Mayor Brandon Scott fired Health Commissioner Dr. Ihuoma Emenuga on Monday evening after learning she is under criminal investigation. Her abrupt departure, just months into the job, leaves the Health Department once again without a leader as Baltimore struggles with rampant overdose deaths at a rate not seen before in a major American city.

The Baltimore Office of the Inspector General opened a probe into Emenuga’s work at a private health clinic while she was also serving as health commissioner, according to multiple people familiar with the matter but who were not authorized to speak publicly. The inspector general’s office made a criminal referral to the Office of the Maryland State Prosecutor, which is now investigating.

Emenuga’s clinical work was done at Chase Brexton, a nonprofit health care center founded in 1978 as a volunteer-run gay health clinic in the Mount Vernon neighborhood. Today the clinic has locations throughout Maryland and sees about 40,000 patients a year with a focus on providing services to poor and underserved populations. A spokesperson for Chase Brexton did not immediately return a request for comment Tuesday evening.

Emenuga could not be reached for comment. Scott’s office declined to comment about the investigation. The inspector general and state prosecutor’s offices do not confirm or deny the existence of investigations.

Emenuga has an active certification with the Maryland Board of Physicians, issued in 2014 and set to expire in September of this year. The board’s website notes that Emenuga has a primary practice at Park West Health System in Northwest Baltimore, where a Health Department bio notes that she has served as chief health officer. She began her career as a primary care physician in Côte d’Ivoire and holds numerous degrees, including a medical degree from the University of Nigeria, a master’s of science in public health from the University of London, and a master’s of business administration from the University of Maryland’s Smith School of Business.

Most recently, Emenuga was a managing partner at the health care consulting firm Vie Health. She had previously served with the Baltimore Health Department’s Youth Wellness and Community Health Division, where she oversaw clinical services in schools and also worked as medical director at Chase Brexton Health Care.

While the nature of Emenuga’s work at Chase Brexton during her tenure in the Health Department is unclear, it’s not uncommon for city health commissioners to maintain involvement in an outside practice. Dr. Leana Wen, a former city health commissioner, recounts in her memoir “Lifelines: A Doctor’s Journey in the Fight for Public Health,” that she volunteered once a month at a local health center for underinsured patients, because she felt it was important to maintain that community tie while serving as the city’s top doctor.

A financial disclosure Emenuga filed before the city Board of Ethics did not disclose any outside sources of income, though it did report that she holds a 100% stake in Vie Health, the consultancy where she worked before joining the Health Department.

The mayor’s unexpected search for a new public health leader comes when the city is struggling acutely with responding to opioids on city streets.

The death rate from overdoses in Baltimore has been nearly double that of any other major city in the country in recent years, a New York Times/Banner investigation found. Since the synthetic opioid fentanyl took over the illegal drug supply about a decade ago, overdose deaths in Baltimore have quadrupled, claiming on average three lives a day.

In Emenuga’s short time helming the department, she made few public appearances, but spoke at length at a city budget hearing in June about her plans to combat the overdose crisis.

“There is not a magic bullet when it comes to addressing the overdose pandemic,” she told the council. “Frankly speaking, all options are on the table.”

Scott’s administration is tasked with recruiting a new health commissioner, looking to fill a position that not so long ago launched the careers of some of the country’s biggest public health stars: Dr. Joshua Sharfstein is now a vice dean at the Johns Hopkins Bloomberg School of Public Health; Wen left the Health Department to lead Planned Parenthood and today is among the most widely recognized health analysts nationally.

“The danger in turnover [at the Health Department] is you lose track of data and processes,” said Dr. Peter Beilenson, who served as health commissioner for the city from 1992 to 2005. “Look what happened in the last couple of years with overdoses.”

Drawing on the findings of a recent investigation by The Baltimore Banner and The New York Times, Beilenson noted that top officials in City Hall weren’t aware of how much worse Baltimore’s overdose epidemic had grown compared to other cities. “You can’t address problems you don’t know you have.”

Beilenson resigned from his job in 2020 as director of Department of Health Services in Sacramento County, California after using a racist term to refer to Asian Americans.

The city is nearing a critical moment in its opioid response — city attorneys are scheduled to go to court in September with a group of major pharmaceutical companies.

Councilman Mark Conway, who recently clashed with Scott’s administration over the transparency of its overdose response, said losing Emenuga is clearly a “setback” in the city’s efforts, but expressed optimism about the department’s ability to address the crisis going forward. Stable, capable leadership could have significant impact, and Baltimore presents an opportunity that should have candidates “chomping at the bit,” Conway said.

“I think we are really well positioned to make some significant headway,” he said.

Wen, the former Baltimore health commissioner and national public health expert, said Baltimore is a city with deeply rooted, decades-old health challenges, but also a city with a renowned Health Department filled with committed and experienced employees.

“The Health Department needs strong, stable, and visionary leadership to address the myriad of urgent challenges,” Wen said, including its escalating opioid epidemic.

Since an initial memo sent to City Council members Monday night, the Scott administration has altered its immediate plan for the Health Department. According to a new memo Tuesday, Deputy City Administrator Simone Johnson will serve as the department’s interim commissioner until Aug. 12, at which point Deputy Commissioner Mary Beth Haller, who has previously led the Health Department in an interim capacity, will take over as the city conducts a national search for a permanent head.

Scott’s office expressed confidence in a statement that “the incredible staff” of the Health Department will continue to serve the community in the meantime. While the city pursues a national search for a new commissioner, Scott has “the utmost confidence” in Haller.

“Under her leadership, the Health Department’s critical work will proceed uninterrupted,” his office said.

Some in Baltimore’s overdose prevention community were caught off guard by Emenuga’s abrupt departure but also said they don’t expect the turnover in City Hall to interrupt their work.

“We don’t wait for the Health Department to tell us what to do,” said Howard Ashkin, a former president of the Maryland Association for the Treatment of Opioid Dependence. “We’re making efforts regardless of who’s in charge.”

Ashkin is also a member of the Health Department’s Opioid Prevention Team, which is responsible for creating a citywide strategic plan to combat overdoses. He said he has never viewed the city’s health commissioner as the driving force behind overdose response in Baltimore.

Until The Banner/Times published their investigation in May, the Opioid Prevention Team has met infrequently and without much attention from city leaders, Ashkin said. In his four or five years with the group, Ashkin said no city health commissioner has attended a meeting until the most recent one in June, when Emenuga showed up.

Whatever prompted the criminal investigation into Emenuga, the mayor’s confidence in her evaporated quickly.

“I am thrilled to nominate Dr. Emenuga to be the City of Baltimore’s next Health Commissioner to lead our Health Department,” Scott said in a news release in December. “Given her background, I know she will bring her extensive experience, dedication to public health, and innovative thinking to her work on behalf of Baltimoreans in every neighborhood.”