Two Gunshots on a Summer Night

A Deputy’s Pistol, a Dead Girlfriend and a Flawed Investigation

By WALT BOGDANICH and GLENN SILBER

Sunday, November 24, 2013

The death of a woman in Florida and the investigation that ruled it a suicide raise questions about how police departments handle cases of possible domestic violence involving officers.

At 11:25 p.m., the three St. Johns County officers arrived at 4700 Sherlock Place, a one-story suburban house in this historic seaside community. A young deputy, Jonathan Hawley, was already there. “Oh my God,” he cried, seeing a young woman he knew lying on the bedroom floor, an inert, bloody mess.

Michelle O’Connell, 24, the doting mother of a 4-year-old girl, was dying from a gunshot in the mouth. Next to her was a semiautomatic pistol that belonged to her boyfriend, Jeremy Banks, a deputy sheriff for St. Johns County. A second bullet had burrowed into the carpet by her right arm.

Ms. Maynard quickly escorted Mr. Banks, who had been drinking, out of the house. “All of a sudden he started growling like an animal,” she said. With his fists, Mr. Banks pounded dents in a police car.

“I grabbed him and tuned him up,” another deputy, Wesley Grizzard, recalled. “I told him, I don’t care if you’re intoxicated or not, you better sober up.”

Within minutes of the shooting on Sept. 2, 2010, Mr. Banks’s friends, family and even off-duty colleagues began showing up, offering hugs and moral support. He huddled with his stepfather, a deputy sheriff in another county, before a detective interviewed him in a police car.

With his off-duty sergeant listening from the front seat, Mr. Banks gave this account: Ms. O’Connell had broken up with him and was packing to move out when she shot herself with his service weapon

Ms. O’Connell’s family, immediately suspicious, received a starkly different reception from the authorities. Less than two hours before she died, Ms. O’Connell had texted her sister, who was watching her daughter: “I’ll be there soon.” Yet when her outraged brother tried to visit the scene, officers blocked his way. The family’s request for an independent investigation was rebuffed, as was one sister’s attempt to tell the police that in the months before she died, Ms. O’Connell said she had been subjected to domestic abuse by Mr. Banks.

Before the sun rose the next morning over this place that calls itself “the nation’s oldest city,” the sheriff’s investigation was all but over.

Over time, though, the official narrative began to change. The sheriff asked the Florida Department of Law Enforcement to re-examine the case, and investigators found two neighbors who said they had heard a woman screaming for help that night, followed by gunshots. Their account prompted the medical examiner to revise his opinion from suicide to homicide, a conclusion shared by the crime reconstruction expert hired by state investigators.

Eventually, however, a special prosecutor appointed by Gov. Rick Scott decided there was insufficient evidence to prosecute and closed the case early last year. But that was hardly the final word. The state law enforcement agency asked for a special inquest into the death, saying significant questions remained. The sheriff, David B. Shoar, struck back in support of his officer, prompting an extraordinary conflict between two powerful law enforcement agencies.

And through it all, the O’Connell family continued to believe that the sheriff’s office, investigating one of its own, had blinded itself to the possibility that the shooting was a fatal case of domestic violence.

Domestic abuse is believed to be the most frequently unreported crime, and it is particularly corrosive when it involves the police. Taught to wield authority through control, threats or actual force, officers carry their training, their job stress and their guns home with them, amplifying the potential for abuse.

Yet nationwide, interviews and documents show, police departments have been slow to recognize and discipline abusers in uniform, largely because of a predominantly male blue wall of silence. Victims are often reluctant to file complaints, fearing that an officer’s colleagues simply will not listen or understand, or that if they do, the abuser may be stripped of his weapon and ultimately his family’s livelihood.

Officers investigating possible domestic violence face special circumstances “when it’s somebody you know or you’ve worked with,” said Mark Wynn, a former Nashville police official who teaches departments how to use model rules for handling domestic violence in their ranks. “Like the military, you build bonds together by saving one another’s lives.”

The model rules, issued by the International Association of Chiefs of Police, insist on zero tolerance for abusers and urge departments to begin formal investigations of all complaints immediately. Yet most departments, including the St. Johns County Sheriff’s Office, follow only parts of the policy. Law enforcement officers in Florida are arrested on charges of domestic abuse more often than they are on charges of any other form of misconduct, but other offenses are far more likely to cost them their jobs, according to an analysis by The New York Times of more than 29,000 complaints received by the state.

In St. Johns County, a review of records found three cases in recent years in which sheriff’s officers failed to open immediate investigations of domestic-abuse reports involving their colleagues. Two years before Ms. O’Connell’s death, supervisors learned of accusations of domestic abuse against an officer, but followed up aggressively only after his frightened wife fled the house naked, clutching her child, and called the authorities. Dismissal was recommended, but the sheriff kept the officer on staff.

The O’Connell case, in which the sheriff’s department failed to explore the possibility of domestic violence, is a vivid demonstration of what can go wrong in an inquiry when the police, lacking effective supervision and a clear mandate, confront potential abuse in their own ranks.

The Times examined the case in collaboration with the PBS investigative news program “Frontline,” reviewing police, medical and legal records, interviewing dozens of people connected to the case, and consulting independent forensic and law enforcement experts.

The examination found that the investigation was mishandled from the start, not just by the sheriff and his officers, but also by medical examiners who espoused scientifically suspect theories that went unchallenged by prosecutors. Because detectives concluded so quickly that the shooting was a suicide, investigators failed to perform the police work that is standard in suspicious shootings, including collecting and testing all available evidence and canvassing neighbors.

“This investigation stinks,” said Vernon J. Geberth, a former New York City police commander and the author of a widely used textbook on investigating suspicious deaths, who reviewed the case at The Times’s request. “Every death investigation should be treated as a homicide until proven differently.”

