As homicides and drug-related deaths continue their years-long rampage, Maryland’s long-serving and well-regarded chief medical examiner said he plans to leave his post.
Dr. David Fowler, who has led the Office of the Chief Medical Examiner for the past 17 years, confirmed to The Baltimore Sun that he will step down by the end of the year.
Fowler said resource challenges related to the opioid epidemic factored into his decision.
Those overdose-related deaths so overworked his staff that in 2017 the office was in danger of losing a national accreditation that had given strong credibility to evidence it gathered during autopsies. The rating is prized by prosecutors and valued by families whose bodies were examined in the office.
“There comes a time when I think having somebody who is new and establishes a new culture and re-establishes a relationship with the administration, the health department, et cetera, is a good thing,” Fowler said in an interview.
Fowler is only the fourth person since 1939 to occupy the position.
“It’s been an incredibly stable office," he said, "and I think that’s a testament to the administrations and citizens who have put the resources in place.”
Fowler said he’s been a “bit of a squeaky wheel” at times and at some point his credibility could get “used up to some extent.”
The office has seen a rapid increase in workload in recent years. Medical examiners are required to investigate deaths from injury, homicide, suicide and those that occur under unusual or suspicious circumstances or when they are not attended by a physician. In Maryland, this is about a third of all deaths, though most do not have full autopsies.
The office also alerts public health officials of injury trends and infectious diseases that could pose risks.
The office has added examiners over the years, but by 2013 each handled more than the national standard of 250 autopsies a year. By 2017, the average bumped over 325, a threshold that could put the accreditation in jeopardy. The volume also could cause delays in reporting findings and releasing bodies, which can be a burden for families and law enforcement.
State officials transferred two additional positions to the office after the excessive workload was publicly reported, but the positions proved tough to fill and keep staffed.
Over the years, Fowler also has dealt with space constraints that were alleviated when the office moved to a new facility in the West Baltimore neighborhood of Poppleton.
A panel called the Post Mortem Examiners Commission oversees the office. Members declined to comment on Fowler or the process of choosing a new chief.
Bruce Goldfarb, a spokesman for the medical examiner’s office, didn’t comment on the resignation but said: “Everyone here from top to bottom has tremendous respect for Dr. Fowler. We couldn’t ask for a better chief.”
Others who worked with Fowler also said they were impressed by him, especially as he faced a record number of overdose deaths fueled in large part by the powerful synthetic drug fentanyl. The lethal drug is often mixed with or replaces heroin sold on the street.
Dr. Leana Wen, former Baltimore City health commissioner and a former commission board member, cited Fowler’s “professionalism, dedication and tenacity" as he handled the onslaught of cases.
“Medical examiners are part of the public health system and also on the front lines of the opioid epidemic,” she said. “Dr. Fowler faced enormous challenges with escalating numbers of people dying from overdose, particularly with the rise in deaths due to fentanyl.”
Dr. Brian L. Peterson, a past president of the National Association of Medical Examiners who has worked with Fowler, said he has served “enthusiastically and admirably” during an opioid crisis that “is the health crisis of our time.”
The Maryland office was once of many across the country that face excessive workloads, the association has said. It did not end up losing the association’s accreditation.
"Maryland’s citizens should be grateful for his energy, leadership and devotion to a field outgunned, sometimes literally, by volumes of work that are predictable only in the sense that there seem to be increases every year,” Peterson said.
Baltimore alone has logged more than 300 murders for the fifth year in a row. Overdose deaths eclipsed that tally, with 1,182 drug and alcohol-related fatalities statewide in the first half of 2019, or more than 200 a month.
Fowler said he would not be involved in naming his successor but was willing to offer input.
When he leaves the office, he said he plans to travel with his wife and remain involved in private consultations. At times during his tenure, he worked outside the state occasionally helping other jurisdictions develop capital spending plans.
To cope with the challenges, the office needed to get creative, he said. That included having board-certified forensic pathologists perform autopsies on weekends. The office handled more than 1,000 cases that way last year, the equivalent of four medical examiners’ worth of work.
“I hope the opioid crisis will unwind and we’ll get back to a quieter workload,” Fowler said.
If not, the office will continue to find ways to handle the load, he said. “We’re taking everything head on.”