Susann Sills was no shrinking violet, says her friend Chris Solimine. They had met while both earned an MBA at the University of Miami.  "Susann was ... smart, witty, sarcastic, but not in a mean way... just enough to dig at you," he said.  "Incredibly driven, a loyal friend."

And she was an accomplished businesswoman. Together with her husband, Dr. Eric "Scott" Sills, a renowned fertility specialist, they had started their own IVF practice in April 2015. "She started the business ... she built it," Solimine said, adding, "Susann pretty much ran everything with the exception of actually doing the procedures."

So, it came as a shock when he read the news that Susann Sills had suddenly died on Nov. 13, 2016, from an apparent accidental fall. "It didn't seem plausible to me that she just fell down the stairs with a migraine headache," Solimine said. But that was the story Dr. Sills had told the 911 operator that morning when he called and reported finding his wife face down on the staircase. Solimine says he wondered if there was more to the story.

Rick Leeds, another friend of Susann Sills, said she had left him a troubling message about a month before her death. "She sounded like she was whispering," Leeds said. "It was so different from the happy, jovial, excited voicemails I got before. This one was definitely ... things weren't good." When they spoke, Leeds said it sounded like there was tension over a photo.  "She said it was a topless photo of her that had appeared on a ... blog."  As it turned out, the topless photo was one that Susann Sills had posted of herself on a political chatroom called Patrick.net.

"Susann apparently was one of the few women who was involved in this forum," according to former Orange County Sheriff's Homicide Detective Dave Holloway, who was the lead case agent. "She ... kind of threw out on this forum that ... if Donald Trump won the presidential nomination, that she would post a picture of her bare breasts," Holloway said.

Leeds says that when he and Susann Sills spoke, it was clear that, "She and Scott were in a really rocky place, and that she was thinking about leaving him." He adds, "Whatever was going on between her and Scott ... and this picture ... was just ... a pivotal point for her."

But Holloway and his team had no idea about the photo or what, if any, significance it had on Susann Sills' death when they arrived at the Sills' San Clemente home.

"Susann had injuries to pretty much her whole body," said Holloway. "Her face was all bruised up. Her back was bruised up ... both arms and legs ... had bruising and abrasions."

"48 Hours" correspondent Tracy Smith asked, "At that point in time that morning November 13th, was Scott Sills a victim or a suspect?"

"To us ... he was a victim," Holloway said. "We were going to a house where two kids and a husband just lost their wife and mother." But as they continued their investigation, the questions would mount.

Smith goes inside the investigation in "The Puzzling Death of Susann Sills," an all-new "48 Hours" airing Saturday, May 18, 2024, at 10/9c on CBS and streaming on Paramount+.

Detectives interviewed the couple's 12-year-old twins, Mary-Katherine and Eric Sills. Everyone described the marriage as "loving." The children said their parents rarely fought and were never violent. And they all confirmed that Susann Sills had been suffering from a migraine all weekend. Mary-Katherine, whose room was the quietest, said she had cleaned and tidied it up to look like a hotel suite so that her mom could rest, while Mary-Katherine slept in her parents' bedroom.

In his 911 call, Scott Sills said his wife's shoe had come off on the stairs, suggesting she had gotten up in the middle of the night, tripped and fell. A collection of items around Susann Sills' body seemed to support the story of an accidental fall. There was a large stainless-steel cooking pot, which seemed odd at first, but Susann Sills' family had explained she would sometimes carry a bowl when she felt nauseated. And there was an empty bottle of Tramadol, a pain medication, which Scott Sills said Susann Sills often took to treat her migraines. And off to the side was a red and white scarf. Mary-Katherine told investigators her mother had been wearing it around her neck when she was discovered in the morning. But she had taken it off so as not to impede her mother's breathing.

During a preliminary examination of Susann Sills' injuries, the deputy coroner had noticed some other injuries to her neck that didn't appear to be consistent with a fall.  "Her neck had a pretty pronounced ligature mark," Holloway said,

Smith asked, "Is it possible that she could have fallen down the stairs and then somehow the scarf strangled her?"

"Could have caught on a banister ... sure, I suppose so," Holloway said, "but we didn't have any evidence of that."

Instead, investigators say, they found something suspicious. There was blood in Mary-Katherine's room where Susann Sills had been staying that night, on the curtains, the wall, and the nightstand. And they discovered that Scott Sills, who had been wearing a beanie on his head, had a cut on his head, and a bruise on his forearm. He said he had injured himself while working on his car with his son Eric. Meanwhile Eric told the detectives he'd heard his parents arguing in the early hours of the morning. Scott Sills admitted he had argued with Susann, but said it was because he was upset that she was working late on her laptop, which aggravated her migraines.

Smith asked, "When you came to the house, it was a death investigation...By the time you left, was it a murder investigation?

"No," said Holloway, "It wasn't just as clear-cut as that."

DNA tests on the blood in the bedroom eventually came back positive for Scott Sills, with a smudge on the wall that showed a mixture of both Scott and Susann's DNA. "They were both there," said Holloway, "There's a fight." And forensic analysis of Susann's phone suggested there was tension in the marriage. In texts sent in late August, less than three months before her death, Susann wrote, "I am trapped" ... "You are killing me" ... "I just want out" and "We just aren't right for each other."

In November 2017, a year after her death, the coroner's office cited Susann Sills' cause of death as ligature strangulation, and the manner as homicide. Dr. Sills was now the prime suspect.

When investigators interviewed Scott Sills again in August 2018, he denied killing Susann Sills, and for the first time he offered an explanation for the blood in Mary-Katherine's room. He said he'd cut himself while changing a window screen.

But on the day of Susann Sills' death, detectives had found something else -- a possible motive. In Scott Sills' home office was a printout of an online exchange between Susann Sills and a male member of Patrick.net dated Aug. 30, 2016. They were discussing that topless photo Susann Sills had posted. The man, who went by "tenpoundbass" wrote: "All I've got to say is you must have a super cool Husband." Susann, aka "turtledove" replied, "He's exhausted, actually. It isn't easy being married to a woman who is partially naked and posing, alluringly, all the time ..."

Scott Sills had denied printing the chat. But investigators had later found a copy of the same exchange on his phone.

"Does this sound like this could lead to motive?" asked Smith.

"Yes," said Holloway. "If it's ... something that's building up in him, some kind of anger ... or jealousy about ... what his wife's doing online without him."

"Enough to kill her?" asked Smith. "Mm-hmm," Holloway replied. 

In April 2019, Dr. Scott Sills was arrested on his way to surgery and charged with the alleged murder of his wife.

At his trial in late 2023, Sills' defense attorney Jack Earley argued there was no motive for murder. And that topless photo? He told Smith, "It wasn't a big deal."

"It's not striking to you that he had this photo in two places on his phone and then on the printer?" she asked. "No," he said. "First of all, I don't know really who printed this stuff up."

And Earley offered a unique theory to explain how the forensic pathologist could have found ligature strangulation. He said one or both of the family's dogs had tugged on the scarf that was wrapped around Susann's neck after she fell on the stairs.

"Mary-Kate ... saw the dogs pulling on the scarf," Earley told Smith.

"Do you honestly think that the dogs pulled hard enough to strangle her to death?" Smith asked.

"No," he said. "That was not the main theory."  

Instead, Earley focused on another injury identified in Susann's autopsy: a fractured C3 vertebra near the base of the neck, which can be fatal, or at least have left Susann incapacitated.

 "Their breathing is compromised," Earley explained. "If they're then choked, it doesn't take much to kill 'em." 

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