2005 Annual Report

Office of the

Chief Medical Examiner

State of Maryland

DAVID R. FOWLER, M.D. CHIEF MEDICAL EXAMINER JACK M. TITUS, M.D. DEPUTY CHIEF MEDICAL EXAMINER MARY G. RIPPLE, M.D. DEPUTY CHIEF MEDICAL EXAMINER BARRY LEVINE, PH D. TOXICOLOGIST

STATE OF MARYLAND OFFICE OF THE CHIEF MEDICAL EXAMINER

FORENSIC MEDICINE CENTER

111 PENN STREET

BALTIMORE, MARYLAND 21201-1020 PHONE (410) 333-3250

FAX (410) 333-3063

POST MORTEM EXAMINERS COMMISSION SANFORD A. STASS, M.D. - Chairman BROOKS JACKSON, M.D. – Vice Chairman

JOSHUA SHARFSTEIN, M.D. S. ANTHONY McCANN SUPERINTENDENT THOMAS E. HUTCHINS

July 1, 2006 The Honorable Robert L. Ehrlich Jr. Governor State House 1 State Circle Annapolis, Maryland 21401 Dear Governor Ehrlich: On behalf of the Post Mortem Examiners’ Commission and the staff of the Office of the Chief Medical Examiner (OCME) of the State of Maryland, I am pleased to present for your information the 67th Annual Report analyzing the death investigations carried out by this Office in 2005. In carrying out its duties under Health-General §5-309, the OCME investigated 8782 cases. 6119 of these cases were determined to be within the jurisdiction of the OCME. There were 4056 autopsies performed to allow an accurate cause of death to be determined. Homicides in Maryland increased to 595 in 2005 compared to 545 in 2004. Firearm homicides increased from 404 deaths in 2004 to 443 in 2005. Suicides decreased to 487 in 2005 from 506 in 2004. In this report we included information regarding the involvement of alcohol and drugs in homicides, suicides, transportation accidents, and drownings as well as data regarding illicit drugs used in fatal drug intoxications.

The Honorable Robert L. Ehrlich Jr. July 1, 2006 Page 2 The information developed in this report is being shared with various programs at the local, state and federal levels. This office provides assistance not only on a short or occasional basis, but also participates in ongoing projects as well. A few of the many requests for data and statistics were received from: Health Care for the Homeless, Inc., Carroll County Drug Task Force, The Maryland State Medical Society Maternal and Child Health Committee, Uniformed Services University of the Health Sciences Environmental and Occupational Health Division, Johns Hopkins University School of Hygiene and Public Health – Department of Epidemiology and School of Nursing, Center for Substance Abuse Research (CESAR), Child Fatality Review Board, Maryland Department of Transportation, Maryland Department of Labor, Licensing and Regulation, Alcohol and Drug Abuse, Capital Gazette, Homeland News, The Baltimore Sun for Anne Arundel County, Office of Public Health Anne Arundel County, Harford County Department of Community Services, Harford County Sheriff’s Office, Maryland State Police, Health Quest, Harborview Medical Center, Worcester County Health Department, The Carroll County Public School System, Maryland Department of Health and Mental Hygiene, National Drug Intelligence Center, Washington Post Newspaper, Baltimore Sun Newspaper, Federal Bureau of Investigation (FBI), Baltimore City Health Department, Baltimore Examiner Newspaper, Department of Justice, Consumer Product Safety Commission, and the University of Maryland National Study Center. Respectfully submitted,

