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Not Life or Death, but the Stakes Are Still High
When Md. Medical Examiners Dissect a Body, Tiny Clues Can Have Enormous Implications

By Aaron C. Davis
Washington Post Staff Writer
Sunday, November 2, 2008

The corpse of inmate 225597 lay on a steel gurney in the state medical examiner's basement lab. Beside the body was a plastic bag stuffed with pants issued by the Prince George's County jail.

Ronnie White, 19 and charged in the death of a county police officer, had been found alone and unconscious in his cell a day earlier. His autopsy would be critical in determining whether guards might have been responsible for his death.

In the corners of White's eyes, pathologist J. Laron Locke spotted petechiae, or tiny burst blood vessels: a clue that White died from a lack of oxygen, not natural causes. Locke turned to White's neck, searching for telltale bruising that can distinguish hanging from strangulation, suicide from homicide.

Finding none, he probed more deeply. At the top of White's neck, in a bone no larger than a curled-up pinky finger, he found it: a fracture.

"These findings are indicative of strangulation," Locke later wrote in a confidential report reviewed by The Washington Post.

Almost four months later, the fallout from that ruling continues. An attorney for the guards insists White committed suicide, and the broken hyoid bone remains the only publicly known piece of evidence pointing to homicide.

But with an average of 11 bodies arriving each day, David R. Fowler, Maryland's chief medical examiner, says he has little time to worry about the controversy. As evidenced in a series of interviews and in rare access granted to The Post, Fowler's team has reduced dissection of Maryland crime victims to a hauntingly efficient process.

The lab, one of the busiest in the country with more than 4,000 autopsies conducted annually, is a place where academic pursuits and strict adherence to procedure and protocol seem to insulate scientists and doctors from the death that surrounds them.

"We don't deal in hypotheticals. We deal in verifiable facts," Fowler said as he led a visitor through his offices, speaking with the crisp British-sounding accent he acquired as a youth in Zimbabwe and pathology student in South Africa. "We know everything we do will potentially be examined, challenged and cross-examined."

At the doorway to the lab, which is so crowded that the state broke ground nearby on a $43 million replacement this month, Fowler paused, gesturing toward a line of eight corpses in various stages of dissection. "We have to assume that every body here has some legal or public health implication," he said. "Every day, we have to be able to reconstruct a coherent account of what we believe happened."

Unbeknownst to most passersby outside, the work of dissecting yesterday's dead begins each morning at 8:30 in the basement of a nondescript stone building in downtown Baltimore. Next door to a blinking sign for souvlaki and subs, the building's sterile name -- Maryland Forensics Center -- reveals little of the graphic scenes that unfold inside.

Fowler granted a reporter access to the lab to show the process of checks and balances -- "quality assurance," as he put it -- that goes into every ruling. On any given morning, in a ritual that resembles hospital doctors' rounds, more than a dozen of the office's 16 pathologists cluster around the day's new bodies. They take turns reading the investigative reports that accompany the corpses and divvy up the dissection tasks.

"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.

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