Sheriff Shoar, the most powerful elected official in this North Florida county and a former co-chairman of its domestic violence task force, declined to be interviewed for this article. But in a letter to The Times, he said, “I have a long history of holding subordinates accountable.”

Yet only when The Times began examining the case more than two years after the young mother’s death did the sheriff publicly acknowledge that his investigators “prematurely embraced the mind-set” that she had killed herself.

Even so, he defended his inquiry in a 153-page report and attacked those who had found fault with it, particularly two agents with the Florida Department of Law Enforcement.

At the sheriff’s request, the state agency is investigating his accusation that the agents engaged in misconduct during their inquiry.

Mr. Banks declined to be interviewed. But he has told investigators that he never harmed Ms. O’Connell. He recently filed suit against the state agency and its lead investigator, alleging misconduct.

In his letter, Sheriff Shoar called Mr. Banks a fine young man stigmatized for life.

“This case,” the sheriff wrote, “has been and always will be a suicide.”

The First Responders

What struck Crystal Lynn Cuzzort most were the little red slippers, just like ones her daughter used to have. “I remember looking around and seeing little kids’ stuff and pictures,” said Ms. Cuzzort, one of the paramedics who was trying to save Ms. O’Connell as her airway filled with blood.

Ms. Cuzzort found herself wondering what had really happened. “Not that it’s out of the ordinary for anyone to commit suicide — we know that — but it is not common that a girl that age, 23, 24 years old, however old she was, but to have a young child and to commit suicide. She was a really pretty girl, and it looked like she was well taken care of,” she said. “She just didn’t fit the picture of typical suicide.”

Twenty-three minutes after the police arrived, Ms. O’Connell was pronounced dead.

The following account of that night is based largely on sworn, recorded interviews by the Florida Department of Law Enforcement.

The job of informing the family fell to Ms. Maynard and another officer. They stopped first to tell Ms. O’Connell’s brother Scott, himself a St. Johns deputy. He had introduced his sister to Mr. Banks.

“I said, ‘Michelle’s not with you anymore,’ ” Ms. Maynard said. After the initial shock, he “did the strangest thing,” she said. “He immediately got up and got his gun, and we weren’t sure what he was going to do with it. And brought it to us and his car keys and said: ‘Please take these away from me right now. Get them out of here.’ ”

Mr. O’Connell then drove with Ms. Maynard to see his mother, Patty, who also worked at the sheriff’s office, as a file clerk. “My mom opened the door with a smile on her face — heartbreaking,” he said.

Back at 4700 Sherlock Place, investigators knew little beyond what Mr. Banks had told them — that after hearing the first shot, he ran in from the garage, heard the second shot, broke down the locked door and called 911. There was no suicide note, no apparent witnesses. A child suddenly had no mother to care for her.

And the sheriff faced an important decision: have his office investigate the case itself or, as is often done when an officer may be involved in a suspicious shooting, call in independent investigators from the Florida Department of Law Enforcement.

If anyone seriously considered this, it is not reflected in the sheriff’s official reports. The next month, Sheriff Shoar’s point man on the case, Lt. Charles Bradley, told the O’Connell family that the state’s investigators did not have the experience for the task.

“To be honest with you,” he said, according to a recording of the meeting, “my investigators are far and above better than what F.D.L.E. is ever going to give you.”

He did not disclose that the two lead detectives on the case had worked just three homicides between them, or that one supervisor had been disciplined for an “inept” investigation of an attempted murder, records show.

Lieutenant Bradley did object to the tone of the family’s questions.

“I feel like this is a damned inquisition on me,” he said. “I haven’t done anything wrong, guys. The sheriff’s office hasn’t done anything wrong.”

The early consensus among the detectives was that Ms. O’Connell had taken her own life. “For her to stand still and allow somebody to put a firearm in her mouth is ridiculous,” Eugene Tolbert, one of two detectives on the case, said.

Plus, there was “absolutely no bruising on Michelle,” indicating the absence of a struggle, Lieutenant Bradley told the family. That wasn’t exactly correct: she had a bleeding cut above her right eye, an injury that would become a central forensic issue in the case.

Not all of the officers were so certain about what had happened.

“I’ll just say it — when I first walked into that room, the first thought that went through my mind was, this is not good for Jeremy,” said Sgt. Scott Beaver, who initially took charge of the scene. “We need to document the scene as it is as much as possible, because I felt there would be questions later on.”

At his direction, an officer took photographs that show the gun — a Heckler & Koch .45-caliber pistol — on the ground just inches from Ms. O’Connell’s left hand, suggesting that she would have used her weaker hand to shoot herself. Curiously, the gun’s tactical search light, attached to the barrel, is on. There is also the unexplained second bullet, buried in the carpet several inches from her body.

“I mean, I was in the homicide unit for a few years, and it didn’t add up,” Sergeant Beaver said. “But I didn’t do more investigation into this to see why things were like they were.”

Officers also found two empty pill bottles belonging to Mr. Banks visible in Ms. O’Connell’s open purse. Pills from those bottles were found in her jeans pocket, and tests later found alcohol but no trace of pills in her system. If she had intended to kill herself by overdosing, why did she shoot herself? Lieutenant Bradley theorized that Ms. O’Connell made a “snap” decision.

Still, she would have had to pull the gun from its retention holster — designed to make it difficult for an unauthorized person, particularly one unfamiliar with guns, to withdraw a weapon.

Detective Tolbert said that every time something “bugged me” about the crime scene, there was a plausible explanation.

“You could say, she was holding the gun in her left hand, but she’s right-handed — that’s suspicious,” he said. But if she was intent on suicide, it would not matter which hand she used.

