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SIOUX CITY | Manuel Ramirez was 6 years old when he was buried in an unmarked grave.

Police call the Sioux City first-grader's death two years ago Thursday "suspicious" and are still investigating the unsolved case.

His body is in the Marian Section of Calvary Cemetery, placed there free of charge by the Catholic cemetery. The section, dubbed Babyland by the cemetery staff, is for young children, stillborn infants and abandoned fetuses.

Cemetery caretaker Walt Peterson said visitors frequent the Marian Section to remember children lost too soon and those who never took a breath.

Those who watch over the graves say Manuel's burial spot doesn't get many visits.

Over the Christmas holidays, someone placed stuffed toys and figurines on the boy's grave. The gifts were left anonymously.

QUESTIONS REMAIN

Manuel lived in the 1400 block of Virgina Street with his father, Jose De Los Santos, and stepmother, Maria Miranda, and four siblings. Police responding to a 911 call from the house on March 7, 2011, found the boy unresponsive in the bathtub. Officers administered CPR.

Born in El Monte, Calif., on July 3, 2004, Manuel came to Sioux City to live with his father and stepmother in 2009, according to an investigation by the Iowa Department of Human Services. He attended Irving Elementary School.

De Los Santos was in jail when Manuel died, held on federal immigration charges after being stopped for a traffic violation. Miranda was home with the couple's children, according to the DHS report.

Miranda could not be reached for comment on this story. Investigators believe she moved to Mexico after Manuel died and De Los Santos was deported.

In the DHS report, investigators report Miranda was watching television with other children downstairs while Manuel was bathing alone upstairs. Investigators were told the door to the bathroom was shut because Manuel didn't like anyone else in the room.

Police say he was dead when they arrived.

Manuel's cause of death is listed as being consistent with asphyxia, or lack of oxygen. The manner of death could not be determined.

Unexplained deaths like Manuel's are investigated as homicides until proved otherwise, Sioux City police Lt. Mark Kirkpatrick said.

Police Chief Doug Young said evidence doesn't point to drowning, which is what officers at the scene were told.

"It's a suspicious death as far as we're concerned, and that's why it's still open," he said. "We're not satisfied with the explanations that we've received."

Asphyxia is a medical term for when a person stops breathing, said Dr. Tom Benzoni, staff physican at Mercy Medical Center.

It can happen as a result of many traumas or conditions, Benzoni said, including drowning, strangulation or even being in an oxygen-poor environment.

Benzoni thought it would be unusual for a healthy 6-year-old child to drown in a bathtub. The victims he's tended to over the years are usually infants too small to help themselves.

"They can't crawl out," Benzoni said.

AN OUTSIDER?

Investigators with DHS placed blame on Miranda, saying in the report she denied Manuel critical care, the agency's term for neglect. The report also cites a "preponderance of evidence that she is responsible" and says information suggests she was "either overtly or covertly" involved in his death. Miranda didn't have a reasonable explanation for the boy's death and was the person supervising him at the time, and medical reports showed he did not drown, according to the DHS report.

The report also notes a long history of unexplained injuries to Manuel and the family's expressed dislike for him.

No one, including Miranda, has been charged in the case. Police and prosecutors won't say if she is a suspect.

Young, the police chief, said Manuel's case appears to be one in which one member of a family is viewed as an outsider.

Manuel doesn't have any relatives or other advocates pushing the police department, which Young said is rare but sometimes happens when an outsider is brought into a family.

"Usually there's somebody wanting to know what's going on," Young said. "There's nobody."

Investigators would like to talk to anyone who knows anything about Manuel's death or believes they have information detectives should know, Young said.

"We're not going to push this under the rug," Young said. "We'll do whatever we can to solve this. And if it remains active forever, that's the way it'll be until we can successfully bring it to some type of conclusion. We take these matters very seriously. Unfortunately, sometimes crimes aren't solved."

GRAVE TO GET MARKER

Peterson said the toys left on Manuel's grave over Christmas likely were from people moved by a segment on KMEG-TV. The station aired a story about Manuel's death in November. Viewers later raised money for a bronze grave marker, which will be placed when the weather warms.

Someone's making occasional trips to Babyland, Peterson said, and showing the boy is remembered.

"That's kind of good to know he won't be completely forgotten," he said.

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