An autopsy report from the Honolulu Medical Examiner’s Office provides new insight into Sheldon Haleck’s deadly encounter with police the night he was arrested outside Iolani Palace on March 16.

Haleck, 38, died due to “multiple metabolic and cardiac complications” stemming from a what Honolulu Medical Examiner Christopher Happy described as a “violent physical struggle” with Honolulu police.

The death was ultimately ruled a homicide — which in medical examiner lingo only means that his death was caused by another, not that a murder occurred — yet police officials have been largely silent about the circumstances. Honolulu Police Department officials have refused to release details to the Haleck family or to the public to help explain what happened.

Happy’s autopsy report, which was officially released Monday, now provides the most comprehensive set of facts that have been made public about Haleck’s death.

Many of the details come straight from HPD reports from the incident.

Haleck’s confrontation with police began shortly after 8 p.m. on March 16. Bystanders had called 911 to report a man walking through traffic on King Street near Iolani Palace. The first officer arrived on the scene at 8:18 p.m. with a second close behind.

According to the autopsy, Haleck had a history of mental illness, including anxiety, depression and post-traumatic stress disorder. He was high on methamphetamine at the time officers arrived and was displaying signs of drug-induced delirium. He didn’t understand where he was.

Haleck refused the officers’ orders to get on the sidewalk. They then used pepper spray and deployed a Taser to try to get him to comply, but to no effect. A third officer, who arrived at 8:22 p.m., also pepper sprayed Haleck in an attempt to get him under control.

The officer who first used a Taser on Haleck tried again to shock him into compliance. It didn’t work. In fact, the autopsy shows that the barbs on the Taser electrodes didn’t pierce Haleck’s skin except for a small puncture wound on his chest.

Haleck then tripped in the street while trying to run away and was restrained by multiple officers who put him in handcuffs and leg shackles as he continued to struggle. A fourth officer who had arrived on the scene placed a knee on Haleck’s back while he was face down on the ground, the autopsy said.

But when officers turned him over he was unresponsive. It was 8:24 p.m.

An ambulance was called at 8:25 p.m. and arrived eight minutes later. Emergency medical technicians found Haleck without a pulse and began to resuscitate him. They were able to get his heart started but the beat was irregular.

Haleck was pronounced dead at Queens Medical Center at 7:33 a.m. on March 17. He’d never regained consciousness after his arrest.

The autopsy doesn’t pinpoint one specific reason for Haleck’s death. Rather, the medical examiner found he died from a combination of factors stemming from his altercation with police and his heightened state of physiological and mental agitation from methamphetamine.

For instance, the autopsy said, his abnormal heartbeat could have been the result of being high on a stimulant and getting into a physical altercation with police. Muscle breakdown in his body, also as a result of his struggle with the cops, appeared to have resulted in kidney failure.

Happy also mentions a controversial syndrome known as “excited delirium” that’s often cited in sudden in-custody deaths and officer-involved shootings.

Some of the symptoms include violent and combative behavior, great strength, high body temperatures and hallucinations. Happy notes that many of the symptoms associated with excited delirium have high mortality rates.

“Mr. Haleck displayed many of the signs and symptoms described in this syndrome,” Happy said. “However, there are currently no well established diagnostic criteria for this syndrome and the terminology represents a heterogeneous constellation of medical findings.”

You can read the full autopsy report here:

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