“As far as two shots being fired,” the detective added, “that kind of bugged me. But the more I thought about it, well, if she’s not familiar with the weapon, which is kind of what I got by the fact that the tac light is on, maybe she’s sitting here and she’s looking at this thing and doesn’t know how and, you know, then lets one ride by accident.”

The other detective, Jessica Hines, said she found nothing to suggest anything other than suicide.

Hours later, a sheriff’s officer, dropping off Ms. O’Connell’s car keys, visited her sister Christine. “He comes up and says: ‘Well, the investigation is done. It’s a suicide,’ ” she said.

The quick embrace of suicide colored investigators’ decisions from the start.

“It’s almost in police officers’ DNA, when they hear the word suicide, it’s like, ‘Oh, O.K., it’s not an important crime,’ ” said Mr. Geberth, the expert on homicide investigations. “Assume the suicide position — take shortcuts, don’t do this, don’t do that.”

In fact, though investigators collected the gun, clothing and other evidence, they never tested it for fingerprints, DNA or gunshot residue. Officers also failed to canvass neighbors; failed to file required reports on what officers had seen that night; failed to download Mr. Banks’s cellphone data or collect and test one of the shirts he wore that night and failed to isolate and photograph Mr. Banks before he was interviewed.

Two days after the shooting, a medical examiner, Dr. Frederick Hobin, performed an autopsy and concluded that Ms. O’Connell had taken her own life.

One morning over coffee, Dr. Hobin explained that because suicides are so fraught with emotion, they should be investigated even more rigorously than homicides.

“Investigating a suicide,” he said, “is like letting out a black dog that will come back later and bite you.”

A Lack Of Curiosity

Although there was no suicide note, investigators believed that they had found the next best thing — cryptic text messages expressing concern about her daughter, Alexis, that Ms. O’Connell had sent while attending a rock concert that evening with Mr. Banks and her brother Sean.

They would have heard about a young woman with a new job and high hopes for an independent future, but also a fear of Mr. Banks and how he might react when she announced that she was leaving him.

Ms. O’Connell’s life had not been trouble-free. She grew up without a father and competed for attention and space with five older siblings in a crowded St. Augustine apartment. The ocean and beach were her escape.

“She was an amazing athlete,” said her eldest sister, Jennifer Crites. “She could climb a tree faster than anybody.”

By her early teenage years, she began doing poorly in school and rebelling. When she was 15, she was taken into custody after a fight with a brother. The police were called to the O’Connell apartment again the next year, after she fought with a sister.

But with medication and counseling for what juvenile records describe as anger problems and depression, Michelle turned herself around. Her schoolwork and attitude improved profoundly, earning praise and enthusiastic support from juvenile authorities and clearing the way for her to work part time caring for children. “She had a great little smile, and children would do whatever she said,” her mother said.

At age 20, she gave birth to Alexis. “Lexi was her world,” said Ciara Morris, a close friend. “Everything that you asked Michelle to do, it was always, ‘Well, how is this going to affect Lexi?’ ”

As a single mother, Ms. O’Connell sometimes had to work three jobs. So when she secured full-time employment in a day care center, she felt she had finally made it.

“She had the job of her dreams,” said Teresa Woodward, her employer and one of her former high school teachers.

“She could bring Alexis in and take her home with her. No weekends, no nights, and she loved that. She had retirement benefits. She had everything.”

Hours before she died, Ms. O’Connell left her mother a voice mail message, saying she would call the next day to make breakfast plans. She also stopped for lunch at Christine’s apartment.

When the O’Connell family met later with Lieutenant Bradley, the sheriff’s representative, Christine complained that on the night of the shooting, officers had rebuffed her efforts to tell them what her sister had revealed at that lunch.

“I said: Am I allowed to submit a statement? Because she told me a lot of things about — and I’m just going to spell it out for anyone here — domestic violence. She came to my house, she said: ‘I’m leaving. I’m scared of this and that.’ And I said, ‘Michelle, don’t go to the concert,’ ” she told the lieutenant.

This information was of no use, the police told her, because it was hearsay.

Later, Christine told state investigators that Michelle said she might have to make Mr. Banks believe that breaking up was his idea.

Christine O’Connell said there were other incidents that went unreported for fear of causing trouble for Mr. Banks and for her relatives who worked at the sheriff’s office.

On one occasion, two family members said, Ms. O’Connell told them that she had come home to find Mr. Banks masturbating to a cellphone picture of a former girlfriend; then, she said, he smeared semen on her face and hair. Mr. Banks denied the latter part of that story, records show.

And about a month before the shooting, during an argument that turned physical, Mr. Banks used a “leg sweep” to put her on the ground so she would stop hitting him, he told the Florida Department of Law Enforcement. Mr. Banks weighed almost twice as much as Ms. O’Connell.

“She was afraid of him, and Alexis was afraid of him,” Christine O’Connell said.

Had investigators wanted to know Ms. O’Connell’s mood in the hours before she died, they could have asked her brother Sean, who was with the couple at the concert. Seeing that Mr. Banks seemed “pissed off,” Mr. O’Connell said, he told him: “ Why don’t you trade spots with me and Michelle? If you don’t want to hang out with her, I will.’ So we were hanging out, and we were hugging and listening to music, having a good time, and she seemed really happy.”

After Ms. O’Connell’s death, her family found photos from the concert on her camera. The last one was taken around the time she texted her sister that she would be there soon. She is smiling.

Upon learning that investigators believed she had killed herself, Ms. Woodward called the sheriff’s office to say Ms. O’Connell would never have done that. “We wanted to be interviewed,” she said. No one came.

Twelve days after the shooting, Mr. Banks submitted to a second interview. In the videotaped interview, he made a surprising admission — that he had read the department’s investigative file.

“I know I probably shouldn’t have, but I just wanted to know what went down on the other side,” he told the detective, who did not respond.

“How did he gain access to a confidential investigative report, and how come she didn’t challenge him on that?” said Mr. Geberth, the homicide expert.

