Thousands of times a year, forensic prosecutors in the Maryland medical examiners’ office probe the details — and the bodies — of the dead to answer a basic question: How did they die?

A new book, for release in February, shows how the nation’s first centralized, statewide examiners’ office seeks the information for families and prosecutors about homicides, overdoses, suicides and all other unexplained deaths.

It’s a story of high-profile and controversial investigations, but also of the rising backlog of cases stemming from surges in violence and substance use that has lead to a crisis for a once pioneering agency.

“OCME: Life in America’s Top Forensic Medical Center” is written by Bruce Goldfarb, a former EMT/paramedic and sometime reporter who left the office last year after a decade as an executive assistant to the erstwhile chief, Dr. David Fowler.

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Most controversial cases explored in the book garnered considerable media coverage. But Goldfarb, officially the Office of the Chief Medical Examiner’s public information officer, couldn’t or wouldn’t give details in real time. The new insight may interest “CSI”-devotees and anyone who knows someone who died a questionable death.

Fowler is a main character in the book. He didn’t respond to a request for comment from The Baltimore Banner. Although, in the book he’s portrayed as a man who easily managed the OCME’s controversies and crises until, like his office, he didn’t.

In this image from video, Dr. David Fowler, a retired forensic pathologist and former chief medical examiner for the state of Maryland testifies as Hennepin County Judge Peter Cahill presides, Wednesday, April 14, 2021, in the trial of former Minneapolis police Officer Derek Chauvin at the Hennepin County Courthouse in Minneapolis, Minn. Chauvin is charged in the May 25, 2020 death of George Floyd.
In this image from video, Dr. David Fowler — a retired forensic pathologist and former chief medical examiner for the state of Maryland — testifies as Hennepin County Judge Peter Cahill presides, Wednesday, April 14, 2021, in the trial of former Minneapolis police Officer Derek Chauvin at the Hennepin County Courthouse in Minneapolis, Minnesota. (Court TV via AP, Pool)

Troubles sparked by the chief began when Fowler testified as one of the witnesses in the defense of Derek Chauvin, the Minneapolis police officer ultimately convicted of murdering George Floyd.

“Like the rest of America, I watched the video of Chauvin kneeling on Floyd’s neck for an agonizing eight minutes and 45 seconds,” Goldfarb wrote. “Talking with others at work, we couldn’t figure out what Fowler could possibly say in Chauvin’s defense.”

According to media accounts relayed in Goldfarb’s book, what Fowler said in the 2021 trial was Floyd’s death was undetermined, rather than murder, caused by underlying cardiovascular disease that resulted in a fatal cardiac arrhythmia during his arrest. Floyd’s use of drugs and carbon monoxide from nearby car exhaust contributed, according to his book.

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The OCME under Fowler long leaned on undetermined as a manner of death, calling it “intellectually honest” when there was uncertainty, Goldfarb wrote. But here it was stunning, and in defiance of other experts.

Goldfarb wrote in the book, “The blowback from Fowler’s testimony was swift and fierce.”

Some called the office racist. Officials called for review of in-custody deaths from his time as chief until his retirement in 2019, although Fowler didn’t personally perform autopsies or determine manner of death. Then-Maryland Attorney General Brian Frosh tasked Goldfarb with listing deaths to revisit from tens of thousands of possible cases. The cases selected totaled 1,313.

Another controversy that Goldfarb wrote about in the book involved the death of Baltimore Police Detective Sean Suiter, found shot in the head in an alley with his own gun. Suiter’s death occurred just days before his federal grand jury testimony in a case involving the Gun Trace Task Force, a rogue police unit terrorizing the city.

Police initially said Suiter’s death was a suicide, but the OCME determined it was a homicide. The Baltimore State’s Attorney’s Office considers the case open.

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“Nothing about Suiter’s death made sense, either as a homicide or a suicide,” Goldfarb wrote. If it was homicide, why would an attacker’s plan involve taking a police officer’s gun? If it was suicide, why wouldn’t Suiter have staged a better scene?

The main villain in the book, however, was less the stuff of ghoulish TV. Gov. Larry Hogan, a Republican, began trimming the state budget in 2014, and the OCME never again kept pace with spiking homicide and overdose cases, Goldfarb wrote.

The administration, however, did reverse course, adding a range of OCME positions, including 20 in the current fiscal year, budget documents show. But the national shortage of medical examiners and the OCME’s increasingly bad reputation for a crushing workload has meant a dearth of live bodies to investigate dead ones.

State health officials who oversee OCME staffing declined The Banner’s request for comment on hiring or workloads. Chase Cook, spokesman for the Maryland Department of Health, said officials were preparing a report for the General Assembly.

Goldfarb wrote that there were 18,000 investigations by the office in 2021, up 80% from a decade before, with a third of them requiring full autopsies. Yet, an 84-person staff was whittled to 63. By the middle of 2022, the OCME had seven examiners, although there should have been 26.

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A state budget document for the current fiscal year ending June 30 shows health officials estimated the number of examiners would drop to four from a high of 20 in 2019, leaving examiners to each tackle 1,588 autopsies a year.

The number is stunning considering the standard is 250 autopsies, set by the National Association of Medical Examiners. The OCME was skating close to losing accreditation.

Backlogs of bodies posed emotional and practical hardships for families and challenges for prosecutors, Goldfarb wrote, adding loss of accreditation would also send a dire message: “More than an ornamental ribbon, accreditation is an endorsement of competence.”

It’s not clear how the office would replace the examiners. The chief who replaced Fowler, Dr. Victor Weedn, resigned in February 2022 just a year into the job. The OCME website lists staff including an interim chief, two deputies and 10 examiners, although it’s not clear how many remain on the job.

The OCME has leaned on contractors to help meet the office’s needs, paying $850 per autopsy. In March, the Federal Emergency Management Agency sent volunteer examiners normally deployed after natural disasters. FEMA cleared the unprecedented 240 bodies in OCME freezers, plus a makeshift morgue in a downtown Baltimore parking garage initially opened to handle COVID-19 cases.

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Del. Kirill Reznik, a Montgomery County Democrat who introduced a bill last year requiring adequate OCME staffing, told The Banner it’s a frustrating turn for an office that was once a national model. He said the incoming Democratic administration of Gov.-elect Wes Moore would have to pay early attention to the troubles.

“Last year, the office had to turn to FEMA for help,” he said. “It was a disaster and was embarrassing, and it’s something that needs to be addressed. ... The medical examiner’s office is not normally an office new administrations spend a lot of time thinking about, but there will be pressure to jump-start hiring.”

Goldfarb told The Banner he wanted to write the book to highlight OCME contributions to forensic medicine, as well as show true-crime followers how things are really done. But that was not the ultimate story.

“Someone needs to ring the alarm bells,” he said. “Most people are fortunate and never interact with the office. But others are waiting and waiting for results.”

In an epilogue, Goldfarb was uncertain about what happens next in an office that was a “gold standard” for the field.

Now, he wrote, “Whether the OCME can pull out of its years-long tailspin is still questionable.”

Meredith Cohn is a health and medicine reporter for The Baltimore Banner, covering the latest research, public health developments and other news. She has been covering the beat in Baltimore for more than two decades.

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