The Medical Examiner Found Fentanyl That Killed Eric Richins. She Still Couldn't Call It a Homicide.

Dr. Pamela Sue Ulmer took the stand today and told the jury exactly what killed Eric Richins.

Fentanyl. In his blood at 15 nanograms per milliliter, a level that should have been zero for someone with no prescription. In his stomach at 20,000 nanograms per milliliter, a concentration so high that when Dr. Ulmer saw it, she called the toxicologist to make sure the number was real.

She also found quetiapine in his stomach at 16,000 nanograms per milliliter. Eric Richins was never prescribed quetiapine. His wife Kouri was.

So cause of death? Easy call. Fentanyl intoxication. Dr. Ulmer had no hesitation there.

Then came the harder question. The one this entire trial turns on.

How did it get there?

Dr. Ulmer had five options on the death certificate: natural, accident, suicide, homicide, or undetermined. She picked undetermined. She finalized that ruling on June 6, 2022. She retired from the Utah Office of the Medical Examiner on January 1, 2023. She never changed it.

That's the tension at the center of today's testimony, and it's one the defense drove home hard.

Defense counsel walked Dr. Ulmer through every manner of death category one by one. Could this have been natural? Could it have been an accident? Could it have been suicide? For each one, Dr. Ulmer explained why the evidence didn't clearly point in that direction. But it didn't clearly point to homicide, either. That's why she chose undetermined. And she stood by it under cross-examination.

The prosecution knew this was coming. On redirect, they asked Dr. Ulmer what she didn't have when she made that determination. No text messages. No phone records. No financial documents. No electronic evidence of any kind. The implication was clear: of course she couldn't call it a homicide. She was working with an incomplete picture.

That's a fair point. But it cuts both ways.

If the ME needed more information to make this call, then the question becomes whether the information the jury will eventually see actually fills that gap. Does it prove how fentanyl entered Eric Richins' body? Does it prove Kouri Richins put it there? Or does it prove motive, opportunity, and suspicious behavior without ever answering the mechanism?

Because that's the gap the defense is living in. The state can show you everything Kouri Richins allegedly did before and after Eric's death. The insurance policies. The texts. The phone calls to the medical examiner's office, where Kouri called on March 17 and again on April 21, 2022, providing narratives about Eric's health, Lyme disease, a fungal infection. All of that is the "why." The state still has to prove the "how." And the person who was closest to the science, with the body right in front of her, couldn't get there.

One more thing worth paying attention to. Dr. Ulmer mentioned that the manner of death on the death certificate went from "pending" to "not determined." That's a deliberate choice. Pending means you're waiting for more information. Not determined means you've reviewed what's available and it's not enough to pick a category. Dr. Ulmer moved from one to the other and stopped. She didn't go back. Even as the criminal investigation continued, even as charges were filed, she did not amend the death certificate before she retired.

Does that matter legally? Not directly. A medical examiner's ruling doesn't bind a jury. Jurors are free to reach their own conclusions based on the totality of the evidence. But it matters practically. When the expert who held the scalpel says she couldn't determine the manner of death, and the state is asking you to call it aggravated murder, that's a gap the prosecution has to address.

We're only on Day 2. The state has weeks of testimony ahead. They'll bring in the text messages, the financial records, the witnesses who allegedly helped Kouri obtain fentanyl. All of that is coming. But today, the defense landed something real. The medical examiner who autopsied Eric Richins testified under oath that she could not determine how fentanyl killed him. The state needs the jury to get past that. Whether they can is what the next several weeks will answer.