“He was never treated like a suspect,” said Ms. Morris, Ms. O’Connell’s friend. “He was treated like a brother. I mean, that’s the best way I can put it. He was treated like a brother.”

The Boyfriend

Jeremy Banks comes from a law enforcement family. His father, now deceased, was an officer in the state’s wildlife division; his stepfather works for the Jacksonville Sheriff’s Office.

Mr. Banks’s job conferred power and authority at a young age, no college required. He carried a gun, wore a uniform and held a largely recession-proof position in an organization that commanded deep respect in the community.

“I believed in the sheriff’s office wholeheartedly. My family, you know, worked for the sheriff’s office,” said Ms. O’Connell’s sister Jennifer.

Mr. Banks, 23 when Ms. O’Connell died, had been on the force nearly four years. Later, he would admit that he had not always had “the best reputation.”

Jeremy Banks. Photo supplied by O’Connell family

“I was looked at as a young punk, just cocky, just full of himself,” he told internal affairs officers after being brought up on departmental charges for making an obscene gesture in uniform.

In the O’Connell case, the only formal accusation against Mr. Banks, for which he was reprimanded, was that he had not secured his service pistol. Indeed, there are indications that he was not always careful in storing his guns.

Crime scene photos show two long guns leaning against the wall in Mr. Banks’s house. Although departmental policy requires that weapons be secured, Mr. Banks told investigators that he sometimes dropped his gun belt on the floor after work.

“He had guns everywhere,” said Michael Plott, a deputy who once roomed with Mr. Banks. “I told him he had to keep the guns locked up in his room when my kids were there.”

Deputy Plott said his former roommate also had anger issues. “His temper was uncontrollable,” he said. “He’d drink and he’d just get pissed” and throw things around, Deputy Plott added. But both he and another former roommate of Mr. Banks agreed that they had never seen him violent.

Mr. Banks nearly got into a fight at Thanksgiving at the O’Connells. The eldest brother, Justin, felt that Mr. Banks had treated his sister shabbily and insisted he leave. Mr. Banks refused, and with tempers rising told Scott, his fellow deputy, that he was “Signal 0” — carrying a weapon.

“I said, ‘Well, Jeremy, why would you bring a gun into a Thanksgiving dinner?’ ” Scott O’Connell told state investigators. “It’s time for you to leave.” The argument ended there, but the party was ruined.

Mr. Banks told state investigators that over time, his yearlong relationship with Michelle O’Connell had devolved into near-constant bickering. So, on the ride home from the concert, when she said she was leaving him, “I said, ‘Are we breaking up?’ She said, ‘Yes.’ And I was, ‘All right.’ And we were talking about it, and we, we, I raised my voice, she raised her voice, we argued. But we got to the house, we were fine.”

Mr. Banks told investigators that back home, they did not raise their voices. “We bought a dog sometime last year, and I asked her, I said, ‘Who’s going to get Chuck?’ She said: ‘You keep him. I’ve got Alexis, and I’ll be fine.” Everything was calm, he said, and “I told her I loved her.”

As she continued packing, Mr. Banks said, he asked for one last kiss. She said no and asked him to leave, so he retreated to the open garage to sit on his motorcycle and wait. Soon after, he said, he heard a pop. “I knew exactly what it was.”

A Mysterious Blogger

Within days of the shooting, a woman at a computer 2,700 miles away in Washington State came across a tiny news article that struck her as odd. It reported that the unidentified girlfriend of an unidentified deputy sheriff in St. Augustine had used his service weapon to take her own life, and that no foul play was suspected.

Over the years, the woman, who blogs as “Cloudwriter,” had trained herself to spot suspicious cases of domestic abuse involving police officers. The subject had special meaning for her, she said, because she had had a troubled marriage to a police officer.

After reading the article, published Sept. 3, 2010, she became angry that the names had been withheld. “She deserved a name,” said the blogger, who does not want to be identified for fear of threats. “She deserved an investigation. She deserved media coverage. She deserved for the conditions to be examined the same as me. I would want that, and I want that for her.”

With few leads, she began posting on the Internet, looking for a name. Eventually she found it, along with the name of Jeremy Banks. “Never did I say Jeremy did it,” she said, adding, “This was not a ‘Let’s crucify Jeremy Banks.’ This was, ‘Let’s find out what happened.’ ”

For the O’Connell family and friends, the blog became a rallying point. “She gave our family a voice,” said Ms. Crites, one of the sisters.

In January 2011, with the blog post drawing nearly 250 comments and the family complaining to the sheriff’s office about its investigation, Sheriff Shoar asked for an independent inquiry by the Florida Department of Law Enforcement.

Leading the inquiry was Rusty Rodgers, a 30-year veteran of law enforcement, named the agency’s Special Agent of the Year in 2008 and the Investigator of the Year by the State Law Enforcement Chiefs’ Association in 2010. He was well known in St. Johns County, having been called in before on sensitive cases.

In the coming months, Mr. Rodgers would do what the sheriff’s office had not: He interviewed the O’Connell and Banks families and others. He sent evidence for testing, hired a crime reconstruction expert and interviewed many employees of the sheriff’s office.

Nothing made a bigger impact than his quick discovery of the two neighbors, Stacey Boswell and Heather Ladley, who said they were talking outside on the night the fatal shot was fired. Mr. Rodgers had gotten a tip from Ms. O’Connell’s friend Ciara Morris, who had heard that the women might know something important.

In separate interviews, the neighbors told Mr. Rodgers nearly identical stories: They were smoking cigarettes in Ms. Boswell’s open garage when they heard the faint sound of arguing. Curious, they walked down the driveway to hear what was being said.

A man and woman were screaming, Ms. Boswell said in an interview with The Times. “There was something wrong,” she said. “There was nothing playful, no nothing. It was somebody that was scared.”