David R. Fowler, M.D. Chief Medical Examiner DRF/skw

Table of Contents Cases Reported to OCME: Action Taken. ............................................................................................................... 1 Autopsied .................................................................................................................. 2 Manner of Death .......................................................................................................... 3 Manner of Death: Classified by Sex.......................................................................................................... 4 Classified by Race........................................................................................................ 4 Medical Examiner Cases: Cause and Manner of Death........................................................................................ 5 A Three-Year Comparison ........................................................................................... 7 Manner and Jurisdiction. .............................................................................................. 8 Type and Jurisdiction ................................................................................................... 8 Toxicologic Testing: Percentage of Cases Positive for Alcohol and/or Drugs.............................................. 9 Drug Abuse Deaths: By Jurisdiction (3-Year Comparison) ......................................................................... 10 Undetermined Manner Only....................................................................................... 11 Homicide Deaths: Cause of Death .......................................................................................................... 12 A Five-Year Comparison............................................................................................ 13 Deaths by Age............................................................................................................ 14 Gunshot Wound Deaths: A Five-Year Comparison............................................................................................ 15 Sudden Infant Death Syndrome: A Five-Year Comparison............................................................................................ 16 Classified by Age........................................................................................................ 17 Classified by Race and Sex. ...................................................................................... 17 Suicide Deaths: Cause of Death ......................................................................................................... 18 Youth Suicides ........................................................................................................... 19 Deaths by Age ........................................................................................................... 20 Transportation Deaths: Classified by Activity .................................................................................................. 21 Type of Vehicle........................................................................................................... 22 Classified by Age........................................................................................................ 23 Alcohol/Drug Results.................................................................................................. 24 Alcohol Levels in Cases Testing Positive .................................................................. 25

Cases Reported to OCME - 2005Action Taken

1105

4056

646

2663

22587

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Autopsy Field Inspection Approval Decline Inspection atOCME

Inquiry

8782 Total Cases

-1-

2005 Medical Examiner Cases Autopsied*

*One case was classified as "not applicable"

Homicide** 59215%

Undetermined71518%

Accident92223%

Natural147436%

Suicide3529%

Total Cases Autopsied - 4056-2-

** Three homicides were not autopsied due to final disposition prior to Medical Examiner notification.

2005 Cases Reported to OCME Manner of Death

5337

212

602

963

586487595

0

1000

2000

3000

4000

5000

6000

Homicide Suicide Accident (MVA) Accident (Other) Natural Undetermined* Undetermined**

Total Cases - 8782

-3-*Undetermined Manner: Drugs/Narcotics**Undetermined Manner: Other

Manner of Death - 2005

0

500

1000

1500

2000

2500

3000

3500

Classified by Sex

Male 3085 1024 515 388 412 126

Female 2250 525 79 99 190 44

Unknown 2 0 1 0 0 42

Natural Accident Homicide Suicide Drug Abuse Undetermined

Other Undetermined

0

500

1000

1500

2000

2500

3000

-4-

Classified by Race

White 2710 1037 89 386 370 82

Black 2497 405 456 75 220 72

Asian 39 18 9 11 3 2

Other 91 89 41 15 8 13

Unknown 0 0 0 0 1 43

Natural Accident Homicide Suicide Drug Abuse Undetermined

Other Undetermined

Medical Examiner Cases – 2005 Cause and Manner of Death

Cause of Death

Manner of Death

Total

Natural Homicide Suicide Accident Undeter-mined

Infectious disease AIDS Other

40 64

- -

- -

- -

- -

40 64

Malignant neoplasms (Cancer) 325 - - - - 325Endocrine and metabolic disease Diabetes Other

63 3

- -

- -

- -

- -

63 3

Mental Disorders Alcohol abuse Other

62 3

- -

- -

- -

- -

62 3

Nervous system disease Meningitis Seizure disorder Other

9 27 47

- - -

- - -

- - -

- 4 -

9 31 47

Circulatory system disease Hypertensive cardiovascular disease Arteriosclerotic cardiovascular disease Cardiac arrhythmia Cardiomyopathy Pulmonary embolism Cerebrovascular disease Aneurysm Hemorrhage Other

416 3378

100 46 77 16 35

101 57

- - - - - - - - -

- - - - - - - -

- - - -

16 - - -

- - - - - - - -

416 3378

100 46 93 16 35

101 57

Respiratory system diseases Respiratory distress syndrome Pneumonia Chronic obstructive pulmonary disease Asthma Other

