By Justin Fenton, The Baltimore Sun
4:55 PM EDT, June 10, 2012
Amber Brown, 24, was complaining of chest pains the night police say she and her girlfriend drank alcohol and injected each other with heroin in their Northeast Baltimore apartment. Brown passed out and never woke up; her companion could face criminal charges.
Brown's death was not unlike hundreds of others each year in Maryland from drug overdoses, but it is the only one in recent memory to be ruled a homicide. Because authorities rarely find witnesses, the medical examiner frequently labels such deaths "undetermined," a distinction that has led to debate over whether deaths in Maryland, including homicides, are being counted accurately.
Unlike his counterparts in most other states, Maryland's chief medical examiner David R. Fowler said he opts against assigning a cause of death without compelling evidence. He said his office was able to make the call this time because police know who injected the drugs.
Fowler can't recall his office previously making such a finding since he joined the office in 1993, and a check of his office's computer system returned six results in the past 20 years across Maryland — four of which were state executions. A medical determination of a homicide doesn't necessarily mean a crime has been committed — that call belongs to prosecutors — but can be a crucial part of the police investigation.
Israel Cason, who runs the Northwest Baltimore drug treatment center I Can't, We Can, says there are instances where drugs are used deliberately to kill someone. It's called a "hot shot" — replacing heroin with battery acid, or placing anti-freeze in a bottle of methadone.
The motives, said the former addict, range from child support and other debts to relationship troubles or revenge. He said the medical examiners and police don't know what to look for in such cases.
"You really don't know what you're looking at unless you lived that life," Cason said. "If you don't live in that lifestyle, you can't imagine it."
Marvin Sydnor, a retired Baltimore homicide detective who spent 25 years in the unit, said he never saw a drug overdose ruled a homicide.
"I can understand how they'd make [a homicide] ruling, because, one person caused the death of another. I think it probably happens a lot, but our problem is we would find an overdose" and not know anything else about the death, he said. He said police would check for a victim's drug history and typically wrap up the case.
Baltimore Clerk of Courts Frank M. Conaway is among those who believe there's more to the number of undetermined cases; he has questioned the figure, and his daughter, Belinda, a former City Councilwoman, unsuccessfully sought to hold an investigative City Council hearing on the issue.
The questions were driven largely by reports of the 2006 death of Tyra McClary, who was found in Northwest Baltimore under a pile of mulch with trauma to her neck and a bag around her legs – a death that raised questions but which didn't have enough information for the medical examiner to render a definitive ruling.
"They have tried to explain it … but I believe the homicide rate is down because there are a lot of deaths that weren't counted," Frank Conaway said.
Politicians point to the homicide rate as a gauge of their stewardship; police make reference to it as a measure of their effectiveness; journalists use the rate to track crime in a city where violence has been a constant. Homicides, most criminologists agree, are one of the least subjective and most reliable of the major crime statistics.
Brown is currently listed as the 85th homicide victim in Baltimore in 2012. Yet despite the finding, it is not clear whether Brown's death will be reported to the FBI as a killing.
The bureau's Uniform Crime Reporting program instructs law enforcement agencies to report murders and non-negligent manslaughters, defined as the "willful and non-negligent killing of one human being by another." It specifically states that the classification is based solely on a police investigation, and not the determination of a medical examiner or judicial body.
On April 18, police say medics were called to the 3100 block of Hamilton Ave., in Northeast Baltimore's Glenham-Belhar neighborhood, for a report of a woman in cardiac arrest. An investigation showed that Brown had earlier complained of chest pains, and she and her girlfriend consumed alcohol and injected each other with heroin, police said.
Brown fell asleep, then lost color and became unresponsive. Her friend called for help, but Brown was pronounced dead at Good Samaritan Hospital, police said. On April 24, the autopsy concluded that the cause of death was heroin intoxication, and the manner of death was homicide, and detectives added the case to the official homicide count on May 28.
Attempts to locate family of Brown were unsuccessful, and police have not identified the girlfriend.
Any death that comes at the hands of another person is a homicide, the exception being most motor vehicle deaths. Knowing that Brown was injected by someone else makes the determination easy, Fowler says. But his doctors usually aren't supplied that crucial detail from investigators.
Heroin is the most common cause of overdose death in Baltimore, representing 75 percent of such cases, though the overall number has been on the decline in recent years. In 1999, 283 people died from heroin overdoses; that total declined to 118 in 2009, according to the city health department.
Drug dealers themselves have in some instances been charged with selling drugs that led to an overdose; in Washington State, a drug dealer was convicted of "controlled-substance homicide" for selling black tar heroin to a 24-year-old man who later overdosed, while in January a Virginia man was charged after a two-year investigation with felony homicide for selling Opana, a powerful narcotic, to a woman who later died.
Federal statutes also allow prosecutors to seek sentencing enhancements against convicted drug dealers if it can be proved that a buyer died from drugs the defendant sold to them. Prosecutors in Maryland have secured such enhancements — leading to a mandatory minimum of 20 years in prison without parole — in three recent cases.
But the lack of insight into many deaths leads to a high number of undetermined deaths here, officials say. A 2006 study by the Centers for Disease Control showed that Maryland, followed by Massachusetts and Rhode Island, had the highest number of undetermined deaths in the country between 1999 and 2003. The states share the same methodology, which Fowler calls "intellectually honest."
While that study's findings have been used by critics to raise questions about the number of deaths, the study's author, Matthew Breiding, said in an interview last week that in other states, these undetermined deaths would likely have been called "unintentional." He said his study did not find that Maryland's approach drove suicides down, and it didn't look at the effect on homicides, though it does cite research from California that many "undetermined" infant deaths appeared to be "unrecognized homicides."
In 2009, the most recent year for which statistics from Fowler's office are available, Maryland's medical examiners conducted 3,856 autopsies, listing 19 percent as undetermined, compared with 21 percent accidental and 8 percent suicide.
North Carolina reported 4.5 percent of its autopsied cases as "undetermined," with 34 percent ruled accidental and 8.4 percent suicides. In Virginia, 28 percent of cases were accidental and 13 percent were suicides, with just 5 percent undetermined.
Leah Bush, the chief medical examiner for Virginia, said her office tries to use other available information to fill in the gaps when they lack details about the circumstances of a death. For example, if the person has a long history of drug abuse or "drug seeking behavior but no history of suicide, then we call it an accident," she said in an e-mail.
If the drug levels in the person's body are "very high such that the … the usual recreational user cannot possibly survive, then we call it a suicide because the intent is obvious from the very high drug levels," Bush said. To Fowler, those are assumptions.
City prosecutors won't say where their investigation into Brown's death stands, or whether anyone could be charged. Calling it an "uncommon situation," spokesman Mark Cheshire said it is "very much under investigation."