What came next was unexpected. “We heard her yell ‘Help,’ and there was one gunshot, and then she yelled ‘Help’ again, and there was a second gunshot,” Ms. Ladley told Mr. Rodgers. After that, silence.

“It was probably 10, maybe 15 minutes, and then the sirens came,” Ms. Boswell said. “That’s why we didn’t call anybody.”

The next day, the women said, they learned from a news crew in the neighborhood that the shooting had occurred in a deputy’s house. “I wasn’t really sure if I should say anything,” Ms. Ladley said. “I didn’t know if I wanted to be involved in giving a statement against a deputy.”

Their account called into question Mr. Banks’s statements that he and Ms. O’Connell had not argued or raised their voices at the house that evening. The women gave sworn statements. Given the profound implications of their accounts, Mr. Rodgers also arranged for the Secret Service to give them polygraph tests. Both passed.

On the basis of those statements, the pathologist, Dr. Hobin, changed his ruling to homicide.

After Sheriff Shoar called in the state investigators, he assured employees at a meeting that the agency “won’t find anything,” recalled Ms. O’Connell’s mother, who worked in the office.

It took Mr. Rodgers just two weeks to prove him wrong.

A Question of Forensics

For months, the forensic evidence collected by the sheriff’s office had been sitting, unexamined. It was not until February 2011 that state investigators finally tested for fingerprints, DNA and gunshot residue. What they found raised a host of questions.

No blood was found on the gun, nor did it have any DNA or fingerprints from Mr. Banks, who had worn his gun belt on his previous shift. Ms. O’Connell’s DNA was found on the gun, but there was no trace of her on the two pill bottles in her purse.

The lab found a forensically insignificant amount of gunshot residue on Mr. Banks’s hands, even though he said he held Ms. O’Connell moments after she shot herself. Because a positive test can result from simply entering a room shortly after a gun goes off or by touching someone in that room, Mr. Rodgers suspected that Mr. Banks had washed his hands before the test — something he denies, records show. Significant residue was found on Ms. O’Connell’s hand.

But the central forensic question concerned the bleeding cut above Ms. O’Connell’s right eye, and whether it was a defensive wound — a possible sign of a violent struggle before the fatal shot.

Ms O’Connell had a cut above her right eye, as shown in photo to the right

The lab also detected two tiny spots of Ms. O’Connell’s blood on the inside of Mr. Banks’s T-shirt. He told investigators he did not know how the blood had gotten there.

To make sense of all this, the agency sought the opinion of a crime scene reconstructionist, Jerry Findley. Mr. Findley, a former police officer who has testified as an expert witness more than 150 times, was known in St. Johns law enforcement circles, having consulted on three cases there.

Mr. Findley believed that the eye cut had indeed occurred before the fatal shot. The dimensions of the wound, he said, matched the protruding gun sight on the end of the pistol’s barrel.

That conclusion was in conflict with the finding of Dr. Hobin, who found no evidence of battery and attributed the cut to the ejected bullet casing. Firearms experts told The Times, though, that the casing would have ejected away from her eye.

Mr. Findley also thought the location of the two spent shells might reveal something about who fired the gun. He acknowledged that the shells’ location can sometimes mislead investigators because rescue workers may have accidentally kicked them. But that was highly unlikely in this case, he said, because there were sizable objects on the ground between the body and the shells. “You’d almost have to have a pitching wedge or something of that nature to get them over,” he said.

Mr. Findley said he fired the gun 18 times in different positions and concluded that for the shells to end up where they had — in the corner of the room, behind and to the left of the body — whoever pulled the trigger had to have been left-handed. Unlike Ms. O’Connell, Mr. Banks is left-handed. Mr. Findley also wrote that he found the absence of Mr. Banks’s DNA on the gun “suspicious.” Mr. Banks has denied cleaning the gun before the police arrived.

In late April, Mr. Findley submitted his findings to the state agency.

The totality of the circumstances are not consistent with suicide,” Mr. Findley concluded. “However, they are consistent with homicide.”

That conclusion energized the investigation. The state agency, which has no prosecutorial authority, began briefing the local state attorney, R. J. Larizza, and his staff. His investigators examined autopsy photos and noticed what looked like a broken tooth, not documented by the medical examiner. (Dr. Hobin has acknowledged that he should have documented the mouth more thoroughly.) Eager to learn if it had been damaged in a fight or by the gun, prosecutors began considering whether to exhume Ms. O’Connell’s body.

Then, with momentum building, the investigation was jolted by several events. In October, citing his close working relationship with the sheriff, Mr. Larizza asked the governor to appoint a special prosecutor. But before stepping aside, he told Dr. Hobin that he should wait for the new prosecutor before filing the revised finding of homicide, the pathologist said in an interview. Dr. Hobin never did file it, and he was soon joined by a new chief medical examiner, Dr. Predrag Bulic.

Mr. Larizza did not respond to messages asking about Dr. Hobin’s account and about why he had waited months to declare a conflict of interest.

Dr. Bulic aggressively took control of the case. Ms. O’Connell’s mother had agreed to the exhumation, but the effort came to a halt after Dr. Bulic said it “would not produce any further forensic evidence,” records show.

Dr. Bulic reviewed the case file and solidly backed the sheriff’s determination of suicide. He argued that there were no signs of battery and offered yet another explanation for the cut above the eye: Ms. O’Connell, he said, had turned the gun upside down, put the gun barrel in her mouth and pulled the trigger with her thumb. At that moment, the tactical light attached to the bottom of the gun barrel — now on top — had broken the skin above her eye.

That assumes Ms. O’Connell could have taken the gun from the retention holster in the first place.

Dr. Bulic could not remove a replica of the gun from the same make and model holster provided by The Times. After struggling with it, he asked, “Does anybody know how to open it?”

