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On the hit television series "CSI," forensic scientists use state-of-the-art technology to discover with little doubt why and how a person died. In real life, it?s not so easy. TV is not reality.

It?s difficult at times to categorize someone?s death as a homicide, a suicide, an accident or simply natural causes, said State Medical Examiner Dr. David Fowler. In Maryland, almost one of 10 deaths investigated by Fowler?s team fall into a category that sounds downright mysterious, according to his latest annual report.

It?s called "undetermined."

In Maryland there were 814 undetermined deaths, according to the most recent annual report from the state medical examiner that looked at deaths in 2005. Baltimore City reported 333 undetermined cases. Baltimore County had 111 cases and Prince George?s County tracked 75 undetermined cases. By comparison, Washington had 76 undetermined deaths in 2005. Philadelphia, a much larger city, listed 124 deaths as undetermined in 2005.

In comparison to other deaths, the state reported an increase in homicides, accidents and natural causes and a decline in suicides in 2005.

"These [undetermined] cases are mostly drug-related," said University of Maryland criminologist Brian Wiersema. "The medical examiner is forced to use undetermined because there is not enough information gathered in the death investigation to assign the case to ? suicide, accident, homicide, natural causes. Because of this, rates of accidental drug overdoses and suicides are likely to be underestimated."

Of the state?s 814 undetermined deaths, about 76 percent were classified as drug-related. The other cases ranged from gunshot wounds to strangulation. Even so, there was not enough evidence to classify these cases as homicides, accidents or suicides.

Baltimore?s vast number of undetermined deaths ? 333 in 2005, a slight decrease from 341 in 2004 ? is a matter of medical philosophy, Fowler said.

"Since in the great majority of drug cases the mechanism by which the drug came to be in the deceased?s body cannot be determined, the manner of death is usually not known," Fowler said. "If someone injected you with heroin and you died, would it be a homicide?"

Fowler said drug addicts die without witnesses and leave few clues.

"When someone is found dead in alleyway, did they take the drug themselves to end there life, or was it simply an accident?" he asked. "Many medical examiner?s office presume the majority of drug-related deaths are accidents, without any method of substantiate it."

But not all undetermined deaths were categorized as the results of drug abuse. The report shows that 73 "undetermined" deaths were included in the "other ? non-natural cause" category. For example, Fowler said, "if somebody finds some bones in their backyard, they are sometimes non-human remains ? they?re a bunch of strange things that are not even human."

Gregory Davis, University of Kentucky College of Medicine professor, said he doesn?t see any red flags from the way Maryland?s medical examiner classifies cases as undetermined.

"Drug overdoses are tough," he said. "Some offices around the country default to accident. It?s tidy. It?s neat. But other offices, like Maryland, say, ?I?m going to be intellectually honest. I don?t know if this person meant to kill themselves.? "

For Wiersema, though, the mystery that surrounds undetermined deaths leaves an incomplete picture for scientists to study.

"Both accidental drug overdoses and suicides are preventable, but if we are not aware of the complete picture that these deaths represent, we cannot fully address the problem, especially the parts of the problem that remain hidden within the undetermined category," he said.

Death by the number

Homicides

2004: 545

2005: 595

Suicides

2004: 506

2005: 487

Accidents

2004: 1,464

2005: 1,549

Natural causes

2004: 5,107

2005: 5,337

Undetermined

2004: 807

2005: 814

Among the undetermined deaths in 2005

Anne Arundel: 62

Baltimore County: 111

Carroll: 11

Harford: 30

Howard: 13

Montgomery: 51

Prince George?s: 75

Baltimore City: 333

Examiner Staff Writer Luke Broadwater contributed to this article.

sjanis@baltimoreexaminer.com

Stephen Janis

Hundreds of undetermined deaths on books