GOLDEN, Colo. — The February death of a woman who was injured in the 1999 shooting at Columbine High School has been ruled a homicide.

Anne Marie Hochhalter passed away on Feb. 16 at age of 43. At the time, it was believed that she had died of natural causes.

But the Jefferson County Coroner’s Office said Hochhalter, who was left paralyzed from the waist down after being shot twice, had died because of sepsis, with complications of paraplegia due to two gunshot wounds considered a significant contributing factor. 

“The manner of death is best classified as homicide,” the report says. 

The ruling means a total of 13 students were killed in the April 20, 1999, shooting, and one teacher. More than 20 were wounded.

In the decades after the shooting, Hochhalter spoke out in support of victims of other mass shootings, and others who faced physical challenges. 

Sue Townsend, a close friend of Hochhalter’s and stepmom to Columbine shooting victim Lauren Townsend, said after her passing that Hochhalter was “fiercely independent” and that she wanted what happened to her to benefit somebody else. She said Hochhalter fought against letting adversity define her.

In 2016, Hochhalter wrote a letter to the mother of one of the gunmen offering her forgiveness.

Last year, at a vigil to mark 25 years since the tragedy, she said she was flooded with happy memories from her childhood and wanted those killed remembered for how they lived, not how they died.

She missed the 20-year vigil because of post-traumatic stress disorder, she said in a social media post last year.

“I’ve truly been able to heal my soul since that awful day in 1999,” she wrote.

The Associated Press contributed to this report.