COEUR d’ALENE — Kendy Howard’s death “bears the hallmarks of a staged crime scene,” a doctor said in court Friday.

It was the fifth day in the murder trial of Daniel C. Howard, a former Idaho State Police trooper accused of killing his wife, Kendy Howard, then placing her body in a bathtub and shooting her in the mouth. He has pleaded not guilty to first-degree murder and felony domestic battery. Defense counsel maintains that Kendy Howard shot herself.

Dr. Bill Smock, a Louisville physician in forensic medicine who previously testified in the murder trial of former Minneapolis police officer Derek Chauvin, told jurors Friday that Kendy Howard did not die by suicide.

“Ms. Howard died of homicide,” Smock said.

Prosecutors say Daniel Howard killed his wife by putting her in a “carotid restraint,” a technique that involves hooking an elbow around the subject’s head and using the forearm and bicep to apply pressure to both sides of the neck. This cuts off blood flow to the brain and can render a person unconscious in five to 10 seconds. Sustained pressure can be fatal.

Law enforcement officers have testified that Daniel Howard was trained and proficient in the technique.

Defense counsel said Kendy Howard had no marks on her neck to indicate strangulation, nor did she have petechiae, tiny hemorrhages that occur in the eyes and skin when capillaries overfill with blood and pop. Strangulation often causes petechiae.

Smock said petechiae aren’t a given when carotid restraint is used.

“If no blood is flowing into capillaries, they won’t pop,” he said.

Carotid restraint may leave no bruising on the neck, Smock added. It takes just 11 pounds of pressure to block the carotid artery.

“That’s nothing,” he said. “That’s how easy it is to block blood flow to the brain and never, ever leave a mark.”

Kendy Howard’s body was covered in bruises sustained before her death. Her jaw was broken — not from the force of the gunshot, Smock said, but by blunt force trauma. Sometime after she left work the day she died, she sustained a large second-degree burn on her forearm. Shallow cuts on her feet suggested she stepped on something sharp, like the glass shards found in the bedroom.

Smock said all these elements indicate a struggle.

“Something doesn’t fit,” he said. “That’s why my opinion was this was, in fact, an altered crime scene, that she was deceased when she was placed in the bathtub.”

Defense counsel noted that Kendy Howard had no DNA under her fingernails and Daniel Howard had no defensive wounds on his body the night his wife died.

The bullet that shot Kendy Howard had a downward trajectory. Smock said that’s inconsistent with a self-inflicted gunshot wound.

“Suicides go up,” he said. “Homicides go down.”

Dr. Ryan Rambaran, a Pennsylvania trauma surgeon, testified that Kendy Howard sustained a gunshot wound inside her mouth after she died.

The bullet traveled through her tongue, nearly bisecting it, then severed the C2 vertebra and lodged in the back of the neck, behind the spine.

Had Kendy Howard been alive when she was shot, Rambaran said, she would’ve been unable to breathe because her spinal cord was severed. But the heart can continue to beat and pump blood through the body, without any input from the nervous system, for some time after breathing stops, usually between one and three minutes.

Rambaran said Kendy Howard would have bled profusely from the wound in her tongue for as long as her heart continued to beat.

“There’s going to be a tremendous amount of blood loss that occurs from this type of wound,” he said.

Because the vocal cords and esophagus would’ve closed when the spinal cord was severed, the blood would have filled her mouth and then poured out. Smock said the blood in the bathtub appeared to come from her nose, not her mouth.

If Kendy Howard’s heart beat for one minute after she was shot, Rambaran estimated she would’ve lost about a liter of blood. It would’ve sprayed throughout the tub and made the bathwater totally opaque, he said. But police could easily see a handgun and spent shell casing at the bottom of the tub where her body lay, through the red-tinted water.

“To a degree of medical certainty, she was not alive when she was shot,” Rambaran said.

The night his wife died, police asked Daniel Howard if he had any gunshot residue on his hands. He told them it was there because he’d fired his Glock earlier in the day to test the new sights he’d installed.

Then he “plunged his hands into his coat pockets” and rubbed them around, said Jerry Northrup, an investigator with the Idaho State Police cold case unit.

Northrup helped process the scene at the Howard residence after Kendy Howard’s death. He collected Daniel Howard’s Glock and examined it.

“The firearm exhibited no obvious signs that it had been recently fired or recently cleaned,” Northrup testified.

The gun also had the original factory sights, he said.

Northrup also collected the handgun found in the bathtub, which was sent to the Washington State Patrol crime lab for testing. Kendy Howard’s DNA was found on the gun, he said, along with that of an unidentified male. Daniel Howard’s DNA was not found on the gun that shot his wife.

The trial continues Monday.