Not Life or Death, but the Stakes Are Still High

"We surround the gurney. The body is right in front of us," Fowler said. "So when we're discussing that we can see this mark, or the absence of this mark, we've got 14 forensic pathologists looking at the body and saying, 'You're right, we see it,' or, 'No, we don't.'

"We're also asking questions. Say this person apparently fell down the stairs. Well, if this person fell, why aren't there any abrasions on the knees and elbows? What kind of stairs were they? Were they carpeted? Was there padding under the carpeting? Were they wood? Hardwood?"

The dissections ensue. Blood, urine and vitreous fluid are collected. Organs are removed, weighed and inspected. Finally, the top of the skull is sawed off, the scalp peeled back and the brain pulled away for neuropathology examination.

At 3 p.m., the group meets again, and the pathologists submit their findings for peer review. If a death can't immediately be classified, experts from any number of disciplines are summoned, studies are ordered and the case is reviewed weekly until it can be scratched off the list.

Two bodies that arrived in September remain on that list despite being found in a condition that might seem to make them obvious candidates for homicide.

Unlike the relatively ambiguous circumstances in which White was found, slumped on the floor of his cell, the two young girls' bodies had been wrapped up and stuffed in a freezer. A Maryland woman, Renee Bowman, was said to have told investigators that the bodies were those of two adopted daughters.

Even so, despite high-tech scans and days of tedious examination, pathologists have not determined how the girls died or even confirmed their identities. Fowler was forced to initially list the cause of death as "pending." He said six weeks of microscopic lab work would be needed to determine how the girls died and to verify their identifies.

Fowler declined to comment specifically on the White and Bowman cases because both remain under investigation by law enforcement and because he could be called to testify in court on either one.

Speaking of no case in particular, Fowler said he is amused at the public perception fueled by the 6 o'clock news. "They always say, 'The body has been sent to the medical examiner to determine the exact cause of death.' "

Spending time in Fowler's lab makes clear the source of his amusement: There often is no precise cause. Some cases are obvious -- gunshot and stab wounds, for example -- but more often pathologists must call on their experience and their 13 years of medical training, consult with police and peers, and then make what is essentially a judgment call. And they must do so with the expectation that they'll have to defend it in court.

In White's case, the discovery of the broken hyoid profoundly shaped the investigation. Without it, the autopsy might have been inconclusive; the state police and FBI might never have been called in. The investigation might well have been in a far different place in July, when a guard came forward and said he had found White hanging with a sheet around his neck.

But since Lock and Fowler finalized the autopsy in September, the ruling has been challenged in some quarters.

Clothilda Harvey, an attorney for the union representing guards at the jail, blasted Fowler's office for disregarding the corrections officers' accounts and "not looking at the facts." Prince George's State's Attorney Glenn F. Ivey said at a news conference announcing the findings that he had not embraced the ruling and was open to the possibility of suicide.

Fowler played down the criticism, saying someone somewhere in the state is always motivated to be critical of an autopsy his office has recently completed. The controversy over White's, however, is unusual. When Fowler's office is criticized, it is almost always for declining to rule on a cause of death.

Under Maryland law, Fowler can chose to leave a cause of death "undetermined," which he does for about 700 drug-related deaths in the state each year. That conclusion makes the most sense, he said, when he can't determine whether a death was an accident or a suicide or whether someone deliberately gave the victim an overdose.

"I'd rather be criticized for being honest than making something up," Fowler said.