After George Floyd was killed by former Minneapolis police officer Derek Chauvin in 2020, Maryland's former Chief Medical Examiner Dr. David Fowler was called in as a defense witness for the 2021 trial.
On the stand, Fowler testified that, based on his study of the forensic evidence, Floyd's death should be classified as "undetermined" and not a homicide, due to a medley of factors including heart disease, drug use and carbon monoxide exposure.
Chauvin was later convicted of murder and manslaughter for kneeling on Floyd's neck for more than nine minutes. But Fowler's testimony — which contradicted the Hennepin medical examiner's determination that Floyd's death was a homicide — sparked immediate concern among hundreds of his peers around the country, who suggested he might be motivated by racial or pro-law enforcement bias.
As a result, officials in Maryland launched a review last year of similar "in-custody" death reports that were performed during Fowler's tenure at the helm of the state medical examiner's office.
Now, that probe has spurred further scrutiny.
After reviewing the work by Fowler and his team on over 1,300 cases in which people died in police custody, an independent audit design team is recommending that the state reinvestigate about 100 of those. The cases share key similarities, including the absence of an "obvious medical cause of death," and they each involved physical restraint.
"We embarked on this process with the goal of overseeing a professional and independent audit that adheres to the highest standards of impartiality and integrity," Attorney General Brian Frosh said in a statement on Wednesday.
What will the new audit be looking for?
The new investigations will be led by an independent group of experts in forensic pathology, Frosh announced. As they reopen reports and comb through the records, they'll be tasked with deciding whether they agree or disagree with the original medical examiner's conclusions on the cause and manner of death. They'll also judge if those involved followed existing protocols.
Among their many questions, the new panel will explore the role of physical restraint in each death, and whether the person would have lived but for the application of restraint. They will also recommend the need for changes in training, policy or procedure regarding the application of physical restraint that might reduce the risk of death in such cases.
Fowler, who has been considered one of the foremost medical examiners in the country and served on the National Board of Medical Examiners, has defended his record, noting that he did not work alone when preparing autopsy conclusions.
Fowler did not respond to NPR's requests for comment.
"There's a large team of forensic pathologists, with layers of supervision, and those medical examiners always did tremendous work," Fowler told the Baltimore Sun.
Closer scrutiny could reopen cases for families who have long-doubted the medical examiner's findings
The findings of the audit could have a significant impact on several cases involving the deaths of other men in police custody, including the 2018 death of Anton Black.
Video footage of Black's death shows that the 19-year-old was chased by a white civilian and three white police officers, who then fired a taser at the teen and pinned him face down on the ground for six minutes until he eventually stopped breathing. Fowler ruled that Black's death was an accident caused by a sudden cardiac event while struggling with police and his bipolar disorder, and not due to the prone position Black was forced into.
No officers were charged in his death.
Black's family filed a federal lawsuit in 2020 against the officers, Fowler, the three towns where the officers served and the two police chiefs involved in the case, claiming the medical examiner tried to cover up his death in his autopsy report.
Civil rights advocates called the recommendations made in the latest report a step toward ending police violence, as close inspection will likely reduce the opportunity for medical examiners to downplay the role of law enforcement's actions in a person's death.
"For decades, family members of those killed by police have said that the medical examiner's reports are wrong. This preliminary audit report is a vindication of exactly what they said. That it does not pass the smell test to claim that their loved ones died because of car exhaust, or hot temperatures, or bipolar disorder, when police restrained them right before they died," Sonia Kumar, senior staff attorney with the ACLU of Maryland said in a statement on Wednesday.
Kumar added: "The government must tell the truth about what caused death in these cases, and it must do so based on evidence. If we don't tell the truth about what caused the deaths, we can't learn how to prevent them."