A 38-year-old man subjected to a controversial restraint by police officers in downtown Greensboro during the North Carolina Folk Festival died from “sudden cardiopulmonary arrest due to prone restraint,” as well as the presence of MDMA, cocaine and alcohol, and hypertensive and atherosclerotic cardiovascular disease, according to an autopsy released by the state Office of the Chief Medical Examiner.

The state medical examiner is classifying the manner of death as homicide.

Marcus Deon Smith’s family has said that the actions of four officers “appear to have caused him to pass away.”

“By ‘hog-tying’ Marcus, these officers made it impossible for him to continue breathing,” the family said in a statement earlier this month.

An internal investigation by the Greensboro Police Department found no violation of directives and returned the officers to regular duty earlier this month. The Guilford County District Attorney’s office likewise found no criminal liability on the party of the officers. Police Chief Wayne Scott has said that he believes the restraint method applied to Smith — known as hog-tying and Ripp Hobble, among other monikers — is safer than the alternative of using flexicuffs.

“Based on the autopsy findings and circumstances surrounding the death, as currently understood, the cause of death is listed as sudden cardiopulmonary arrest due to prone restraint; n-ethylpentalone, cocaine and alcohol use; and hyptertensive and atherosclerotic cardiovascular disease,” the autopsy states. “The manner of death is classified as homicide.”

The autopsy notes that toxicological testing performed on Smith detected n-ethylpentalone — described as “a drug commonly sold purported to be MDMA/ecstacy” — along with “a low level” of cocaine, and a blood alcohol level measured at 30 mg/dL.

A “summary and interpretation” included in the autopsy states that officers patrolling the folk festival found Smith “running in an out of traffic, stating he wanted to kill himself, and apparently very agitated. He stated that he wanted to go to the hospital and was placed in a patrol vehicle. Emergency Medical Services were summoned; on their arrival, the decedent was screaming and hitting the windows of the vehicle. Officers opened the door of the vehicle and the decedent exited.”

Graham Holt, a lawyer representing Smith’s family, has previously described Smith’s behavior as “erratic but nonthreatening” after the officers let him out of the vehicle.

“Marcus asked the officers for help, but instead of being offered help, four white officers used as much force as possible without directly hitting or shooting him,” Smith’s family said in a statement to reporters earlier this month. “There were nine officers on the scene, and four that came in direct contact with him. They could have used other methods to restrain him. ‘Hog-tying’ him was completely unnecessary.”

The summary from the autopsy released by the chief medical examiner continues, “Multiple officers then placed him on the ground. His hands were then cuffed behind his back, and a strap was placed on his ankles to secure them to the handcuffs behind his back. No chokeholds or conducted electrical weapons were applied. During this process, the decedent was grunting loudly, then more quietly. After restraints were applied, officers checked on him and found that he was unresponsive (not breathing, but with a pulse). The restraints were removed, and he was placed on the EMS stretcher and loaded into a waiting ambulance. CPR was started in the ambulance. He was transported to Moses Cone Hospital. Despite continued attempted resuscitation, death was pronounced in the emergency department.”

Marcus Smith’s family is asking Greensboro City Council to review the police body camera footage of the incident and hold the four officers accountable, according to a press release issued today by the Homeless Union of Greensboro. The family is also asking concerned residents to attend a mass meeting at Shiloh Baptist Church on Dec. 3 at 6:30 p.m.

Graham Holt, a lawyer who is representing Smith’s family, declined to comment on the autopsy and toxicology report.

Carla Banks, the city’s communications and marketing director, said she had attended a meeting on the matter, adding that the city will issue an official statement later today.

Additional documentation: Medical examiner’s report

UPDATE, 3:06 p.m.: The city of Greensboro is filing a petition with Guilford County Superior Court requesting the public release of the police body-worn camera footage capturing the police officers’ involvement with Smith at the time of his death.

“Due to the multitude of factors that led to tragic circumstances for Mr. Smith, detailed in the NC Department of Health and Human Services Medical Examiner report, the city of Greensboro believes there is a compelling public interest to share the video,” the city said in a press release.

UPDATE, 9:34 p.m.: You can review the video here. Warning: This video may be extremely disturbing.

The city obtained a court order from Guilford County Superior Court Judge Susan Bray at 4 p.m. today allowing for the release of the video. City council members have reviewed the video in small groups.

The city issued a press release at 6:49 p.m. on Friday indicating that city officials “continue to review the initial findings of the medical examiner’s report,” which listed the manner of death as homicide. The city also said that police Chief Wayne Scott “has elected to modify the application of the Ripp Hobble device used to restrain individuals, while police continue to review the use of this method of restraint.”

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