PROVO — Michele MacNeill inhaled a large amount of water and died from drowning, not heart disease, a forensic pathology expert told jurors hearing evidence in her husband’s murder trial Friday.

Prescription drugs in the 50-year-old former beauty queen’s system may have also contributed to her death, but slides of tissue taken from her heart showed no sign of the heart problems — specifically myocarditis, or an inflammation of the heart — which Utah medical examiners said were a factor, Dr. Joshua Perper testified.

“I looked very carefully at the slides of her heart,” said Perper, the former chief medical examiner from Dade County, Fla., an expert for prosecutors who is being paid about $14,000. “I did not find any evidence of myocarditis.”

However, like other medical and pathology experts involved in the case, Perper did not rule the death a homicide, even though he said he found many “suspicious elements” in the medical records.

“Undetermined,” Perper said of the manner of death.

MacNeill was found dead and partially submerged in a bathtub at her Pleasant Grove home on April 11, 2007, about a week after having plastic surgery. An initial autopsy found she died of natural causes related to heart disease, specifically “chronic hypertension and myocarditis, which are capable of causing acute unexpected arrhythmia and sudden death.”

Utah County authorities began an investigation into the death in 2008, after family came forward with suspicions that Martin MacNeill had murdered his wife in order to be with his mistress.

A subsequent review of the findings by a second Utah medical examiner changed her cause of death to “undertermined” and labeled the circumstances “suspicious.”

Perper, the now-retired pathologist, said his conclusions in the case came after a review of autopsy, emergency room and toxicology reports, along with blood and tissue samples and investigative documents. Additional medical reports were also used, he said.

Some of the data on the woman’s death pointed to unusual circumstances not typically seen in drowning deaths, according to Perper. But reports from paramedics say Michele MacNeill expelled as much as seven cups of water from her mouth during resuscitation efforts which indicate that the mother of eight had “inhaled a significant amount of water,” the doctor said. The amount would be about a half-gallon of water.

In addition, lab results showed a high level of dilution of Michele’s blood. “This dilution of essential blood chemicals can be fatal,” Perper said.

Martin MacNeill is charged with murder, a first-degree felony, and obstruction of justice, a second-degree felony. Prosecutors contend MacNeill over-medicated his wife of nearly 30 years with drugs given to her by a plastic surgeon and then drowned her in the tub.

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Prosecutors in MacNeill murder trial use bathtub in demonstration

Utah County prosecutors used a bathtub as a courtroom prop on Friday to demonstrate how the body of a former beauty queen was found when it was discovered by her youngest daughter and neighbors who came to her aid.

Cross-examination by defense attorney Randall Spencer lasted for nearly two hours and included several testy exchanges. Spencer wanted yes or no answers from Perper, while the doctor sought to explain his answers in detail.

The pair wrangled over medical details and sometimes confusing science, including the woman’s body temperature and what that may indicate about a person’s time of death, when signs of post-mortem lividity were spotted in her body and whether CPR would or would not produce an immediate expulsion of water from the lungs and stomach of a person who had drowned. The exchanges appeared to confuse both parties at times.

“Your question is not a clear question," Perper, who is 80, said to Spencer as the defense attorney used a marker to draw cells on an easel mounted with paper.

In addition, Spencer took issue with the fact that Perper provided expert opinions about MacNeill’s cause of death on the "Nancy Grace" TV show in 2010, well before he was hired by prosecutors in the fall of 2011.

Spencer tried to make an issue out of chest X-ray taken of MacNeill while in the emergency room on the day she died. The scan show no evidence of water — “abnormal infiltrate” in medical terms — in the lungs that would suggest she had drowned.

Perper conceded the point but never wavered in his opinions, later telling deputy Utah County attorney Chad Grunander that MacNeill’s death by drowning is a “reasonable medical certainty.”

Perper was one of only two witnesses called by prosecutors on Friday. The other was Dr. David Cragun, a cardiologist hired to evaluate the extent of Michele MacNeill’s heart disease.

Based on his review of autopsy findings and other medical reports, Cragun said the woman had only a mild case of myocarditis that would not have caused a sudden arrhythmia.

Said Cragun: "The chance of a serious or life-threatening complication would be very rare.”

The trial resumes Tuesday and is expected to last for two more weeks.

Video Contributing: Sam Penrod

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