In an interview with NBC News, Smock dismissed the anthropologists’ concerns and said he had studied strangulation and asphyxiation for nearly four decades. He stood by his findings and said there was only one possible cause of Noble’s death.

“As far as I’m concerned, Emily Noble’s hyoid bone fracture did not come from her hanging,” he said. “It came from strangulation.”

Despite Smock’s assertions, the jury returned a not guilty verdict for Moore.

One of the Delaware County prosecutors who tried the case, Mark Sleeper, told “Dateline” that Smock’s conclusions were his “strongest piece of evidence” at trial. He declined to comment on the experts’ concerns in response to a request from NBC News. In an interview with “Dateline” he pushed back against Garvin, the forensic anthropologist who testified for Moore, saying she didn’t have the same expertise as Smock and wasn’t able to properly analyze Noble’s fatal injury. 

Garvin, who is also a professor of anatomy at Des Moines University, responded that it was clear Smock did “not understand fracture biomechanics.”

“I am not saying that this is a hanging based on the fracture pattern,” she added. “I am refuting Dr. Smock’s claim that this fracture pattern cannot occur in a hanging and I do so using the scientific literature.”

Moore’s lawyer, Diane Menashe, attributed the failed prosecution to a problem she summed up as “garbage in, garbage out.” Noble’s bones were mishandled, she told “Dateline” and noted in her closing argument, producing flawed conclusions with little scientific certainty.

“You’re only as good as the information you get,” she said.

Hundreds of strangulations, high-profile cases

Three local women searching for Noble told “Dateline” they found her skeletal remains on Sept. 16, 2020, months after Moore reported her missing from her home in Westerville. She was discovered in a wooded area where she often foraged for edible plants. They found her in a kneeling position, suspended from a branch. 

Westerville police Detective Steve Grubbs, who led the investigation into Emily’s disappearance and death, confirmed to “Dateline” that Noble was suspended by a USB cord. A water bottle containing alcohol was also at the scene, he said.

At the request of a local coroner, the Injury Biomechanics Research Center at the Ohio State University analyzed the remains and reported what Sleeper described to “Dateline” as two “major” findings: Emily Noble suffered “perimortem” trauma — or trauma from around the time of her death — to her nasal bones and throat, including bilateral fractures to her hyoid bone and thyroid cartilage.

Eleven days after the university lab filed its report with the coroner, the coroner concluded that Noble died from multiple injuries to the head and neck. The report, which was obtained by “Dateline,” was largely based on the lab’s findings and did not say if she died by suicide or homicide.

After the reports were completed, Grubbs reached out to Smock for an opinion.

“They wanted someone who has expertise in evaluating strangulation-related deaths,” Smock told “Dateline.”

Smock said he is not a forensic pathologist — a medical doctor whose expertise is in determining cause and manner of death and performing autopsies — but a forensic physician, which he described in his case as a medical doctor with specialized training in forensic medicine and forensic pathology. 

He completed a one-year fellowship in clinical forensic medicine with the Kentucky Office of the Medical Examiner in 1994, he said.  

Smock later testified in the Noble case that he’d been trained to perform autopsies and had participated in “thousands,” including hundreds of cases involving strangulations, according to a transcript of the court hearing. He said he’d edited and written multiple textbooks on the subject and had been recognized as an expert in strangulation more than 100 times in state and federal courts in the United States.

Among the high-profile cases he testified in were the murder trials of former Minneapolis police officer Derek Chauvin and Robert Feldman, a Colorado man convicted of murder in his wife’s death last year after Smock said the scene had been staged to look like a suicide. In both cases he testified for the prosecution. 

After reviewing the lab report and images of Noble’s remains and the crime scene, Smock came to several conclusions about Noble’s death, including that she died by homicide: She sustained at least one episode of manual strangulation and suffered a quadruple fracture that was not “consistent with a ligature strangulation,” he wrote in a May 27 report obtained by “Dateline.”

Noble also had facial fractures caused by “significant” blunt-force trauma from around the time of her death, which was staged to look like a suicidal hanging, Smock wrote.

A warrant for Moore’s arrest was issued June 17, the same day a grand jury returned an indictment charging him with murder. 

Sleeper pointed to the couple’s troubled marriage as a motive, but Grubbs, the detective, acknowledged to “Dateline” that authorities had no DNA or blood linking Moore to Noble’s death. (In an interview with “Dateline,” Moore acknowledged that the couple had troubles after his son died by suicide in 2019 — “I was a wreck,” he told Dateline — but he said the marital relationship had improved before Noble’s death.)

