The state medical examiner’s office has removed references to alcohol consumption as potentially contributing to the death of a Massachusetts man who perished while hiking the Appalachian Trail in Maine last summer.

The wife and family of Jeffrey Aylward of Plymouth, Massachusetts, have spent several months contesting the conclusion that alcoholism or alcohol consumption were potential factors in the 63-year-old man’s death on the trail in late July or early August. Insisting Aylward hadn’t touched alcohol in years, the family instead pointed to forensic science showing that types of alcohol can accumulate naturally as a body decomposes, particularly among diabetics.

“My husband didn’t drink,” Ann Aylward said in an interview Saturday evening. “At his time of death, he was not an acute or chronic alcoholic.”

On Friday, the office of the state’s chief medical examiner, Dr. Mark Flomenbaum, sent Ann Aylward an amended autopsy report that no longer contained references to “acute and chronic alcoholism” as a contributing factor in her husband’s death. Instead, the report notes that the two types of alcohol found in Jeffrey Aylward’s body during the August autopsy, ethanol and isopropanol, can result from “postmortem putrefaction” as the body decomposes.

The amended report was issued roughly one week after Ann Aylward sent Flomenbaum’s office an analysis by an an independent toxicologist contesting the original finding and after a former medical examiner contacted by the Bangor Daily News raised additional questions. Both the original and the amended autopsy report classify Aylward’s death as being from “natural” causes, particularly heart disease and diabetes.

Reached Saturday, Flomenbaum declined to discuss the Aylward case in detail on the record but did say it is relatively common for medical examiners to amend reports or death certificates.

“It is very routine to be making changes when new information is brought forward,” Flomenbaum said.

Flomenbaum added that it is also routine for his office to conduct additional toxicology tests. And when Ann Aylward raised the possibility of alternative explanations for the presence of alcohol, his office conducted additional tests.

The Aylward case is the latest incident that has focused attention on Flomenbaum, who has served as state medical examiner since 2013.

Earlier this year, a judge declared a mistrial in a murder case after Flomenbaum changed an autopsy report, although the defendant, Noah Gaston, was found guilty of murder Friday in a second trial.

An independent legislator from Friendship, Rep. Jeff Evangelos, has filed complaints with the Maine Attorney General’s Office – which oversees the Office of Chief Medical Examiner – over Flomenbaum’s side work as an expert witness in legal cases and the Gaston case. Additionally, Evangelos has accused Flomenbaum of an “inappropriate” job advertisement in 2017 because the ad contained macabre attempts at humor such as describing Maine as a “winter mecca” with a “short season of decomposed bodies.”

Flomenbaum declined to comment on those complaints because they were the subjects of potentially active investigations by the Attorney General’s Office.

The Aylward case, meanwhile, highlights the emotional impact of the difficult work done by medical examiners as they attempt to pin down a cause of death.

Despite his diabetes, Jeffrey Aylward was in the final stages of what had been a four-year effort to finish hiking the entire 2,000-plus miles of the Appalachian Trail between Georgia and Maine. His family reported him missing on Aug. 4 after he hadn’t been heard from for nearly two weeks.

Game wardens found Aylward’s body still in his tent on Aug. 5 not far from the Height of Land in the Rangeley Lakes region, and Flomenbaum later determined he had likely been deceased between three and seven days.

Aylward’s body showed no signs of physical trauma during the Aug. 6 autopsy. But his heart showed signs of high blood pressure and calcifications around some of the major blood vessels while his kidneys had scarring typical of high blood pressure, diabetes or both.

Aylward’s body did contain higher levels of ethanol (the type of alcohol found in drinks) and isopropanol (the type found in rubbing alcohol). While the original report said Aylward died a natural death likely caused by heart disease and diabetes, it listed alcohol consumption as a “contributory factor.”

Ann Aylward said she raised questions about that determination as soon as it was read aloud to her over the phone when she called Flomenbaum’s office to check on the status of his death certificate roughly a month after his demise. After reading the full report, Aylward noted that her late husband’s liver was listed as appearing normal rather than showing signs of chronic alcohol use.

Since then, Ann Aylward describes a frustrating series of conversations with staff in the medical examiner’s office – but never Flomenbaum himself – as she attempted to get the references to alcohol consumption or alcoholism removed from the report.

In an addendum Friday to the autopsy report, Flomenbaum wrote that he was “aware that in advanced putrefactive changes, especially in diabetics, ethanol could be produced as postmortem artifact” and that isopropanol can also result. Flomenbaum added that “the relatively large quantities of each alcohol” combined with the relatively short period since death “raised doubt that this was the sole reason for their presence.”

In the end, however, the references to alcohol consumption were removed and the cause of death listed as “likely atherosclerotic and hypertensive cardiovascular disease due to diabetes mellitus.”

Ann Aylward said the reality is she may never know the exact cause of death for her husband, whose body was cremated. But her push to change the report was about clearing the name of a lifelong public servant who served in the military, on Massachusetts hazmat and bomb squad teams and for decades on the local fire department.

“We tried to tell (Flomenbaum) that Jeff was a good man, and we told him he didn’t drink,” she said. “Why didn’t he believe us? I love him and he didn’t drink. I just didn’t want it on there because Jeff didn’t drink.”

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