March 11--When Marc and Amanda Bell and their 3-year-old son, Dylan, were found dead after a 2006 fire in their home near Rexburg, authorities asked Dr. Steve M. Skoumal to conduct autopsies on the bodies. Skoumal determined they had died of carbon monoxide inhalation, the staff of the Idaho Board of Medicine says.
At first, Skoumal's finding seemed to be the end of it. The bodies were buried. But police found a gun at the house. Roy Klingler, the sheriff of Madison County, wasn't convinced that Skoumal had gotten it right. "I personally looked at the X-ray film and had some big questions, and so we got second opinions," Klingler said.
The bodies were exhumed and sent to Boise, where an examiner found bullets or bullet fragments in the victims' heads.
"It sure made a mess at the time," the sheriff said. "We had a lot of family members -- it's not fun to have your family members exhumed."
The autopsy is one of 10 incidents the Board of Medicine staff cites in a complaint against Skoumal, a Pocatello pathologist and faculty member at Idaho State University who has been licensed to practice medicine in Idaho since 1999.
The complaint asks the board to suspend, revoke or take other action against Skoumal for delivering substandard health care, allowing unlicensed individuals on his staff to practice medicine, and engaging in conduct that constitutes abuse or exploitation of patients.
Skoumal denies almost all of the allegations. His lawyer says the complaint arose from confusion about the kind of work Skoumal does and how the autopsies are ordered. The complaint's charges stem from matters outside of Skoumal's control, he says.
The lawyer, Richard A. Hearn, also a Pocatello doctor, said Skoumal has been wedged between law enforcement officers who were displeased with autopsy results and a medical board that didn't get all the facts before it filed the complaint.
Skoumal is accused of giving evidence or testimony that "somehow he didn't do ... as well as a medical examiner," which isn't his profession, Hearn said.
"Some people are unhappy with what he did," said Hearn. "The people who are complaining about Dr. Skoumal are primarily police and legal people that didn't get the answers they sought."
EVIDENCE TO COME
Hearn said "all of our evidence will be presented" at an administrative hearing on the complaint that may be about a year away. "But there are a couple problems with the case (so far)," he said. "We are dealing with the practice of medicine. And it's not clear that performing an autopsy is practicing medicine."
As for not getting its facts right, Nancy Kerr, executive director of the Board of Medicine, declined to comment on the Skoumal case but said accused physicians are normally afforded a chance to meet informally, discuss the case and provide pertinent records and other information before a complaint is filed.
Skoumal was "the only pathologist doing autopsies in this area," Hearn says. He has been called on to testify in trials.
The board's complaint does not give full names of the people whose bodies Skoumal examined. But details in the complaint match the publicly known facts in three of the most prominent cases: the unsolved Madison County deaths, the 2006 murder of Pocatello High School student Cassie Jo Stoddart, and the death of a Bingham County woman whose granddaughter was then prosecuted for homicide.
THE BELL FAMILY: MISSED BULLETS
In the case of Marc, Amanda and Dylan Bell, Skoumal didn't look at X-rays that "were available at the time," the board staff's complaint said. If he had -- or if he'd dissected their heads -- he might have seen the gunshot wounds to each person's head.
He reported that the bodies had soot in their airways without dissecting their necks, the complaint claims.
Skoumal denies that and says he noted carbon monoxide as one of the findings, not a cause of death.
Klingler, the sheriff, said he assumed Skoumal would do a full-body autopsy. However, the coroner -- not Klingler -- is the one who orders the autopsy. That's the problem, said Skoumal's attorney.
"The people who brought the bodies (such as the coroner's office) have to pay for the doctor to do more autopsy or less autopsy," Hearn said. Skoumal's rebuttal says the lack of brain dissection was because of the Madison County coroner's instructions.
The coroner did not respond to a request for comment.
"He (was) not asked to review those X-rays ... nor was he asked to do a complete autopsy," Hearn said. The coroner looked at the X-rays and told Skoumal what he saw, according to Skoumal's rebuttal to the allegations.
"He got some people who had appeared to have been burned in a house fire," Hearn said. "I don't think there was ever an allegation that there were entry wounds or exit wounds in the head missed by Dr. Skoumal."
Klingler dismisses that, saying Skoumal could and should have spotted the bullet wounds. "When they do an autopsy, they're supposed to look at everything," he said. "We wanted a complete and thorough autopsy."
Skoumal also either didn't collect blood for toxicology tests or collected the wrong kind of blood and ran the wrong kind of tests, the complaint said.
Skoumal is no longer doing autopsies for Madison County, Klingler said.
Skoumal says the reason he didn't do the second, post-exhumation autopsy was that he had a scheduling conflict. But Klingler laughed when asked if he had ordered a second opinion from Skoumal. "If he would've been available, we wouldn't have used him," the sheriff said.
The case was never solved and is now inactive, Klingler said. "As far as the final outcome, I don't know if (Skoumal's errors) would really change anything or not," he said.
OPAL WARD: A MORPHINE QUESTION
Opal Ward was in her 90s and a hospice patient when her granddaughter Mikel McBride, a nurse, started caring for her. Ward died in March 2009 and was embalmed and buried soon after.
Then police got an anonymous tip that Ward had been overdosed by McBride, the complaint against Skoumal said.
The body was exhumed in August 2009, and Skoumal did an autopsy. He reported that Ward had died of a drug overdose.
The complaint said Skoumal had taken embalming fluid instead of blood for the sample and misinterpreted the toxicology results that contributed to McBride's prosecution.
Hospice patients can be given prescription morphine to help manage pain in their final days. Skoumal didn't consider some of the effects of prescription morphine on a body's opiate level, the complaint said. He disagrees.
McBride was charged the next month with first-degree murder. The prosecutor dropped the charges by the end of the year. He and McBride's lawyer did not respond to messages seeking comment.
THE STODDART CASE
Cassie Jo Stoddart was 16 when she was stabbed to death. Police found four knives they suspected had been used in the stabbing.
Brian Draper and Torey Adamcik are serving life sentences for her murder.
The board's complaint says that although the knives had unique characteristics, Skoumal couldn't identify the length or size of knives that made the stab wounds and couldn't interpret or evaluate the wound patterns. Skoumal agrees with the first allegation and denies the second.
Adamcik's unsuccessful appeal to the Idaho Supreme Court argued that the "state failed to prove which of the wounds were fatal, as the state's expert witness, Dr. Skoumal, only offered testimony that 12 of the wounds were 'potentially fatal,'" said the court's January 2012 opinion.
The Supreme Court ruling said Skoumal documented 30 knife-related wounds, and an Ada County board-certified forensic pathologist testified about the knife blades' characteristics.
The board's complaint also said Skoumal testified in the case that he was a forensic pathologist despite not being one and that he misdated his autopsy report. Skoumal agrees that he's not a board-certified forensic pathologist and says a software glitch caused the misdated report, but he denies everything else.
Audrey Dutton: 377-6448
Copyright 2012 - The Idaho Statesman, Boise