Dr. Bulic said that he probably would have figured it out eventually. “I see your point,” he said. “But that doesn’t mean that even a child cannot pull that by accident.”

Nonetheless, Dr. Bulic’s upside-down-gun theory would come to dominate discussion of the case. But there was a problem: The laws of physics, not to mention crime scene evidence, made the theory not only highly unlikely, but virtually impossible.

“Dr. Bulic’s theory is fraught with problems and almost laughable,” said Peter De Forest, a widely respected forensic scientist. “It’s emblematic of the entire official investigation.”

Occam’s Razor

Dr. De Forest has spent a lifetime trying to make sense of complex crime scenes, while passing on lessons learned to generations of future investigators at the John Jay College of Criminal Justice in New York.

“We get this idea from the media that we have all this high-tech stuff being done all the time,” said Dr. De Forest, who has a doctorate in criminology and has served as a consultant and expert witness for the police, prosecutors and defense lawyers. “The reality is that in many cases, there’s very little scientific input early in the investigation.”

That is particularly true, he said, in smaller jurisdictions like St. Johns County, where investigators have little experience with complex crimes. “Much of the problem in this case stems from a very cursory scene investigation and a very cursory autopsy,” he said. “Because of it, normally avoidable ambiguities abound.”

Given the significance of the cut above Ms. O’Connell’s eye, The Times asked three independent experts to evaluate Dr. Bulic’s finding that the tactical light cut into her skin as the gun was fired. All said the theory lacked credibility.

“The idea of it recoiling forward is absurd,” Dr. De Forest said. “Basically it appears to be an attempt to explain the wound without considering the possibility of antecedent physical violence.”

Peter Diaczuk, a firearms expert at John Jay, said he had fired guns tens of thousands of times and never experienced a gun moving forward. With a reporter present, he test-fired the same make and model gun with the same tactical light and documented the result with high-speed photography. “The tac light went rearward along with the rest of the gun,” he said.

Mr. Geberth, the New York expert on homicide investigations, said it was “absolutely ludicrous” that Ms. O’Connell “would take a gun, turn a tac light on, turn it upside down to shoot herself.”

Dr. Bulic’s theory was flawed for another reason, according to Dr. De Forest and Mr. Diaczuk: If Ms. O’Connell held the gun as Dr. Bulic suggested, the spent casing might not have ejected, because her grip — left hand underneath, right thumb pulling the trigger — would have covered the ejection port or impeded the rearward movement of the slide that ejects the shell.

If the shell had ejected, it would have gone in the opposite direction from where it was found. In addition, her hand would have been wounded, the experts said.

“This slide comes back incredibly fast and has two very sharp edges on the bottom rail,” Mr. Diaczuk said. Autopsy records mention no wounds to the hands.

Finally, Dr. Bulic appears to have measured the gun incorrectly. He said the distance from the outer rim of the tactical light to the gun barrel precisely matched the distance — 3 inches — from the cut above Ms. O’Connell’s eye to her mouth. As proof, Dr. Bulic taped a picture of the actual gun on top of an autopsy photo of Ms. O’Connell’s face.

But Mr. Diaczuk measured the gun and found that the distance from the outer rim of the tactical light to the top of the gun barrel was 2 3/16 inches — a “huge” error. “I’m not saying that the tactical light could not have made that injury,” he said. “I’m saying that it did not make that injury at the same time that the fatal shot was fired because it simply doesn’t line up.”

The Times gave Dr. Bulic the replica of the gun and tactical light, which measures within a tenth of an inch of the actual weapon, and asked him to demonstrate how the eye wound might have occurred. When he placed the barrel in his mouth, the tactical light came nowhere near the skin above his eye.

To Dr. De Forest, there is a simpler — and more plausible — explanation: Ms. O’Connell was battered before the fatal shot.

“There’s an old principle of logic,” he said, “called Occam’s razor — that if you have to twist things around and have a lot more explanations, that the simplest answer is often the best one.”

Special Prosecutor Decides

As the new year approached, the O’Connell investigation had followed an increasingly tangled path. It fell to the special prosecutor, Brad King, a longtime state attorney from a nearby district, to assess the two opposing scenarios of how Michelle O’Connell had died.

In March 2012, Mr. King’s office contacted the O’Connells and said he and his team would deliver his decision at the St. Augustine courthouse.

Everyone sat around a long table, and as Mr. King made his opening remarks, Ms. O’Connell’s mother grew impatient.

“They were beating around the bush, just giving real vague descriptions of what was going on, and she says, ‘Are you going to prosecute Jeremy Banks for the death of my daughter or not?’ ” recalled Michelle’s sister Jennifer. “And he said, ‘No, ma’am.’ ”

“The day my family met with Brad King I refer to as the second-worst day of my life,” the other sister, Christine, said. “Losing my sister was the worst.” Scott, the brother who worked as a deputy for Sheriff Shoar, unleashed a tirade so emotionally charged that it cost him his job.

Dominick Pape, the head of the state law enforcement agency’s Jacksonville office, was so unhappy that he called for a special inquest.

According to a five-page memo from Mr. King’s office, the decision had been based primarily on the pathologists’ findings. “Three medical examiners have reviewed the file and concluded that this was a suicide,” it states. To Mr. Pape, their conclusions — particularly Dr. Bulic’s upside-down-gun theory — were confusing and unpersuasive.

Dr. Hobin, the original pathologist, would ultimately change his finding three times. After saying it was suicide and then homicide, he told a local reporter he did not know what had happened, before telling The Times that he again believed it was suicide.

Mr. King had also asked a former medical examiner in his district, Dr. Steven Cogswell, to review the case.

