By BRIAN WITTE and LEA SKENE

ANNAPOLIS, Md. (AP) — An audit of Maryland autopsies has uncovered at least 36 deaths in police custody that should have been considered homicides, state officials announced Thursday following a comprehensive review of such cases spurred by widespread concerns about the former state medical examiner’s testimony in the death of George Floyd.

Medical examiners under Dr. David Fowler displayed racial and pro-police bias, according to the review. They were “especially unlikely to classify a death as a homicide if the decedent was Black, or if they died after being restrained by police,” Attorney General Anthony Brown said during a news conference.

“These findings have profound implications across our justice system,” Brown said. “They speak to systemic issues rather than individual conduct.”

The auditors reviewed 87 in-custody death cases after medical experts called Fowler’s work into question because he testified that police weren’t responsible for Floyd’s death. The Maryland team focused on cases in which people died suddenly after being restrained, often by police, officials said.

Three-person panels evaluated each autopsy and, in 36 cases, they unanimously concluded that the deaths should have been classified as homicides but were not. In five more cases, two of the three reviewers came to that conclusion.

Fowler didn’t immediately respond to messages seeking comment.

State officials could reopen death investigations

Democratic Gov. Wes Moore said he has signed an executive order directing Brown to review the 41 cases and determine if any should be reopened for investigation.

Moore acknowledged the families whose loved ones have died in police custody, some of whom have been “screaming for this type of analysis — and have been met with silence.” He also acknowledged the many members of law enforcement who do their jobs honorably and protect the public.

Moore said he has also created a statewide task force to study the deaths of people restrained in law enforcement custody. He said the state won’t shy away from rooting out misconduct and working to create a more equitable justice system.

Among a list of recommendations, the review suggested better training for law enforcement officers on the dangers of improper restraint techniques. It also directed the Office of the Chief Medical Examiner to create standardized procedures for investigating restraint-related deaths.

The governor described the review as the first of its kind in the nation, saying he hopes it will provide a model for similar investigations elsewhere.

In a national investigation published last year, The Associated Press and its reporting partners found that medical examiners and coroners, whose rulings have huge consequences in the courts, can face pressure from law enforcement to exonerate officers. Some medical officials based their decisions not on physical evidence, but instead on whether they believed police intended to kill.

When deaths are ruled accidental, prosecutions of officers are exceedingly rare — of 443 cases that were ruled accidental, just two resulted in criminal charges. A family’s chances of winning a wrongful death lawsuit also become much tougher.

While the audit findings are troubling, Maryland officials said they don’t suggest intentional or malicious conduct. They emphasized that a homicide classification simply means someone died because of another person’s action, not necessarily that the officers involved should be prosecuted.

Fowler was criticized for embracing a widely rejected theory

Fowler, who testified for the defense at the 2021 murder trial of former Minneapolis police Officer Derek Chauvin, attributed Floyd’s death to a sudden heart rhythm disturbance as a result of his heart disease — a widely rejected theory that did little to persuade the jury. Chauvin was ultimately convicted of murder and manslaughter for kneeling on Floyd’s neck for more than nine minutes.

After his conviction, 400 medical experts signed a letter to the Maryland attorney general asserting that Fowler’s testimony deviated way outside the bounds of accepted forensic practice. In addition to citing heart problems, he classified the manner of death as “undetermined” rather than “homicide.”

The letter called for an investigation to determine whether the office’s in-custody death determinations under Fowler’s leadership exhibited certain bias, among other potential issues.

Officials said Thursday that their audit found a troubling systemic pattern.

Nearly half of the reviewed cases cited “excited delirium” as a cause of death, a diagnosis that has been debunked by medical experts in recent years. Critics say it was often used to justify excessive force by police. The report recommended that medical examiners stop using the term altogether.

Fowler was Maryland’s chief medical examiner from 2002 to 2019.

Two high-profile deaths are among the 41 cases highlighted

In 2023, state officials approved a settlement agreement that reformed the process for conducting autopsies on people killed in police custody.

That change came in response to the 2018 death of Anton Black, who died in police custody on Maryland’s Eastern Shore. His death was captured on video, which showed police in rural Greensboro holding the unarmed teenager down for more than six minutes. Fowler ruled that Black died because of a sudden cardiac event while struggling with police — not because they pinned him in a prone position. His death was declared an accident.

Fowler similarly ruled that Tyrone West died of natural causes after struggling with Baltimore police following a traffic stop in 2013. Witnesses and the officers themselves said there was a violent struggle between the officers and West. His manner of death was undetermined, according to the autopsy.

Both Black and West are now included on the list of cases that should have been ruled homicides.

Tawanda Jones, West’s sister who has held weekly rallies for 616 weeks to highlight his case, said she feels something positive will come from the investigation. “They’re finally listening to me now,” Jones said. “It feels good that finally they’re listening.”

Fowler’s tenure also included the death of Freddie Gray 10 years ago. The autopsy concluded Gray died from spinal injuries sustained during transport in a Baltimore police van. It also classified his death as a homicide because officers repeatedly failed to seek medical attention while he was in distress. Prosecutors filed charges against six officers, but none were convicted.