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State medical examiners have been unable to determine how a 47-year-old Emery County woman died, but events surrounding her death are "strongly suggestive that a homicide had taken place," according to an autopsy report.

Relatives found Kristi Maxwell dead in her Orangeville home July 17 when they stopped by to check on her.

They also found her husband, 55-year-old Richard Maxwell — the only person of interest identified by police — who shot himself in the chest that day. Three weeks later, after being released from the hospital, he shot himself again, this time fatally.

The autopsy suggests the woman's death could be a homicide, based on Richard Maxwell's behavior and the positioning of Kristi's body and the state of her clothing.

The woman was found lying on a bed, with her shirt pulled up above her breasts, and her underwear cut on one side and pulled down around one leg. Her pants had been cut off and placed under her legs, the report said.

There were small abrasions on the woman's upper lip and nose, bruises on her head, abrasions on her right arm and a small puncture wound on her right forearm. None of the injuries would be life-threatening, the autopsy report said.

Material in the woman's esophagus and stomach were "suggestive of pill material," but toxicology testing was negative for any drugs, the report said.

"An asphyxial event, such as a smothering, cannot be totally excluded as causing this death," Deputy Chief Medical Examiner Edward Leis wrote in his final report, which was dated Nov. 23.

Leis concluded: "The cause and manner of death are therefore certified as undetermined."

The medical examiner's report was provided to The Salt Lake Tribune by Kristi Maxwell's brother-in-law, James L. Davis, of Spanish Fork, who said Wednesday many family members were frustrated by the reluctance of police and prosecutors to call the case what it was: a homicide investigation.

As portrayed in previous news reports, Davis said, Kristi Maxwell's death "could have been construed as death by natural causes or possibly due to a drug overdose."

"Nothing could be further from the truth," he said. "She fought for her life."

He added that in the tightknit community of Emery County, where "everyone knows everyone ... this death has shaken many to their core and divided them among those who believe the truth and those who believe Richard Maxwell could never have done something like this."

"In memory of her, those who knew and loved her deserve to know that she did not die of natural causes," Davis said. "She died as she lived, fighting for life."

Davis said Wednesday that family members had asked the county attorney and sheriff's office to put out a statement that they were, indeed, investigating Kristi Maxwell's death as a possible homicide.

He said that to not state the truth about the case "diminishes her life and buoys the life of a killer."

"Their reluctance to not publicly state that is baffling," he said. "It just keeps the wound bleeding."

Emery County Sheriff's Office spokeswoman Janalee Luke said Wednesday: "I can tell you that, internally, we always called it the Kristi Maxwell homicide investigation, and we still do."

Luke added the Emery County attorney's office had been responsible for issuing news releases about the case. Calls to that office were not returned.

According to search warrant affidavits unsealed in August, a sister had told police that Kristi Maxwell "has been praying for her life and that her husband has been suicidal and told [Kristi Maxwell] that he is going to take [her] out with him."

Richard Maxwell was taken to a hospital for treatment of his gunshot wound July 17.

A police officer reported overhearing medical personnel stating that "on top of being intoxicated, [Richard Maxwell] had opiates and benzodiazepines in his system," search warrant affidavits state. Benzodiazepines are often used as sedatives or to lower anxiety levels, according to WebMD, and one commonly known benzodiazepine is Xanax.

Richard Maxwell had been struggling to find steady employment, the affidavits state, "and this has had an impact on his mental state and marriage, according to friends and family."

Family members also reported Kristi Maxwell suffered from "extreme migraine headaches and also had surgery a few years back on her brain from an aneurysm," the affidavits state.

From the home, police later seized several beer cans and bottles, three shot glasses — one of which contained an "unknown partial tablet," four pet prescription bottles, a medicine measuring cup and bedding and pillows from where Kristi Maxwell's body was found, which an officer thought might contain "vomit which is evidence of drug overdose," the affidavits state.

During an attempt by police to interview Richard Maxwell on July 20, his heart began beating irregularly and he was unable to talk, the affidavits state.

He was released from the hospital the first week of August. On Aug. 8, deputies received a request for a "welfare check" and went to the home where Maxwell had been staying, according to the Emery County Sheriff's Office. Deputies found he had shot himself again and had died.