10 108

5 26 86

- - - - -

- - - - -

- - - - -

- - - - -

10 108

5 26 86

Digestive system disease Fatty liver Cirrhosis Gastrointestinal hemorrhage Other

4 56 31 30

- - - -

- - - -

- - - -

- - - -

4 56 31 30

Congenital anomalies 6 - - - - 6Perinatal conditions 13 - - - - 13Ill-defined conditions Sudden Infant Death Syndrome Other

15 11

- -

- -

- -

- 46

15 57

-5-

Cause of Death

Manner of Death

Total Natural Homicide Suicide Accident Undeter-

mined

Traumatic injury Head/Chest injuries Multiple injuries Blunt force Gunshot wound Sharp force/cutting Fracture Other trauma

- - - - - - -

10 5

33 443

74 - -

- 27

- 216

13 - -

323 639

3 1 -

70 1

- 12

- 5 - - -

333 683

36 665

87 70

1Poisoning Alcohol intoxication Drug intoxication/abuse Alcohol and drug intoxication Carbon monoxide Cocaine intoxication Cocaine and alcohol intoxication Cocaine and narcotic intoxication Narcotic intoxication Narcotic and alcohol intoxication Inhalant intoxication

- - - - - - -

7 - -

- - - - - - - - - -

2

45 5

7 - - -

12 2 4

2 2 -

9 1 - - 1 1 -

9

81 12

- 60

5 97

309 40

1

13

128 17 16 61

5 97

329 43

5Asphyxiation Airway obstruction/Aspirated stomach content Hanging Smoke inhalation Strangulation/Asphyxiation Suffocation Drowning Unspecified type of asphyxia

- - - - - - -

- - 1

25 - - -

- 115

- 22

- 5 -

24 4

53 46

- 64

-

- - - 9 - 9 -

24 119

54 102

- 78

-Hypothermia - - - 46 - 46Hyperthermia - - - 43 1 44Thermal injury (Burns) - 1 3 6 1 11Electrocution - - 1 6 - 7Other non-natural cause - 3 8 188 73 272Other natural cause 60 - - - - 60Unknown cause - - - - 5 5Non-human remains - - - - 35 35Accident during surgery - - - - - -TOTAL 5337 595 487 1549 814 8782

-6-

Manner of Death - 3 Year Comparison Medical Examiner Cases: Manner of Death, Maryland 2005

Manner of Death Number %

Natural ....................................................................................................................................... 5337 60.8

Homicide ................................................................................................................................... 595 6.8

Suicide ....................................................................................................................................... 487 5.5

Accident..................................................................................................................................... 1549 17.6

Undetermined ............................................................................................................................ 814 9.3

Total ...........................................................................................................................................

8782

100.0*

Medical Examiner Cases: Manner of Death, Maryland 2004

Manner of Death Number %

Natural ....................................................................................................................................... 5107 60.6

Homicide ................................................................................................................................... 545 6.5

Suicide ....................................................................................................................................... 506 6.0

Accident..................................................................................................................................... 1464 17.4

Undetermined ............................................................................................................................ 807 9.6

Total ...........................................................................................................................................

8429

100.0*

Medical Examiner Cases: Manner of Death, Maryland 2003

Manner of Death Number %

Natural ....................................................................................................................................... 4954 59.1

Homicide ................................................................................................................................... 556 6.6

Suicide ....................................................................................................................................... 491 5.9

Accident..................................................................................................................................... 1494 17.8

Undetermined ............................................................................................................................ 892 10.6

Total ...........................................................................................................................................

8387

100.0*

*Because of rounding, percentages do not necessarily total 100.

-7-

County Natural Accident Homicide Suicide Undetermined TOTALAllegany 107 46 1 13 11 178Anne Arundel 234 79 13 49 62 437Baltimore County 415 164 28 71 111 789Calvert 73 15 2 5 5 100Caroline 11 10 0 2 2 25Carroll 86 38 2 19 11 156Cecil 43 28 8 13 14 106Charles 37 41 4 15 4 101Dorchester 17 15 2 2 4 40Frederick 83 55 3 23 18 182Garrett 25 11 0 4 1 41Harford 175 48 3 21 30 277Howard 72 25 5 16 13 131Kent 17 6 1 3 1 28Montgomery 204 111 18 56 51 440Prince George's 1204 235 171 49 75 1734Queen Anne's 13 8 2 7 3 33St. Mary's 48 17 2 13 17 97Somerset 10 5 1 2 5 23Talbot 30 13 2 4 5 54Washington 96 55 4 19 19 193Wicomico 113 47 5 11 12 188Worcester 41 14 0 5 7 67Baltimore City 2183 463 318 65 333 3362TOTAL 5337 1549 595 487 814 8782

