PROVO — Dr. Todd Grey admits the pieces of information he had regarding the death of Michele MacNeill didn't change between 2008 and 2010. But his mindset did.
"My thinking about the case changed," the veteran Utah state medical examiner conceded from the witness stand Tuesday.
During cross-examination on the fourth day of a preliminary hearing in the murder case of Martin MacNeill, defense attorney Randy Spencer tried to raise the argument that Grey was pressured into changing his opinion about Michele MacNeill's death so they could file a homicide charge.
But Grey said that was not the case.
When the Utah County Attorney's Office asked him to re-evaluate MacNeill's death in 2010, he said the toxicology report was something that he spent more time thinking about.
While there was "smoke surrounding this case and uncertainty on how those drug levels came to be" in her system, Grey insisted he wasn't pressured. "I certainly wasn't feeling like someone was saying, 'Get with the program here, we've got a homicide we've got to take care of.'"
Grey said there were a lot of suspicious factors surrounding the death, and the issue of the drugs found in MacNeill's body and how they got into her system needed to be studied. Because of the investigative information that had been collected and the "behaviors of various people" involved in the case, Grey felt there was a "lot of information that raised a question whether this was a simple natural death."
After taking another look at the case in 2010, Grey said he changed the manner of death to "undetermined." He also changed her cause of death from heart disease to the combined effects of heart disease and drug toxicity. Grey also testified he does not believe MacNeill died solely of a drug overdose.
Furthermore Grey conceded at one point, "This is a very difficult homicide case to prove," and said he was surprised that the state was proceeding, "considering the difficulties of the case."
Grey was one of several medical experts who testified Tuesday.
Martin MacNeill, 56, is charged with murder and obstructing justice in the April 2007 death of his wife. Prosecutors say he gave Michele MacNeill, 50, a dangerous combination of drugs and she was later found dead in a bathtub. Fourth District Judge Samuel McVey will likely determine later this week if there is enough evidence to order MacNeill to stand trial. The evidence is mostly circumstantial.
Spencer and fellow defense attorney Susanne Gustin noted that the original autopsy on Michele MacNeill in 2007 was conducted by an assistant medical examiner who has since died. That autopsy concluded that MacNeill died of heart disease and concluded the "circumstances (were) not suspicious." Grey essentially agreed with her findings in 2008 before reviewing it and changing his opinion in 2010.
Dr. David Cragun, an interventional cardiologist at the Central Utah Clinic in Provo, was also asked to review the initial autopsy. He concluded it was "very unlikely" that myocarditis (heart disease) led to her death.
While Grey said it's not common for a medical examiner to change their opinion on a death, it's not unusual. He referred to a high-profile murder in Salt Lake City some years ago where that occurred. In the MacNeill case, he said he looked at the "totality of drugs in her system."
"There was a potential that this mix of drugs could lead to potentially lethal effects or sedated effects," he said. "It's possible that this individual may have been coerced or forced to take medications that she might not otherwise."
Post-mortem toxicology analysis of MacNeill showed there were four powerful prescription medications in her system — Valium, oxycodone, Phenergan and Ambien. A pharmacology/toxicology expert testified that there was little chance that MacNeill would have been alert with the dangerous quadruple combination of prescription meds found in her system at the time of her death.
"You have a tank that's nearly 3/4 full, 7/8 full, and you drop (Zolpidem) in, it's very surprising anyone could maintain a level of alertness with that in their system," Dr. Gary Dawson said. "That would be the fourth piece that dropped in on the top brick."
But what may have been most surprising, he said, was that she had such a high level of the potent sleeping drug, typically sold under the brand name Ambien, in her system at midday.
If MacNeill had taken the sleeping agent the night before at the customary bed time, there shouldn't have been any left in her system by the time her body was found, he said. A more likely scenario was the drug was administered within two hours of when she was found.
The defense noted that the levels of the individual drugs found in Michele MacNeill's system were relatively low.
But Dawson agreed with Grey that the totality of the drugs had to be considered. "You can't single out one drug and say that's probable or possible. It's the combination," he said.
Grey said it was possible that the recorded level of drugs in Michele MacNeill's body were higher before she died and fluids used in an attempt to revive her lowered the levels.
Steven Mickelson, director of nursing for the Utah County Health Department, worked with MacNeill for about seven years. On the day Michele MacNeill's body was found in a tub, he said he received a call that something was wrong at the MacNeill house and he needed to go there immediately.
He described Martin MacNeill's demeanor as "a little bit distraught, quite animated." What he thought was odd, was that the bathtub where he had allegedly found his wife "face down the wrong way," was already drained.
"I'm not sure why it was empty, it just seemed a little odd," Mickelson said, noting that he would have thought performing CPR would be a higher priority than draining the tub.
When Mickelson asked MacNeill a couple of days later what had happened, he told him, "Maybe she had fallen into the tub, hit her head and drowned, or something around those lines."
Grey, however, testified that he did not believe, based on the evidence, that Michele MacNeill died as a result of drowning.
Mickelson said he also noticed that when MacNeill returned to work after his wife's death, he was wearing a different ring where he used to wear his gold wedding band. The new ring, which looked like a type of wedding band, was black.
On Wednesday, Gypsy Gillian Willis, 35, is expected to take the witness stand. Prosecutors say MacNeill was having an affair with Willis in the weeks leading up to his wife's death. After the death, family members say Martin MacNeill announced that Willis was going to become the new nanny for his children. He later announced their plans to marry.
Willis was convicted last year of identity fraud after she and MacNeill tried to steal the identity of MacNeill's 16-year-old daughter.