PHILADELPHIA — After years of controversy and calls for change, the Philadelphia Medical Examiner’s Office on Monday issued a report affirming its ruling that the 2011 stabbing death of a Manayunk teacher was a suicide.

Greenberg, who was 27 at the time, was discovered with 20 stab wounds inside the apartment she shared with her fiancé, on the evening of January 26, 2011. The peculiar circumstances of her death have fueled controversy ever since.

Chief Medical Examiner Dr. Lindsay Simon, in a detailed 32-page report, stated that Greenberg could have inflicted the injuries upon herself. The report highlights the absence of any signs of struggle or evidence of an intruder at the scene, supporting the suicide ruling.

Simon said Greenberg’s fiancé’s assertion that he was at the gym at the time of her death is corroborated by surveillance video, keycard swipes and other evidence.

Simon also points out that the fiancé’s DNA was not on the knife.

The medical examiner said Greenberg was “a young woman suffering from anxiety at the time of her death.”

“The anxiety appeared to mostly be due to her work as a teacher. She was specifically worried that the grades she needed to submit on the day of her death would indicate she had previously given inflated grades to her students,” Simon continued.

She wrote that Greenberg “expressed this anxiety about her grades to friends, co-workers, and her fiancé in the hours leading up to her death.”

Simon said Greenberg was under the care of a psychiatrist for her anxiety, but “she did not survive long enough to address the anxiety itself.”

“Thus,” Simon wrote, “she had an increase in energy to act on her anxious thoughts.”

While Simon concedes that the distribution of Greenberg’s injuries, which included a stab wound to the back of her neck, is unusual, she said Greenberg would have been capable of inflicting the wounds herself.

The report also detailed three more superficial stab wounds on Greenberg’s body than what was documented in the original autopsy. Simon said it does not appear these three wounds contributed to any significant internal injury. Twenty additional bruises were also newly documented, Simon said.

The report was issued one day before the next court hearing in this case.

William Trask, the Greenberg’s family attorney, blasted the findings in a statement to 6abc Action News on Monday:

“Simon’s so-called ‘independent review’ of Ellen Greenberg’s death is a deeply flawed attempt to justify a predetermined conclusion. It includes false claims – like the assertion that a stab wound in Ellen’s spinal column was made during autopsy, a theory rejected by every credible expert, including the City’s own neuropathologist.

“By ignoring key evidence that contradicts suicide-the extensive 3D photogrammetry, a recreation which proves Ellen could not self-inflict all of the wounds, unexplained bruises, missing surveillance footage, an intact lock, accounts of a toxic relationship, etc. – Simon builds a flimsy case on distorted portrayals of Ellen’s mental health, propped up by cynical distortions of Ellen’s managed anxiety, a condition widely experienced daily by over 40 million Americans.

“Shame on Dr. Simon. This report is an embarrassment to the City and an insult to Ellen and her family. Ellen’s family just wanted the truth. It is clear the truth will not come from Philadelphia’s law enforcement machinery. Though Ellen’s city turned its back on her, we will continue through other avenues to get justice for her murder, by any means necessary.”

The review of Greenberg’s death came after a settlement between her family and the City of Philadelphia, who have been fighting to have the suicide ruling for more than 14 years.

Shortly before the settlement, Dr. Marlon Osbourne, the pathologist who performed the autopsy, said in a court document that Greenberg’s death “should be designated as something other than suicide.”

Osbourne had originally classified the death a homicide before changing it to suicide two weeks later.

Dr. Osbourne said in the court filing, “Since issuing the amended death certificate, I have become aware of additional information,” and “it is my professional opinion Ellen’s manner of death should be designated as something other than suicide.”