An independent investigation has concluded that Colorado police and paramedics made a series of errors that led to the death of Elijah McClain who was placed in a chokehold and given a powerful sedative.

The Aurora City Council in Colorado commissioned a report from medical and legal experts in July 2020 over the death of McClain and the results are now in, CBS News reported. The 23-year-old was stopped on August 24, 2019, after walking home from a store wearing ski goggles.

Read More: Parents of Elijah McClain sue Colorado police over his death

Police officers Nathan Woodyard, Jason Rosenblatt, and Randy Roedema responded to a call that he was behaving suspiciously. Subsequently, he was placed in a chokehold.

The 157-page finding, released on Monday, found that police in Colorado triggered a chain of events that “had ramifications for the rest of the encounter.”

“Based on the record available to the panel, we were not able to identify sufficient evidence that Mr. McClain was armed and dangerous in order to justify a pat-down search,” the report stated. “The panel also notes that one officer’s explanation that that Aurora officers are trained to ‘take action before it escalates’ does not meet the constitutional requirement of reasonable suspicion to conduct (a stop or frisk).”

The findings also referenced the body cam footage from the incident. McClain is seen and heard pleading with the officers on the scene.

“Body worn camera audio, limited video and … interviews with the officers tell two contrasting stories. The officers’ statements on the scene and in subsequent recorded interviews suggest a violent and relentless struggle.”

The report also added: “The limited video, and the audio from the body worn cameras, reveal Mr. McClain surrounded by officers, all larger than he, crying out in pain, apologizing, explaining himself, and pleading with the officers.”

Read More: Ex-Justice Department lawyer will lead Elijah McClain probe

The Aurora Fire Department arrived and personnel injected McClain with the sedative ketamine based on the assumption that he was in an excited state. The report pushed back on this determination, declaring that McClain, who was 5-foot-7, 140-pound, was vulnerable to the dosage given to him.

“Aurora Fire appears to have accepted the officers’ impression that Mr. McClain had excited delirium without corroborating that impression through meaningful observations or diagnostic examination of Mr. McClain,” the report said.

“In addition, EMS administered a ketamine dosage based on a grossly inaccurate and inflated estimate of Mr. McClain’s size. Higher doses can carry a higher risk of sedation complications, for which this team was clearly not prepared.”

McClain suffered a heart attack on his way to the hospital. He was taken off life support on August 30, 2019.

McClain’s death and the circumstances around it gained national prominence almost a year after he died following the death of George Floyd while in the custody of Minneapolis police. The three officers involved in McClain’s violent arrest were taken off patrol duty in June 2020 but no charges have been filed.

A grand jury investigation was initiated last month by Colorado’s Attorney General, Phil Weiser.

“Our investigation will be thorough, guided by the facts and law, and worthy of the public’s trust. In order to maintain the impartiality and integrity of the process, we have no further comment at this time,” the Jan. 8 announcement read.

Rosenblatt was one of three officers fired for texting “haha” over a photo that re-enacted the chokehold McClain was placed in.

McClain’s family filed a lawsuit last year alleging that his civil rights were violated. Mari Newman, a lawyer who is representing the family, told NBC News on Monday that the findings supported their claims.

“This is a broadside on the city of Aurora from top to bottom, beginning with the illegal stop that set the wheels in motion and the illegal conduct every step of the way,” Newman said.

The Aurora Police Department chose not to provide a comment and the Aurora fire department have not yet responded to the findings.

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