of July 13, when Harrison left his wife and 12-year-old son at the pool after telling them he didn't feel well. He returned to their room to take a nap. When Harrison woke up later that evening, he seemed to be feeling better, but McCoy said she immediately noticed something wasn't right.
The 45-year-old woke up in the middle of that night drenched in sweat and exuding a pungent odour.
"He had a very potent strange smell," she said. "It was very strong."
Then, about 5:20 the next morning, McCoy said, she woke up to Harrison "struggling to get out of bed."
"He couldn't talk," she said. "He was mumbling ... He was sweating profusely."
McCoy said she immediately called for help, but that by the time the resort's doctor arrived at the room about 20 minutes later, Harrison appeared to be dead. According to official documents obtained by the Post, it was recorded at 6:48 am that he "had no vital signs, he was cold." Harrison's body was flown back to the US later that month and cremated, McCoy said.
Harrison's death certificate, which was issued by the US Government, classified the death as "natural, nonviolent."
"I accepted it," McCoy told the Post. "Then, when all these people started passing, I stopped and thought to myself, 'How can all these people have the same cause of death as David? What is missing? What am I missing here?' ... I am a fighter and I accepted his death for what they said it was. Now, I'm sorry that I accepted it."
McCoy said she emailed the US Embassy in the Dominican Republic last week to inquire about whether a toxicology report was done but has not heard back.
"I just want answers," she said, noting that she isn't seeking monetary compensation. "I think it's pointless at this point to even look into a lawsuit. It's not going to bring him home."