As a military pathologist in the mid-1990s, Dr. Cogswell had been criticized for concluding that Commerce Secretary Ron Brown had been shot in the head before his plane crashed in Croatia, killing all aboard. Air Force officials categorically rejected his finding.

Asked about the O’Connell case in an interview, Dr. Cogswell said he could not recall it in detail.

Mr. Pape also complained that Dr. Bulic and Dr. Cogswell had not written reports explaining their decisions. Dr. Bulic said he had not done so because the case was actually Dr. Hobin’s, not his. He said he had looked into the case “out of my pure curiosity and to satisfy the many different people who came and asked about my opinion.”

As for Dr. Cogswell, Mr. King said, “I simply was not willing to spend 5,000 taxpayer dollars to get another report to say it’s suicide.”

The crime scene reconstructionist hired by the state agency, Jerry Findley, also took issue with the special prosecutor.

When Mr. King’s investigators came to talk to him, Mr. Findley said, “the whole tone of the interview was for me to tailor my report or soften my report to where it would be more conducive to suicide rather than homicide.”

In the prosecutor’s memo, investigators wrote that Mr. Findley had not considered the upside-down-gun theory.

“That’s a lie,” Mr. Findley said. “I did consider that, and like I told them, I ruled it out fairly fast,” because guns recoil after firing and the shells would have ejected in the opposite direction from where they were found.

That was affirmed in several tests conducted by Mr. Diaczuk.

Mr. King backs his investigators. “It’s not in his report that he ever test-fired the gun upside down,” he said in an interview. “You can’t predict necessarily where a shot shell is going to end up. You simply can’t.”

He also disputed firearms experts’ statements about the tactical light and the eye wound. “The recoil is essentially going to make the tactical light move forward into the face as opposed to away,” said the prosecutor, a former deputy sheriff. “That is also consistent with my years of training with firearms.”

For all that, Mr. King never explicitly stated that Ms. O’Connell had killed herself. He simply concluded that there was not sufficient evidence to bring charges.

The memo explaining his decision said that while the two witnesses who heard shouts and gunfire that night appeared credible, their testimony did not “support any type of homicide conviction on its own.”

In the interview with The Times, Mr. King said that looking at the evidence, “I think even you have to say it’s legitimately possible that she killed herself. And if that’s the case, I lose.”

In the end, he rejected the call for an inquest.

The Sheriff Reacts

Sheriff Shoar greeted the decision with gushing praise for Mr. King’s two investigators, Bill Gladson and John Tilley. In a letter to Mr. King, the sheriff described them as “class acts” and “on top of their game,” adding, “From one elected official to another, I would never try to recruit someone away from your office, but I did tell Bill and John that I may know of some decent real-estate deals in St. Johns County, just kidding of course.”

After starting as a St. Augustine police officer in 1981, Sheriff Shoar has been elected three times, twice unopposed. Challenging his authority is not without risk, Mr. Rich said.

“I confronted Sheriff Shoar in 2006 and 2007 when I was the chairman regarding his budget and the bloating of his budget,” Mr. Rich said, “and he declared war on me.” Mr. Rich was up for re-election at the time, and soon the sheriff began appearing in ads praising the experience of his 24-year-old opponent. Mr. Rich lost.

His hard edge notwithstanding, the sheriff has cultivated a somewhat eclectic persona. He is a leading member of an influential Christian prayer group that believes in spreading its gospel in government offices and schools. Well-versed in history and popular music, he is given to extemporaneous discourses that touch on the likes of Seneca and the Stoics, Keats, Shakespeare, Solzhenitsyn and Stonewall Jackson.

When Mr. King decided not to prosecute Jeremy Banks, the sheriff saw it as vindication. Case closed.

A year later, after The Times began asking questions, he went on the offensive. He began a new inquiry — into how the state agency had investigated the shooting.

Citing The Times’s interest in the case, the sheriff had his office spend “hundreds of hours” combing through interviews conducted by Mr. Rodgers and his direct superior, Mark Brutnell.

In late March, Sheriff Shoar released a report that accused Mr. Rodgers of hyping his case against Mr. Banks, coaching witnesses and using false information to get a search warrant. The report, given to the news media and law enforcement officials, also accused Mr. Pape of failing to rein in his agent.

Sheriff Shoar also paid two former law enforcement officers — one of them an acquaintance — to review his report, and both agreed that Mr. Rodgers’s investigation had been flawed. Neither examined the underlying evidence or conducted independent interviews.

The sheriff’s report, filled with opinion and at times factually inaccurate, also sought to discredit the testimony of Mr. Banks’s two neighbors, who had given sworn statements about hearing a woman screaming for help.

One of them, Stacey Boswell, said in an interview that Mr. Rodgers had never sought to influence their testimony. “He just asked us what we seen, what we heard that night,” she said.

The report also said the women had confessed to investigators for the prosecutor’s office that they often smoked marijuana together in the evenings and could not remember if they had done so that night. The statement was underlined, in boldface type.

But in the interview, Ms. Boswell said, “That’s not true.” And Leanna Freeman, the lawyer for the second neighbor, said one of the investigators, Robert Hardwick, had confirmed that the women made no such admission.

Ms. Freeman said she asked Sheriff Shoar to correct his mistake, but he refused. (Mr. Hardwick declined to be interviewed.)

In his report, Sheriff Shoar did finally acknowledge — briefly — his department’s failure to canvass neighbors, interview the O’Connells, download Mr. Banks’s cellphone data, isolate and photograph Mr. Banks, collect all his clothing, send evidence for testing, interview the paramedics, write a crime scene log and file the proper reports.

The sheriff also questioned the decision to assign two “relatively inexperienced” detectives to “such a sensitive case.” (Just two months after the shooting, one of those detectives, Mr. Tolbert, was reprimanded for sexually harassing a female officer, records show.)

Despite the mistakes enumerated by the sheriff, only two midlevel supervisors were disciplined, and not seriously.