County Autopsy OCMEInspections

FieldInspections Inquiry Approval Decline TOTAL

Allegany 74 5 49 2 26 22 178Anne Arundel 264 5 84 1 28 55 437Baltimore County 427 30 140 10 70 112 789Calvert 43 0 18 1 6 32 100Caroline 11 1 10 0 2 1 25Carroll 87 2 38 3 12 14 156Cecil 73 1 18 1 6 7 106Charles 68 3 23 0 5 2 101Dorchester 27 1 2 0 4 6 40Frederick 98 6 38 2 30 8 182Garrett 20 1 9 0 4 7 41Harford 131 7 76 1 11 51 277Howard 80 3 27 1 6 14 131Kent 12 0 8 0 4 4 28Montgomery 275 4 60 14 48 39 440Prince George's 721 19 171 7 52 764 1734

Type and Jurisdiction

Manner and Jurisdiction

Medical Examiner Cases - 2005

2005 Toxicology Testing# of Cases Positive for Alcohol and/or

Drugs (Percentage of the Manner of Death)

301(19%)

127(26%)

190(32%)

55 (4%)

35(7%)

90(15%)

0

50

100

150

200

250

300

350

Homicides (595) Suicides (487) Accidents (1549)

Manner of Death

-9-

Alcohol Drugs

Drug Abuse Deaths 3 Year Comparison by Jurisdiction

0

50

100

150

200

250

300

350

2003 16 46 130 4 3 16 13 11 3 15 2 38

2004 11 49 100 6 2 16 18 11 3 16 1 19

2005 10 58 102 4 0 14 14 5 4 19 1 24

AlleganyAnne

ArundelBaltimore Co Calvert Caroline Carroll Cecil Charles Dorchester Frederick Garrett Harford

0

50

100

150

200

250

300

350

-10-

2003 22 1 43 52 3 5 3 5 11 8 10 331

2004 14 0 38 54 3 4 2 3 14 13 11 300

2005 13 0 43 57 2 13 3 5 16 12 5 273

Howard Kent MontgomeryPrince

George'sQueen Anne's

St. Mary's Somerset Talbot Washington Wicomico WorcesterBaltimore

City

2005 Drug Abuse Deaths Undetermined Manner

82

12

309

40

60

5

97

0

50

100

150

200

250

300

350

Drug Drugs &Alcohol

Narcotics Narcotics &Alcohol

Cocaine Cocaine &Alcohol

Narcotics &Cocaine

Total Cases - 605

-11-

Narcotics include Heroin, Morphine, Methadone, PhencyclidineDrugs include Prescription Medications

3

0

19

15

6

2

74

33

443

0 50 100 150 200 250 300 350 400 450

Total Deaths - 595

-12-

Other

Child Abuse

Asphyxiation

Head/Multiple Injuries

Strangulation/Suffocation

Smoke Inhalation

Sharp Force

Blunt Force

Firearms

2005 Homicide Deaths Cause of Death

Homicides 5 Year Comparison

2001 - 2005

505

545

556

545

595

460

480

500

520

540

560

580

600

620

2001 2002 2003 2004 2005

-13-

Num

ber o

f Cas

es

10

116

131

93

65

43

46

31

17

17

7

6

4

5

3

1

0 20 40 60 80 100 120 140

Total Deaths - 595

-14-

0-14

15-20

21-25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65

66-70

71-75

76-80

Over 80

Age Unknown

Age

Gro

up

2005 HomicidesDeaths by Age

0

50

100

150

200

250

300

350

400

450

-15-

Firearm Deaths 2001 - 2005

2001 1 368 220 4

2002 0 374 233 2

2003 0 410 233 3

2004 2 404 244 1

2005 1 443 215 5

Accident Homicide Suicide Undetermined

32

19

22

17

15

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005

-16-

SIDS Deaths2001 - 2005 Comparison

Sudden Infant Death Syndrome2005

3

1

7

2

0

1

0

1

0 0 0 00

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8 9 10 11 12Age in Months

Total of 15 Deaths

Classified by Age

Classified by Sex

Male (7)

