Maryland officials will conduct an independent review of reports of deaths in police custody during the tenure of retired chief medical examiner Dr. David Fowler, representatives from the offices of the governor and attorney general confirmed to NPR on Saturday.

Fowler served as Maryland's chief medical examiner from 2002 to 2019. He was in the spotlight as a defense witness in the trial of former Minneapolis officer Derek Chauvin, who was convicted on murder and manslaughter charges this week in the death of George Floyd.

Fowler testified that he believed Floyd had died of a sudden cardiac event due to his underlying heart disease while being restrained by police, citing multiple possible contributing factors such as drugs in his system and potential exposure to carbon monoxide from vehicle exhaust. While the Hennepin County medical examiner concluded that Floyd's death was a homicide, Fowler argued the manner of death should be classified as "undetermined."

That testimony alarmed Washington, D.C.'s former chief medical examiner Dr. Roger Mitchell Jr., who wrote an open letter calling for investigations into Fowler's medical license, as well as a review of the Maryland medical examiner's office under Fowler's leadership. At least 458 physicians have signed the letter, Mitchell tells NPR.

Signatories of the open letter criticized Fowler's testimony about Floyd's cause of death — and especially the suggestion that carbon monoxide exposure may have contributed to it — as "baseless, revealed obvious bias, and raised malpractice concerns."

Fowler's opinion that Floyd's death during police restraint should be classified as "undetermined" was outside the standard conventions for investigating and certifying in-custody deaths, the letter says, adding that it raises concerns about his previous handling of such cases.

"Our disagreement with Dr. Fowler is not a matter of opinion. Our disagreement with Dr. Fowler is a matter of ethics," it reads.

Mitchell tells NPR the need for a review is "about the citizens of Maryland. This is about the individuals in this country that die while in custody while in contact with the criminal justice system."

The office of Maryland Attorney General Brian Frosh said it agrees with the need for an independent review and has offered to coordinate it.

Gov. Larry Hogan's office says it will work to identify experts to serve in the workgroup.

Bruce Goldfarb with the Maryland Office of the Chief Medical Examiner said in a statement that it is "committed to transparency and will cooperate with any inquiry."

Fowler has defended his record, telling the Baltimore Sun that he was not solely responsible for autopsy conclusions as he worked with a large team of forensic pathologists, and saying of a potential review that "people need to do what they need to do."

"I stand behind the outstanding work that all of our dedicated staff at the Maryland State Medical Examiner's Office performed during my tenure as the Chief ME," he told The Washington Post in a statement.

Fowler also stood by his work in the Chauvin trial, explaining that his "opinion was formulated after the collaboration of thirteen other highly experienced colleagues in multiple disciplines" and that it "set an ethical standard for the work needed in sensitive litigation."

Signatories argue that Fowler's involvement in a separate case involving an in-custody death, where Fowler is among Maryland officials subject to a lawsuit, raises the concern of a potential "pattern of bias in practice."

That case has to do with Fowler's handling of the medical records of Anton Black, a 19-year-old Black man who died in police custody in Maryland in 2018.

Maryland civil rights attorneys have said that video of the incident shows three white police officers and a white civilian chasing, Tasing and pinning Black face down on the ground until he eventually stopped breathing. Fowler ruled Black's death an accident and named his heart condition and bipolar disorder as contributing factors.

Black's family alleges that Fowler and others "covered up and obscured police responsibility for Anton Black's death."

The Maryland Attorney General's Office, which is representing Fowler and several other plaintiffs in that case, filed a motion for dismissal earlier this month. On Saturday, spokesperson Raquel Coombs addressed efforts by the attorney general's office to avoid conflicts of interest.

"The Office of the Attorney General is also charged with representing state agencies and employees who are sued for actions taken within the scope of their employment," she wrote. "We have taken steps to wall off those in our office who are representing the OCME and its current and former employees, including Dr. Fowler, from those who might be involved in any review of OCME reports."

The medical examiner's office oversaw numerous cases of in-custody deaths during Fowler's tenure. It ruled several — such as those of Anthony Anderson in 2012 and Freddie Gray in 2015 — as homicides.

But the American Civil Liberties Union of Maryland argued last week that the office had been "complicit in creating false narratives about what kills Black people in police encounters," listing the cases of Black, Tyrone West and Tawon Boyd as examples.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

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