BALTIMORE (AP) — A man with Down syndrome who died of asphyxia after he was restrained by deputies at a movie theater had anger issues and health problems that made him susceptible to sudden death, according to an autopsy report made public Tuesday.

The report by the Maryland medical examiner’s office provides new public details about the death of Robert Ethan Saylor, 26, of New Market. He died Jan. 12 after three Frederick County sheriff’s deputies, moonlighting as mall security guards, tried to remove him from a Frederick movie theater at the management’s request.

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The autopsy said the death was ruled a homicide, a conclusion that was already known. A Frederick County grand jury declined last week to indict the three deputies involved.

The Associated Press reviewed the autopsy report at the medical examiner’s office in Baltimore and the Frederick County Sheriff’s Office hasn’t released its investigative file on the case.

The report said Saylor had a reported medical history of anger issues, especially when confronted or touched. Saylor family lawyer Joseph B. Espo has said that Saylor didn’t like being touched, particularly by strangers. Saylor’s obituary and acquaintances have portrayed him as a warm, playful person.

Police have said Saylor, who stood 5’6″ and weighed 294 pounds, yelled and cursed at the deputies after they confronted him for refusing to leave an auditorium where he had watched the movie, “Zero Dark Thirty.” The autopsy report says one deputy then touched Saylor to remove him from the theater. When he resisted, the others joined in.

“In their effort, three deputies and Mr. Saylor all fell into a heap” in a side aisle of the auditorium, the report says.

The deputies then handcuffed Saylor, using three sets to accommodate his girth, while he was face down on the floor, according to the autopsy report. He became unresponsive and the deputies rolled him over. They couldn’t find a pulse, so they removed the handcuffs and started chest compressions.

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Saylor started breathing on his own, and still had a pulse when emergency medical workers arrived, the report says. But his heart stopped again as they tried to apply a breathing apparatus and a breathing tube, which they had difficulty inserting, according to the report. Saylor was pronounced dead at Frederick Memorial Hospital.

The report says Saylor had injuries to his wrists, face and torso consistent with being handcuffed while lying on his stomach. He also showed signs of “positional” asphyxia, or having been in a position in which he couldn’t breathe.

The autopsy found that Saylor’s developmental disability, obesity, atherosclerotic cardiovascular disease and a heart abnormality contributed to this death. His left main coronary artery was 50 percent blocked by plaque. He also had “accessory conduction pathways” of the heart, an electrical abnormality that can trigger an accelerated heart beat and sudden death, the autopsy said.

Espo said he hadn’t seen the report but that the deputies had acted improperly.

“One of the options they had was to simply tell the theater manager, `We’re just simply not going to deal with this.’ They should have and could have just walked away,” he said.

Separately Tuesday, advocates for people with Down syndrome said they were meeting in Washington with representatives of the U.S. Justice Department, Johns Hopkins University and the Kennedy Krieger Institute to discuss police training for dealing with people with the genetic disorder. The meeting was prompted by the Saylor case, said Denny Weikert, president of a Frederick County support group, or organized the session.

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