By Jane Prendergast and Sharon Coolidge
The Cincinnati Enquirer

The obese, intoxicated man who died after a violent struggle with Cincinnati police could not breathe in part because he was left lying on his large stomach, according to the final autopsy report.

Hamilton County Coroner Carl Parrott Jr. has said Nathaniel Jones died Nov. 30 after his enlarged heart gave out during the struggle, which was caught on police videotape and shown repeatedly on national news shows. Parrott said Jones' history of high blood pressure, intoxicating levels of drugs in his system and his obesity all contributed to his death. Jones weighed 348 pounds.

The report doesn't change the cause of Jones' death. But it adds another contributing factor: probable positional asphyxia, which means Jones couldn't breathe because of the way his body was positioned.

"Once you get a guy that big handcuffed, you've got to get him off his belly," Dr. Robert Pfalzgraf, the forensic pathologist who performed Jones' autopsy, said in an interview Thursday. "They got him cuffed, he's face-down. And that's when he stops breathing.''

Depending on the circumstances, Pfalzgraf said, a person can asphyxiate - or suffer a lack of oxygen - in as little as 30 seconds to a minute. But he can't conclusively say that rolling Jones over earlier would have saved his life.

It remained unclear how long Jones was lying on his stomach. The videotape shows officers, realizing Jones wasn't breathing, rolling him on his side.

Jones had significant health problems - plus cocaine and PCP in his system, as well as methanol.

Mayor Charlie Luken and Police Chief Tom Streicher have said the six officers who struggled with Jones followed department policy. Streicher was out of town and could not be reached for comment.

Ken Lawson, the attorney for the Jones family, said the coroner's report indicates that Cincinnati police did not follow procedure.

"I think now if you look at everything - the policy and the autopsy - that man died a horrible death," Lawson said. "He could not breathe. When you get to the point where eyes bulge and you can't breathe oxygen in, you're going to die.

"For them to do this, and then parade around saying this was by the book without waiting for a complete investigation, is absurd," Lawson said.

A February 2003 written police training bulletin instructs officers on how to spot warning signs of positional asphyxia. It says underlying health problems, drug use and a person's size can increase the risk of positional asphyxia. It instructs officers that once a suspect is under control not to leave the suspect in a prone position and to look for signs that the person is having trouble breathing.

Lawson said the final autopsy report indicates officers violated that policy.

"I'm saying if (they) have this policy and don't follow it, somebody should be seriously looking into it,'' Lawson said. "But here we have the chief and the mayor saying department policy was followed. The mayor and the chief owe the family an apology.''

City Manager Valerie Lemme will determine whether the officers should be disciplined.

Hamilton County Prosecutor Mike Allen is reviewing the final autopsy to determine whether he should take the case to the grand jury for possible criminal charges. He declined to comment Thursday night.

Parrott said Thursday he doesn't think the additional contributing factor of positional asphyxia to the final autopsy report changes much.

"Restraint implies a degree of asphyxia,'' Parrott said. "The bottom line is this guy was in a struggle and he was restrained - and he had a loss of oxygen.''

Pfalzgraf said his findings in the Jones death are just that - medical findings, and that they're not intended to place blame.

"This is something they might not have been aware of,'' he said. "So I don't want to blame anybody. In the heat of the battle, you don't know what people are thinking.''

Enquirer reporter Gregory Korte contributed. E-mail jprendergast@enquirer.com; scoolidge@enquirer.com