A Light Touch

Sheriff Shoar describes himself as a disciplinarian. “I have terminated, demoted, suspended and reprimanded many subordinates over the years,” he wrote in his letter to The Times.

At times, though, he has shown a light touch with wayward officers.

Three years before the O’Connell shooting, the sheriff’s office broke up a peaceful graduation party in a predominantly black neighborhood, firing pepper gas, unleashing a police dog, brandishing shotguns and making nine arrests. “If I didn’t know better, I would have thought it was back in the ’60s — the only thing that was missing was a water hose,” said the party’s host, Charlie Gilliam.

Officers later filed a report saying that they were responding to a noise complaint, that they saw open bottles of alcohol, that bottles were thrown at them, and that the dog was unleashed after a young man pushed an officer.

But after internal affairs investigators determined that much of the report was fallacious, prosecutors dropped the charges, and residents received a $275,000 settlement. Sheriff Shoar, however, overruled his internal affairs department’s recommendation that the lieutenant in charge be suspended for three days and that an overly aggressive deputy with a history of misconduct be fired. In the following months, that deputy repeatedly engaged in misconduct before being dismissed.

As for the lieutenant, he would be the district commander on the scene the night Michelle O’Connell died.

A year before that, Sheriff Shoar’s disciplinary posture had been called into question in a domestic violence case involving a deputy named Halford (Bubba) Harris II.

Two supervisors learned of accusations that Mr. Harris had abused his wife. But no investigation was immediately opened, records show.

One sergeant did prepare an affidavit documenting the accusations. But he was told by his supervisor to hold it back, so he stuck it under the visor in his squad car, where it remained, even after another officer became aware of further incidents, according to Mr. Harris’s internal affairs file.

The case came to a head on Christmas Eve, when his wife fled their house and called the police. Internal affairs officers uncovered other possible acts of domestic violence before his hiring, records show. His wife said that before they married, he had held a knife to her throat and hit her. His ex-wife said he had threatened her with a gun. No charges were filed.

Col. Todd R. Thompson, the sheriff’s director of law enforcement, recommended that Mr. Harris be fired, saying his actions were “particularly egregious and trouble me deeply.”

In an interview, Mr. Harris insisted that he had never engaged in domestic abuse: “Is there proof?”

“They’re telling one story,” he added. “I’ll tell you another one.” He said the state attorney brought no charges and noted that, though they divorced after the Christmas Eve incident, his wife later wrote a letter of support, calling him “a wonderful man and father.”

Sheriff Shoar overruled the dismissal recommendation, citing mitigating factors, like an “exemplary” work record and an absence of citizen complaints.

“I hope you understand how fortunate you are to receive a second chance,” the sheriff wrote to his deputy.

After the decision leaked out and caused an uproar, Mr. Harris said, he was pressured to resign. He is now a deputy in a nearby county.

A Final Reckoning

Three years after Michelle O’Connell’s death, the case continues to tear at her family.

Scott O’Connell recently made up with Mr. Banks and now accuses the state agency of manipulating his family into thinking his sister was murdered. After a long talk in April with Sheriff Shoar, which was transcribed and released to the public, Mr. O’Connell was rehired. He is no longer welcome in the family, his sister Jennifer says.

Patty O’Connell and her daughters, along with their brother Sean, continue to believe that Michelle did not kill herself.

“It’s unfair to my sister, to her memory, to her daughter and to my family,” Christine O’Connell said. “I still am hopeful that eventually, it may be 20 years, but eventually, we will have justice for my sister and for her daughter.”

Alexis O’Connell is 7 now. She and her grandmother recently moved to Virginia to live with the oldest O’Connell brother, Justin.

Jeremy Banks has declined to talk to The Times. “I’m not really sure that would be in Jeremy’s best interest,” said his lawyer, Robert L. McLeod.

Mr. Banks, who recently married, did acknowledge to investigators that there were questions he could not answer, such as why none of his DNA was found on his service weapon. “I know it’s got that plastic grip, and I’ve seen skin from my hand in there,” he said, according to his internal affairs file. “There should be DNA on there.” Or why neighbors said they heard screams followed by gunshots.

“Just because it raises questions doesn’t mean it happened that way,” Mr. Banks said.

The sheriff’s flawed investigation left many unanswered questions.

“It’s just simply the failure to collect evidence, and if it’s not collected at the beginning, chances are good it’s going to be lost,” said Thomas Cushman, a former prosecutor and longtime defense lawyer in town. “And if it’s lost, you can’t put it back together.”

Mr. King understands that there are questions, but he is firm in his decision not to prosecute.

“Yes, there is a visceral sense of ‘Oh, what if she was murdered and this guy goes free?’ ” he said. “There ought to at least be some visceral sense of ‘What if she did commit suicide and he’s in prison for the rest of his life?’ ”

Sheriff Shoar’s accusations have cast a long shadow on the state agency’s reputation. A spokeswoman said the agency would comment only after it completed its inquiry into the handling of the case by Mr. Rodgers, who is on paid leave, and Mr. Pape. A special prosecutor is also investigating.

The sheriff has not been hesitant to speak out. Over the summer, he held what amounted to a pep rally for Mr. Banks, attended by his staff, at the Renaissance World Golf Village Resort. Scott O’Connell and his wife were there as well. The sheriff introduced Mr. Banks’s parents, saying he had known them “for many, many, many years.”

“Jeremy Banks had nothing to do with that case,” he said, calling Mr. Banks and Mr. O’Connell “victims.” “I’d stake a 33-year career on it.”

He motioned to Mr. Banks and added, “This guy right here came so damn close to being charged with homicide, it’s scary.”

Then the sheriff asked Mr. Banks and Mr. O’Connell to stand. “Let’s give these two guys a hand.”