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.