Courtesy of Orlando Sentinel

More than a year after a 3-month-old overdosed on fentanyl in Kissimmee, the infant’s mother has been arrested in Puerto Rico and charged with manslaughter.

Caroline Quiles Sánchez, 26, was taken into custody on Wednesday in Gurabo, a small town about 25 miles southeast of San Juan, according to a statement from the Puerto Rico Police Department.

According to the Kissimmee Police arrest affidavit, a member of the baby’s household was using prescription fentanyl patches for pain relief and police believe Quiles Sánchez used a patch to administer “a lethal dose” of fentanyl inside the baby’s mouth.

The arrest comes a week after the Orlando Sentinel asked Kissimmee Police for details on the July 12, 2016, death of Danuel Ortiz. The agency had not released any information about the baby’s overdose death when it happened. The Sentinel discovered the death in a public database of child fatalities investigated by the Department of Children and Families.

DCF closed its investigation into the case in May after determining an “unknown caregiver” was responsible for Danuel’s death, according to the report, which is partially redacted to protect the identity of Danuel’s sibling, age 1 at the time.

“It is unknown how the fentanyl got into Danuel’s system, however, it was determined Danuel would have had to ingest the fentanyl as large amounts were found in his gastric contents,” the report stated. “There are major concerns for how the fentanyl got into Danuel’s system as Danuel was not mobile due to his age and it is unlikely Danuel would have accidentally ingested this.”

When the Sentinel asked last week why no arrest had been made, Kissimmee Police spokeswoman Stacie Miller said detectives were still investigating the case and did not yet have enough evidence or probable cause.

Days later, detectives flew to Puerto Rico and charged Quiles Sánchez, who had been living there since shortly after her baby died.

Angelina Rivera, the baby’s paternal grandmother, talked to the Sentinel before the arrest was made and questioned why the investigation was taking so long.

Rivera said her infant grandson was healthy until he died and said she “wants the truth” about what happened.

“Why aren’t the police doing anything?” she asked in Spanish.

Rivera and her son, Anuedes Ortiz, the baby’s father, were also home when the baby died.

Ortiz declined to comment Thursday about what happened, but offered in Spanish about his son, “He was an angel. He is resting now.”

Rivera said her son was getting ready for work when Quiles Sánchez came out of her room and said the baby was unconscious.

Quiles Sánchez screamed for the baby’s grandmother, and they attempted to perform CPR on the infant until paramedics arrived, according to her account in a report by the Department of Children and Families.

An autopsy revealed 19.6 nanograms per milliliter of blood in Danuel’s body, according to the DCF report. Fentanyl can be lethal in adults in as little as 3 or 4 nanograms.

The summary of the DCF case notes that Danuel was put to bed in his bassinet by his mother at 10 p.m. the night before he died.

The baby’s mother fed him about 4 a.m. and put him back in the bassinet, according to the report. She woke up again about 6 a.m., the report says, and moved him to her bed, where she found him unconscious when she woke up again about 8 a.m.

No fentanyl was found in Danuel’s last bottle or on his pacifier, the report noted.

Quiles Sánchez left for Puerto Rico with her and Ortiz’s older child, now 2, after Danuel’s death.

At least one family member told police that Quiles Sánchez may have been suffering from postpartum depression, according to the arrest affidavit.

Danuel is among the youngest victims in a scourge of opioid, and particularly fentanyl, overdoses leaving a wake of death through Florida — from Key West to Pensacola.

The latest is a 10-year-old boy who died of an apparent fentanyl overdose last month in Overtown, a neighborhood north of Miami’s downtown.

Investigators are trying to determine where Alton Banks, a fifth grader, came in contact with the drug, possibly at a neighborhood pool or on his walk Home. 

Fentanyl is a synthetic opioid long used by doctors to treat pain in terminally ill patients and other severe cases. The drug is often prescribed in patch form, which allows the opioid to be absorbed slowly through the skin.

As recently as five years ago, many of the fatal fentanyl overdoses seen by Orange-Osceola Medical Examiner Dr. Joshua Stephany involved people who abused patches by putting them in their mouths or using a needle to extract and inject the drug.

Stephany told a group gathered earlier this month to discuss the epidemic that today, most fentanyl deaths are the result of street forms of the drug — powder that is snorted or injected.

The powder can be so potent — 50 to 100 times stronger than morphine — that law enforcement and other officials are encouraged to wear protective gear and keep Narcan, an opioid antidote, on hand. Orlando Police Chief John Mina said this week that one of his officers was treated over the weekend for overdose symptoms after accidental exposure to the drug while investigating a case.

Stephany said he could not comment on Danuel’s case but noted that overdoses among children are rare and that the 3-month-old is the youngest victim his office has seen.

The baby and the 10-year-old Miami boy are just two of the state’s youngest victims of the overdose epidemic.

Fentanyl killed just one child under age 18 in 2014, according to a statewide report on drug deaths. In 2015, fentanyl caused the deaths of three kids. And in the first half of 2016, medical examiners logged seven fentanyl deaths in children. The figures for the full year are not yet available.

Florida’s child fatality database shows that DCF investigated at least 16 deaths related to opioids since 2009. Those included toddlers who accidentally ingested pills left within reach, teens who overdosed on heroin and newborns who tested positive for the drugs at birth, among other cases.