A Kaneohe man who died in June after a struggle with Honolulu police died from “a toxicity of cocaine and ethanol complicated by physical struggle and restraint,” according to the Honolulu medical examiner.

The medical examiner concluded Isaiah Pama’s interaction with police exacerbated an existing heart condition.

“Although there were several risk factors of sudden death mentioned above, it seems that his death was precipitated by his struggle with others while he was restrained,” the autopsy says.

The medical examiner ruled the death of 28-year-old Pama a homicide but emphasized in the autopsy that homicide does not equal murder.

Honolulu police reported more incidents involving force last year than the previous year. Anthony Quintano/Civil Beat

“The decedent was reportedly restrained because he was exhibiting violent and bizarre behaviors. Despite these circumstances, the manner of death is classified as a homicide because acts by others appear to have at least contributed to the decedent’s death,” the medical examiner wrote in Pama’s autopsy. “The classification of homicide for the purpose of death certification does not indicate or imply criminality of the acts or intent to harm or kill.”

Honolulu prosecutors won’t be pressing charges against police officers involved in the death of Pama, according to Michelle Yu, a spokeswoman for the Honolulu Police Department.

Pama’s death was the third caused at least in part by police this year, according to Yu. She added all three officers involved in Pama’s death are on full duty.

The autopsy report, based on interviews with witnesses, details a situation in which Pama was acting erratically: entering someone else’s truck, tumbling out of the passenger’s seat head-first, trying to hit an officer when they tried to calm him down.

After Pama was handcuffed, he lay on his stomach where “he continued to resist and attempted to kick,” the autopsy recounts. “More officers arrived with shackles.”

It was after Pama was shackled and was sitting upright that he started going in and out of consciousness. He died at 9:22 p.m.

There is no body camera footage of what happened. HPD said cameras hadn’t been issued to those officers at the date of the incident.

Pama’s death came in the midst of national scrutiny of police use of force. Honolulu police killed eight people last year — the highest annual police killings in the city in more than a decade. The number of incidents of police use of force increased as well compared to 2018, according to official tallies.

The autopsy report notes that Pama was part-Hawaiian. Data from HPD shows that people who are Native Hawaiian or another Pacific Islander ethnicity represent more than a third of police force incidents, even though they only make up about a fourth of the state’s population.

Honolulu Police Chief Susan Ballard is expected to report to the police commission about police use of force on Dec. 16.

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