What Law Enforcement Should Know About Strangulation

Months before she would end up shooting and killing her abusive boyfriend in what she and domestic violence advocates attest was self-defense, Tyesha Wayne was strangled by her boyfriend. She lost consciousness when Daniel Walker put her in a chokehold, which he admitted to Arizona law enforcement. He just says he didn’t do it that hard.

Yet, it was hard enough that Wayne, 40, lost consciousness and sank to the floor. It was hard enough that she lost control of her bladder. It was hard enough that Walker thought he had killed his girlfriend and called 911. 

By the time police arrived, Wayne had regained consciousness. She told them what happened, but they seemed reluctant to believe her. According to their police report, Wayne had no visible injuries. The officer on scene wrote, “due to the color of her skin” he couldn’t tell if her neck had any marks on it. Wayne is Black. She showed police where she lost control of her bladder on the floor, and they made a note of it in the report. However, Wayne ended up being the one put in handcuffs, arrested and determined to be the primary aggressor. 

Nine months later, Wayne says Walker attacked her again. He struck her in the head with a motorcycle helmet before he began to throw her around the garage. Wayne says he wouldn’t let her go and she was afraid. She reached for a pistol and shot Walker multiple times, killing him. Walker was charged with second-degree murder, though the case would later be dismissed without prejudice, meaning that it’s possible Wayne can be charged again in the future. 

Could Walker’s escalation of violence and Wayne’s two arrests have been prevented if police had held Walker accountable the first time? How much of a difference would it have made for police to believe that Walker was strangled, an abusive tactic that advocates say is the highest predictor of homicide? 

Casey Gwinn, President of Alliance for HOPE International, says when women end up killing their abuser it is usually because the system has failed them and they see no other way out of the abuse.  “Stranglers exercise the ultimate coercive control over their victims.  When she tries to get away, the strangler becomes a stalker.  If the system fails to help, sadly, the victim, in terror and fear, has to sometimes take the law into her own hands.”

Gael Strack, CEO of Alliance for HOPE International, trains law enforcement officers on how to identify the primary aggressor in cases like Wayne’s. “The most important evaluation in strangulation and domestic violence assaults is determining who the primary aggressor is in each case.  Unfortunately, law enforcement officers don’t always do a thorough analysis of this and end up arresting the victim.  In the most violent strangulation assaults, the injuries are often on the perpetrator because the victim fights back. Officers who are not well trained can get fooled.”

Strangulation Can Make Homicide Look Like Suicide

Bill Smock, MD is a police surgeon—someone who conducts forensic examinations of victims and perpetrators for the police department in Louisville, Kentucky. He’s also the Medical Director of the Training Institute on Strangulation Prevention. He helps educate law enforcement on the signs of strangulation that may not be immediately noticeable, as well as how to talk to a victim of strangulation in order to get the most complete story. 

When asked if someone can be near fatally or even fatally strangled and still have no visible injuries, Smock says yes, absolutely.  

“The easiest way to get away with murder is to strangle someone, stage it and call 911. If police don’t do their due diligence, they may facilitate in helping someone get away with murder,” Dr. Smock says.

Libby Caswell is suspected by her family to be one of those victims. The 21-year-old had been trying to leave an abusive boyfriend for some time when Missouri police found Libby’s body in a hotel room. Her boyfriend’s belt was around her neck and they determined she had committed suicide. Libby’s mom, Cindy Caswell, vehemently denies that her daughter, who had a young son, would take her life.  

“The reason they didn’t have a case was nobody collected enough stuff to have a case,” says Cindy of the police. “They worked hard to prove it was a suicide.” 

California is the first state to address these “hidden homicides,” passing the first suspicious death law in the country last month. “Joanna’s Law,” or SB 989 would allow families to request additional scrutiny of death cases that they believe are suspicious after a history of domestic violence, among other standards.

6 Critical Steps Law Enforcement Should Take

Smock says there are several things law enforcement should do when they respond to a domestic violence call where there is a suspected strangulation. 

1. Ask the victim, “What did you experience?”

A survivor may not recognize what they experienced as strangulation. So, asking them if they were strangled may not tell the entire story. A survivor may describe what happened as “being choked” or say that a partner put pressure on their neck in some other fashion. They may not realize that any restriction of air and blood flow via the neck falls under the definition of strangulation. The Institute recommends asking the survivor if pressure was applied to her neck or chest “by any means.”  If the survivor says, “He choked me,” investigators should ask what “choking” means to the survivor because survivors will rarely use the word strangulation.

2. Ask if this has happened before. 

“It’s probably not the first time,” says Smock. If it’s a common occurrence, the survivor may downplay it. It may be normal behavior by their partner. If it’s the first time, they may reflect this by being more panicked and anxious. 

