A devastating public health accountability gap is hiding in plain sight in San Antonio. Axios San Antonio's May 2026 investigation — relying on data from Metro Health, Bexar County's public health authority, and research from UTSA's Department of Public Health — documented a finding that should alarm every San Antonio resident, elected official, and healthcare administrator: between 2018 and 2023, Metro Health posted exactly one heat-related death in its publicly available data.

One. In five years of San Antonio summers in a city that has experienced the death of at least one well-known outdoor worker directly from heat exposure, that hosts an unhoused population of thousands sleeping outdoors in 100-degree heat, and that operates in the same meteorological environment that kills 400–600 people per year in neighboring Maricopa County, Arizona. That single recorded death strains credibility against the broader Texas and national data — and the UTSA research says it should.

The UTSA research cited in the Axios investigation, co-authored by Jeffrey Howard, an associate professor in UTSA's Department of Public Health, and Andrew Dessler of Texas A&M, found that heat kills far more Texans than official records show, and that the undercount comes from several system-wide problems in how heat deaths are identified, classified, and reported in Texas.

The study found that the number of deaths during extreme heat waves is much higher than the number officially labeled as heat-related on death certificates. This means many people who die during extreme heat are instead recorded as having died from heart disease, respiratory problems, or unknown causes. In many cases, doctors filling out death certificates may not know the person was exposed to extreme heat, or local reporting practices do not consistently list heat as a contributing factor.

Why Bexar County May Be the State's Worst Underreporter

The reason Bexar County's heat death numbers may be unreliable is explained in the Axios investigation. County spokesperson Monica Ramos confirmed that the Bexar County Medical Examiner's Office does not list any deaths as primarily heat-related. The office also does not release public numbers for cases where heat is identified as the main cause, even when that determination is made.

Metro Health also does not review full autopsy reports to look for heat as a contributing factor. Instead, it only checks a monthly list of deaths and the codes assigned to them. This means heat deaths are only counted if very specific conditions are met, such as the person being taken to an emergency room, having their body temperature measured right away, showing it was high, and having heat recorded as the cause of death at that time.

The article also describes the case of a 46-year-old unhoused woman, Jessica Witzel, who died on a sidewalk in the Five Points area of San Antonio. Her situation matched a high-risk pattern for heat death, including homelessness, severe mental illness, no access to cooling centers, and exposure to extreme urban heat in an area with little tree cover. Even though her case strongly fits what public health systems look for in heat deaths, it was likely not included in official Bexar County heat death counts because the system is structured in a way that misses cases like hers.

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The Public Health Consequences of Not Counting

The effects of undercounting heat deaths go beyond statistics. Public health funding is based on recorded numbers, so cities and counties decide how many cooling centers to open, how many outreach workers to send, and how much emergency support to provide based on official death counts. If Bexar County reports only one heat death in five years, the case for strong heat emergency funding becomes weaker than it would be if the true number, which UTSA research suggests is much higher, were properly recorded.

In May 2026, San Antonio Metro Health said it would start tracking heat-related deaths more closely. This came after pressure from the UTSA study and the Axios investigation. The change is important, but experts say it also needs stronger rules for how the Medical Examiner's Office decides when heat is a factor in a death.

For residents this summer, Metro Health's cooling centers are open and can be found on the city's website or by calling 311. Locations in South San Antonio are especially important because that area experiences more extreme heat due to the urban heat island effect. These centers are most important for unhoused people, older adults without air conditioning, and outdoor workers. Anyone seeing someone in severe heat distress who cannot get help should call 911, since heat stroke is a medical emergency.

San Antonio's Beat the Heat resources are updated daily during the heat season with cooling center availability and heat health advisory information.