47%Female

(8)53%

Classified by Race

Other (2)

13%Black

(7)47%

White (6)

40%

-17-

Sudden Unexplained Death In Infancy 2005

20

13

1

6

23

0 01

0 0 002468

101214161820

1 2 3 4 5 6 7 8 9 10 11 12Age in Months

Total of 46 Deaths

Classified by Age

Classified by Sex

Male (31)67%

Female(15)33%

Classified by Race

Other(5)

11%

Black(28)61%

White (13)28%

-17A-

2005 Suicide Deaths Classified by Cause of Death

12

27

115

216

58

5

13

7

12

22

0 50 100 150 200 250

Others

Multiple injuries

Hanging

Firearms

Drug Intoxication

Drowning

Cutting/Stab Wounds

Carbon Monoxide

Narcotic Intoxication

Asphyxia

Total Cases - 487

-18-

2005 Youth Suicides 25 Years of Age and Under

0

1

0

4

1

66

4 4

9

7 7 7

8

9

0

1

2

3

4

5

6

7

8

9

10

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

AgeTotal Cases - 73

-19-

35

38

39

43

48

63

52

38

19

19

19

29

19

26

0 10 20 30 40 50 60 70

Total Deaths - 487

-20-

10 thru 20

21-25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65

66-70

71-75

76-80

Over 80

2005 Suicide Deaths by Age

382

110

89

2 3

0

50

100

150

200

250

300

350

400

Drivers Passengers Pedestrians Bicyclists Pilots

*Includes motor vehicles, boats, planes. bicycles, and trains

Total Cases - 586

-21-

2005 Transportation Accidents* Classified by Activity

2005 Transportation Deaths Type of Vehicle

4

9

99

1

325

77

8

4

5

37

3

11

3

0 50 100 150 200 250 300 350

Other

Watercraft

Trucks/Vans

Trains

Passenger Cars

Motorcycles

Motorbikes

Farm Vehicles

4-Wheelers

Sports Utility Vehicles

Buses

Bicycles

Aircraft

Total Cases - 586

-22-

7

9

12

62

82

36

58

50

47

34

38

30

19

25

23

15

24

14

1

0 10 20 30 40 50 60 70 80 90

Total Cases - 586

-23-

0-5

6-10

11-15

16-20

21-25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61-65

66-70

71-75

76-80

81-85

Over 85

Age Unknown

2005 Transportation DeathsBy Age

2005 Transportation Accidents Alcohol/Drug Results

102(27%)

33(30%)

27(30%)

0(0%)

1(33%)

83(22%)

19(17%)

27(30%)

1(50%) 0

(0%)

190(50%)

41(37%) 35

(39%)

0(0%)

2(67%)

7(2%)

17(15%)

0(0%)

1(50%) 0

(0%)0

20

40

60

80

100

120

140

160

180

200

Drivers (382) Passengers (110) Pedestrians (89) Bicyclists (2) Pilots (3)

586 Transportation Deaths

-24-

Alcohol Positive Drugs Positive

Alcohol & Drugs Negative No Tests Performed

26(16%)

24(15%)

28(17%)

26(16%)

31(19%)

17(10%)

6(4%)

2(1%)

3(2%)

0

5

10

15

20

25

30

35

.01-.05 .06-.09 .10-.15 .16-.19 .20-.25 .26-.29 .30-.35 .36-.39 .40+

586 Transportation Deaths 338 Negative for Alcohol 85 No Testing Performed

-25-

2005 Transportation DeathsBlood Alcohol Concentration in 163 Cases

33%* Tested Positive

*Percent based on total cases tested for alcohol