3. If there are no visible injuries, record that there are no visible injuries at this time. 

Injuries from strangulation can show up 24 to 48 hours later, says Smock. 

4. Offer the survivor a forensic nursing exam. 

“Forensic nurses can go into much more detail, looking for injuries in places where law enforcement cannot,” says Smock. Other injuries on a survivor’s body can support their claim of domestic violence or assault. Most victims also need imaging of their neck at a hospital to rule out internal vascular injuries.

5. Encourage the survivor to take photos every day for at least several days after the incident. 

Marks, bruises and discoloration can show up hours if not days after a strangulation. These photos may help in a future court case. 

6. In the case of a death, investigate further if there is a history of domestic violence.

Smock says that when police decide on the scene that a death is self-inflicted, the victim is not sent for an autopsy. “Evidence of strangulation may only be seen on the inside of a person,” he says. He explained that there can be different levels of ligature marks, or marks that denote a victim was strangled. If there is more than one level of ligature mark discovered during the autopsy, it can mean there was more than one mechanism of strangulation. In other words, it may not be only a belt that killed a victim, but also someone’s hands. 

A bone fracture can also give police additional clues as to the actual cause of death. “If you don’t do an autopsy, you could miss the fact that there is a hyoid bone [the small U-shaped solitary bone in the midline of the neck] fracture unassociated with the ligature which says somebody’s fingers were higher on the throat and squeezing. And once they were unconscious or dead [the perpetrator] put the belt around their neck and hung them up,” explains Smock.

The Institute has published a manual on the investigation and prosecution of strangulation and suffocation cases with the California District Attorneys Association including 20 key questions that law enforcement should ask.

Other Signs of Strangulation

Simply looking for bruising on the neck is not enough. These are some of the other signs that can indicate a survivor has been strangled:

• Scratches on the neck
• Changes in one’s voice
• Neck pain
• Difficulty swallowing or breathing
• Ear pain
• Vomiting blood
• Vision change
• Tongue swelling
• Bloodshot eyes
• Lightheadedness 
• Small red spots on the neck, face, or head (known as petechial hemorrhages)
• In the case of pregnant victims, premature labor or miscarriage

The 10 Signs of a Hidden Domestic Violence Homicide 

Smock says spotting hidden homicides is precisely what he trains officers on around the country.

“I ask them, ‘Do you want to help someone get away with murder?’ They say, ‘Of course not.’ OK, I say, ‘Then tell me, when you have a suicide, are you looking for these factors?’ And they say ‘No we’re not, because it’s just a suicide.’ Your suicide could be a staged homicide.”

Alliance for HOPE International, through their Justice Project program, independently reviews hidden homicide cases around the country at the request of family members or law enforcement agencies. They estimate there could be at least 1,000 hidden homicide cases in the U.S. each year. 

The Alliance identified 10 factors of hidden homicides that, when they exist, make the death suspicious and should require a medical examiner to take another look at the body and should cause law enforcement to conduct a homicide investigation. Those factors include:

• The person died prematurely or in an untimely manner.
• The scene of the death gives the appearance of death due to suicide or accident.
• One partner wanted to end the relationship.
• There is a history of being victimized by domestic violence that includes coercive control.
• The person is found dead in a home or place of residence.
• The person is found by a current or previous partner.
• There is a history of being victimized by domestic violence that includes strangulation or suffocation.
• The current or previous partner of the person who has died, or child of the person who died or the person’s current or previous partner, is the last to see the person alive.
• The partner had control of the scene before law enforcement arrived.
• The body of the person has been moved or the scene or other evidence is altered in some way.

Training for Law Enforcement and Other Professionals is Available

The Training Institute on Strangulation Prevention hosts  trainings for law enforcement officers and other professionals across the country and around the world. The Institute is the  largest training program in the world on strangulation assaults. It trains 50,000 or more law enforcement officers, prosecutors, doctors, nurses, and advocates  every year on the handling of strangulation assaults and promotes the use of multi-disciplinary teams for investigating and prosecuting strangulation assaults. For law enforcement officers, even if you cannot attend a virtual or in-person training, the Institute has excellent online resources including  a free, short online course on handling strangulation cases and a roll call/line-up video downloadable from YouTube.

If you are an advocate, healthcare professional, police officer or anyone else who may come in contact with a survivor of strangulation, make sure to check out the Advocacy Toolkit for Survivors of Strangulation/Suffocation from the Training Institute on Strangulation Prevention’s Advocacy Committee. The toolkit provides a variety of questionnaires, checklists, infographics and more that take the guesswork out of supporting strangulation survivors.