Their strongest evidence, Grubbs told “Dateline,” was Smock’s opinion.

“You would love to have the full confession,” the detective said. “You’d love to have it on videotape. You would ultimately love to have anything like that. But what we have is Emily’s body, and Emily’s body is telling us the fact that we have a homicide.”

Standing by his conclusions

In court testimony and in an interview with “Dateline,” Smock offered more details about his conclusions. He pointed to medical literature on hangings and said that a woman of Noble’s small size — she weighed less than 100 pounds — could not have suffered a quadruple throat fracture from an “incomplete” hanging, as the position she was found in is known.

“If there was anything even close in the medical literature, it’s never been reported,” he said. “No woman of her size, her stature has ever had those sorts of fracture patterns from leaning forward into a ligature. It doesn’t happen.”

But forensic anthropologists familiar with the research said that Smock’s definitive claims gloss over important gaps in the literature. 

Much of it does not report body weight, “so it is hard to state with certainty that all of the literature does not support these findings,” Pilloud, the University of Nevada professor, said in an email. And much of that research is “relatively inconclusive,” Langley, from the American Board of Forensic Anthropologists, said. 

In an interview with NBC News, Smock said that his students at the University of Kentucky, where he is a professor of emergency medicine, helped him review 1,400 hangings for the case. He was unaware of how many included body weight.

In an email, Garvin, the Des Moines University professor and a board-certified forensic anthropologist who testified in Moore’s defense, cited conflicting findings in the literature, including weight (some researchers have said heavier people are more prone to fractures; others have not) and type of hanging (some have found fractures are more common with incomplete hangings; others have not).

“The one thing that they almost all agree on is that age is a significant factor, with more fractures in individuals over 40,” she said. 

“I think if you’re going to look for such specifics in the literature, then you really should look at the whole picture,” she wrote. “We’re not just talking about a 95lb woman. We’re talking about a 95lb, 52 yo” woman who had osteopenia, a condition that can make bones more fracture-prone, Garvin said.

“Lack of proof is not proof,” Garvin added. “Absence of evidence of this exact injury occurring in this exact same scenario does not mean that it cannot occur.”

Asked if he considered the variables highlighted by Garvin, Smock said yes — but “where that data wasn’t available in the literature it doesn’t exist.” 

“I’ve been studying asphyxiation, strangulation for almost 40 years,” he said. “I teach asphyxiation-related deaths all over the world, to the FBI, to the U.S. attorney’s office, to judges and prosecutors. I don’t know what the background is of these forensic anthropologists, whether they have studied strangulation, specifically trauma to the neck, the larynx to the hyoid bone, as I have for 40 years. I’m not sure where they’re coming from, but if they can’t show you a case with similar variables as Emily Noble, with a hyoid bone fracture, then it doesn’t exist.”

Claims of incorrect, outdated methods

Another problem with Smock’s conclusions, the experts said, was his claim that Noble showed signs of significant blunt-force trauma — a finding that he said he based on the Ohio State University report that described facial trauma from around the time of her death.

Garvin, who reviewed hundreds of high-resolution 2D images for the case, disputed that finding. In an email, she said it was “fairly easy” to determine that the fractures were healed and from a broken nose. (Noble fell and broke her nose in 1983, according a police report obtained by “Dateline.”)

Pilloud and Langley, who reviewed a report from the lab that includes low-resolution images, also disputed its finding of perimortem trauma. Passalacqua, the forensic anthropologist from West Carolina University, criticized the lab’s processing techniques, saying it used incorrect or outdated methods — such as letting the bones soak in a hydrogen peroxide solution for 24 hours — when it examined Noble’s remains. And he said the report offered unsupported conclusions about facial trauma.

In an email, lab director and forensic anthropologist Amanda Agnew defended her lab and its practices, saying the concentration of hydrogen peroxide was low — 2% — and the goal was to preserve the skeletal remains for long-term analysis. 

“This was especially difficult in this case given the condition of the remains,” which were mummified, she said.

Agnew and a co-author of the report were the only ones to examine the remains in person, she added, and other anthropologists weighing in were likely unable to see what they saw, she said.

“It can be extremely difficult to see some evidence of trauma in a 2D image, especially in very small and thin bones of the face,” the lab director said. “It is best practice to observe the actual remains to be confident in observations.” 

Agnew added that in an effort to remain unbiased, she did not talk to Smock after he signed on to the case, nor has she read his report or seen his testimony.

“I would like to make it clear that myself/OSU did not assist Dr. Smock in any way, nor was there any communication or collaboration between OSU and Dr. Smock before, during or after the trial,” she said.