Same Autopsy, Opposite Opinions: What the Birchmore Murder Trial Teaches About Forensic Expert Credentials

A 23-year-old woman is found dead in her apartment, seated on the floor, a duffel bag strap around her neck and tied to a closet door. The medical examiner calls it suicide. Five years later, a former police detective is on trial in federal court for her murder, and the case may come down to a bone about the size of a wishbone.

That is where things stand in United States v. Farwell, the trial over the 2021 death of Sandra Birchmore. The prosecution rested on October 28. The defense began calling its medical experts on November 2. As I write this, there is no verdict, and I am not going to guess at one. What I want to talk about is the expert fight, because every attorney who handles a disputed death will recognize it.

The case in brief

These facts come from the federal charging documents and from trial coverage in the Boston Globe and other Boston outlets.

• Matthew Farwell, a former Stoughton, Massachusetts police detective, is charged with killing a witness or victim under 18 U.S.C. § 1512 and with causing the death of a child in utero under 18 U.S.C. § 1841. Birchmore was about 8 to 10 weeks pregnant.
• Prosecutors say he killed her on February 1, 2021 to keep her from reporting sexual abuse that prosecutors say started when she was a teenager in the police Explorers program he helped run, then staged the scene.
• Farwell has pleaded not guilty. His defense is that Birchmore, who had a documented mental health history, took her own life.

One bone, two readings

The autopsy found a fracture on the right side of Birchmore’s hyoid, the small U-shaped bone at the front of the neck, along with petechial hemorrhages in the eyes and bleeding in a neck muscle. The state medical examiner ruled the cause of death asphyxia by hanging and the manner suicide.

The government’s key medical witness, Dr. William Smock, reviewed the scene photos, the autopsy photos and the report. He told the jury the death was a homicide and the scene had been altered. His reasoning, as reported from his testimony:

• In young adults the hyoid is still flexible and has not fused, so it is hard to break.
• Birchmore was found seated, with only part of her weight on the strap. He testified he knew of no documented case of a hyoid fracture in a young person in that kind of partial hanging.
• Her weight appeared to rest on the left side of her neck, but the fracture was on the right.
• Her hair was tangled in the strap, and a mark on her chest matched the strap’s clasp, which he demonstrated with a replica pressed into clay.

The defense answer was aimed as much at the witness as at the bone. Smock is an emergency medicine physician with forensic fellowship training and decades of work with a medical examiner’s office and law enforcement in Kentucky. He does not hold board certification in forensic pathology, and Farwell’s lawyers have made sure the jury heard that more than once. Their lineup includes a forensic anthropologist expected to testify that a hyoid can break under about seven pounds of force and to challenge the research Smock relied on, Kentucky’s chief medical examiner on what Smock was and was not authorized to do without that board certification, and Dr. Thomas Andrew, who spent years as New Hampshire’s chief medical examiner and is board certified in forensic pathology. He has said the medical evidence does not rule out a suicidal hanging.

Same autopsy. Same fracture. Opposite opinions.

The medical examiner in the middle

The most instructive testimony may have come from the examiner who did the autopsy. Earlier this year she amended Birchmore’s manner of death from suicide to undetermined. On the stand she explained that the police intake described a suicide with no signs of foul play, that a state police report she reviewed was headed “Birchmore suicide,” and that she had no information about a broken necklace found at the scene. “We’re dependent on other agencies to provide the information,” she testified. She said she could recall changing a death certificate only once or twice in her career.

That is not a criticism of her. It is a reminder of how death determinations actually get made. A manner-of-death ruling is a medical opinion built on top of an investigation, and it is only as good as what the examiner was given.

Five lessons for attorneys on either side

You do not need a homicide case to use these. The same disputes show up in wrongful death suits, unexplained nursing home deaths, med mal cases where the family questions the death certificate, personal injury claims with a contested mechanism of death, and life insurance suicide exclusions.

1. Match the credential to the question

Cause and manner of death is the core of forensic pathology. An emergency physician, a clinical pathologist or a treating doctor may know a great deal, but if your expert sits next to the specialty instead of inside it, opposing counsel will make that the theme of cross. Decide early whether your question is about death investigation, injury interpretation, clinical care, or bone biomechanics, and retain for that.

2. Know what the credential allows

The defense plans to ask what Smock was permitted to do at the medical examiner’s office without forensic pathology board certification. Titles like “assistant medical examiner” or “police surgeon” mean different things in different states. Pull the actual job descriptions and authority before your expert’s CV becomes someone else’s exhibit.

3. Find out what the original examiner was told

Request the investigator’s intake report, the scene notes sent to the medical examiner’s office, and any correspondence about follow-up. In this case an email from a state police lieutenant saying “Nothing new to report” became part of the story. If the examiner worked from an incomplete file, that is either your best argument or your biggest problem.

4. Test the literature, not just the conclusion

A big part of the defense plan is to challenge the studies behind the opinion. Ask your expert for every source they relied on, read the populations and methods in those studies, and make sure the opinion does not stretch the data. Since the 2023 amendment to Federal Rule of Evidence 702, the party offering the expert must show the court it is more likely than not that the opinion rests on sufficient facts and reflects a reliable application of reliable methods. Many state courts apply similar standards.

5. Do not overlook the forensic nurse

Injury documentation, ligature and fingernail marks, evidence collection and chain of custody are core forensic nursing territory. A forensic nurse expert can explain to a jury what was, and was not, documented at the scene and at intake, and can help you see gaps before opposing counsel does.

How Med Legal Pro helps

When a death is disputed, the right expert is the one whose training matches the question opposing counsel will ask. We work with attorneys on criminal, wrongful death, medical malpractice, personal injury and nursing home cases, for plaintiffs and defendants, and our experts review the records.

• Joseph A. Felo, D.O. is a forensic pathologist with more than 33 years in practice. His work covers cause, manner and mechanism of death, wound interpretation, autopsy review, toxicology, suicide and homicide determinations, and deaths in nursing homes.
• Ariana Miller, MSN, RN, SANE-A is a forensic nurse and Level 1 trauma emergency nurse with medicolegal death investigator training. Her focus includes forensic evidence collection and preservation, injury documentation, and forensic examinations.

To find out whether one of our forensic experts is a fit for your case, call 844-633-5345 or submit a case. We run conflicts and confirm availability before anything moves forward. You can also read more about our cause-of-death and forensic pathology experts.

This article is for informational purposes only and is not legal advice. It discusses a pending criminal case based on public reporting and court filings. The defendant is presumed innocent, and nothing here predicts or comments on the outcome.