Ronald Silver II died of hyperthermia, according to an external autopsy report by Maryland’s Office of the Chief Medical Examiner.

The Baltimore City Department of Public Works employee was on the clock as a sanitation worker when he collapsed on a porch on a day in early August that had a heat index of 103. The heat index is what the temperature feels like when relative humidity is taken into account.

According to the report, Silver was in good condition without evidence of external injuries. However, a complete autopsy was not performed due to his family’s religious opposition. He had asthma and last had an attack in 2022, according to the report, and Silver’s body had an IV in his left arm and signs of CPR attempts on his chest when it was examined.

“Given the limitations of an external examination only, the determination as to whether any other factors played a role in the death of the decedent could not be determined,” the medical examiner wrote in the report.

The report references Silver complaining about altered mentation or mental state, muscle rigidity, leg cramps and dehydration, and asking for water to be poured on him before he died, saying those actions are “consistent with his death being heat related.”

The autopsy was performed Aug. 4, two days after his death, and the medical examiner publicly defined the cause of death as hyperthermia on Aug. 5.

Following his death, city and union leaders, backed by the fiancee and five children Silver left behind, have called for a city investigation into his death as well as new safeguards for DPW workers. Two weeks after Silver’s death, Mayor Brandon Scott and DPW acting Director Khalil Zaied hired a law firm to review the department’s safety policies.

Conn Maciel LLP, a Washington, D.C.-based law firm specializing in workplace safety, began its independent review last month. Final recommendations from the firm are expected by the end of September.

In July, a report from the city’s inspector general said DPW facilities and trucks had broken air conditioning and did not provide enough water, ice and fans to workers. Later last month, DPW paused trash and recycling collection during extreme heat.