PROVO — Whether she died from heart disease or drowning, none of the facts or circumstances surrounding Michele MacNeill’s death provided sufficient evidence to conclude the death was a homicide, Utah’s chief medical examiner told a jury Thursday.

“I certified that the manner of death was undetermined,” Todd Grey said, testifying in the 4th District Court murder trial of the woman's husband, Martin MacNeill. “I did not feel that I could reach a conclusion of homicide.”

Grey's conclusions came in a 2010 reassessment of an original autopsy, which said Michele MacNeill died of natural causes related to heart disease, specifically “chronic hypertension and myocarditis, which are capable of causing acute unexpected arrhythmia and sudden death.”

Grey told jurors he believes the combined effects of natural heart disease and drug toxicity — a cocktail of painkillers and other drugs found in Michele MacNeill's system — were the likely cause of her death.

Michele MacNeill, 50, was found unconscious and partially submerged in the bathtub of her Pleasant Grove home on April 11, 2007, about a week after having plastic surgery.

Utah County prosecutors charged her husband with murder, a first-degree felony, and obstruction of justice, a second-degree felony, in connection with her death. They contend he over-medicated Michele MacNeill with drugs prescribed by her surgeon — Lortab, Ambien, oxycodone and Valium — to render her listless, get her in a bathtub and then drown her so he could make a new life with his mistress.

Like Grey, neither the original autopsy nor an analysis by the state’s paid expert from Florida ruled the death a homicide, nor were the drugs in her system at lethal levels. The state’s paid expert, Dr. Joshua Perper, however, is expected testify Friday that Michele MacNeill's death was the result of drowning.

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An emotionally distraught Rachel MacNeill testified against her father Thursday, saying he insisted an autopsy be conducted on her mother's body in case police launched an inquiry and accused him of murder.

“It’s a possibility, but I cannot prove it,” Grey said of the theory when questioned by defense attorney Randall Spencer.

Grey noted that there was no evidence in Michele MacNeill’s lungs of a significant inhalation of water, although her lung weights were heavier than normal.

“I could not make a diagnosis of drowning,” he said.

Utah County authorities did not begin to investigate Michele MacNeill’s death until 2008 after her daughter Alexis Somers and other family members came forward with information they had gathered on their own.

Authorities then pushed Grey to reconsider the initial autopsy because they were intent on bringing a murder case against Martin MacNeill. Grey resisted until 2010 and said Thursday he did so only after investigative information presented to him raised questions about whether the death was “straightforward and simple … or much more complicated.”

In the end, Grey said he amended the findings of medical examiner Dr. Maureen Frikke, who died from breast cancer in 2008, after concluding that the drugs in Michele MacNeill’s body were “significant enough” to have contributed to her death.

Still, Grey testified he sent an email to investigators informing them that neither the medical science of the case nor the evidence they had gathered from interviews was “so compelling that it leads to the conclusion of homicide.”

Prosecutors have also alleged that Martin MacNeill lied about the details of his wife’s health and his discovery of her in the bathtub when he spoke to Frikke in hopes of influencing the autopsy’s findings.

Grey countered that theory under cross-examination Thursday, saying he saw nothing in Frikke’s notes to suggest Martin MacNeill had influenced her decisions or conclusions.

Earlier Thursday, Somers took the stand for the second time in her father’s trial, parrying with Spencer over inconsistencies in statements she’s made over years of emails with family and police, in media interviews and earlier court testimony.

Spencer’s questioning seemed designed to convince jurors that the trial has been fueled by Somers’ vigorous pursuit of an investigation into her mother’s 2007 death and anger over her father’s affair with a nursing student.

Somers, herself a doctor, spent more than five hours on the stand over two days, talking about her care of her mother after the surgery, stating how few painkillers her mother had taken and said her mother was "upbeat and happy" just hours before she died.

Under cross-examination, the defense has queried Somers about the 18-page summary of allegations she initially drafted and gave to police, her editing of police investigative summaries over the years, and a copy of the medication record she’d kept on her mother, which surfaced for the first time in 2011. The record, Spencer noted, was discovered at the same time Somers was suing her father in civil court over her mother’s estate and possession of the family home.

Somers held her own throughout, reviewing thousands of pages of court and investigative reports but noting at times that she “may have misspoke or mis-wrote” some things at different times over the past seven years.

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