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State v. Combs9/25/2002 cars observed on Esther's back were self-inflicted. Dr. Stiefel responded that those scars did not fit the pattern or typical distribution shape of self-inflicted scars. When asked the same question concerning the scars on Esther's head and scalp, Dr. Stiefel replied it was "possible," but "highly unlikely" that the causative injuries were self-inflicted. As for the other scars, Dr. Stiefel testified that the appearance of some were consistent with burn injuries; others appeared linear, which would be consistent with cuts made into the flesh. Burn wounds were located on Esther's arms, thighs, and backside. Dr. Stiefel was informed by Evangeline that these wounds were the result of cooking accidents, as Esther frequently prepared family meals. Dr. Stiefel testified that, all things considered, the scars on Esther's body were inconsistent with the personal/medical history provided by Evangeline and Joseph Combs.
Dr. Stiefel learned that Esther was adopted at the approximate age of five or six months and that she had lived with the Combs family since that time. Esther had never attended public school. Rather, she had been home-schooled, as were the other Combs children. Evangeline claimed that Esther had the equivalent of a 12th grade education and was preparing to take the "GED" exam. As for Esther's employment status, Dr. Stiefel was informed that Esther's job was to care for the children in the church nursery and work for her father, performing cleaning services and secretarial duties at the church.
Susan Francis Early, a clinical social worker employed by the Medical Center, was asked to investigate the suspicions of abuse prompted by Esther's condition. Early testified that her first visit with Esther occurred on February 19, 1997, while Esther was still in the hospital. Early noted the scars on her face, abdomen, breast, and back. She recalled that the scars on her back were thick and raised approximately 1/4 inch above her skin, running in a "sideways" direction from the base of her neck to her buttocks. Sections of hair were missing from the top of Esther's head. Early questioned both Evangeline and Joseph Combs as to the origin of the scars on Esther's body. Initially, neither defendant would respond to her question. Later, Evangeline informed Early that Esther "fell a lot and was clumsy." Esther was discharged on February 25, 1997. Prior to Esther's departure, Early informed her that the Department of Human Services operated an adult protective services program and that the program was responsible for investigating suspected cases of abuse and/or neglect concerning adults over the age of 18. Esther told Early that she wanted to return to her family and subsequently did so.
Debbie Richmond-McCauley, a detective with the Bristol, Tennessee Police Department, was also alerted to the possibility that Esther was a victim of abuse. Detective McCauley arrived at the Medical Center during the evening on February 18, 1997. Esther was unclothed and semi-conscious. McCauley noted the scarring on Esther's face, neck, chest, inner thighs, back, buttocks, arms, hands, and legs. She took photographs. When Esther regained consciousness, McCauley questioned her about the scars and showed her the photographs. Esther would not look at them or make eye contact with her. During their meetings, Esther experienced periods of shaking and stuttering; her right leg shook very rapidly.
Over the next few days, McCauley spoke with the entire Combs family: the parents, Joseph and Evangeline; Esther's brothers Jimmy, David and Peter; and her sisters Cindy and Sarah. Joseph completely disavowed any knowledge of Esther's scars, claiming that he had never observed any. According to Joseph, Esther p
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