An independent audit of Maryland’s Office of the Chief Medical Examiner (OCME) between 2003 and 2019 determined that about half of the deaths reviewed, including five in Montgomery County, should have been classified as homicides but were not.
The four-year investigation was headed by the Office of Attorney General and included 87 cases.
“In 36 of these cases, all three independent forensic pathologists unanimously concluded the deaths were homicides where the OCME had classified them as ‘undetermined,’ ‘accidental,’ or ‘natural.’ In an additional 5 cases, two of the three reviewers determined deaths should have been classified as homicides. This means that in nearly half of all reviewed cases, our expert reviewers disagreed with the original classifications,” according to the 70-page report.
Five of the misclassified cases involved Montgomery County incidents. All five were considered homicides by the independent investigators.
In 2007, George Barnes’ death was ruled undetermined. The independent investigators labeled it homicide.
In 2010, Kareem Ali’s death was labeled undetermined. The independent investigators labeled it homicide.
In 2011, Delric East’s death was ruled an accident. The independent investigators labeled it homicide.
In 2013, Anthony Howard’s death was ruled undetermined. The independent investigators labeled it homicide.
In 2019, the death of Ricardo Manning was ruled undetermined. The independent investigators labeled it homicide.
All the cases under review were conducted while forensic pathologist Dr. David Fowler was Chief of Maryland’s Office. He testified in defense of Officer Derek Chauvin during the George Floyd trial. Floyd died after being restrained by Minneapolis police officers.
Montgomery County Police Chief Marc Yamada pointed out that one of the five cases attributed to Montgomery County actually may be a Prince George’s case.
During a press briefing last week, he said, “As of right now we are reserving our comment until we have a chance to fully explore the contents of the report and try to figure out whether the AG’s office is going to move forward with any sort of investigation.”
Yamada did note that “the officers involved in these cases were subject to investigations, both internally and externally, and were found to be in compliance at that time.”
Dr. Earl Stoddard, assistant chief administrative officer for the county, said that some of the cases involved the shooting of tasers. Since the incidents that were investigated, the police department has updated its taser polices to reflect the current best national practices, he said.
According to the report, deaths involving Black individuals and deaths involving law enforcement restraint were significantly less likely to be ruled homicides compared to other cases.
Some of the cases were originally blamed on excited delirium, which according to the report is a diagnosis that is not accepted by leading medical organizations.
The auditors “found systemic deficiencies in autopsy documentation, including missing photographs, incomplete incident information such as the absence of available body camera footage, and inconsistent acknowledgment of restraint-related injuries,” according to a news release from the Attorney General’s office.
“Marylanders deserve a justice system built on transparency, accountability, and equity. This audit’s findings pave the way for meaningful reform in how medical examiners approach death investigations and propose changes that could address systemic inequities that have persisted for too long,” said Attorney General Anthony Brown.
“Maryland’s leadership in conducting this audit, the first of its kind in the nation, gives other states a blueprint on how to safeguard their death investigations against bias, ensure accountability across our legal institutions, and guarantee that when someone dies in law enforcement custody, the case is handled according to the highest professional standards of fairness and impartiality,” Brown wrote.
Twelve independent forensic pathologists, who were initially blinded to the decedent’s race and OCME’s original conclusions, conducted the investigations.
