(CNN) — The death of Irvo Otieno has been ruled a homicide by asphyxiation, the Office of the Chief Medical Examiner of Virginia said in a statement to CNN affiliate WWBT.

The 28-year-old’s cause of death was officially ruled “positional and mechanical asphyxia with restraints,” the medical examiner’s office confirmed to WWBT.

Seven sheriff’s deputies and three hospital workers have been charged with second-degree murder in Otieno’s death on March 6 as he was being admitted to a state-run mental health facility. Otieno’s family has said he was in the midst of a mental health crisis.

The workers “smothered him to death” during the facility’s intake process, Dinwiddie County Commonwealth’s Attorney Ann Baskervill has said.

Otieno was being transferred to Central State Hospital, a state-run mental health facility south of Richmond, from the county jail, where he was being held after authorities allege he assaulted three officers while being hospitalized.

After hearing the medical examiner’s official ruling, Otieno’s mother, Caroline Ouko, was initially speechless, according to a statement from the offices of family attorneys Ben Crump and Mark Krudys.

“All must know what they did to my son,” Ouko said, according to the statement.

Crump and Krudys said in a separate statement that the medical examiner’s conclusions are “not surprising” as they align with the actions shown in surveillance footage released by prosecutors.

“The official declaration confirms what all could see in the video. Irvo, while facedown and handcuffed at his wrists and shackled at his ankles, was not permitted to breathe. For over 11 minutes, the ten officer/hospital defendants pushed down hard on every part of Irvo’s body until he was limp and lifeless,” Crump said.

“We cannot continue to treat the mentally ill with such brutality,” Crump added.

Otieno was an aspiring hip-hop artist who moved to the US from his birthplace of Kenya at the age of 4, Krudys has said.

Ouko, said last month that Otieno had a mental illness which necessitated medication. Her son would go long stretches of time when “(you) wouldn’t even know something was wrong,” Ouko explained, but then sometimes “he would go into some kind of distress and then you know he needs to see a doctor.”

The hospital workers charged in connection to Otieno’s death have been placed on leave “pending the results of the legal proceedings,” Central State Hospital said.

CNN has not been able to determine whether the hospital employees have legal counsel.

The local law enforcement officers’ union, Henrico Fraternal Order of Police Lodge 4, has said its members “stand by” the seven deputies charged in Otieno’s death.

What led up to Otieno’s death

On March 3, Henrico County police officers responded to a possible burglary and encountered Otieno.

The officers and the county’s crisis intervention team placed Otieno under an emergency custody order after interacting with and observing him, police said.

Under Virginia law, a person may be placed under an emergency custody order if there are concerns they may harm themselves or others as a result of mental illness.

The officers took Otieno to a hospital where authorities say he became “physically assaultive” towards officers. Police took him to Henrico County Jail and he was booked.

Three days later, Otieno was transferred to the mental health facility in Dinwiddie County where he died during the intake process. State police investigators were later told Otieno became “combative” and was “physically restrained” during the intake process, the attorney’s office said in a statement on March 14.

Surveillance footage of his death released by a prosecutor last month begins as Otieno, bound by his hands and feet, is brought forcibly into a room and dragged into an upright seated position on the floor.

Ten minutes later, Otieno appears to be on his side and is being held by three deputies. His body jerks and five more deputies and workers move to pin Otieno to the floor.

A clear view of Otieno is blocked in much of the video, but one deputy appears to be lying across Otieno for most of the incident as he is forced onto his stomach. Eventually, Otieno is rolled onto his back, where several deputies appear to be restraining him with their knees. One deputy holds Otieno’s head still by grabbing his braided hair.

After 12 minutes of Otieno being pinned to the ground, one deputy can be seen shaking Otieno’s hair and attempting to take a neck pulse, but Otieno is unresponsive. Three more minutes pass before CPR begins, with Otieno’s limbs still shackled.

Medical workers from the hospital are seen converging on the room as CPR continues for nearly an hour. After he is pronounced dead, Otieno is covered in a white sheet, still lying on the floor, his body briefly left alone in the room.

During Otieno’s funeral service last week, speakers called for law enforcement reform and improvements to mental health care in Virginia.

“We can develop mental health courts where they will be treated like they have illness and not like they are criminals and degenerates not worthy of dignity and respect,” Crump told mourners. “Irvo deserved dignity and respect.”

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